Why is it an issue?Drinking alcohol is a freedom that many enjoy, however this must be balanced with the need to avoid harm and improve health outcomes. Alcohol is the world’s third largest risk factor for premature mortality, disability and loss of health (World Health Organisation, 2011). The conditions most strongly related to health inequalities, such as cancer and cardiovascular disease, are strongly associated with alcohol.
A quarter of people in England drink at hazardous levels and the number that go into hospital for alcohol-related reasons rose by 52% between 1996 and 2006. The number of dependent drinkers now stands at 1.6 million and the cost to the NHS of dealing with this is £2.7 billion every year and is expected to continue rising to £3.7 billion (Wakefield Place Based Budgeting – Alcohol Final Report, 2011).
Alcohol is not solely a health issue, as it also causes problems for UK society as a whole, contributing to around 1.2 million incidents of violent crime and 40% of domestic abuse cases. 5% of all road casualties are people injured from drink driving, and alcohol has a significant impact on both families and the workplace (Wakefield Place Based Budgeting – Alcohol Final Report, 2011). The Government calculates the overall annual cost of productivity lost as a result of alcohol misuse to be £6.4billion per annum with up to 17 million working days lost through alcohol related absence (Wakefield and District Alcohol Related Harm Profile, 2009)
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
- Alcohol related admissions show a very steep slope indicating again a high correlation with areas of deprivation. The majority of the district showing levels above the England average (HEA, 2010).
- The North West Public Health Observatory provides twenty three statistical indicators of alcohol related harm broken down by district. Wakefield is worse than the regional average across many of the indicators including months of life lost, alcohol specific and attributable mortality, chronic liver disease, hazardous drinking, harmful drinking and binge drinking. (NWEPHO Local Alcohol Profiles, 2010; Wakefield Place Based Budgeting – Alcohol, 2011).
- Almost a quarter (23.6%) of adults in Wakefield (over 70,000) consume at least twice the daily recommended amount of alcohol in a single drinking session. This compares slightly favourably with the regional average of 24.5% but worse than the national average (NWEPHO Local Alcohol Profiles, 2010).
- 21.4% of the population report engaging in increasing risk drinking and 7.5% of the population report engaging in higher risk drinking. This compares favourably to the regional average but worse than the national average (NWPHO Local Alcohol Profiles, 2011).
- Harmful or hazardous drinking is more prevalent amongst the unemployed who are available to work, approximately 29.2% for men and 16.9% for women (Lifestyle Survey – Alcohol Analysis, 2009).
- Alcohol related recorded crime stands at 7.7% which is comparable with the regional and national averages.
- Around a third of those who drink at excess levels are concerned and plan to reduce their drinking but less than 5% think they need help to do it. Those in middle age are more aware of their hazardous drinking and have the intention to reduce it (Lifestyle Survey – Alcohol Analysis, 2009).
- Harmful or hazardous drinking is more prevalent amongst the unemployed who are available to work, approximately 29.2% for men and 16.9% for women, although this is likely to be an underestimate when compared with the national figures (Lifestyle Survey – Alcohol Analysis, 2009).
Children & Young People
- The problem of harmful or hazardous drinking is greater with males than females. Males drinking at more than sensible levels peaks in the 45-54 age group whilst with females it is mainly younger who harmfully or hazardously drink (Lifestyle Survey – Alcohol Analysis, 2009).
- PCT data from June 2008 indicates that Wakefield has 72 admissions per 100,000 that are due to alcohol specific conditions for persons under the age of 18. This compares to 73.8 for Yorkshire and Humber and 72.5 for England (CJSNA, 2010).
- According to the North West Public Health Observatory (NWPHO), Wakefield is considered to be performing significantly worse than the England average and worse than the regional average in relation to alcohol specific hospital admissions for under 18’s. NWPHO also indicates that alcohol specific hospital admissions for under 18’s occurs at the rate of 69.5 per 100,000 population for the period of 2004/05 – 2006/07 (CJSNA, 2010).
- National research suggests that the UK has among the highest incidences of youth drunkenness with 24% of 15 year olds being drunk 10 times or more over the last year and that these higher levels of consumption are also being linked to a range of other high risk behaviours such as youth offending and unplanned/protected sex, truancy, exclusion and illegal drug misuse. (Wakefield Alcohol Profile 2009)
- The Wakefield Health Related Behaviour exercise in schools found that 15% of males and 8% of females in Year 6 said that they had drunk at least one alcoholic drink in the week of the survey. The range within the various schools was between 4% and 19% (CJSNA, 2010).
What’s the trend and what can we predict?
- Both nationally and locally alcohol related hospital admissions have been increasing year on year. The numbers admitted to hospital for alcohol related harm nationally have recently topped 1 million and are expected to reach 1.5 million by 2015 (Alcohol Concern, 2011).
- Alcohol Related Hospital Admissions have been designed to measure a reduction in the trend in increase of alcohol related admissions based on a range of disease and injuries attributable to alcohol. There are 34 conditions which are partially attributable to alcohol and 13 conditions are wholly attributable or ‘direct admissions’. Although the rate of alcohol related hospital admissions in Wakefield are better than both national and regional averages, the rate of increase is higher (Wakefield Place Based Budgeting – Alcohol, 2011).
- In 2009/10, 1648 per 100,000 admissions were alcohol related in the Wakefield district. This was a 17% increase from the rate in 2008/09. Since 2004/05 the alcohol admissions rate has almost doubled. Measurement and coding may have some impact on these figures (Wakefield Place Based Budgeting – Alcohol, 2011).
- As with alcohol related admissions, alcohol specific admissions have increased year on year with a steep increase between 2008/09 and 2009/10. However, there was a slight reduction in admissions in 2010/11.
- The North West Public Health Observatory estimate 5.5% of dependent drinkers in treatment. This compares with 3% regionally and 2.7% nationally. Department of Health guidance shows that providing evidence based specialist treatment for at least 15% of dependent drinkers has the greatest impact (Delivering Healthy Ambitions Better For Less – Tackling Alcohol Abuse, 2010).
- Estimates suggest that the total population aged 18-64 predicted to have alcohol dependence will rise from its current level of 12,150 to approximately 12,650 by 2030, assuming prevalence remains static (PANSI, 2010).
- As the financial crisis takes hold, we may well see reduced levels of consumption as disposable income becomes tighter. There are already initial reports of this being the case, strengthening the case for increased taxation on alcohol. Conversely, we should be aware of the possibility that this may increase demand for black market goods. There has been a report that 10% of West Yorkshire retailers who were subject of targeted checks were found to be selling counterfeit alcohol. Elsewhere in the country, the figure was 26% although we cannot assume that this reflects the true scale of the problem on the ground.
What are we doing and what can be done differently?
- Alcohol Implementation Plan: The Alcohol Implementation Plan sets out the priorities for partnership delivery between 2009 and 2011 which will tackle alcohol related harm. The priorities have been informed by the Alcohol Profile for Wakefield District April 2009 and within the context of national and regional policy relating to alcohol harm. The Implementation Plan will be revised for 2012.
- Wakefield and District Alcohol Team: Treatment for alcohol misuse is both effective and cost effective. Analysis from the UK Alcohol Treatment Trial (2005) suggests that for every £1 spent on treatment, the public sector saves £5 (NTA, 2006). Wakefield and District Alcohol Team provide advice, support and treatment to adults affected by alcohol misuse.
- Identification and Brief Advice (IBA): The recently published NICE guidance recommends that professionals from health and social care, criminal justice, community and voluntary sector should screen people who may be at risk of harm from the amount they drink. Furthermore NHS professionals should routinely screen all adults using a validated screening tool as an integral part of practice. Those identified as drinking at hazardous and harmful levels should be offered relevant brief advice (NICE, 2010).
- The evidence base is strong for IBA – for every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels which compares favourably with smoking where only one in twenty will act on advice given (NHS Yorkshire and the Humber, 2010). NICE public health guidance (2010) also recommends that alcohol-use disorder prevention should be prioritised as an ‘invest to save measure’.
- Whilst there has been an increase in activity particularly across criminal justice settings, IBA is not fully implemented across all social and health care settings in particular primary care. With approximately 98% of the population registered with a GP, primary care is well placed to identify and provide early interventions with people misusing alcohol (Heather and Kaner, 2002). However, performance data taken from the Alcohol Risk Reduction Scheme suggests that screening is not routinely undertaken and IBA varies widely across the primary care.
- The Community Alcohol Development Worker has put a short training package together to up skill community workers around IBA. These will include carers association staff, Wakefield District Housing, Independent living managers, people in the community and professionals.
- Alcohol Health Workers in acute settings: The Department of Health identify appointing Alcohol Health Workers in acute settings as an effective way to reduce alcohol harm. Evidence demonstrates such appointments provide significant financial benefits and improved patient care.
- The Substance Misuse Team is currently putting forward a proposal to implement an Alcohol Liaison Service within Mid Yorkshire Hospitals Trust which would offer an effective case management approach, improve discharge procedures, reduce alcohol related hospital admissions and A&E attendances.
Children & Young People
- Historically the problems caused by children and young people drinking alcohol particularly as portrayed through the media have been focused on town centre violence or anti social behaviour impacting on local communities. There is a need to move the focus of our attention to the damage caused to children and to young people’s health and wellbeing.
- A recent report published by Alcohol Concern talks of the link between the numbers of people admitted to hospital due to alcohol misuse and the density of off licences per head of population in a given area. In many cases young people see drinking alcohol a part of the natural steps to becoming an adult with some drinking responsibly with guidance from parents. However, as a priority area, the community network feel it is now time to look more closely at the means whereby under eighteen year olds get hold of alcohol.
- The Community Alcohol Development worker is working with partner organisations and the community in Airedale and Ferry Fryston to raise awareness and highlight the damage caused to the health and wellbeing of children and young people due to alcohol misuse through proxy sales.