Alcohol Chapter
Wigan Borough Joint Strategic Needs Assessment
March 2013 Update, which complements and updates the 2011 Alcohol chapter.
Author: Nicki Thomas
Topic
Page
Alcohol Misuse in Wigan – Chapter summary
1
Strategic recommendations
1
Why is drinking a priority?
2
What is the cost of drinking harm?
2
How much are we drinking?
2
Alcohol and lifestyle behaviours
4
Who is at risk of alcohol-related harms?
5
What is the level of alcohol-related health needs in the population?
5
How well are current services meeting need?
9
What is the social and economic level of need?
11
Domestic abuse
14
Violent crimes
16
Anti-social behaviour
17
Safeguarding
20
Who will be coordinating the work to tackle alcohol-related harm
20
Recommendations
20
References
23
This document represents a snap-shot – a picture at a single point in time. Assessing needs
is an on-going process, and updates and new sections will be added over time, and posted
on the web-site Wigan JSNA web pages:
http://www.wigan.gov.uk/Council/Strategies-Plans-and-Policies/JSNA.aspx
Author: Nicki Thomas
07/01/13
0
Alcohol Misuse in Wigan: JSNA Chapter Summary
This is the JSNA chapter on alcohol. It is a refresh of the chapter published in 2011. It has
enabled us to look into the future and paint a picture of that future based on who is at risk
and why, the level of need in the population, service provision and unmet needs. The main
data sources utilised throughout this chapter include:
Local Alcohol Profiles England (LAPE): For health, mortality and economic data
Substance Misuse Adults Needs Assessment 2011-2012: For treatment data
Joint Intelligence Unit: For local crime and incident rates with victim / offender profiling
Operational data regarding specific interventions / initiatives has been provided by
service managers and local reporting structures.
Strategic Recommendations:
To capitalise and build on the high-quality work that has already been undertaken strategic
and operational recommendations are put forward throughout the chapter. Below is a
summary of the strategic recommendations that have been proposed to help minimise the
gap between where we are today and where we would like to be to prevent and respond to
the harms caused by alcohol misuse to individuals, their families and local communities:
Develop a 3 year integrated substance misuse Information & Behaviour Change Strategy
for Adults, Families and Young People to influence public behaviour and attitudes towards
alcohol. The Strategy will focus on harm reduction, safe drinking levels, reducing stigma
and targeting those communities at risk of alcohol harm who are not currently engaging
with recovery services such as home drinkers, older people and people with liver disease.
Complete a baseline assessment of alcohol screening and brief intervention activity and
practice (inclusive of all ages) across the relevant settings and agencies in-order to
determine that current practice is appropriate, meeting local need and producing positive
outcomes for people drinking at increasing and higher risk levels. The review should be
used to develop an improvement plan which identifies actions such as training and
support (alongside available resources) to enhance the quality of current interventions.
Develop a strategy that works towards breaking the cycle of substance misuse in families
by addressing the silent voices of children who are affected by parental / familial
substance misuse.
Rising mortality from alcohol related liver disease requires immediate attention both from
prevention and end of life care perspective. Commissioners need to build on and
contribute to the evidence base by undertaking a local needs assessment to establish a
greater understanding of prevalence rates and what contributes to liver disease to inform
future commissioning decisions.
Continue to identify partnership solutions and interventions (such as the Long Term
Conditions programme and the 24 hour psychiatry service) and explore how these can
contribute to reducing the upward trend in alcohol-related hospital admissions.
The current re-commissioning of Local Drug and Alcohol Recovery Services (for both
adults and young people) provides opportunities to build on evidenced based good
practice and ensure that services and initiatives are accessible to those who need them.
Both services need to use appropriate outcome monitoring tools that can demonstrate
clinical effectiveness, patient outcomes and cost effectiveness.
Author: Nicki Thomas
07/01/13
1
Consider the Combined Authority report due out in early 2013 outlining the results of a
town centre review to understand the threats facing the town centre along with an
appraisal of opportunities (including Purple Flag) to renew town centre plans.
Consider the Borough position on the new licensing provisions in the Police and Social
Reform Bill for example Early Morning Restriction Orders (EMROs) and Late Night Levy.
Conduct a detailed problem analysis as part of the Anti-social Behaviour Strategic Review
and Local Strategic Assessment including; an analysis of the costs of the problem, costs
of current interventions, options for new investment models, potential benefits and ways
of measuring those benefits.
Author: Nicki Thomas
07/01/13
2
Why is drinking alcohol a priority?
head. These are staggering figures and
continue to demonstrate Wigan’s problem
with alcohol. Though in reality this is only
the tip of the iceberg as many of the costs,
particularly social costs such as the
turmoil caused to family and friends of
heavy drinkers, cannot be accounted for. ii
At both a policy and political level the
alcohol harm agenda has gained
momentum in recent years. The
Government’s much anticipated Alcohol
Strategy was published in March 2012.
The aim of the strategy is to reshape
society’s approach to alcohol and to “turn
the tide against irresponsible drinking”.i
As a region the North West accounts for
13.3% of the population of England. Yet it
bears the burden of 14.8% of the National
alcohol related costsiii. It is evident that
there is a stark geographical division in
alcohol related harm between the North
and the South, particularly the North West
which bears the brunt of the harms
compared to the South East.
The Local Alcohol Profile for Wigan shows
that the Borough frequently scores much
worse than the national average for a
range of alcohol indicators. Reducing
alcohol-related harm is a key priority for
the Borough and is addressed through the
Local Alcohol Strategy 2013-2016. The
overall
responsibility
for
delivering
outcomes for local people against these
alcohol indicators will be the goal of the
Local Health and Wellbeing Board. The
Board will ensure that the harms caused
by alcohol misuse are tackled at a local
level and will co-ordinate work, in
partnership with Wigan Borough Clinical
Commissioning Groups from April 2013, to
make the most of the resources and
expertise available.
How much are we drinking and have
consumption patterns changed?
It can be difficult to obtain reliable
information about drinking behaviours as
social surveys frequently record lower
levels of alcohol consumption than would
be expected from data on alcohol sales.
This is most likely a result of people
under-estimating the amount of alcohol
they consume due to the increase in glass
sizes and the strength of many wines and
beers over recent years, which has added
to the confusion over alcohol units.
What are the costs of alcohol harm?
In terms of alcohol related harms there is
a common distinction between those that
are health related and those that are
associated with wider social and economic
harms like alcohol-related crime and risk
taking behaviours. Research published by
Drinkwise (May 2012) showed that the
cost of alcohol-related harm to the
Borough in 2010-2011 was a huge
£123.97 million. This equates to £403 per
head of the population in Wigan,
compared with an Regional average of
£439 and an England Average of £387 per
In the absence of reliable local measures
of drinking patterns among Wigan
residents, modelled estimates from the
North West Public Health Observatory,
have been produced to show the
population in Wigan aged 16 and over
who are drinking above recommended
levels. These are synthetic drinking
estimates and should be viewed with
some caution. Whilst the majority of the
borough (74%) consume alcohol within
the recommended guidelines, there is still
Sector
Total Cost per
sector- Wigan
Cost per headWigan
Cost per headEngland Average
£100
Cost per headRegional
Average
£93
NHS
£30.79 million
Crime and Licensing
£34.07 million
£111
£137
£137
Workforce Productivity
£49.63 million
£161
£176
£142
Social Services
£9.47 million
£31
£33
£32
Total:
£123.97million
£403
£439
£387
Author: Nicki Thomas
07/01/13
£77
3
20% of the population in Wigan (16+)
drinking at increasing risk levels and a
further 6% drinking at higher risk levels.
Very few people drinking at increasing and
higher risk levels recognise their own
alcohol consumption levels as harmful and
in need of intervention; this creates a
challenge for both policy makers and
service providers to engage with this
group.
Drinking Typology
Total
Count
Higher Risk Drinkers:
Drink at very heavy levels measured by
consumption of over 50 units per week
for males and over 35 units per week for
females which significantly increases the
risk of damaging health and may have
already caused harm to health
16,267
people
(6%)
The increase in consumption in recent
years is thought to be attributable to the
growth in the proportion of alcohol
purchased
from
off-licensed
trade
(including off-licenses and supermarkets)
and consumed within the home. ivThis shift
to an increase in alcohol consumption via
off trade rather than on-trade is associated
with the availability and heavily discounted
prices of alcohol within off-trade. One of
the main risks associated with home
drinking is that many people will pour
more than the standard measures
available in pubs and clubs without
realising the number of units they are
consuming in one sitting. This may lead to
long term public health consequences as
many people are not aware of, or do not
believe that, they are doing anything
risky.v It is important that policy makers
gain a greater understanding of the drivers
of this trend to respond effectively.
Increasing Risk Drinkers:
Drink above the recommended levels
measured by consumption of 20-50
units per week for males and15-35 units
per week for females, which increases
the risk of damaging their health
51, 124
people
(20%)
Lower Risk Drinkers:
Drink within the recommended alcohol
guidelines
190,810
People
(74%)
Recent research has continued to study
the effects of price changes on alcohol
consumption. It shows that as with other
consumer goods, purchases of alcoholic
beverages decline when their prices rise.
Based on the link between affordability
and consumption the Government are
proposing to introduce a 45p minimum
unit price. This has been the most high
profile and politically sensitive aspect of
their policy which is currently under
consultation. The 10 authorities in AGMA
(Association of Greater Manchester
Authorities) have been pursuing and
looking into the possibility of passing a
local by-law that would set the minimum
unit price at 50p, though no decision had
yet been made.
Author: Nicki Thomas
07/01/13
Alcohol & related lifestyle behaviours
Modifiable
risk
behaviours
include
excessive alcohol consumption, smoking,
poor diet and a lack of physical exercise.
To date most interventions programmes
have targeted single, topic based
behaviours however there are now
proposals for interventions to adopt a
broader more holistic approach as
evidence suggest that the majority of
adults in England engage in “multiple risk
behaviours” at the same time.
Research from the Kings Fund has shown
that while the proportion of the population
engaging in 3 or 4 lifestyle risks has
reduced significantly between 2003 and
2008 those in lower socio-economic
groups with less formal education did not
experience as much improvement.vi To
start to address health inequalities and
reduce the number of unhealthy
behaviours people engage in, policy
makers need to find effective ways to
engage with people, particularly those in
lower socio-economic groups, and move
beyond siloed approaches to integrated
public health policies that focus on
multiple lifestyle risks.vii
4
Who is at risk of alcohol related
harms?
With so many in the population consuming
alcohol, alcohol misuse can affect anyone
either directly or indirectly; though some
population groups are more likely to
experience alcohol-related harms than
others. For example safe drinking levels
are different for men and women due to
biological and physical differences.
Women are affected more rapidly by
alcohol due to lower volumes of body fluid,
a higher proportion of fat to lean muscle
tissue and less of the gastric enzyme
(dehydrogenase) that metabolises alcohol
before it enters the bloodstream.
Therefore a male and female of similar
age, weight and build are likely to suffer
different effects after drinking the same
volume of alcohol.
A local Equality Impact Assessment
document has been produced to inform
the Local Alcohol Strategy which explores
the relationship between alcohol and the
following population groups, including any
associated health inequalities, in more
detail;
- Men and Women
- Young and Older People
- Differing socio-economic groups
- Black and Minority Ethnic
Communities
- Lesbian, Gay, Bisexual,
Transgender population
- Disabilities including mental health
- Carers
- Offending population
What is the level of alcohol-related
health needs in the population?
Alcohol is a major cause of preventable
health harms going right across the life
course, from pre-birth, through childhood,
teenage years, adulthood, into old age,
and perhaps, a premature death.
Foetal Alcohol Spectrum Disorder (FASD):
We know that drinking during pregnancy
can have harmful effects on the unborn
child and heavy alcohol consumption in
pregnancy can result in a range of
Author: Nicki Thomas
07/01/13
preventable mental and physical birth
defects for the developing foetus known
collectively as Foetal Alcohol Spectrum
Disorders (FASD). However diagnosing
FAS can be hard because the effects can
affect each person in a different way.
There is also no single medical test to
diagnose FAS and other disorders, such
as ADHD (attention-deficit/hyperactivity
disorder) and Williams syndrome, have
similar symptoms. What is urgently
needed is to advance the field of FAS
diagnosis through the development of
guidelines based on empirical evidence
and clinical experience. This would allow
commissioners and providers to better
determine the prevalence and impact of
FAS and support FAS sufferers and their
families.
Women do not drink to intentionally harm
their baby. There are a number of reasons
why women might drink alcohol while they
are pregnant: they might not know they
are pregnant; they might be pressured
socially to drink; they might be trying to
cope with problems and stress; or they
may be unaware of the risks of drinking
alcohol during pregnancy. The National
Organisation on FAS suggests that 1 in
100 children are born with alcohol-related
disorders, which equates to 40 children
per year in Wigan. Although many children
born with FASD are not diagnosed, or do
not receive a correct diagnosis, which
again makes calculating the prevalence of
the condition extremely difficult.
An Alcohol and Drugs Liaison Midwife is
commissioned locally to encourage early
contact with recovery services and the
local NHS trust to promote optimal
outcomes before, during and post
pregnancy. The service received 53
referrals for 2012 (as at November): 20
were seen and given brief advice and
support, 32 were managed by specialist
midwife and 1 was not pregnant. Out of
the clients managed 5 has an alcohol
misuse need only (16%) and 7 (22%) had
a combined drug and alcohol need.viii
Universal awareness raising campaigns
and expanding provision with regards to
pre-pregnancy work with clients needs to
be improved at a local level.
5
Alcohol Attributable Hospital Admissions:
Levels of hospital admissions for alcohol
attributable
conditions
provide
an
indication of the level of harm associated
with alcohol in the population, as well as
the burden that alcohol consumption
places on the NHS. Locally the costs of
alcohol-related harm to the NHS were
£100 per head of the population for
2010/11. This is slightly higher than the
regional average (£93 per head) but
substantially larger than the National
average of £77 per headix. However, since
only the more acute cases will be admitted
to hospital actual levels of harm among
the population are likely to be much
higher.
Rates of alcohol related hospital
admissions have for the most part shown
an annual increase over the past few
years for the Borough, though there
appears to be a levelling off of the rapid
increased in both the number and rate we
have experienced in recent years. There
were 10,644 alcohol related admissions in
2011/12, a 1% increase on 2010/11
(10,555). This translates into a rate per
100,000 of the population of 2,943 (a 0%
increase on 2010/11 (2,933).
Yet despite the apparent fall in the rate of
increase Wigan still remains above the
national, regional and Greater Manchester
averages for alcohol related admissions
which is a cause for concern.
Greater Manchester Average: 7539.86
admissions, 2,623.64 per 100,000 pop.
North West Average: 9,790 admissions
(total), 2,464 per 100,000 pop.
England Average: 1,220,046 admissions
(total), 1,974 per 100,000 pop.
The demographic profile of alcohol-related
admissions data reveals that admissions
are higher amongst middle aged groups
and there continues to be a clear gender
dominance with a higher number of male
than female admissions.
Three conditions accounted for over 70%
of all alcohol-related admissions at Royal
Albert Edward Infirmary: high blood
pressure was the underlying cause for
39.7%, followed by alcohol specific mental
and behavioural disorders (17.7%) and
heart palpitations (14.7%).
Alcohol Specific Hospital Admissions:
Alcohol specific hospital admissions are
those where alcohol is a contributing
factor in all cases. They provide a relative
measure of the direct impact of alcohol on
health. In 2010/11 there were a total of
1734 admissions to hospital for an alcohol
specific condition in Wigan. There were
more male than female admissions (63%
compared to 37%), a pattern that occurred
consistently across Greater Manchester.
The rate of alcohol specific hospital
admissions for males had been increasing
Rate of alcohol-related admissions per 100,000 pop (EASR) by local authority
(326)
3,200
3,000
2,800
2,600
Wigan
2,400
GM average
2,200
North West
2,000
England
1,800
1,600
1,400
2008/09 (final
revised)
Author: Nicki Thomas
07/01/13
2009/10 Annual
Refresh (Final)
2010/11 Annual
Refresh (Final,
revised2)
2011/12 (Provisional)
6
both the Greater Manchester and North
West average rate (insert GM and 93.71.
per 100,000 pop) and the gap between
Wigan and the National rate (55.79 per
100,000 pop) is significant. Out of 326
areas nationally (England) Wigan is
ranked 295 for this measure where 1 is
best and 326 is worst. For alcohol-specific
hospital admissions the top presenting
conditions for young people include
alcohol specific mental and behavioural
disorders (24%), accidental injury (21%),
intentional self harm (13%) and assault
(12%).
year on year, with a 37% increase from
2006-07 to 2009-10. However, things are
starting to improve locally and not only is
the figure down slightly on 2009/10 but we
are now below the Greater Manchester
average (698.27 compared to 756.12 per
100,000 pop). Looking at female
admissions the rate is continuing to show
an upward trend and we have seen a 35%
increase from 2006-07 to 2010-11. The
rate for females (403.17 per 100,000) is
now above both the Greater Manchester
average (363.66 per 100,000 pop) as well
as the England average (225.01 per
100,000 pop)
Alcohol Specific
(under 18s):
Hospital
It is however important to note that the
figures above do not include any alcoholrelated attendances at A&E for under 18s.
According to an independent report
commissioned by Wigan Council if a
young person arrives in A&E they are split
with under 16’s to Rainbow Ward/ Over
16’s to Adult A&E. However actual figures
are not known for alcohol related
admissions for under 18s.
Admissions
High alcohol consumption and intensive
patterns of risky drinking mean that young
people in the UK are more likely to suffer
accident or injury as a result of drinking
than in any other country in Europe.
Locally the rate of alcohol specific hospital
admissions for under 18s has been
decreasing since 2006/07. Between
2008/09 and 2010/11 there were 192
alcohol specific admissions for under 18’s
in Wigan. This translates as a rate of
96.58 per 100,000 of the population- a
13% reduction on the 2007/08 – 2009/10
figure. However the figure still remains a
cause for concern as we are still above
Alcohol Specific Months of Life Lost
Months of life lost per person due to
alcohol misuse provides a measure of
how much alcohol contributes to life
expectancy in the general population. In
Wigan men lose an average 12.09 months
of life and women lose an average 5.64.
The figures for both men and women had
Number admitted to hospital with alcohol specific conditions
2000
1800
1600
1400
Wigan
1200
GM average
1000
North West average
England average
800
600
400
200
2007/08
Author: Nicki Thomas
07/01/13
2008/09
2009/10
2010/11
7
been steadily increasing since 2004.
While the rate for men continues to
increase, women did see a marked
reduction in the 2007-2009 figure (5.38
MLL) though it has crept up again and it is
too early to determine if this figure will be
sustained.
Alcohol Specific Mortality:
Alcohol-specific mortality varies by age,
gender and socio-economic status. There
has been slower increases in alcoholspecific mortality over the past 15 years in
the more affluent areas of Wigan
compared to more deprived areas in spite
of similar consumption patterns, which
reflects the National trend;
“If it were not for alcohol-related
deaths, the objective to narrow overall
spearhead life expectancy gaps would
almost certainly have been achieved
for males and would be well on the way
to being achieved for females”. (DOH)x
attributable to alcohol-related liver disease
(ALD) equates to 92.6%, with males still at
a greater risk of dying from alcohol-related
liver disease compared to females.
The graph below is interesting in that the
peak age in deaths from ALD for both
genders has moved to a younger age
band. For male deaths this has moved
from 50-54 years (2007-09, 2008-2010) to
45-49 years and for female deaths from
60-64 years (2007-09, 2008-2010) to 4044 years. This shift and the fact we are
seeing an overall increase in the number
of people dying from ALD under 45 follows
the current national trend that people are
presenting and dying at a much younger
age with ALD.
Despite
the
increase
in
mortality
From 2008-2010 a total of 120 people
died in Wigan from alcohol specific
conditions where alcohol is causally
implicated in all cases of the condition, for
example alcohol-induced behavioural
disorders and alcohol-related liver disease
including cirrhosis. There were more
alcohol-related deaths in males than
females (74 compared to 46) which
equates to a rate of 15.44 per 100,000
population and 9.07 per 100,000
population respectively
The major components of alcohol-related
mortality increases in recent years are in
alcohol-related liver disease in early
middle age (45-64) and also in digestive
cancers and alcohol-related dementia in
late middle age (60-74)xi. Over the last 10
years the number of deaths from chronic
liver disease, including cirrhosis, has been
steadily increasing at the same time that
the mortality rates for all the other 4 main
causes of death- heart disease, cancer,
stroke and respiratory diseases, have
been declining.
On average (from 2007-09 to 2009-11) the
proportion of alcohol specific deaths
Author: Nicki Thomas
07/01/13
associated with alcohol-related liver
disease, for most people with fatty liver
and alcohol-related hepatitis the liver will
recover and heal itself if they stop
drinking. Even if they have cirrhosis, they
will reduce any further damage to the liver
and increase their chances of survival if
they stop drinking. Though we know from
local statistics that lots of patients who are
diagnosed with alcoholic liver disease fail
to engage with both gastro services and
structured recovery services and do not
abstain from alcohol once they are
discharged from hospital.
Investing in primary care based prevention
and treatment for liver disease is a priority
8
for the region. At a local level we are
developing a treatment pathway to
integrate liver screening into the existing
Alcohol Local Enhanced Service. This will
enable us to identify people with early onset liver disease who can be managed
within the community and rationalise
secondary care referrals. We are also
planning to undertake consultation with
patients diagnosed with ALD who are
discharged from the hospital to better
understand why they are failing to engage
with
services
and
what
support
mechanisms need to be in place.
Interventions
and
communications
regarding alcohol-related liver disease
need to be targeted at those most at riskxii.
Whereas men have the highest rate of
ALD mortality locally, national evidence
suggests that women and young people
will be more at risk in the future; for
example alcohol-related hepatitis and
cirrhosis develop after less alcohol intake
in women than men and nationally the
biggest increase in hospital admissions for
ALD has been in the 25-29 age group
across both genders.
The earlier the age at which children drink
and the more they drink the greater the
chance of them developing serious liver
disease in adult life. This is exacerbated
when the young person is also obese.
According to ChiMat obesity in young
people in Wigan is 10% at entry into
school reception (approx 5 yrs) a figure
which doubles at year six (approx 11 yrs).
One characteristic of obese children is
their low self esteem which is a link further
down the line for increased likelihood for
misuse of alcohol and drug use. There
have been a small number of cases of
liver damage caused by obesity in the
under 16 population.
How well are current services meeting
the local health need?
The evidence base indicates that although
most alcohol related harm is preventable,
most people are not aware the impact
their alcohol consumption is having on
their health and wellbeing (until they start
to experience serious problems) and thus
Author: Nicki Thomas
07/01/13
continue to drink at harmful levels. The
sooner services are able to identify those
that are drinking above recommended
guidelines and help them to reduce their
consumption, the more likely it is that they
will not need increased medical care in the
future due to excessive consumption. New
drug and alcohol local recovery services
are currently being commissioned as part
of the revised alcohol treatment model for
Wigan. These will become operational
from the 1st April 2013.
Alcohol Identification & Brief Advice:
(Tier 1 Service Provision)
There is good empirical evidence
underpinning the value of alcohol
screening in a number of settings, with
studies indicating that it is both clinically
effective in reducing alcohol consumption
and contributing to the reduction of long
term conditions. For example for every
eight people drinking at increasing and
higher risk levels who receive simple
alcohol advice, one will reduce their
drinking to within lower-risk levels.xiii This
compares favourably with smoking where
only one in twenty will act on the advice
given.xiv
Within primary care GPs have been
incentivised to provide identification
and brief advice to people who are
drinking too much through an ‘Alcohol
Locally Enhanced Service’ (LES). In
2011-2012, 14,826 patients received an
alcohol screening with 532 going on to
receive an alcohol brief intervention
and 56 follow up appointments.
However, only 28 practices have
signed up, which is less than half and
few referrals were made to recovery
services from primary care in the whole
of 2011-2012.
NHS health checks are a key element
of prevention within the Government’s
Alcohol Strategy. Find and Treat has
existed across the Borough for several
years and last year (2011-2012) 11,626
Health Checks were conducted under
the programme, with 449 patients
receiving alcohol brief advice. However,
9
again only 15 patients were referred to
structured treatment services.
Since November 2011 the AUDIT C
tool has been embedded within the
Hospital’s IT system. Staff, including
those based within the Emergency
Department, refer all patients with a
positive AUDIT C score to the Alcohol
Specialist Nurse Team where they
complete
the
remaining
AUDIT
questions and are given brief or
extended advice where appropriate.
Alcohol IBA activity within the trust has
been included in the Commissioning for
Quality and Innovation (CQUIN)
contract since last year.
Making Every Contact Count is a large
scale behaviour change programme,
being rolled out across the Borough,
with the following delivery groups
identified as a priority given the
association with alcohol related harm;
A&E, CDW, Maxillo-facial, Fracture
Clinic, Pre-op Assessment Clinic,
Maternity, Coronary Care Unit, Cardiac
Catheter Lab and Medical wards.
Although NICE advises that IBA be
offered to those aged 16 and over there
is limited evidence as to the
effectiveness
and
best
delivery
approaches for children and young
people. Locally the Young People’s
Substance
Misuse
team
have
developed a Drugs, Alcohol and You
Screening Tool which focuses on wider
substance misuse. The intervention
focuses around risks to the young
person’s personal safety, injuries,
appearance or other more immediate
harms, as these is more likely to
motivate them to change their
behaviour than stating longer-term
health consequences.
People who are drinking at non-dependent
levels but require further support are
offered “extended brief interventions” by
the Alcohol Specialist Nurse Team and
the Community Alcohol Team. These
services provide follow up support to
people that are aiming to reduce their
alcohol consumption over 2-6 meetings
Author: Nicki Thomas
07/01/13
and will be provided in their current format
until 31st March 2011. However, it can be
difficult to measure the success of
screening programmes and little is known
about the quality and performance of
alcohol screening. A review is being
conducted locally to consider current
practice in terms of quality and ensure that
provision is meeting local need and
achieving the anticipated outcomes for
people drinking above sensible levels.
Alcohol Specialist Nurse Team
(Tier 2/3 Service Provision) :
The Alcohol Specialist Nurse Team
(ASNT) based within RAEI provide a
liaison service to people who are admitted
to an acute medical bed where alcohol
has been identified as a significant factor
in their admissions. The ASNT oversee
medical detoxification and liaison with
community recovery services. In 20112012 the ASNT saw 1761 patients with
alcohol as a primary substance misuse
issue. Out of these patients 205
completed a detox, with a further 173
completing a partial detox before being
referred onto structured recovery services.
Active Case Management
(Tier 3 Service Provision):
Local research has found that a relatively
small number of people with alcoholrelated conditions are accounting for a
large number of presentations to A&E and
admissions to Royal Albert Edward
Infirmary. The Active Case Management
service actively targets those patients
whose alcohol use has been impacting so
significantly on their health that they are
the most frequent people admitted to
hospital for alcohol related issues. The
service
engages
patients
in
a
comprehensive assessment of their needs
and co-ordinates their care and treatment
with other specialist services such as
housing, criminal justice, social care etc.
Local Drug & Alcohol Recovery Services:
(Adults) (Tier 3 Service Provision)
10
Specialist treatment for moderate to
severely dependent drinkers is delivered
by Greater Manchester West NHS Trust.
The Service provides both cognitive
behavioural
interventions
and
pharmacologically assisted withdrawal for
people that may also include moderate comobidities. It provides psychosocial
interventions on an individual and group
basis. The majority of referrals received by
the Local Drug & Alcohol Recovery
Service for 2011-12 were self referrals
(67%), followed by health & mental health
sources (12%). Out of the 911 alcohol
clients accessing services within this
period, 637 were new treatment journeys.
The mean age of clients was 41.8 years
with a relatively even gender split- 57%
male and 43% female. Our proportion of
females accessing recovery services is
much higher than the national average
which is 36%. Out of the 911 clients, 443
left recovery services in 2011-12 (49% of
the total alcohol treatment population),
with 237 (53%) completing successfully.
Detoxification Services, Residential Rehab
and Aftercare (Adults);
(Tier 4 Service Provision):
Although there is some national evidence
to show that inpatient detoxification and
residential rehabilitation can be highly
effective (especially when combined), a
review undertaken in 2011 of Tier 4
services found that evidence for this
locally is weak. The report concluded that
there
is
a
pressing
need
for
commissioners to put into place much
more robust data collection systems to
measure outcomes, including those
relating to people’s long-term and
sustainable recovery.xv In this regard we
have also highlighted the importance of
developing seamless aftercare services
following people’s exit from tier 4 provision
and have identified some weaknesses in
current provision which will require urgent
attention.xvi
the 2011/12 period this combined figure
represents tier 2, 3 work and anti social
behaviour. For tier 3 work the top three
referral agencies to YPDAT are the Youth
Offending Team, Schools and Social Care
whilst the top referrer to tier 2 services are
the Neighbourhood teams. Substance
misuse services for young people are
being reviewed to ensure the service
meets the needs of young people in
Wigan. Currently the Specialist and
Targeted commissioning service is
undertaking
a
needs
assessment
including
consultation
with
service
providers, young people and service
users. The new service will begin in 2013.
What is the social and economic level
of need?
In addition to placing an increasing burden
on health services, alcohol consumption
can contribute to a range of social and
behavioural problems that affect society
more widely which this section explores in
more detail.
Alcohol-related harm in the Night Time
Economy
Local Alcohol Recovery Services:
(Young People)
Wigan has always had a vibrant night-time
economy with people flocking to visit the
infamous “King Street”, the heart of
Wigan’s club scene, from across the North
West. Locally the night time economy is a
key contributor to the economy, for
example the average pub injects around
£65,000 into the local economy annually.
It generates employment, particularly for
young people, and in 2010 there were
2200 employees working in bars,
representing 2.14% of all employees in
Wigan. This is a slightly higher proportion
than the North West (1.88%) and England
overall (1.96%). However, despite the
economic advantages the night time
economy can bring in terms of
employment and regeneration it can also
bring a wide range of social problems
including anti-social behaviour, crime and
disorder, noise and litter pollution and
contribute to acute and chronic ill health.
Locally the young people’s substance
misuse service received 173 referrals in
License Premises within the NTE: Density
and Operating Style
Author: Nicki Thomas
07/01/13
11
One of the factors that appears to play a
significant role in alcohol-related crime
and disorder within the NTE is the density
of licensed premises within a single
locality. Within Wigan town centre there
are 24 licensed premises situated on King
Street and the surrounding area. With so
many premises clustered together there is
an over-capacity which has created fierce
competition to attract customers through
drinks promotions and reduced entry
prices.
alcohol purchased from supermarkets in
the home beforehand in a phenomenon
known
as
“pre-loading”.
Anecdotal
evidence suggests that those who engage
in pre-loading tend to enter night time
economy at the busiest time and continue
to drink heavily. Allowing those who are
visibly drunk to access premises or to be
served more alcohol is an area that needs
to be given more attention locally through
door staff and bar staff training under the
Best Bar None Scheme.
Alcohol-related Crimes within the NTE:
Under the reforms of 2003 Licensing Act
there was a steady relaxation of licensing
laws and practice, with premises being
able to apply for a 24 hour license. It was
hoped that the liberalisation of the
licensing laws would catalyse a move
towards more continental drinking patterns
with fewer revellers downing their drinks in
short time periods. However, the resulting
expansion in licensing hours has
consequently increased the availability of
alcohol with many revellers continuing to
binge drink into the early hours of the
morning.
Crime is concentrated in town centres due
to the large number of people who are
drawn into them for work and leisure,
especially leisure related to the night time
economy. The majority of alcohol-related
offences within the NTE still occur at the
weekend (Friday and Saturday nights)
during the hours of 12am- 3am in Wigan
Town Centre and 11pm-4am in Leigh
Town centre. This coincides with the
trading hours and closing times of busy
bars and clubs.
According to the latest crime data 57% of
violent crimes within Wigan Town Centre
also contained an alcohol marker (104
crimes) compared to 45% of violent
crimes in Leigh Town Centre (52 crimes).
However, these figures are likely to be an
underestimate as not all the crimes that
occur within the Night Time Economy are
reported to, or recorded by, the police.
Some crimes may not be reported
because the victim may find it
embarrassing, they may be unaware that
they are a victim or they may not want to,
or be fearful of, reporting the offender to
the police. Yet those crimes that result in
injury can often require health treatment
with many victims presenting at the
Accident and Emergency Department.
Apart from drinking later into the night
people entering the Night Time Economy
are more likely to do so later in the
evening after consuming discounted
Author: Nicki Thomas
07/01/13
In response to this A&E reception staff at
Royal Albert Edward Infirmary have been
using the “Cardiff Model” since November
2011 to supply local agencies with assault
intelligence. Between November 2011 and
October 2012 there were 981 assault
attendances by Wigan residents to the
Royal Albert Edward Infirmary. Out of this
12
89% had consumed alcohol within a 12
hour period. There is still a higher risk to
males (61% of assault attendees
compared to 39% female) particularly in
the 20-34 age group. Approximately one
fifth of alcohol-related assaults were
recorded as occurring within a public
place (19.84%).
However there is still a large proportion of
null responses within the available TIIG
data rendering it unreliable. Areas for
improvement within the current system
include improving the quality of current
data through the training of reception staff,
triage nurses and clinicians. Wigan is
currently partaking in a national TIIG pilot
conducted by the Department of Health to
determine the local partners between
which TIIG data is shared with and its
current uses. It is anticipated that one of
the outcomes for the Trust from being
involved in the pilot will be improved data
quality.
Tackling Alcohol-Related Harm within the
NTE via Multi-component Programmes;
The Night Time Economy is an important
provider of jobs and contributor to the
local economy through attracting business
and tourists to the area. However on
developing and sustaining the night time
economy it is important to address
balance between the expansion of the
NTE and the management of the NTE to
ensure that negative impacts of alcohol
related harm are minimised as far as
possible. There is no single or easy
solution to alcohol-related problems within
the Night Time Economy; however it is
important that local agencies continue to
work in partnership to ensure local
arrangements are operating well. Several
interventions have been implemented
locally (or recommended);
Partners need to investigate and make
use of local intelligence to ensure that
interventions are targeted within
hotspot areas and at the populations
most at risk. Locally this data includes,
but is not restricted to: the number of
licensed premises within the NTE,
their operating style and visits to
Author: Nicki Thomas
07/01/13
licensed premises provided by the
Multi-Agency Licensing Team (MALT),
Police Crime and Incident statistics
and TIIG data collected at Royal Albert
Edward Infirmary.
Using
approved
and
validated
accreditation schemes to ensure high
standards and quality of premises
operating within the Night Time
Economy, such as Best Bar None. Last
year 23 premises within Wigan Town
Centre engaged with BBN with 18
premises put forward for accreditation.
A review of the scheme for year 1 is
underway and will inform how we move
forward into year 2.
Utilise the new powers given to
regulatory agencies under the 2012
Alcohol Strategy. The majority of the
Government’s measures to ‘rebalance’
the 2003 Licensing Act came in to force
on 25 April this year, with the ‘Late
Night Levy’ and ‘Early Morning
Restriction Orders’ introduced on 31
October 2012.
There is a clear drop in activity levels at
the end of working day (6pm) and
before the NTE begins (9pm). We need
to identify how planning policies such
as the Core Strategy and Wigan
Central Area Action Plan and Leigh
Central Area Action Plan can help to
encourage diversity within the night
time economy and contribute to the
development of an early evening
economy.
Hidden Harm:
Approximately one in three of England’s
treatment population has a child living with
them at least some of the time and it has
been estimated that 1.3 million children
under 16 in England are affected by
parents whose drinking is classified as
either harmful or dependentxvii Within local
recovery services 252 alcohol clients
(40%) are parents. 78 of which (31%)
currently live with their own children, with
a further 28% living with someone else
who has children. Additionally 103 clients
13
(41%) are parents not currently living with
their children. The Hidden Harm Service in
Wigan provided a service to 137 young
people during the 2011/12 period where
the behaviour of parents due to alcohol
and substance misuse is having a
negative impact on their personal
wellbeing and development.
According to the 2011 Census information
the 0-19 population in Wigan is 75,600.
The 2008 Northern Ireland Health and
Social Services and Pubic Safety report
into parental substance misuse estimates
that in 1 in 11 of all children in the UK are
at risk so this equates to around 6,870
Children and young people in Wigan. It
has been identified that a range of
genetic,
physical,
environmental,
developmental,
psychological
and
psychosocial harms to children are all
associated with parental substance
misuse. Children living with dependent
drinkers are also more likely to become
dependent themselves. The Willow Young
People’s Counselling Service along with
the Hidden Harm service (that is part of
Restorative Solutions) is working to
prevent these children developing their
own alcohol misuse problems in the
future.
Author: Nicki Thomas
07/01/13
Domestic Abuse:
Domestic abuse is traditionally defined as
physical, psychological, sexual or financial
abuse that takes place within an intimate
or family type relationship and forms a
pattern of coercive or controlling
behaviour. Strong links have been found
between alcohol misuse and the
occurrence of domestic abuse. Evidence
suggests that alcohol misuse increases
the occurrence and severity of the abuse.
xviii
Alcohol is estimated to be a factor in a
third of all domestic violence crimes and
incidents
with
many
perpetrators
consuming alcohol before the assault and
victims turning to alcohol as a coping
mechanism.
Between November 2011 and October
2012 there were 1,268 domestic abuse
crimes recorded across the Borough- 49%
of which (617 crimes) also contained an
alcohol marker. Domestic abuse crime
rates had reduced by 19% from
2009/2010 to 2010/11 overall, with
alcohol-related domestic abuse also
reducing by 9% in the same period. These
crimes were concentrated in the following
wards; Ince (60 crimes), Atherton (48
crimes) and Douglas (40 crimes), which
show a strong link to deprivation. In
addition to the recorded crimes there were
9410 domestic abuse incidents recorded
14
in the same period, with 748 (8%)
containing an alcohol marker.
Domestic violent incidents with an alcohol
marker have continued to steadily rise
across the Borough for the last few years
though the rate of increase has reduced
this year. There was a 17% increase from
2009/10- 2010/11 in line with the overall
increase of 10% for all domestic abuse
incidents - but only a 2% increase from
2010/11- 2011-12 (again this is broadly in
line with overall trends within 11/12 which
saw incidents remain fairly static with
around a non statistically significant rise of
5%).
Both the crime and incident statistics show
that domestic abuse still tends to be a
gender specific crime. Perpetrators of
domestic abuse are more likely to be
male, including those instances where
alcohol is involved (88% compared to 12%
female perpetrators) with higher offending
rates in the 36-56 age group. Women are
more likely to be victims of domestic
abuse, including alcohol-related domestic
abuse (86%). Victim profiling suggests
that domestic abuse still affects those in
the 26-56 category more, though
anecdotal evidence suggests that more
and more young women are affected both
directly and indirectly by domestic abuse
issues.
It is important for policy makers to target
interventions at the most vulnerable
groups which should include children and
young people. The definition of domestic
violence will be amended from March
2013 with two important changes; the
inclusion of coercive behaviour and the
recognition of 16-17 year olds as victims
of abuse.xix It is hoped that the broadened
definition will help to increase awareness
among young people in this age group
who are experiencing domestic abuse and
encourage more of them to come forward
and access the appropriate support.
According to Stark & Flitcraft (1996)
women who experience domestic violence
are 15 times more likely to have alcohol
dependency and 9 times more likely to
have a drug problem than women not
Author: Nicki Thomas
07/01/13
experiencing
domestic
violence.xx
However, information on the number of
alcohol clients within recovery services
who have been identified as having a
domestic abuse need was not available at
the time of this needs assessment.
Information sharing is vital to safeguard
and protect the welfare of victims of
domestic abuse and it is imperative that
this information is not only routinely
collated but shared with relevant partners.
This could be achieved through the
development
of
a
confidentiality
agreement.
Wigan is currently designing the
operational framework of a multi-agency
public protection co-located team. This
will have a specific focus on more efficient
assessment
and
care
pathway
management for people experiencing and
perpetrating domestic abuse but within a
wider context of managing other key
safeguarding issues. The co-located multi
disciplinary team will work to improve
services, raise awareness and enhance
the support for victims and their children
as well as develop preventative services,
processes,
care
pathways
and
interventions
for
those
that
are
responsible for the abuse. Strong
pathways have already been established
between domestic abuse and local drug
and alcohol recovery services to ensure
that both perpetrators and victims of
domestic abuse receive the necessary
support. This has involved;
All Local Drug and Alcohol Recovery
Services have specific domestic abuse
policies and protocols to enable them to
respond
to
clients
who
have
experienced domestic abuse.
Domestic abuse as a safeguarding issue
continues to be built into Local Drug and
Alcohol Recovery Services contracts
service
specifications
and
job
descriptions with an increase in the
number of staff confident in the use of
the common assessment framework for
adults (CADDA-DASH) and young
people (DV RIM)
15
Local Drug and Alcohol Recovery
Services are a key agency within the
Multi-Agency
Risk
Assessment
Conference (MARAC) process.
Staff from domestic abuse services have
been trained to identify and respond to
problematic
alcohol
consumption
through training in the AUDIT screening
tool and IBA.
Domestic abuse perpetrators are
targeting at the point of arrest through
the Tough Choices Team.
Wigan is one of the areas chosen to
pilot the Domestic Abuse Disclosure
Scheme, which is also referred to as
Claire’s Law. Under the scheme people
are able to ask the police if their partner
has a history of domestic abuse.
Although there is plenty of good practice
within this field it’s imperative that these
interventions are fully monitored within the
context of the multi-agency team, and
within the context of delivering the key
outcomes of the Domestic Abuse Strategy
which will be overseen by the Support and
Safeguard Delivery Group within the
BSCP.
Author: Nicki Thomas
07/01/13
Violent Crime within Communities;
Alcohol is associated within violent crime
with heavy drinking and verbal arguments
usually preceding the violent act. Between
November 2011 and October 2012 there
were 2,180 violent crimes recorded across
the Borough- 41% of which (889 crimes)
also contained an alcohol marker. This is
a 2% reduction in alcohol-related violent
crime from 2010-11 and a 4% reduction
from the 2009-2010 figure. It is also
promising that Wigan’s rate of alcohol
attributable violent crime (3.73 per 1,000
population) for 2011-12 is significantly
lower than both the North West and
England averages (4.93 and 5.03 per
1,000 population) However, the crimes
were concentrated in the following Wards;
Wigan Central (133 crimes), Ince (67
crimes) and Douglas (60 crimes), again
showing a strong link to deprivation.
In addition there were 152 serious violent
crimes recorded in the same period, with
59 (39%) containing an alcohol marker.
Again there is a downward trend in the
number of alcohol related serious violent
crimes with a 2% reduction from 2010-112011-12 and a 20% reduction from 200910 to 2010/11.
16
Alcohol-related Anti-Social
including Street Drinking:
Alcohol related ASB
Behaviour
2300
2100
Anti-social behaviour is defined as any
aggressive, intimidating or destructive
activity that damages or destroys another
person’s quality of life and local
community. It can include but is not
restricted to criminal damage, street
drinking, noise and rowdy behaviour,
intimidation and drunkenness.
1900
1700
1500
1300
1100
900
700
500
The primary vehicle for measuring
perceptions of ASB locally was the Place
Survey. The last survey results (taken
from 2008) showed that 35.9% of
residents surveyed felt that drunk or rowdy
behaviour was a very big, or fairly big
problem in their area. This compared with
an average of 32% across the North West
and 29% across England. However, the
Place Survey has since been discontinued
and
locally
we
are
looking
at
replacements.
Nevertheless, incident reporting data
suggests that alcohol-related ASB has
seen a dramatic decrease over the last
three years. The downward trend shows
that from November 1st 2011 to October
31st 2012 there were 19,703 reported
incidents of ASB across the Borough with
1123 (6%) alcohol related. This is a 10%
reduction on the 2010/11 figure (1254)
and a 45% reduction on the 2009/10
figure (2053) This could be attributable to
the fact that since 2011 the Borough
replaced the existing 8 Designated Public
Place Orders in favour of a single
Boroughwide one. The benefits of which is
that it prevents displacement from
hotspots into other areas, though no
formal evaluation has been completed.
There has also been a significant
reduction over the same period in alcoholrelated youths causing annoyance. Local
statistics indicate that there has been a
42% reduction from 2009/10 to 2010/11
with a drop from 996 incidents to 584
incidents. This downward trend has
continued with a further 27% reduction
from the 2010/11 figure of 584 to the
2011/12 figure of 426.
Author: Nicki Thomas
07/01/13
2009/10
2010/11
2011/12
Youths causing annoyance - alcohol related
1100
1000
900
800
700
600
500
400
300
200
2009/10
2010/11
2011/12
Interventions for Offenders:
Alcohol misuse among the offending
population is more common than in the
general population with 57% of all
offenders in Wigan assessed by Greater
Manchester Probation Team (April 2010Feb 2011) identified as having a alcohol
misuse “need”. This was the highest
proportion across Greater Manchester.
Within Wigan, offenders scoring 20 or
more on the AUDIT tool and where
alcohol is the dominant feature of the
offending can be offered an alcohol
treatment requirement. This is a court
order aimed at reducing alcohol related
offending. It provides mandated access to
a tailored programme with the aim of
reducing alcohol related crimes. Between
2011 and 2012 539 ATRs commenced
across Greater Manchester, with 90 (15%)
in Wigan- the highest number issued. 79
17
out of the 90 ATRs were completed in the
same period, with 57 (72%) successfully
completed, which is slightly lower than the
Greater Manchester average of 76%
successful completions.xxi
There is an association between
alcohol consumption and the use of both
tobacco and illegal drugs. Research has
found that adolescents that drink are more
likely to smoke than non-drinkers.
To define the link between alcohol and
young people’s offending, a recent review
of the Young Offenders Institution
suggests that the percentage of offenders
with an alcohol misuse need is much
higher for young people than the 57%
recorded for adults. In 2011-2012 the
Youth Offending Team referred 29
individuals to YPDAT, which was the
highest proportion of referrals to the tier 3
service across the Borough.xxii Although
further needs assessment is required to
identify the level of alcohol-related need
among all offenders at different stages of
the Criminal Justice System.
The relation between drinking alcohol
and
mental
health
problems
is
complicated for children and young
people. Young people who have certain
mental health issues are more likely to
engage in risky drinking, whereas those
who drink to cope with their problems are
more likely to suffer mental health issues.
Alcohol-related Risk Taking Behaviours:
Most young people have some experience
with alcohol before reaching adulthood
and before they are legally able to drink.
While the majority of young people who
experiment with alcohol do not experience
significant harms or require specialist
interventions, for some excessive alcohol
consumption can lead to the following risk
taking
behaviours
with
negative
consequences;
Unprotected sex can increase the
likelihood of teenage pregnancy in
addition to increasing the risk of sexually
transmitted
infections.
Wigan
has
historically had higher rates of teenage
pregnancy than the North West and
England but has seen consistent
reductions over 2008, 2009 and the first 3
quarters of 2011, to rates just below the
Northwest average. However, young
people who have had specialist substance
misuse interventions from the Young
Peoples Drug and Alcohol service in
Wigan have in most cases reduced their
risk taking behaviours for unsafe sex by
83% and
involvement in sexual
exploitation by 100%. This is at higher
rates than the national average, but at a
lower rate for unsafe drug use and self
harm.
Author: Nicki Thomas
07/01/13
As
mentioned
earlier
anti-social
behaviour is associated with young people
drinking alcohol. Data from Wigan
Community Safety Team shows that in the
first two quarters of 2011/12, 237 young
people were issued with Police Contact
cards for alcohol possession and
associated anti social behaviour. This
represents 41% of the total number of
contact cards issued across the borough
The consumption of alcohol affects
physical and cognitive functions and can
consequently impair driving ability.
Although drink driving figures have been
falling steadily for decades, nationally
traffic accidents are still a leading cause of
alcohol-related deaths among young men
aged 16-24. There have been 14 recorded
deaths in Wigan from land transport
accidents due to alcohol from 2008 and
2010. Further details over drink driving
crimes and arrests was not available at
the time of this needs assessment.
Interventions to reduce alcohol-related
risk-taking behaviours;
Children’s services in Wigan aim to
support young people and allow them to
make informed choices that will reduce
the risk of them drinking alcohol
excessively and reduce alcohol harms /
risk taking behaviour.
The Risk Taking Behaviour strategy
group meets bi monthly to look at
developing a joined up approach across
children’s services.
18
The Responsible Retailer Scheme
introduced by Wigan Council Trading
Standards in partnership with Greater
Manchester Police helps retailers prevent
under age youngsters getting access to
alcohol and other age related products.
There are 107 off-licensed premises
engaged in the Responsible Retailer
Scheme with 55 having completed the
scheme and received the award.
Linked to the Responsible Retailer
scheme,
the
Trading
Standards
department test purchase the retailing of
alcohol and other age restricted products
to underage consumers. There were 54
alcohol specific test purchases carried out
between 2011-2012 with a failure rate of
11% (6 sales). It is recommended that test
purchases are expanded to also cover onlicensed premises.
A Community Alcohol Partnership is
being developed locally to tackle public
underage drinking through co-operation
between alcohol retailers and local
stakeholders, such as Trading Standards,
police, local authority licensing teams,
schools and health networks. The CAP
address both the demand and supply side
of underage drinking through enforcement
education and public perception.
Alcohol related fires:
Alcohol is recognised as a significant
factor in a high percentage of fires, road
traffic accidents and other incidents
attended by the fire service. In 2011-2012
Wigan’s Greater Manchester Fire and
Rescue Service (GMFRS) identified 142
out of 839 fires in dwellings (17%) marked
as alcohol / drug related. During this
period there were 3 fire fatalities
attributable to alcohol / drugs were a
factor (12%). For this financial year (1st
April to 1st December 2012) there were 69
out of 430 fires (16%) in dwellings marked
as alcohol / drug related. There have been
13 fatalities so far this year, (2 involved
alcohol- 15%) which appears to be
following last years trend.
Author: Nicki Thomas
07/01/13
To reduce the rate of alcohol related fires
across the borough approximately 150
staff from Wigan’s Fire and Rescue
Service have been trained to identify and
signpost people to the appropriate
services in relation to alcohol reduction
and smoking cessation. Commissioners
are also working alongside GMFRS to
produce
a
Partnership
Agreement
between GMFRS in Wigan and Local
Recovery Services to outline a shared
commitment to developing integrated care
pathways and improve the number of
referrals between agencies.
What are the Economic Impacts?
Studies from Europe and the US conclude
that there is a negative correlation
between
problem
drinking
and
unemployment, suggesting that alcohol
misuse (particularly binge drinking) is
more likely to start or escalate after
unemployment begins.xxiii In August 2011
there were 210 incapacity benefit
claimants with a main medical reason of
alcoholism- a rate of 111.65 per 100,000
working population in Wigan. This
compares favourable to the North West
rate of 152.83 per 100,000 population.
Even if an employee is not dependent on
alcohol, drinking above recommended
levels may result in a deterioration in
performance, conflict with colleagues,
increase in accidents and worsening of
attendance record. All of which are a cost
to the economy in lost workforce
productivity, which in Wigan equates to
£161 per head.
With regards to young people Wigan’s
(academic age) NEET % figure has
decreased slightly from 2010/11 to
2011/12 from 8% to 7.2 %. This has
consistently been slightly higher than the
North West figures of 7.4 and 7.1% and
higher still compared with the England
equivalent figures of 6.6 and 6.1%. The
decrease of the NEET figure in the
borough might have contributed to the
encouraging decrease in drinking levels of
young people in the borough.
19
Safeguarding in Wigan
Safeguarding is a complex issue and has
many links to the substance misuse
agenda as has been picked up across
some other sections of this document, for
example hidden harm and domestic
abuse.
A pilot is underway in Wigan linking the
Independent Reviewing Service and the
Adult Drug Services which is working in
partnership with key services where a
child is on a Child Protection Plan. A
significant reason for this if parental
substance misuse is identified the parents
will be fast tracked into recovery services.
They will report progress back into the
Child Protection conference system. This
is a recent innovation and impact data will
be produced to investigate if it has
reduced the amount of time a young
person is on a protection plan and/or a
reduction of the number of these young
people who go on to be looked after.
Who will be co-ordinating the work to
tackle alcohol-related harm?
Several alcohol strategies have operated
in Wigan over the last decade to respond
to and tackle the multiplicity of harms
caused by alcohol misuse. The most
recent strategy document which runs from
2013-2016 has been produced to respond
to the National Framework set out in the
Government’s 2012 Alcohol Strategy. Our
current strategies response is centred on
4 High Level Outcomes, behind each of
which lies extensive delivery plans and
performance indicators.
People
live
in
strong,
resilient
communities, safe from crime and
disorder (Communities & NTE)
People are able to live healthy lifestyles,
make healthy choices and reduce health
inequalities (Individuals)
An increased number of individuals are
recovering from their dependency.
(Treatment)
Author: Nicki Thomas
07/01/13
We have an integrated partnership
system that provides value for money
through
effective
and
efficient
enforcement, prevention and early
intervention to tackle the harms caused
by drugs and alcohol. (Value for Money)
As alcohol-related harm affects economic,
social and health outcomes for the
Borough, the success of the local alcohol
strategy requires the commitment of many
stakeholders at both a strategic and
operational level. A clear strategic
governance framework is an essential part
of the response to alcohol-related harm.
The Alcohol Strategy 2013-2016 High
Level Outcomes fall within the remit of
Wigan’s
three
existing
strategic
partnerships. These are;
Wigan Forward Board
Health and Wellbeing Board
3rd Sector Assembly
The Local Alcohol Strategy as a whole will
be ‘owned’ by the Health and Well Being
Board but its implementation will be split
across each group with each board
responsible for the delivery of actions
appropriate to their remit. It is important
that these groups ensure that the thematic
elements within the strategy are coordinated to enable appropriate and
effective decision making, improve local
health and wellbeing outcomes and
reduce the chances of duplication of
resources.
The Building Stronger Communities
Partnership will be responsible for
delivering High level outcomes 1 on behalf
of the Borough, which will require joint
working with Wigan Forward Board.
Whereas the Alcohol Strategy Group will
be responsible for delivering High Level
Outcomes 2, 3 and 4 on behalf of the
Borough, which will require joint working
with Wigan’s Clinical Commissioning
Group.
Recommendations:
To capitalise and build on the high-quality
work that has already been undertaken
several recommendations have been put
20
forward to develop the programme of
activity. These a.) emphasise primary
prevention to prevent the harms from
alcohol misuse occurring and b) highlight
the need to provide responsive services
for those drinking above recommended
levels and their families:
Prevention:
Develop
a
3
year
integrated
Substance Misuse Information and
Behaviour Change Strategy for Adults,
Families and Young People to
influence
public
behaviour
and
attitudes
towards
alcohol.
The
Strategy will focus on harm reduction,
safe drinking levels and targeting
those communities with high levels of
alcohol harm.
To facilitate the Substance Misuse
Information and Behaviour Change
Strategy, local agencies and frontline
staff must be provided with or have
the means to retrieve helpful and
accessible information on alcohol
harm and have the appropriate skills /
knowledge to relay this information to
the people they support and come into
contact with.
Complete an audit of alcohol
screening and brief interventions
activity across the Borough to ensure
that current practice is appropriate,
meeting local need and producing
positive outcomes for people identified
as drinking above the recommended
sensible levels.
Consider interventions that raise
awareness of alcohol-related harms
among women of a child-bearing age,
those trying to conceive and to support
the early identification of pregnant
women
drinking
above
the
recommended levels.
Preventing premature deaths from
liver disease is a key performance
indicator which features in both the
NHS and Public Outcomes Framework
and supports the QIPP Agenda. The
Author: Nicki Thomas
07/01/13
existing Alcohol Local Enhanced
Services needs to be developed to
screen and detect liver disease at an
early stage through utilising liver
function tests in line with the
Southampton Model.
In-order to facilitate this progressive
movement towards management of
patients with alcohol related harm in
primary care, both primary and
secondary
care
staff
including
gastroenterologists, hepatologists and
the Alcohol Specialist Nurse Team
need to be giving training in liver
disease which should include details of
the Local Alcohol Treatment Pathway.
Build on and contribute to the Liver
Disease evidence base by undertaking
a Local Needs Assessment to
establish a greater understanding of
prevalence rates and what contributes
to Liver disease to inform future
commissioning decisions.
Continue to contribute to alcohol policy
discussions at a Greater Manchester
Level including; Liver Disease Case
for Change developments and plans to
introduce a Minimum Unit Price for
Alcohol.
Treatment:
The current re-commissioning of Local
Drug and Alcohol Recovery Services
(for both adults and young people)
provides opportunities to build on
evidenced based good practice and
ensure that services and initiatives are
accessible to those who need them.
Both services need to use appropriate
outcome monitoring tools that can
demonstrate clinical effectiveness,
patient
outcomes
and
cost
effectiveness.
The Drug and Alcohol Action Team will
need to facilitate a further analysis of
the impact of the Active Case
Management team by providing two
years retrospective information on all
the clients in phase 1, 2 and 3. The
21
information
required
will
be
admissions, attendances, costs and all
primary and secondary diagnosis
codes, which will inform whether or not
to expand the initiative to the top 100.
Wigan
Borough
Clinical
Commissioning Group need to ensure
that there is an adequate provision of
consultants in gastroenterology and
hepatology to treat and support
patients identified with alcohol-related
liver disease.
Conduct qualitative research with
patients presenting at Royal Albert
Edward Infirmary with alcohol-related
liver disease to gain a better
understanding of why such patients
when discharged from hospital are
failing to engage with local drug and
alcohol recovery services and gastro
services. The information gathered
from the consultation will be used to
inform the development of Liver
Disease Clinics.
Continue
to
identify
partnership
solutions and interventions (such as the
Long Term Conditions programme and
the 24 hour psychiatry service) and
explore how these can contribute to
reducing the upward trend in alcoholrelated hospital admissions.
Crime and Disorder:
Ensure that the new definition of
domestic abuse is promoted across
the Borough- both within statutory
organisations and local communities.
Part of this work will be to continue to
raise awareness and challenge
attitudes of relationships and abuse
among young people as part of
primary prevention.
Develop a confidentiality agreement
between
agencies
involved
in
domestic abuse (including recovery
services) to improve information
sharing. This is vital to safeguard and
protect the welfare of victims of
domestic
abuse
and
ensure
Author: Nicki Thomas
07/01/13
perpetrators receive the necessary
support.
More detailed needs assessment is
required to identify the level of alcoholrelated need among all offenders at
different stages of the Criminal Justice
System, including those in the Youth
Offending Team. The Youth justice
liaison and Diversion scheme which
has diverted Young People from
custody to treatment services will
contribute to this.
Consider the Combined Authority
report due out in early 2013 outlining
the results of a town centre review to
understand the threats facing the town
centre along with an appraisal of
opportunities (including Purple Flag) to
renew town centre plans.
Use the results of this review to
stimulate a joint Wigan Forward and
Health and Well Being Board
development of Night Time Economy
Strategic Action Plan focussing on
diversity within the Night Time
Economy and the development of an
early evening economy.
Consider the Borough position on the
new licensing provisions in the Police
and Social Reform Bill for example
Early Morning Restriction Orders
(EMROs) and Late Night Levy
On-going
Trauma
Injury
and
Intelligence Group (TIIG) training
sessions to be provided for hospital
staff to ensure accurate data recording
and extraction of alcohol-related
assault presentations and admissions
within Royal Albert Edward Infirmary.
This data needs to continue to be
shared with the appropriate agencies
in a timely fashion to inform tactical
responses and operations.
Continue to develop the electronic
Vulnerable Licensed Premise Matrix to
enable the Multi-Agency Licensing
Team (MALT) to make informed
decisions about the management of
22
licensed
premises
including
applications and harm reduction
strategies. The Matrix should include
intelligence gathered by regulatory
agencies, Police and local acute
hospital trusts.
Conduct
Test
Purchases
on
intelligence
gathered
from
the
Vulnerable Licensed Premise Matrix
within on-licensed premises in-addition
to those conducted within the offlicensed trade.
As part of the Best Bar None
Accreditation Scheme provided conflict
management training for both bar and
door staff. This should have a
particular focus on refusing entry /
sales to patrons who are already
deemed to be intoxicated to reduce
alcohol related harms within the night
time economy.
Establish better links and work with
Area Management Groups (AMGs) to
identify and tackle alcohol-related
harms within their localities. There
needs to be a culture change whereby
AMGs and the communities they work
within and for are encouraged to get
involved in the Alcohol Agenda and
planning processes- particularly those
localities who have identified alcohol
harm as a priority within their locality.
Conduct a detailed problem analysis
as part of the Anti-social Behaviour
Strategic Review and Local Strategic
Assessment. This needs to include an
analysis of the costs of the problem,
the cost of current interventions,
options for new investment models,
potential benefits and ways of
measuring those benefits.
References:
i
The Government’s Alcohol Strategy (March
2012)
ii
The Cost of Alcohol to the North West
Economy Part A: Drinkwise (May 2012)
iii
The Cost of Alcohol to the North West
Economy Part A: Drinkwise (May 2012)
Author: Nicki Thomas
07/01/13
iv
Alcohol Consumption in the UK Factsheet:
Institute of Alcohol Studies (2010)
v
J. Foster & C. Ferguson: (Feb 2012) “Home
Drinking in the UK: Trends and Causes”
vi
D.Buck & F. Frosini (August 2012) Clustering
of unhealthy behaviours over time Implications
for policy and practice
vii
D.Buck & F. Frosini (August 2012)Clustering
of unhealthy behaviours over time Implications
for policy and practice
viii
Adult Substance Misuse Needs Assessment
2011-12, K.Watts (2012)
ix
The Cost of Alcohol to the North West
Economy Part A: Drinkwise (May 2012)
x
T.Hennel (2011) Narrowing the Health
Inequalities Gap; what went wrong and what
went right
xi
T.Hennel (2011) Narrowing the Health
Inequalities Gap; what went wrong and what
went right
xii
Burden of Liver Disease and Inequalities in
the North West of England (2012)
xiii
Moyer et al (2002) Brief Interventions for
alcohol problems: a meta-analytic review of
controlled investigations in treatment -seeking
and non-treatment seeking populations,
Addiction, 97, 279-292
xiv
Silagy, C. and Stead, L.F. (2003) Physician
advice for smoking cessation (Cochrane
Review), in: The Cochrane Library, Issue 4
(Chichester, Wiley).
xv
Review of Tier 4 Provision, John Fairclough
& Kate Watts (2011)
xvi
Review of Tier 4 Provision, John Fairclough
& Kate Watts (2011)
xvii
Alcohol Harm Reduction Strategy for
England, (2004)
xviii
Gil-Gonzalez.D et al (2006) Alcohol and
Intimate Partner Violence, do we know enough
to act? European Journal of Public Health, 16
(3): pp278-284
xix
http://www.homeoffice.gov.uk/mediacentre/press-releases/new-def-of-domesticviolence
xx
Stark E & Flitcraft A: (1996) Women at Risk,
London, Sage Publications
xxi
Adult Substance Misuse Needs Assessment
2011-12, K.Watts (2012)
xxii
Wigan Young People’s Drug and Alcohol
Team End of year Report April 2011 to March
2012, G. Doubleday (2012)
xxiii
Bould et al: (2010) Alcohol misuser’s
experiences of unemployment and the benefit
system, Research Report 718, Department of
Work & Pensions
23