Post on 23-Feb-2016
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Reducing towards Alcohol Harms and Health Inequalities.Julia Miller
What is the Healthy Places, Healthy Lives Programme?
• Funded by DH – originally three years, but reduced to one! Partnered by LGID, NST, Marmot
• Started Jan 2010 – end ?• Developing partnerships to reduce health
inequalities• Implementing Marmot principles• 25 sites in England• Initiatives focus on teenage pregnancy, alcohol,
obesity, community aspirations, CVD,diabetes, smoking, domestic abuse and more…
Why Alcohol?
Health
Crime
Employers
Alcohol related hospital admissions (wholly and partially attributable to alcohol)Outpatients, A&E, AmbulanceGP consultations, practice nurse consultationsSpecialist treatment servicesDependency servicesImpact on families
£2.9Offenders under the influenceYoung people committing criminal damageVehicle-related theftsCrime and Anti-Social BehaviourDomestic violence
Fear of crime & impact on environment £8.0
Average employee absence (7.4 days per year)11 million working days annuallySickness absence (17 million annually)Poor and underperforming
£1.7
Not including estimated costs to the economy of alcohol-related deaths and unemployment
Key Features of Healthy Places Healthy Lives
Developing partnerships to address the “wider determinants”
Working on an area of need in an area
Reducing health inequalities – Marmot
Influencing Commissioning
Reducing
alcohol harms
Wolverhampton
Lincoln
Great Yarmouth and
Waverney
Trafford
Brighton and
Hove
Isle of Wight
Infrastructure
IntelligenceGovernanceSystems & processes
Strategy
Return on Investment
Community Approaches
Service Focused and innovation
interventionsIBA
Lincoln
Training for frontline staff IBA
Supporting the development of work in alcohol and young people
Development of work in A&E – delivery of IBAs & Cardiff Model
Alcohol & Primary Care (DES/LES)
High Impact Users Lincoln Audit
Developing new commissioning models
Work on supporting infrastructure
Strategy
Intelligence
Benefits realisation
Finance and Commissioning
Infrastructure Development
• Cementing partnerships• Think Tanks• Mapping alcohol services• Links to commissioning• Links into other local strategies and Boards e.g. Child Poverty, Community Safety• Local leadership & cementing partnerships• Understanding the wider determinants
Alcohol Strategy: Isle of Wight, Wolverhampton, Brighton, Gt Yarmouth
City-wide Intelligence, Wolverhampton
• Terms of Reference• Multiple stakeholder engagement• Linking data • Analyst expertise • Gaining buy-in across the City• Model to support other strategic work
Benefits realisation, Gt Yarmouth & Waverney, Wolves
• Economic modelling• Benefits realisation• Links to commissioning• Amenable mortality• Convincing commissioners
Cost Effective Interventions
Review of the evidence (eg WHO, NICE)
Review of individual studies
Keep it Safe Wolverhampton
Amenable Mortality
Summary of the evidence of the effectivenessof alcohol interventions
Source: WHO, Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm, 2009
Degree of Evidence
Evidence of action that reduces alcohol-related harm
Evidence of action that does not reduce alcohol-related harm
Convincing • Alcohol taxes• Restricting outlet density• Restricting days/hours of sale• Minimum purchase age• Random breath testing• IBA programmes• Treatment for alcohol use disorders
• School-based education & information
Probable • Minimum unit price• Restricting volume of commercial communications• Enforcing restricted sale to intoxicated/ under-age people
• Training of alcohol servers• Consumer labelling and warning messages• Public education campaigns
Limited • Suspending driving licenses• Workplace programmes• Community-based programmes
• Campaigns funded by the alcohol
industry
Outline:• Increased police presence.• Voluntary ‘Street Pastors’ – street patrol
and guidance.• ‘Safe Havens’ – alcohol free drinks,
somewhere to wait, free call to taxi company.
• Temporary medical centre (on the spot first aid) and triage ambulance to relieve A&E pressure.
• Taxi enforcement officers to monitor unlicensed ‘plying for hire’ activities.
• Multi-agency visits to licensed premises to ensure compliance with licensing and safety conditions.
Impact (compared to same period, 2007/08): • 29% reduction in violent crime• 14% reduction in alcohol-related ambulance call-
outs (28% reduction on New Year’s Eve) • 8% reduction in A&E attendances • 125 visits to licensed premises by
enforcement officers (leading to 1 prosecution and 3 license reviews)
• 12 taxi drivers were stopped for ‘plying for hire’, of which, 10 were prosecuted, enforcing the ‘get home safely’ message.
• Fire Officers conducted 38 inspections across 24 premises. 23 required further action, relating to means of escape and insufficient fire risk assessments.
Night Time Economy, ROI example:Keep It Safe, Wolverhampton
Return on Investment: Total budget was £218,786. Cost analysis indicated total savings to the emergency services alone of £235,000. This shows strong ROI before Wider social determinates are factored in.
Service Focused Interventions
Brief Interventions
Cardiff Model
Pharmacy
Brief InterventionsReview
LES & DESAgree local care
pathways
Better engagement with
Primary Care
Review LES & DES
Discussion with local Boards
Implementation of AUDIT C in
vascular checks
A&EReview &
mapping. A&E champion
Training, development and
embedding
Children and Young
People
Training for 1,000 front-line staff on
screening and IBA
Increased referrals and prevention
Cardiff Model
Engage and consult stakeholdersMap Cardiff
requirements – data, pathway and resource
Implement and continue to improve
Identify existing Symphony data fields (free text)
to avoid IT upgrade
System now working, and
police acting on data received
Continual improvement and feedback
Scratch card scores
Scores above 5 could indicate that drinking levels are harmful or hazardous to health
3438 Scratch cards have been given out• 3322 Over the counter by pharmacies• 110 NHS Health checks (Chamber Health)• 3 Emergency Contraception• 3 Other• Details from Arrest Referral not yet available
Community Focus
Sale West Partnership, Trafford
Bilston East, Wolverhampton
Focussing on the wider social determinants
Bilston East, Wolverhampton
Community Workshop
Training for community members
and workers
Halo effect & Mentoring
• How does alcohol effect people?
• Neighbourhood development
• Awareness raising
• Increased knowledge
• Spreading the word
Addressing Marmot Policy Areas Give every child the best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create and develop healthy and sustainable communities and places
Strengthen the role and impact of all health promotion
Maturing Partnerships
Different needs of sites
Health Inequalities
and prevention
New opportunities
and innovation
Financial austerity
Lessons Learned
• Partnerships take a while to mature and bed in with regular meetings between stakeholders
• The financial climate and the changing shift in staff has been problematic in some places
• Some issues need to be solved at a national level eg incentivising the delivery of IBAs
HPHL into 2011
• New sites joining• New Issues to discuss
– Transforming Communities– Social return on investment– Raising Aspirations
• NHS Institute is moving to Social Enterprise Model
• We would welcome discussions with potential new sites!
More information
• Website - www.institute.nhs.uk/commissioning/general/healthy_places_healthy_lives.html
• Flyer - www.institute.nhs.uk/images/documents/Healthy%20Places%20Healthy%20Lives/62934%20NHS%20Healthy%20Places%20A5%20flyer.pdf
• juliamiller@nhs.net HPHL Alcohol Lead 07903 218321