Alcohol Improvement Program – “What’s over the hill?”Chris Heffer, Deputy Director Drugs & Alcohol

December 2009

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Alcohol

We still face major challenges in preventing illnesses which are rooted in people’s lifestyle choices

• Lifestyle challenges such as alcohol misuse, smoking and obesity cost the NHS at least £9.4bn annually (of £100bn budget), society £37.3bn annually and cause 140,000 preventable deaths each year

Though rates are dropping, 8.5m (21%) of

the general population still smoke; half of

these are routine and

manual workers

10m are drinking at increasing risk levels; 2.5m drinking at twice recommended levels;

6% of all NHS admissions are alcohol related,

increasing by c.80,000 every year

An estimated 330,000 problem

drug users,

209,000 of which

are in treatment

30m (62%) of the adult

population are overweight or obese; by 5,

22% of children are overweight or obese, rising to 33% by age

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Only 40% of men and 28%

of women achieve

recommended weekly levels of physical

activity;

The challenge: to find an effective and appropriate role for Government in supporting individual behaviour change, but on

a mass scale

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…And many of these behaviours can overlap in individuals

Lower risk/ Abstinent

Increasing risk

Higher risk

Moderately Dependent

Severely dependent

Smoking

Increasing/higher risk

drinkers

High BMI

9%

8%30%

4% 7%

10%

3%

22%

24%

49%

Source: Healthy Foundations survey data, DH

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Alcohol

We know alcohol misuse is costly to society and individuals

Levels of consumption risen 60% since 1970s, although may have plateau-ed− 10m drinking above recommended limits , with 3m drinking above 2x limits− 1m+ dependent on alcohol

6% of all hospital admissions are alcohol related− In total, there were 863,000 alcohol-related hospital admissions in 07/08− Rising by around 70,000 admissions p.a.

Up to 35% of all A&E attendance and ambulance costs may be alcohol-related.

Alcohol misuse costs the health service £2.7bn p.a. Alcohol implicated in

− 6,000 babies born p.a. with FASD− Over 7,000 women miscarrying− Up to 1.3m children affected at home− c. 25% of child protection cases− 39,000 reports of serious sexual assaults

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Alcohol

But not always a popular subject with people!

Proportion expressing preference to change behaviour

Source: Professor Theresa Marteau, Kings College London

0 20 40 60 80 100%

drink less

lose weight

stopsmoking

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Meaning we have quite a challenge to slow the rise in admissions

Alcohol admissions

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08

Alcohol attributable(e.g, violence, digestive, cancer , hypertensive, cardiac arrhythmia)

Alcohol specific(e.g. liver disease, mental health, alcohol poisioning)

Hospital Admissions

+11.2% p.a.

+11.1% p.a.

Alcohol Related Hospital Admissions, by cause, 2002/3 – 2007/8

Projection

Planned

Source: HES data

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Alcohol

So what do we do about it?

“politics is the art of choosing between the disastrous and the unpalatable”

JK Galbraith

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Overall approach to tackling health harms from alcohol in England

To succeed in tackling health harms from alcohol, we need to support change in behaviour of millions of people in England, with a consistent approach:

Give individuals the advice and

support they need to make healthy

choices

Create an environment in

which the healthy choice is the easier choice

Identify, advise and treat rapidly and effectively those at risk

Ensure proper prioritisation and

alignment of government to

tackle harm

• Social marketing and segmentation

• Unit and health labelling on products

• POS information• Drinkaware and

the Campaign for Smarter Drinking

• Pricing and taxation

• Advertising regulation

• Mandatory code for alcohol retailing

• Underage sales and disorder measures

• Coalition for Better Health

• Identification and Brief advice

• Direct Enhanced Service (DES) on alcohol advice for new patients

• Specialist treatment services

• National and regional support

• PSA indicator on hospital related admissions

• Alcohol learning centre

• Regional support to early implementer PCTs

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The Alcohol Improvement Programme (AIP) covers a wide range of areas

Evidence Local Level Data (e.g. NW PHO local profiles) Tools and Guidance A new National Treatment Monitoring System The SIPS research programme (covering IBAs in A&E, primary care and probation) High Impact Changes

Support/ Training Regional Alcohol Managers Alcohol Learning Centre National Support Team visits (NST) “Ready reckoner” tool to support investment in reducing hospital admissions A programme integrating alcohol training into undergraduate medical curricula (6,000 p.a.) Alcohol Certificate course for Primary Care practitioners An e-learning module for IBA in primary care Harmful drinkers social marketing strategy

Implementation 20 Early implementer PCTs receiving extra £3m p.a. A £8m Directed Enhanced Service to identify higher risk drinking in newly registered GP

patients aged 16 and over, in all PCTs

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So what next for alcohol and the AIP?

Challenges

Using data well− PCT plans− Specialist treatments/ Read codes− Segmentation of individuals− Outcomes − Costs

Clear delivery chain− Tier 3− Indicator− Partnerships - RDPHs/ SHAs/ GOs/

CDRPs/ DATs, etc.− Future Performance frameworks

Funding pressures− Locally on treatment services− Regionally on support – RAMs, EIs,

NST− Nationally on research, education

and social marketing− Evidence of cost effectiveness

Opportunities

RAMs up and running and supporting PCTs

Build the “business case” around investment in alcohol and in prevention

Liver strategy announced SIPS program reports next year Embedded in medical training

programs New social marketing strategy

for February NHS workforce as exemplar Improve services for offenders Work with industry – maybe

IBAs in every workplace?

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Changes?

FROM:

National

Central

Mass interventions

Health gain

Individual

NHS

Performance Management

TO:

“Frontline”

Done once

“Personalisation”

Cost effective

Family/ society

Partnerships

Prioritisation and outcomes

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Final message

We are all in this together, so let’s make sure we all do the right thing…