The impact of alcohol in Greater Manchester:
Biannual report number 8
Michela Morleo
The impact of alcohol in Greater Manchester: report no. 8
1. Summary
Incidence of alcohol-related harm is increasing nationally and regionally, with the number of 25 to 34 year
olds dying due to cirrhosis increasing seven-fold between 1979 and 2005 in England. Alcohol-related hospital
admissions are also increasing. Incidence of harm is particularly apparent in the North West of England,
where elevated harms are associated with higher levels of deprivation. As part of continued efforts to
understand and monitor the alcohol situation in Greater Manchester, the Greater Manchester Alcohol
Strategy Group is committed to improving data collection on alcohol and related harms. In 2008, the Group
commissioned the Centre for Public Health, Liverpool John Moores University, to collate intelligence on the
alcohol situation in Greater Manchester. This is the eighth report in the series a and relates to data published
up to and including March 2011. In total, this report provides 38 alcohol indicators including: consumption;
alcohol-related road accidents, fires and hospital admissions; alcohol-related crime, police incident data and
details of offenders in contact with probation; intelligence on young people including consumption, drinking
locations, teenage conceptions and hospital admission; and numbers and characteristics of individuals in
structured alcohol treatment. Data collated were divided into eight themes, and key findings from these
highlight that:
•
CONSUMPTION: One quarter of Greater Manchester residents binge drink, over one fifth can be
classified as increasing risk drinkers, and approximately 7% as higher risk drinkers. b Manchester has
the highest levels of higher risk consumption in Greater Manchester.
•
HOSPITAL ADMISSION AND ATTENDANCES: Alcohol-related hospital admission(s) c is increasing in
Greater Manchester with areas such as Trafford experiencing nearly a 40% increase in the rate of
alcohol attributable admission between 2004/05 and 2008/09 for males and females. Manchester
and Salford consistently experienced the highest levels of alcohol-related admission(s) in Greater
Manchester. A small number of authorities have experienced decreases. For example, between
2004/05 and 2008/09, the rate of alcohol specific admission decreased by 1.5% for males and 3.1%
for females in Bolton. In 2010, there were 15,212 assault attendances to Greater Manchester
Emergency Departments (EDs). Of these, 88% lived in Greater Manchester, 72% were male and 36%
occurred within peak hours d. The highest number of attendances to Greater Manchester EDs was
made by residents of Manchester (n=2,858).
•
MORTALITY: Alcohol-related mortality is increasing, particularly for females (with a 38% increase in
the rate of alcohol specific mortality between 2002-04 and 2006-08 in Greater Manchester).
Manchester consistently displayed the highest levels of alcohol-related mortality for males and
Salford displayed the highest for females in Greater Manchester.
•
OTHER HEALTH HARMS: From 2005 to 2008, there was a decrease in the number of road casualties
with a positive alcohol breath test (from 470 to 300) but since 2008, it has increased by 27%.
a
The first five reports were published quarterly. Since then, the report has been a biannual publication.
Binge drinking is defined as women who drink six or more units in one drinking session and men who drink eight or
more units; increasing risk drinking as women who drink between 15 and 35 units per week and men who consume
between 22 and 50 units; and higher risk drinkers as women who drink over 35 units per week and men who consume
over 50 units.
c
The term alcohol-related has been used here as an umbrella term, to draw together alcohol-attributable and alcohol
specific admission(s). Admission(s) is used to refer to both admission (that is individuals being admitted) and admissions
(where individuals can be admitted more than once).
d
Peak hours are defined as weekend evening/night hours: Friday 8pm to Saturday 5.59am, Saturday 8pm to Sunday
5.59am, and Sunday 8pm to Monday 5.59pm.
b
2
The impact of alcohol in Greater Manchester: report no. 8
e
•
CRIME AND OFFENDERS: Alcohol-related crime, violent crime and sexual crime decreased overall
between 2005/06 and 2009/10 in Greater Manchester. Police intelligence also showed decreases in
the numbers of alcohol confiscations, licensing-related and alcohol-related incidents. Manchester
consistently had the highest levels of alcohol-related crime, violent crime and sexual crime in
Greater Manchester, significantly higher than the North West overall. For 50% of individuals seen by
Probation Services in Greater Manchester, their offending was recorded as being linked with alcohol
use (where data were available).
•
ECONOMIC IMPACTS: In August 2009, there were 226 incapacity benefit claimants with a main
medical reason of alcoholism per 100,000 working population in Greater Manchester, significantly
higher than the North West and England rates. In 2008, 2.1% of employees in Greater Manchester
worked in bars, the same proportion as for the North West and England.
•
YOUNG PEOPLE: The Trading Standards survey shows a decreasing trend in frequent drinking, e
drinking in pubs, drinking outside and self-purchase in 14-17 year olds in Greater Manchester
between 2007 and 2009. However, further data are required to understand if this is a long-term
change. The rate of alcohol-specific admission amongst under 18 year olds decreased by 13% in
Greater Manchester between 2004/05-2006/07 and 2006/07-2008/09, proportionally a greater
decrease than those observed for the North West or England overall. Overall decreases in
prevalence were also reported for under 18 conceptions, absenteeism and exclusion (fixed term and
permanent).
•
TREATMENT: In 2009/10, there were 8,932 people in contact with structured alcohol treatment in
Greater Manchester, an 11% increase since 2008/09. In 2009/10, Manchester Primary Care Trust
(PCT) had the highest numbers of both males and females in treatment in Greater Manchester
(1,560 and 778 respectively), more than five times that recorded in Trafford PCT. Analysis of the
characteristics of those in treatment in 2009/10 shows that: 63% were male; the most common age
group was 30 to 44 year olds (41%); and the most common route of referral was through a selfreferral (33%). In 2009/10, there were 4,781 discharges from structured alcohol treatment in
Greater Manchester (with another 3,789 discharges between April and December 2010).
Frequent drinking is defined as drinking at least twice a week.
3
The impact of alcohol in Greater Manchester: report no. 8
Contents
1.
Summary.......................................................................................................................................................2
2.
Introduction ..................................................................................................................................................6
3.
How to navigate this report..........................................................................................................................7
4.
Alcohol consumption ....................................................................................................................................9
4.1 Methodology ..............................................................................................................................................9
4.2 Consumption: synthetic estimates .......................................................................................................... 10
4.3 Consumption: survey estimates .............................................................................................................. 11
4.4 Consumption: summary .......................................................................................................................... 12
5.
Hospital admissions and attendances ....................................................................................................... 13
5.1 Methodology ........................................................................................................................................... 13
5.2 Hospital admissions and attendances: National Indicator 39 (NI39) alcohol attributable hospital
admissions ..................................................................................................................................................... 14
5.3 Hospital admissions and attendances: alcohol attributable hospital admission .................................... 15
5.4 Hospital admissions and attendances: alcohol specific hospital admission ........................................... 16
5.5 Hospital admissions and attendances: emergency department presentations (all attendances).......... 17
5.6 Hospital admissions and attendances: emergency department presentations (peak time attendances)
....................................................................................................................................................................... 18
5.7 Hospital admissions and attendances: summary .................................................................................... 18
6.
Mortality .................................................................................................................................................... 19
6.1 Methodology ........................................................................................................................................... 19
6.2 Mortality: alcohol specific mortality........................................................................................................ 20
6.3 Mortality: alcohol attributable mortality ................................................................................................ 21
6.4 Mortality: alcohol attributable months of life lost .................................................................................. 22
6.5 Mortality: summary ................................................................................................................................. 23
7.
Other health harms ................................................................................................................................... 23
7.1 Methodology ........................................................................................................................................... 23
7.2 Other health harms: alcohol-related road casualties .............................................................................. 24
7.3 Other health harms: alcohol-related fires ............................................................................................... 25
7.4 Other health harms: summary ................................................................................................................ 25
8.
Crime and offenders .................................................................................................................................. 26
8.1 Methodology ........................................................................................................................................... 26
8.2 Crime and offenders: alcohol-related crime ........................................................................................... 27
8.3 Crime and offenders: alcohol-related violent and sexual crime ............................................................. 28
8.4 Crime and offenders: alcohol confiscations (police intelligence; UPDATED DATA) ................................ 29
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The impact of alcohol in Greater Manchester: report no. 8
8.5 Crime and offenders: licensing-related incidents (police intelligence; UPDATED DATA) ....................... 30
8.6 Crime and offenders: alcohol-related (police intelligence; UPDATED DATA) ......................................... 31
8.7 Crime and offenders: individuals on probation (UPDATED DATA) .......................................................... 32
8.8 Crime and offenders: summary ............................................................................................................... 33
9.
Economic impacts ...................................................................................................................................... 33
9.1 Methodology ........................................................................................................................................... 33
9.2 Economic impacts: incapacity benefits claimants ................................................................................... 34
9.3 Economic impacts: employees in bars .................................................................................................... 35
9.4 Economic impacts: summary................................................................................................................... 35
10.
Young people ......................................................................................................................................... 36
10.1 Methodology ......................................................................................................................................... 36
10.2 Young people: alcohol consumption ..................................................................................................... 37
10.3 Young people: drinking locations .......................................................................................................... 38
10.4 Young people: accessing alcohol ........................................................................................................... 39
10.5 Young people: hospital admission ......................................................................................................... 40
10.6 Young people: teenage conceptions (UPDATED DATA) ........................................................................ 41
10.7 Young people: persistent absenteeism in secondary schools ............................................................... 42
10.8 Young people: exclusion in secondary schools ..................................................................................... 43
10.9 Young people: summary ........................................................................................................................ 44
11.
Alcohol treatment ................................................................................................................................. 44
11.1 Methodology ......................................................................................................................................... 44
11.2 Alcohol treatment: numbers in treatment (UPDATED DATA) ............................................................... 45
11.3 Alcohol treatment: characteristics of individuals in treatment (UPDATED DATA) ............................... 46
11.4 Alcohol treatment: summary ................................................................................................................ 47
12.
References ............................................................................................................................................. 48
Acknowledgements
The author would like to thank the following for their contributions to this report: Michael Burrows, Charles
Gibbons, Adam Marr, Zara Quigg, Kevin Sanderson-Shortt and Ian Warren (Centre for Public Health,
Liverpool John Moores University); Mark Doggett (Greater Manchester Fire and Rescue Service); Claire
Brown (Greater Manchester Police); and Christine Gavan (Greater Manchester Probation Trust). In addition,
we would also like to thank the following for their guidance and support during the report writing and
project development: Mike Jones (Greater Manchester Public Health Network), Caroline Hilliard, Julia
Humphreys, Clare Perkins, Kevin Sanderson-Shortt and Elaine Steele (Centre for Public Health, Liverpool John
Moores University).
5
The impact of alcohol in Greater Manchester: report no. 8
2. Introduction
Incidence of alcohol-related harm is increasing nationally and regionally.[1] For example, national intelligence
shows that levels of mortality due to liver cirrhosis f have increased substantially in the past 30 years (19792005).[3] In fact, the number of 25 to 34 year olds dying due to cirrhosis has increased seven-fold.[3] The rate
of alcohol-related hospital admissions are also increasing, rising by 65% between 2003/04 and 2008/09.[1]
Incidence of harm is particularly apparent in the North West of England, where elevated harms are
associated with higher levels of deprivation.[1, 4] As part of continued efforts to understand and monitor the
alcohol situation in Greater Manchester, the Greater Manchester Alcohol Strategy Group is committed to
improving information and data collection on alcohol and related harms. In 2008, the Group commissioned
the Centre for Public Health, Liverpool John Moores University, to collate available alcohol intelligence
disseminated via regular reports to inform the Group on the alcohol situation in Greater Manchester. This is
the eighth such report g and relates to all available data published up to and including March 2011. The
report also incorporates information published in the previous reports,[5] where no updated intelligence is
available, in order to present a comprehensive account of the situation. In total, this report provides 38
alcohol indicators including:
•
Latest survey reports on consumption;
•
Alcohol-related road accidents, fires, hospital admissions and assault attendances;
•
Alcohol-related crime (including violent and sexual crime), local alcohol-related police incident data
and details of offenders in contact with the probation service;
•
Intelligence on young people including consumption, drinking locations, teenage conceptions, and
hospital admission; and
•
Numbers and characteristics of individuals in structured alcohol treatment.
Updated information for this report includes data in relation to assault attendances, alcohol treatment,
alcohol-related crime, individuals in contact with probation, and under 18 conceptions. Methodological
details are available in each chapter to provide background information for each dataset used. As part of the
Centre for Public Health’s continued commitment to producing user-friendly, easily accessible reports, this
version of the Greater Manchester alcohol report has undergone structural changes in order to maximise
usability. The format of the new reports is explained in more detail in Section 3.
CPH endeavours to contact as many organisations as possible to obtain data for inclusion in this series of
reports. We would like to encourage all agencies with relevant data or information to contact Michela
Morleo on 0151 231 4501 ([email protected]) if they would like to contribute to future editions.
f
Approximately 75% of liver cirrhosis cases are thought to be related to alcohol among at risk groups (males under 65
[2]
years).
g
The first five reports were published quarterly. Since then, the report has been a biannual publication.
6
The impact of alcohol in Greater Manchester: report no. 8
3. How to navigate this report
This report collates a wide range of data that help display the alcohol situation in Greater Manchester overall
and in the local areas of Greater Manchester. To do this, data have been extracted from a number of sources:
Local Alcohol Profiles for England (LAPE);[1] local agencies such as the police,[6] probation services,[7] fire
services and the Centre for Public Health (including the Trauma and Injury Intelligence Group, based at the
Centre);[8, 9] national Government data such as school absence and exclusion;[10, 11] and published reports.[12,
13]
The report has been divided into eight specific sections:
•
Consumption,
•
Hospital admissions and attendances,
•
Mortality,
•
Other health harms,
•
Crime and offenders,
•
Economic impacts,
•
Young people, and
•
Treatment.
Within these sections, data are then divided into subsections. So, for example, the sub-sections for Section 1
on alcohol consumption are: methodology, synthetic estimates, survey estimates and a summary. Each
section has a methodology (detailing methodological notes for the individual data types examined) and a
summary at the beginning and end of the section. So, for example, all methodological details relating to the
section on consumption (Section 4) are provided in Section 4.1.
All the information, figures and tables that are relevant for each sub-section are displayed on one page for
ease of access. Each section displays changes over time; differences between local areas; and comparisons
with Greater Manchester, the North West and England overall (where possible). Each sub-section provides
an overview of the main findings, a figure to display trends over time for Greater Manchester (compared
with the North West and England), a table to display the rate or percentage for each local authority, the
associated 95% confidence intervals, and percentage change over time (compared with the North West and
England). Direction of percentage change is indicated through the following symbols: + indicates an increase
and – indicates a decrease. In the text, all figures are rounded to the nearest whole number (unless they are
below 10, in which case, the figure is provided to one decimal place). All tables present figures to one
decimal place for increased accuracy. Line graphs are used to display trends but where aggregated years
overlap (see below for definition of this), bar charts have been provided instead. Where trend data are not
available, bar charts are used to display values for individual measures. Differences between an area and the
North West overall are discussed as being significant when the accompanying 95% confidence intervals do
not overlap. Significant differences are indicated in the tables with an asterisk (*) and by the use of a
coloured table cell. Significance is taken from the non-rounded figure. Where 95% confidence intervals are
not available (for example, for alcohol-attributable months of life lost), the level of variation from the North
West average has been displayed instead. For some topics, such as hospital admission and mortality, the
data are broken down by gender.
Because data are collected from a diverse range of sources, it can be difficult to make direct comparisons
between the data. Differences are evident in the age of the population discussed, the geographies used (for
example, local authority versus primary care trust), and the timescales used. For example, some of the
7
The impact of alcohol in Greater Manchester: report no. 8
datasets shown (such as hospital admissions) use financial years to display the data. Financial years run from
1st April to 31st March and are identified in this report through the use of a forward slash within the years
discussed. So the financial year 1st April 2009 to 31st March 2010 is displayed as 2009/10. Where data are
presented using the calendar year (January to December), no demarcation is used: 2009 is written as 2009.
Alcohol-attributable mortality is an example of a dataset that uses calendar years. For some datasets,
because the numbers are so low, data from a number of years are aggregated (or combined). Where this
occurs a hyphen is used to indicate that the years of data are joined. So data for alcohol specific hospital
admission are aggregated for the calendar years 2006, 2007 and 2008, and are shown as 2006-08.
8
The impact of alcohol in Greater Manchester: report no. 8
4. Alcohol consumption
4.1 Methodology
This section provides details on alcohol consumption in Greater Manchester using estimates from two
sources: synthetic estimates from the Local Alcohol Profiles for England (LAPE)[1] and the North West Big
Drink Debate.[12, 13] At the time of writing, the new consumption data for Greater Manchester had not yet
been released;[14] these will be included in the next report. Together, the Big Drink Debate and LAPE provide
local estimates of the proportions of:
•
Non-drinkers (available via the Big Drink Debate only);
•
Lower risk drinkers (women who consume up to 14 units per week; men who consume up to 21
units per week; available via the Big Drink Debate only);
•
Binge drinkers (women who drink six or more units in one drinking session; men who drink eight or
more units in one drinking session; available via the synthetic estimates only);
•
Increasing risk drinkers (women who drink between 15 and 35 units per week; men who consume
between 22 and 50 units per week; available via both the Big Drink Debate and the synthetic
estimates); and
•
Higher risk drinkers (women who drink over 35 units per week; men who consume over 50 units per
week; available via both the Big Drink Debate and the synthetic estimates).
The LAPE synthetic estimates are derived from the Household Survey for England (HSE) for 2005, and
provide alcohol consumption estimates for those aged 16 years and above.[1] They are weighted to account
for low response bias. HSE data are only available at regional level, so in order to produce local estimates,
the North West Public Health Observatory (NWPHO) models the relationships between factors such as
regional estimates of consumption and local demographics. However, such modelling techniques, while
valuable, are not exact and could under or over estimate the levels of consumption. Thus, data are referred
to as “synthetic estimates”. The data should be used with caution and cannot be used to show trends.
Further, as a household survey, the HSE does not cover all populations such as those residing in student halls
or army barracks, and does not include the homeless. This may affect the accuracy of the estimates provided
if attempting to ascertain an understanding of the total population. The synthetic estimates are not available
by gender or age.
The North West Big Drink Debate survey was run from October to December 2008 (for those aged 18 and
above). It used a variety of data collection methods to capture intelligence on alcohol consumption in the
week prior to survey (online survey, leaflet drops and public events).[12] This ensured participation was
convenient and could reach a wide range of groups; however, the sampling methodology meant that it is not
known to what extent vulnerable groups were included, nor was it possible to generate a response rate.
However, local data were weighted by age and gender, and a large sample size was obtained (7,351 in
Greater Manchester; 30,857 in the North West).[12, 13] This provided statistical robustness at regional level
but samples were too small to allow for detailed local analysis. Thus, at local level, data are not available by
gender or age. No trend data are available as, to date, the survey has only been performed once.
Both sources are based on surveying the population with regards to their alcohol consumption. However,
traditional surveys such as the Big Drink Debate or HSE are known to under-represent the amounts of
alcohol consumed when compared with, for example, the quantities of alcohol shown to be purchased
through taxation data.[15-17] Thus, caution should be used when interpreting the data. Further, the
methodological differences between the two sources could make comparisons problematic.
9
The impact of alcohol in Greater Manchester: report no. 8
4.2 Consumption: synthetic estimates
One quarter of Greater Manchester residents aged 16 and above are estimated to be binge drinkers,
significantly more than England but comparable with the North West overall (Figure 1; Table 1).[1] Binge
drinking was particularly prevalent in Salford (30%) and Oldham (27%) although neither was significantly
different from the North West or Greater Manchester overall. Twenty-three per cent of Greater Manchester
residents were reported to be increasing risk drinkers, comparable with the North West and England overall.
The highest levels were identified in Bury, Stockport and Wigan (all 24%); however none of these were
significantly different from the North West overall. Seven per cent of Greater Manchester residents were
estimated to be higher risk drinkers, significantly more than England overall (but comparable with the North
West average). The highest levels of higher risk drinkers were estimated to be in Manchester (8.8%), where
prevalence was significantly higher than the North West.
Figure 1: Synthetic estimates of alcohol consumption amongst those aged 16 and above in mid-2005[1]
40
35
Percentage
30
25
20
Greater Manchester
15
North West
10
England
5
Higher risk
drinkers
Increasing
risk drinkers
Binge
drinkers
0
Drinking pattern
Table 1: Synthetic estimates of alcohol consumption amongst those aged 16 and above in Greater
Manchester local authorities in mid-2005[1]
Binge drinkers
Increasing risk drinkers
95%
95%
%
confidence
%
confidence
intervals
intervals
Bolton
26.1
22.8-29.8
22.8
21.0-24.6
Bury
25.7
22.5-29.2
24.1
22.1-26.0
Manchester
25.1
21.0-29.9
22.5
20.5-24.6
Oldham
27.2
23.2-31.6
22.5
20.7-24.3
Rochdale
24.2
21.0-27.6
22.4
20.6-24.2
Salford
29.5
25.3-34.1
22.9
21.0-24.9
Stockport
24.3
21.0-27.9
24.3
22.4-26.3
Tameside
26.0
22.9-29.4
23.4
21.4-25.3
Trafford
22.9
19.9-26.3
23.3
21.4-25.1
Wigan
23.2
20.0-26.8
24.2
22.2-26.3
Greater Manchester
25.0
22.0-29.3
23.0
21.3-25.2
North West
23.3
21.2-25.5
22.1
20.3-23.9
England
20.1*
19.4-20.8
20.1
18.4-21.8
*
Greater Manchester figures are based on the mean of its local authorities. The difference
and the North West overall is significant as the 95% confidence intervals do not overlap.
10
Higher risk drinkers
95%
%
confidence
intervals
6.8
6.1-7.5
6.6
5.9-7.2
8.8*
7.7-9.8
7.1
6.4-7.9
7.2
6.5-7.9
7.5
6.7-8.4
6.2
5.6-6.8
7.2
6.4-7.9
6.1
5.5-6.7
7.0
6.3-7.7
7.0
6.3-7.8
6.3
5.6-6.9
5.0*
4.5-5.6
between the area shown
The impact of alcohol in Greater Manchester: report no. 8
4.3 Consumption: survey estimates
In total, 7,351 respondents from Greater Manchester (aged 18 and above) were involved in the Big Drink
Debate (24% of survey participants).[12, 13] Eleven per cent of Greater Manchester residents reported
abstinence, the same as the North West overall (Figure 2; Table 2). Abstinence was highest in Rochdale
(17%), where levels were significantly higher than the North West. Fifty-nine per cent of Greater Manchester
residents were lower risk drinkers, significantly fewer than the North West overall (62%). Bury had the
highest proportion of lower risk drinkers in Greater Manchester (63%) but this was not significantly different
from the North West overall. Twenty-two per cent of Greater Manchester residents were reported as
increasing risk drinkers, significantly higher than the North West overall (20%). The highest levels were found
in Bolton (27%), Rochdale (26%) and Manchester (25%), For Bolton and Manchester, these were significantly
higher than the North West overall. Finally, 7.5% of Greater Manchester residents were reported as being
higher risk drinkers, significantly higher than the North West (6.4%). Proportions were particularly high in
Manchester (9.4%), Tameside (8.7%), Oldham (8.2%) and Bolton (8.3%); only for Manchester was the
proportion significantly higher than the North West.
Figure 2: Survey estimates of alcohol consumption amongst those aged 18 and above in 2008[13]
70
Percentage
60
50
40
Greater Manchester
30
North West
20
10
Higher risk
drinkers
Increasing
risk drinkers
Lower risk
drinkers
Non-drinkers
0
Drinking pattern
Table 2: Survey estimates of alcohol consumption amongst those aged 18 and above in Greater Manchester
local authorities in 2008[13]
Non-drinkers
Lower risk drinkers
Increasing risk drinkers
Higher risk drinkers
95%
95%
95%
95%
%
confidence
%
confidence
%
confidence
%
confidence
intervals
intervals
intervals
intervals
Bolton
13.8
11.0-16.7
50.7*
46.6-54.8
27.2*
23.6-30.9
8.3
6.0-10.5
Bury
11.4
8.8-14.1
62.7
58.6-66.7
19.8
16.5-23.2
5.7
3.8-7.7
Manchester
10.3
8.8-11.8
55.1*
52.5-57.6
24.9*
22.7-27.1
9.4*
7.9-10.9
Oldham
12.1
9.4-14.9
60.5
56.5-64.6
18.8
15.5-22.1
8.5
6.2-10.9
Rochdale
16.6*
12.7-20.6
51.8*
46.6-57.1
25.6
21.0-30.3
5.9
3.4-8.4
Salford
10.3
8.2-12.4
60.0
56.6-63.3
22.8
19.9-25.7
7.0
5.2-8.8
Stockport
8.9
6.9-10.9
61.8
58.3-65.2
22.9
19.9-25.9
6.3
4.6-8.0
Tameside
7.6
5.7-9.6
62.2
58.6-65.8
21.3
18.3-24.4
8.7
6.6-10.7
Trafford
13.4
10.7-16.0
58.2
54.4-62.0
22.3
19.1-25.5
6.1
4.3-8.0
Wigan
14.2
11.9-16.5
60.3
57.0-63.5
19.6
17.0-22.2
5.9
4.4-7.5
Greater Manchester
11.2
10.5-11.9
58.8*
57.7-59.9
22.4*
21.5-23.4
7.5*
6.9-8.1
North West
11.2
10.8-11.6
61.7
61.1-62.3
20.4
19.9-20.9
6.4
6.1-6.7
*
The difference between the area shown and the North West overall is significant as the 95% confidence intervals do
not overlap.
11
The impact of alcohol in Greater Manchester: report no. 8
4.4 Consumption: summary
The Big Drink Debate provided details of non-drinkers and lower risk drinkers: 11% of Greater Manchester
residents were abstinent from alcohol at the time of the survey (similar to the North West overall), and 59%
were lower risk drinkers (significantly fewer than the North West). Rochdale had the highest reported levels
of abstinence in Greater Manchester (17%), significantly higher than the North West. The LAPE synthetic
estimates provided details of binge drinking in Greater Manchester, showing that one quarter of residents
are thought to binge drink, significantly more than England overall but comparable with the North West.
Levels of binge drinking were broadly similar between the Greater Manchester authorities. Both the Big
Drink Debate and LAPE produced estimates of increasing risk and higher risk drinkers. Despite the
methodological differences (see Section 4.1), both showed that over one fifth of the Greater Manchester
population were increasing risk drinkers, and approximately 7% were higher risk drinkers. Only for the Big
Drink Debate were the levels of increasing risk and higher risk consumption significantly higher than the
North West. For both sources, Manchester had the highest levels of higher risk drinkers.
12
The impact of alcohol in Greater Manchester: report no. 8
5. Hospital admissions and attendances
5.1 Methodology
Intelligence relating to alcohol-related hospital admissions is provided through LAPE,[1] detailing comparisons
over time and between genders (for all ages). Hospital admissions data are for inpatient admission(s) only,
and do not include presentations to emergency departments, ambulance services or outpatients
departments (unless they result in an admission). Three indicators (for all ages) are available:
•
National Indicator 39 (NI39) alcohol attributable admissions (the rate of admissions that are
estimated to be wholly or partially attributable to alcohol; Section 5.2);
•
Alcohol attributable admission (the rate of individuals being admitted for whom their admission is
estimated to be wholly or partially attributable to alcohol; Section 5.3); and
•
Alcohol specific admission (the rate of individuals being admitted for whom their admission is
estimated to be wholly attributable to alcohol; Section 5.4).
Alcohol attributable fractions (AAFs) are used to estimate the rate of alcohol attributable admissions.[2, 18]
These use evidence-based research to estimate the involvement of alcohol in conditions such as stomach
cancer, liver cirrhosis or falls. The AAFs provide an estimate of the proportion of conditions that are likely to
be related to alcohol. This proportion is then used to estimate the number of admissions relating to that
condition that are related to alcohol (based on the total number of admissions for that condition). For
example, breast cancer with an AAF of 0.08 requires 12.5 cases to equal one admission, and alcoholic liver
disease, with an AAF of 1.0, is a case by itself. Different fractions are applied depending on age and gender.
However:
•
The model inevitably generates estimates rather than true proportions;
•
As fractions rely on published evidence, fractions cannot be generated where this is absent; and
•
Whilst there are differences at local levels in terms of alcohol consumption and related harms
experienced,[1, 13] attributable fractions are only available on a national basis.
Data for both alcohol attributable admission and alcohol specific admission are available by gender. NI39 is
not delineated by gender. It is important to note that NI39 estimates presented by LAPE and those
calculated at the local level may not match as a result of alternative data sources (Secondary User Service
[SUS] data rather than Hospital Episode Statistics [HES] data), difficulties in replicating the procedure and
differences in geographical demarcation.
In addition to displaying the data in relation to hospital episodes, this report also provides an overview of
emergency department (ED) presentations for assaults in Greater Manchester in 2010.[8] Whilst it is not
known to what extent these assaults are related to alcohol, data from Scotland in 2006 indicate that 70% of
ED assault attendances may be related to alcohol.[19] The data are divided into two sections. The first section
(Section 5.5) explores all assault attendances to Greater Manchester EDs whilst the second (Section 5.6)
explores assault attendances that occurred in peak hours. Peak hours are defined as weekend evening/night
hours: Friday 8pm to Saturday 5.59am, Saturday 8pm to Sunday 5.59am, and Sunday 8pm to Monday
5.59pm. Within each section, the data are explored by residential area, gender, mode of arrival, method of
disposal, and location of assault. Data are discussed in terms of attendance rather than attendee; one
individual may attend more than once.
13
The impact of alcohol in Greater Manchester: report no. 8
5.2 Hospital admissions and attendances: National Indicator 39 (NI39) alcohol attributable
hospital admissions
In 2008/09, the rate of alcohol attributable hospital admissions using NI39 definitions was 2,137 per 100,000
residents in Greater Manchester, significantly higher than the both the regional and national averages
(Figure 3; Table 3).[1] The highest rates were in Manchester, Rochdale and Salford (2,577, 2,547 and 2,527
per 100,000 respectively), significantly higher than the North West overall. Five authorities had rates of
admissions that were significantly lower than the North West overall (Bolton, Bury, Oldham, Stockport and
Trafford). The rate of admissions has increased overall by 37% in Greater Manchester from 2004/05 to
2008/09, in line with regional and national increases. Within Greater Manchester itself, the highest
percentage increases observed in this time period were experienced by Trafford (57%), Rochdale (48%) and
Tameside (48%). No authorities saw a decrease in this time. Since 2007/08, the rate of alcohol-attributable
admissions increased by 9% in Greater Manchester. The percentage increased in nine authorities overall and
increases were highest in Trafford (17%) and Wigan (15%). Bolton was the only authority to experience a
decrease between 2007/08 and 2008/09 (by 4%).
Figure 3: NI39 alcohol attributable hospital admissions from 2004/05 to 2008/09[1]
2500
Rate per 100,000
2000
1500
Greater Manchester
1000
North West
England
500
2008/09
2007/08
2006/07
2005/06
2004/05
0
Financial year
Table 3: NI39 alcohol attributable hospital admissions in Greater Manchester local authorities[1]
Admissions per
95% confidence
% change from
% change from
100,000, 2008/09
intervals
2004/05
2007/08
Bolton
1,816.6*
1,767.2-1,865.9
+21.8%
-4.3%
Bury
1,980.6*
1,919.5-2,041.7
+39.2%
+10.1%
Manchester
2,577.3*
2,527.6-2,627.1
+36.0%
+12.2%
Oldham
1,926.0*
1,869.8-1,982.1
+36.8%
+9.2%
Rochdale
2,547.0*
2,481.2-2,612.9
+48.5%
+11.3%
Salford
2,527.4*
2,464.1-2,590.8
+35.8%
+9.0%
Stockport
1,741.9*
1,695.9-1,787.9
+17.0%
+3.7%
Tameside
2,188.2*
2,128.8-2,247.7
+47.8%
+7.1%
Trafford
1,707.9*
1,655.6-1,760.2
+56.7%
+17.0%
Wigan
2,355.3*
2,304.5-2,406.1
+39.6%
+15.0%
Greater Manchester
2,136.8*
2,081.4-2,192.2
+37.5%
+9.1%
North West
2,070.8
2,060.7-2,081.0
+36.8%
+6.5%
England
1,582.4*
1,579.2-1,585.6
+38.4%
+7.5%
*
Greater Manchester figures are based on the mean of its local authorities. The difference between the area shown
and the North West overall is significant as the 95% confidence intervals do not overlap.
14
The impact of alcohol in Greater Manchester: report no. 8
5.3 Hospital admissions and attendances: alcohol attributable hospital admission
In 2008/09, the rate of admission for males for alcohol attributable conditions in Greater Manchester (1,729
per 100,000) was 1.8 times that of females (988 per 100,000), following regional and national trends (Figure
4; Table 4).[1] Rates of admission have increased considerably since 2004/05 for both males and females in
Greater Manchester (by over 25%), as with regional and national patterns. For all ten Greater Manchester
authorities, the rate of admission for alcohol attributable conditions increased between 2004/05 and
2008/09 for both males and females. Since 2007/08, rates of admission have risen by at least 5% in seven
authorities for males and eight authorities for females. Manchester had the highest rate of admission for
males whilst Salford had the highest for females (2,041.9 and 1,119.6 per 100,000 respectively, both
significantly higher than the North West overall). Salford, Manchester and Trafford experienced some of the
highest percentage increases in alcohol-attributable admission for males and females in Greater Manchester.
2000
1800
1600
1400
1200
1000
800
600
400
200
0
Greater Manchester
North West
Financial year
2008/09
2007/08
2006/07
2005/06
England
2004/05
2008/09
2007/08
2006/07
2005/06
Rate per 100,000
2000
1800
1600
1400
1200
1000
800
600
400
200
0
2004/05
Rate per 100,000
Figure 4: Alcohol attributable hospital admission from 2004/05 to 2008/09 by gender[1]
a) Males
b) Females
Financial year
Table 4: Alcohol attributable hospital admission in Greater Manchester local authorities by gender[1]
Males
Admission
per
100,000,
2008/09
1,533.3*
1,568.7*
2,041.9*
1,628.4
1,969.9*
2,016.7*
1,496.9*
1,777.4*
1,425.0*
1,830.9*
95% confidence
intervals
Females
% change
from
2004/05
% change
from
2007/08
Admission
per
100,000,
2008/09
859.7*
908.0
1,161.5*
877.5*
1,131.4*
1,119.6*
881.8*
1,107.8*
805.4*
1,031.9*
95% confidence
intervals
% change
from
2004/05
% change
from
2007/08
Bolton
1,468.2-1,600.5
+11.8%
-1.6%
812.1-909.3
+11.5%
-3.3%
Bury
1,490.5-1,650.0
+27.7%
+4.1%
850.4-968.4
+22.6%
+5.5%
Manchester
1,978.0-2,107.3
+18.1%
+6.8%
1,114.5-1,209.9
+26.7%
+14.2%
Oldham
1,554.1-1,705.3
+30.7%
+7.9%
824.8-932.5
+24.1%
-0.5%
Rochdale
1,886.3-2,056.1
+32.1%
+7.8%
1,069.6-1,195.8
+44.3%
+12.9%
Salford
1,935.1-2,100.9
+25.1%
+13.4%
1,059.6-1,182.0
+28.9%
+5.5%
Stockport
1,435.6-1,560.1
+15.4%
+7.4%
835.5-929.9
+14.2%
+7.8%
Tameside
1,700.3-1,857.1
+27.9%
+0.6%
1,048.7-1,169.3
+38.5%
+8.8%
Trafford
1,356.3-1,494.4
+39.4%
+10.5%
754.7-858.4
+38.9%
+13.9%
Wigan
1,766.2-1,897.4
+36.8%
+8.1%
984.3-1,081.2
+23.8%
+6.5%
Greater
1,728.9
1,657.1-1,803.1
+26.0%
+6.5%
988.5
935.4-1,043.7
+27.2%
+7.1%
Manchester
North West
1,669.4
1,656.2-1,682.7
+25.9%
+4.9%
958.5
948.6-968.4
+27.5%
+3.8%
England
1,297.8*
1,293.5-1,302.0
+29.7%
+6.7%
732.1*
729.0-735.3
+29.4%
+5.5%
*
Greater Manchester figures are based on the mean of its local authorities. The difference between the area shown and
the North West overall is significant as the 95% confidence intervals do not overlap.
15
The impact of alcohol in Greater Manchester: report no. 8
5.4 Hospital admissions and attendances: alcohol specific hospital admission
In 2008/09, the rate of admission for males for alcohol specific conditions in Greater Manchester (631 per
100,000) was double that of females (310 per 100,000), following regional and national trends (Figure 5;
Table 5).[1] Rates of admission have increased considerably since 2004/05 for males and females in Greater
Manchester (by approximately 25%), as with regional and national patterns. For nine of the ten Greater
Manchester authorities, the rate of admission for alcohol specific conditions increased between 2004/05 and
2008/09 for males and females. Since 2007/08, in seven authorities, rates of admission rose by at least 5%
for males; seven saw such an increase for females. Salford had the highest rate for both females and males
in 2008/09 in Greater Manchester (significantly higher than the North West overall), and saw the highest
percentage increase in admission for males since 2007/08 (for females, it was Rochdale). One authority saw
a considerable decrease in rates: Bolton’s rate of admission for females has decreased by 11% since 2007/08.
700
600
600
500
500
300
200
2008/09
2004/05
0
2007/08
0
2006/07
100
2005/06
100
Financial year
2008/09
200
England
400
2007/08
300
North West
2006/07
400
Greater Manchester
2005/06
Rate per 100,000
700
2004/05
Rate per 100,000
Figure 5: Alcohol specific hospital admission from 2004/05 to 2008/09 by gender[1]
a) Males
b) Females
Financial year
Table 5: Alcohol specific hospital admission in Greater Manchester local authorities by gender[1]
Males
Admission
per
100,000,
2008/09
530.9*
558.2
817.6*
572.1
719.9*
885.1*
584.1
615.5
436.2*
592.6
95%
confidence
intervals
Females
% change
from
2004/05
% change
from
2007/08
Admission
per
100,000,
2008/09
256.3*
270.8*
374.8*
231.1*
366.8*
412.5*
277.3*
330.8
238.0*
339.2
95%
confidence
intervals
% change
from
2004/05
% change
from
2007/08
Bolton
491.8-527.3
-1.5%
-5.1%
229.4-285.5
-3.1%
-10.6%
Bury
510.6-608.9
+42.9%
+1.5%
238.2-306.6
+20.7%
-4.4%
Manchester
777.5-859.2
+6.9%
+0.7%
347.9-403.2
+11.4%
+9.6%
Oldham
527.5-619.5
+26.2%
+6.1%
203.4-261.4
+25.0%
-4.1%
Rochdale
668.8-773.8
+28.7%
+7.0%
330.6-405.8
+67.7%
+22.5%
Salford
830.3-942.4
+37.4%
+22.3%
374.8-452.9
+38.3%
+10.8%
Stockport
544.6-625.7
+34.3%
+17.4%
250.3-306.4
+35.1%
+11.9%
Tameside
569.2-664.5
+19.3%
-5.2%
297.5-366.9
+24.2%
+9.2%
Trafford
397.5-477.5
+24.7%
+5.6%
209.3-269.5
+19.8%
+14.7%
Wigan
554.7-632.4
+55.9%
+11.1%
310.4-369.8
+29.3%
+16.5%
Greater
631.2
587.3-677.6
+25.5%
+6.1%
309.8
279.2-342.8
+25.9%
+7.8%
Manchester
North West
611.7
603.4-620.0
+23.9%
+2.6%
315.5
309.6-321.5
+27.6%
+1.1%
England
397.7*
395.2-400.1
+25.4%
+6.4%
194.4*
192.7-196.1
+27.5%
+2.6%
*
Greater Manchester figures are based on the mean of its local authorities. The difference between the area shown
and the North West overall is significant as the 95% confidence intervals do not overlap.
16
The impact of alcohol in Greater Manchester: report no. 8
5.5 Hospital admissions and attendances: emergency department presentations (all
attendances)
In 2010, there were 15,212 assault attendances to Greater Manchester EDs (Table 6). Of these, 88% lived in
Greater Manchester and 72% were male.[8] This gender balance was consistent across Greater Manchester.
The highest number of attendances to Greater Manchester EDs was made by residents of Manchester
(n=2,858), representing 9% of attendances known to be made by Greater Manchester residents. Most
commonly, assaults occurred in unspecified locations (34%) but were also occurred in public places (30%), at
home (16%) and other locations (including other unspecified, educational establishment, bars/pubs; 17%).
Two per cent occurred at work. Of the assault attendances, 43% arrived by ambulance, 14% by private
transport, and 43% by other means (including by foot, taxi, police and other unspecified). After their
attendance, 46% were discharged, 31% were provided with a referral or a follow-up appointment, 10% were
admitted and, 13%, the attendance ended by other (unspecified) means.
Table 6: All assault presentations to Greater Manchester emergency departments in 2010 by authority of
residence[8]
Number of assault
presentations at
emergency
departments
1,182
754
2,858
1,139
1,466
1,667
1,203
1,172
655
1,377
% male
95%
confidence
intervals
% female
95%
confidence
intervals
Bolton
72.2%
69.5-74.7
27.8%
25.3-30.5
Bury
70.6%
67.2-73.8
29.4%
26.2-32.8
Manchester
72.4%
70.8-74.1
27.6%
25.9-29.2
Oldham
74.5%*
71.9-77.0
25.5%
23.0-28.1
Rochdale
70.3%
67.9-72.7
29.7%
27.3-32.1
Salford
70.4%
68.2-72.6
29.5%
27.3-31.8
Stockport
73.3%
70.7-75.8
26.6%
24.1-29.2
Tameside
69.6%
66.9-72.2
30.4%
27.8-33.1
Trafford
73.0%
69.4-76.3
27.0%
23.7-30.6
Wigan
72.2%
69.7-74.5
27.8%
25.5-30.3
Known resident in Greater
13,473
71.8%
71.1-72.6
28.1%
27.4-28.9
Manchester
Outside Greater
76.8%*
73.8-79.7
23.2%
20.3-26.2
829
Manchester
Residence not known
910
49.3%*
46.0-52.6
50.4%*
47.1-53.7
All attendances in Greater
15,212
72.2%
69.5-71.5
27.8%
25.3-29.9
Manchester
Gender percentages may not sum to 100% due to a small number of individuals (<5) where gender was not recorded.
*
The difference between the area shown and all attendances in Greater Manchester overall is significant as the 95%
confidence intervals do not overlap.
17
The impact of alcohol in Greater Manchester: report no. 8
5.6 Hospital admissions and attendances: emergency department presentations (peak
time attendances)
In 2010, there were 5,450 assault attendances during peak hours to Greater Manchester EDs (Table 7; 36%
of assault attendances overall, see Section 5.5). Of these, 88% lived in Greater Manchester and 75% were
male (a significantly higher proportion of males than for all attendances; 72%).[8] This gender balance was
consistent across Greater Manchester. The highest number of attendances to Greater Manchester EDs
during peak hours was made by residents of Manchester (n=880), 10% of attendances known to be made by
Greater Manchester residents.
Table 7: Assault presentations to Greater Manchester emergency departments during peak hours in 2010 by
authority of residence[8]
Number of assault
presentations at
emergency
departments
455
286
880
466
486
538
433
512
225
500
% male
95%
confidence
intervals
% female
95%
confidence
intervals
Bolton
77.6%
73.5-81.3
22.4%
18.7-26.5
Bury
76.9%
71.6-81.7
23.1%
18.3-28.4
Manchester
76.6%
73.7-79.4
23.4%
20.6-26.3
Oldham
77.9%
73.9-81.6
22.1%
18.4-26.1
Rochdale
73.5%
69.3-77.3
26.5%
22.7-30.7
Salford
72.9%
68.9-76.6
27.0%
23.2-30.9
Stockport
75.8%
71.4-79.7
24.2%
20.3-28.6
Tameside
74.6%
70.6-78.3
25.4%
21.7-29.4
Trafford
77.3%
71.3-82.6
22.7%
17.4-28.7
Wigan
74.2%
70.1-78.0
25.8%
22.0-29.9
Known resident in Greater
4,781
75.6%
74.3-76.8
24.4%
23.2-25.6
Manchester
Outside Greater
331
79.5%
74.7-83.7
20.5%
16.3-25.3
Manchester
Residence not known
338
54.4%*
49.0-59.8
45.3%*
39.9-50.7
All attendances in Greater
5,450
74.5%
73.3-75.7
25.4%
24.3-26.6
Manchester
Gender percentages may not sum to 100% due to a small number of individuals (<5) where gender was not recorded.
*
The difference between the area shown and all attendances in Greater Manchester overall is significant as the 95%
confidence intervals do not overlap.
5.7 Hospital admissions and attendances: summary
Across all three LAPE indicators and in all Greater Manchester authorities, it can be seen that males had
significantly higher levels of alcohol attributable admission than females. In fact typically, males experienced
approximately double the levels of harm compared with females. In general, rates of alcohol-related
admission(s) are increasing in Greater Manchester, and both regionally and nationally, with areas such as
Trafford experiencing nearly a 40% increase in the rate of alcohol attributable admission between 2004/05
and 2008/09 for both males and females. Manchester and Salford were two areas that consistently
experienced the highest levels of admission(s) in Greater Manchester. Conversely, a small number of local
authorities in Greater Manchester have experienced decreases. For example, between 2004/05 and 2008/09,
the rate of alcohol specific admission decreased by 1.5% for males and 3.1% for females in Bolton.
In 2010, there were 15,212 assault attendances to Greater Manchester EDs. Of these, 88% lived in Greater
Manchester, 72% were male and 36% occurred within peak hours. The highest number of attendances to
Greater Manchester EDs was made by residents of Manchester (n=2,858).
18
The impact of alcohol in Greater Manchester: report no. 8
6. Mortality
6.1 Methodology
Intelligence relating to alcohol-related mortality is provided through LAPE.[1] This supplies comparisons over
time and between genders (for all ages). Three indicators of mortality are available:
•
Alcohol specific mortality (where mortality is estimated to be wholly attributable to alcohol).
•
Alcohol attributable mortality (where mortality is estimated to be wholly or partially attributable to
alcohol); and
•
Alcohol attributable months of life lost (the number of months of life estimated to be lost due to
alcohol attributable conditions).
As with hospital admissions (see Section 5.1), alcohol attributable fractions (AAFs) are used to estimate the
rate of alcohol attributable admissions.[2, 18] These use evidence-based research to estimate the involvement
of alcohol in conditions such as stomach cancer, liver cirrhosis or falls. The AAFs provide an estimate of the
proportion of conditions that are likely to be related to alcohol. This proportion is then used to estimate the
number of admissions relating to that condition that are related to alcohol (based on the total number of
admissions for that condition). For example, breast cancer with an AAF of 0.08 requires 12.5 cases to equal
one admission, and alcoholic liver disease, with an AAF of 1.0, is a case by itself. Different fractions are
applied depending on age and gender. However:
•
The model inevitably generates estimates rather than true proportions;
•
As fractions rely on published evidence, fractions cannot be generated where this is absent; and
•
Whilst there are differences at local levels in terms of alcohol consumption and related harms
experienced,[1, 13] attributable fractions are only available on a national basis.
19
The impact of alcohol in Greater Manchester: report no. 8
6.2 Mortality: alcohol specific mortality
In 2006-08, the rate of alcohol specific mortality for males was almost double that for females in Greater
Manchester (19 and 10 per 100,000 respectively), following regional and national patterns (Figure 6; Table
8).[1] Rates of mortality increased overall between 2002-04 and 2006-08 by 4% for males and by 38% for
females in Greater Manchester. Nationally and regionally, both genders saw substantial rises. Since 2003-05,
there has been a 32% increase in rates of alcohol-specific mortality in females in Greater Manchester
(compared with a 3% increase for males). Since 2003-05, four authorities have seen an increase in the rate of
mortality for males and seven saw an increase for females. The highest rate of increases in Greater
Manchester were in Rochdale (for both males and females) whilst Manchester had the highest rate of
mortality overall for males and Salford for females in 2006-08 (significantly higher than the North West).
Tameside, in comparison, had a 31% decrease in rate of mortality for females between 2002-04 and 2006-08
and an 18% decrease for males. However, incidence is low compared with other measures in this report.
40
35
35
30
30
North West
25
England
10
15
10
2006-08
2002-04
0
2005-07
0
2004-06
5
2003-05
5
Year
2006-08
15
20
2005-07
20
2004-06
25
Greater Manchester
2003-05
Rate per 100,000
40
2002-04
Rate per 100,000
Figure 6: Alcohol specific mortality from 2002-04 to 2006-08 by gender[1]
a) Males
b) Females
Year
Table 8: Alcohol specific mortality in Greater Manchester local authorities by gender[1]
Males
Mortality
per
100,000,
2006-08
17.4
14.6
33.3*
19.2
20.1
24.2
15.2
16.7
14.1
14.3
95%
confidence
intervals
% change
from 200204
Females
% change
from 200507
Mortality
per
100,000,
2006-08
12.7
7.4
12.0
11.4
12.4
16.6*
9.1
6.5
6.7
10.3
95%
confidence
intervals
% change
from 200204
% change
from 200507
Bolton
13.6-22.0
+2.0%
-1.7%
9.5-16.7
+40.9%
+43.2%
Bury
10.5-19.9
-1.7%
-8.8%
4.7-11.2
+61.5%
+32.7%
Manchester
28.5-38.5
+30.9%
+32.4%
9.2-15.3
+6.5%
-1.2%
Oldham
14.7-24.7
-23.1%
-28.2%
8.1-15.6
+24.9%
-6.1%
Rochdale
15.4-25.8
+42.3%
+43.2%
8.8-17.0
+280.5%
+203.0%
Salford
19.1-30.3
-10.6%
+21.3%
12.4-21.9
+70.2%
+89.9%
Stockport
11.8-19.4
+12.7%
-6.0%
6.5-12.4
+45.4%
+41.3%
Tameside
12.6-21.7
-18.2%
-18.2%
4.1-9.8
-31.1%
-7.5%
Trafford
10.3-18.8
+40.1%
+30.8%
4.2-10.1
+19.6%
+2.9%
Wigan
11.1-18.0
-5.7%
-16.7%
7.7-13.5
+28.2%
+26.0%
Greater
18.9
14.7-23.9
+3.5%
+2.7%
10.5
7.5-14.4
+37.7%
+31.9%
Manchester
North West
18.5
17.7-19.4
+12.5%
+7.4%
10.0
9.4-10.6
+20.9%
+14.9%
England
13.1*
12.9-13.4
+12.4%
+8.2%
6.1*
6.0-6.3
+15.8%
+12.0%
*
Greater Manchester figures are based on the mean of its local authorities. The difference between the area shown
and the North West overall is significant as the 95% confidence intervals do not overlap.
20
The impact of alcohol in Greater Manchester: report no. 8
6.3 Mortality: alcohol attributable mortality
In 2008, the rate of alcohol attributable mortality for males was more than double that for females in
Greater Manchester (48 and 21 per 100,000 respectively), in line with regional and national patterns (Figure
7; Table 9).[1] Rates of mortality have decreased overall for males by 3% between 2004 and 2008 in Greater
Manchester, whilst for females, rates increased by 7%. Nationally and regionally, rates increased for both
males and females. Three Greater Manchester authorities also experienced increases between 2004 and
2008 for both males and females (Bolton, Manchester and Wigan). Between 2007 and 2008, rates of alcoholattributable mortality decreased by 1% for males and increased by 5% for females. Overall, rates of increase
were considerably higher for females than males with, for example, females in Salford experiencing a 44%
rise in mortality (Salford also had the highest rate of admission in 2008 for females, significantly higher than
the North West overall). However, incidence is relatively low compared with other measures in this report.
80
70
70
60
60
North West
50
England
20
30
20
2008
2004
0
2007
0
2006
10
2005
10
2008
30
40
2007
40
2006
50
Greater Manchester
2005
Rate per 100,000
80
2004
Rate per 100,000
Figure 7: Alcohol attributable mortality from 2004/05 to 2008/09 by gender[1]
a) Males
b) Females
Year
Year
Table 9: Alcohol attributable mortality in Greater Manchester local authorities by gender[1]
Males
Mortality
per
100,000,
2008
52.3
39.2
69.2*
47.7
48.6
56.7
39.8
48.8
33.4
45.3
95%
confidence
intervals
% change
from 2004
Females
% change
from 2007
Mortality
per
100,000,
2008
22.8
13.6
28.5
20.2
17.5
33.8*
15.8
16.5
19.1
20.3
95%
confidence
intervals
% change
from 2004
% change
from 2007
Bolton
40.6-65.7
+10.8%
+2.1%
15.7-31.7
+17.4%
+19.1%
Bury
27.6-53.6
-21.8%
-7.1%
7.4-21.6
-14.2%
-34.2%
Manchester
57.6-82.4
+9.0%
+2.9%
21.4-37.1
+25.1%
+32.7%
Oldham
35.3-62.0
-10.3%
-1.8%
12.8-30.0
-21.9%
-3.7%
Rochdale
36.1-63.6
+10.3%
-4.3%
10.5-26.5
-1.7%
-25.7%
Salford
43.4-72.3
-1.0%
-5.0%
23.4-46.2
+55.5%
+44.3%
Stockport
30.4-51.1
-3.6%
-0.5%
10.2-22.8
-2.0%
-11.0%
Tameside
36.6-63.2
-13.2%
+6.4%
10.1-25.1
-25.6%
-5.5%
Trafford
23.5-45.8
-12.4%
-9.5%
12.2-28.3
+36.7%
+36.4%
Wigan
35.5-56.9
+3.5%
-0.4%
14.2-27.8
+11.4%
+4.0%
Greater
48.1
36.7-61.7
-2.8%
-1.4%
20.8
13.8-29.7
+7.3%
+5.1%
Manchester
North West
48.6
44.2-48.6
+3.5%
+2.8%
22.1
19.2-22.1
+12.1%
+9.6%
England
37.9*
36.4-37.9
+0.8%
+4.8%
15.7*
14.8-15.7
+1.7%
+3.7%
*
Greater Manchester figures are based on the mean of its local authorities. The difference between the area shown
and the North West overall is significant as the 95% confidence intervals do not overlap.
21
The impact of alcohol in Greater Manchester: report no. 8
6.4 Mortality: alcohol attributable months of life lost
In 2006-08, males lost 12.2 months of life that were attributable to alcohol, double that of females (in line
with national and regional patterns; Figure 8; Table 10).[1] Whilst the number of months of life lost has
remained relatively stable for males in Greater Manchester since 2002-04 (and since 2003-05), females have
experienced increases. This pattern can also be observed in national and regional trends, but to a lesser
extent. Rates of increase for females were particularly high in Rochdale and Salford. Five authorities
experienced a percentage increase for female number of months of life lost that was at least 5% between
2003-05 and 2006-08, compared with only three for males. In comparison, Bury displayed decreases of at
least 5% for both males and females (Oldham also did so for males). Manchester had the highest number of
months of life lost in Greater Manchester for males whilst Salford had the highest number for females;
however, without the accompanying confidence intervals, it is not known whether these were significant.
20
18
16
14
12
10
8
6
4
2
0
40
Greater Manchester
Number of months
35
30
North West
25
England
20
15
10
5
Year
2006-08
2005-07
2004-06
2003-05
2002-04
2006-08
2005-07
2004-06
2003-05
0
2002-04
Number of months
Figure 8: Alcohol attributable months of life lost from 2002-04 to 2006-08 by gender[1]
a) Males
b) Females
Year
Table 10: Alcohol attributable months of life lost in Greater Manchester local authorities by gender[1]
Months
lost, 200608
Males
Variation
% change
from
from 2002North
04
West
-0.1
+3.1%
-1.7
-7.4%
+5.2
+10.4%
+0.5
-9.1%
+0.3
+16.3%
+3.2
+4.2%
-2.0
+13.7%
+0.1
-11.7%
-2.8
+2.9%
-0.3
+19.3%
% change
from 200305
Months
lost, 200608
Females
Variation
% change
from
from 2002North
04
West
+0.8
+18.1%
-1.3
+1.5%
+0.8
+1.8%
+0.1
+19.8%
+0.7
+56.7%
+2.2
+34.4%
-0.3
+31.0%
-1.0
-13.4%
-1.7
+0.7%
-0.1
+9.6%
% change
from 200305
Bolton
11.9
+1.7%
6.7
14.3%
Bury
10.2
-5.0%
4.7
-7.7%
Manchester
17.2
+7.0%
6.8
-3.8%
Oldham
12.4
-7.8%
6.1
-3.2%
Rochdale
12.2
+12.2%
6.7
36.6%
Salford
15.2
+14.1%
8.2
42.8%
Stockport
9.9
-3.0%
5.6
28.6%
Tameside
12.0
-10.2%
5.0
-7.4%
Trafford
9.1
+1.3%
4.3
-9.5%
Wigan
11.6
+2.3%
5.9
6.9%
Greater
12.2
+0.2
0.0%
+1.4%
6.0
0.0
+15.1%
9.1%
Manchester
North West
11.9
0.0
+5.7%
+1.5%
6.0
0.0
+8.0%
+6.0%
England
9.3
-2.7
+1.3%
0.0%
4.3
-1.7
+2.7%
+1.0%
Greater Manchester figures are based on the mean of its local authorities. LAPE do not provide 95% confidence
intervals for this indicator and so variation from the North West average is displayed instead.
22
The impact of alcohol in Greater Manchester: report no. 8
6.5 Mortality: summary
Across all three indicators and in all Greater Manchester authorities, males have significantly higher levels of
alcohol attributable mortality than females. Typically, males experienced approximately double the levels of
harm compared with females. In general, alcohol-related mortality has been increasing in recent years, and
these rises have been particularly apparent for females with, for example, a 38% increase in the rate of
alcohol specific mortality for females between 2002-04 and 2006-08 in Greater Manchester. Across all three
indicators, Manchester consistently displayed the highest levels of alcohol-related mortality for males and
Salford for females.
7. Other health harms
7.1 Methodology
Two datasets are provided in relation to other health harms related to alcohol in Greater Manchester:
•
Alcohol-related road casualties: Data in relation to road casualties in Greater Manchester are
published by the Greater Manchester Transportation Unit.[20] The data include those casualties that
were reported as being fatal, serious and slight where there was a positive alcohol breath test from
the driver. Data are available from 2005 to 2008. No data are available on the demographic
characteristics of the individuals involved.
•
Alcohol-related fires: Data are supplied by Greater Manchester Fire Services for alcohol-related fires.
Data are available from 2008/09 to 2009/11. Data for 2009/10 are provisional only (to be confirmed
following the coroners’ inquests). Whether the fire is deemed to be alcohol-related is determined by
investigators’ findings at the scene, subsequent discussions with persons involved and the coroners’
adjudications. Figures are too small to allow demographic or local analysis. It is important to note
that alcohol-related fire deaths may share other contributing factors such as smoking, living alone
and disability.
23
The impact of alcohol in Greater Manchester: report no. 8
7.2 Other health harms: alcohol-related road casualties
In 2009, there were 359 road casualties with a positive alcohol breath test in Greater Manchester, 3.9% of all
road casualties in Greater Manchester. Overall, between 2005 and 2008, there was a considerable decrease
in the number of such casualties (from 470 to 300) but since 2008, the number has increased by 27% (Figure
9; Table 11).[20] The proportion of alcohol-related road casualties as a percentage of all road casualties has
followed a similar pattern. Bolton had the highest proportion of alcohol-related road casualties in Greater
Manchester (6.9%), but this was not significantly higher than Greater Manchester overall. Five authorities
have seen increases in the proportion of alcohol-related road casualties since 2005. These increases ranged
from 22% in Salford to 107% in Rochdale. Where decreases were seen between 2005 and 2009, these were
smaller, ranging from 0.4% in Stockport to 53% in Tameside. More recently, between 2008 and 2009, seven
authorities experienced an increase in the proportion of alcohol-related road casualties. This ranged from an
increase of 13% in Manchester to 266% in Trafford. Three authorities experienced a decrease: Bury by 2.0%,
Oldham by 11% and Tameside by 57%.
500
10
400
8
9
7
Percentage
Number
Figure 9: Alcohol-related road casualties in Greater Manchester from 2005 to 2009[20]
a) Number of road casualties
b) Proportion of all road casualties
300
200
6
5
4
3
2
100
1
0
0
2005
2006
2007
2008
2009
2005
2006
2007
2008
2009
Year
Year
Table 11: Alcohol-related road casualties in Greater Manchester authorities[20]
% of all road
95% confidence
% change since 2005 % change since 2008
casualties
intervals
Bolton
6.9%
2.5-4.5
+103.6%
+106.6%
Bury
3.9%
3.2-5.9
-13.0%
-2.0%
Manchester
2.0%
3.1-4.5
-45.7%
+12.5%
Oldham
4.0%
1.8-3.8
+50.2%
-10.7%
Rochdale
5.2%
1.7-3.5
+106.6%
+29.3%
Salford
4.2%
2.5-4.7
+22.2%
+62.9%
Stockport
2.7%
1.8-3.9
-0.4%
+42.4%
Tameside
2.1%
3.2-6.1
-52.8%
-56.5%
Trafford
4.5%
2.4-5.2
+26.2%
+266.2%
Wigan
5.6%
4.5-7.1
-1.5%
+22.8%
Greater Manchester
3.9%
3.4-4.0
+5.1%
+27.1%
No authorities had a significantly higher/lower proportion of alcohol-related fires than Greater Manchester overall.
24
The impact of alcohol in Greater Manchester: report no. 8
7.3 Other health harms: alcohol-related fires
In 2010/11, Greater Manchester Fire Service reported 8 alcohol-related deaths resulting from fire
(provisional data only), approximately double that recorded in 2008/09 (Figure 10). In fact, the number of
alcohol-related fires has increased year on year between 2008/09 and 2010/11. However, figures are small
and data should be interpreted with caution.
Figure 10: Alcohol-related fatal fires in Greater Manchester from 2008/09 to 2010/11*
30
25
Number
20
15
10
5
2010/11
2009/10
2008/09
0
Financial year
* Data for 2010/11 are provisional.
7.4 Other health harms: summary
Overall, between 2005 and 2008, there was a considerable decrease in the number of road casualties with a
positive alcohol breath test (from 470 to 300) but since 2008, the number has increased by 27%. The
proportion of alcohol-related road casualties as a percentage of all road casualties has followed a similar
pattern. The proportion of alcohol-related road casualties does not differ significantly by area. In 2010/11,
Greater Manchester Fire Service reported 8 alcohol-related deaths resulting from fire (provisional data only).
25
The impact of alcohol in Greater Manchester: report no. 8
8. Crime and offenders
8.1 Methodology
Crime and offender data provided in this section relate to alcohol-related crime, violent crime and sexual
offences obtained from LAPE,[1] local police incident data, and data from probation. Where possible, data
were provided by local authority (for crime data, this refers to where the incidence took place) and over time
to allow trend analysis. However, because data on alcohol-related crime relate to the offence rather than
the offender they cannot provide details on the geographic residence of the offender, their gender or age.
Further, no information is available on the victim of the crime (where one exists).
LAPE employ attributable fractions to estimate alcohol-related crime. These are derived from NEW-ADAM
data h, which tested arrestees’ urine to estimate the proportion of crimes involving alcohol.[21, 22] However:
•
Urine testing is not infallible; alcohol is distributed in the body quickly so a positive test may display
recent use rather than use overall, thereby potentially under-reporting alcohol’s involvement;
•
Urine testing was conducted on those that consented to be involved (of those approached, 59%
agreed to participate); it is not known how more comprehensive coverage might have affected the
fractions;
•
The NEW-ADAM study was published in 2001, and since then levels of alcohol-related harm have
increased considerably.[1] It is not known to what extent this might affect the proportion of crimes
committed that are today related to alcohol; and
•
Alcohol-related crime varies by local area,[1] but fractions are only available on a national basis.
Three types of local police intelligence have been provided: alcohol confiscations; licensing-related incidents
(incidents that contravene the licensing laws, for example selling alcohol to minors; exceeding maximum
capacity, or inoperable CCTV systems all constitute violations); and alcohol-related incidents (where the
police officer perceives alcohol to have been involved, which is likely to be an underestimate of true
incidence). For all crime data reported, it is important to note that recorded crime statistics do not represent
all crime, only those that are reported to the authorities.[23, 24] Rape, for example, is one of the most underreported crimes.[25] Other factors may also affect the levels of recorded crime, such as changes in reporting
and recording mechanisms as well as changes to police policy.[26]
Probation data have also been supplied in relation to the proportion of offenders seen by Probation Services
in Greater Manchester whose alcohol use was linked to their offending;[7] however, changes in the
methodology and criteria used mean that the data shown here are not comparable with those published in
previous reports.[5] Thus, this section will only cover the latest data period available (April to December
2010). Whether an individual’s offending is identified as being linked to their alcohol use is determined by
probation officer’s assessment and the evidence available. No demographic data are available.
h
NEW-ADAM survey data refers to the New English and Wales Arrestee Drug Abuse Monitoring.
and tested the urine from 1,435 arrestees.
26
[21]
Researchers visited eight sites
The impact of alcohol in Greater Manchester: report no. 8
8.2 Crime and offenders: alcohol-related crime
In 2009/10, the rate of reported alcohol-related crime was 8.9 per 1,000 in Greater Manchester, significantly
higher than that observed for the North West and England (Figure 11; Table 12).[1] Overall, rates of alcoholrelated crime display a decreasing trend between 2005/06 and 2009/10 in Greater Manchester (dropping by
26%). Whilst no data are available for the North West and England prior to 2008/09, this decrease is
reflected in the regional and national trends since that year. All authorities in Greater Manchester have seen
a decrease in alcohol-related crime since 2005/06 and nine have seen an increase since 2008/09 (Rochdale
saw a 4% increase). Five authorities had alcohol-related crime rates that were significantly above the
regional average. Manchester had the highest overall at 14.5 per 1,000. Four authorities had crime rates that
were significantly below the regional average. Stockport had the lowest overall at 7.0 per 1,000, half that of
Manchester.
20
18
16
14
12
10
8
6
4
2
0
Greater Manchester
North West
2009/10
2008/09
2007/08
2006/07
England
2005/06
Rate per 1,000
Figure 11: Alcohol-related crime between 2005/06 and 2009/10[1]*
Financial year
* Data were unavailable for the North West and England prior to 2008/09.
Table 12: Alcohol-related crime in Greater Manchester authorities[1]
Crime per 1,000
95% confidence
% change from
% change from
population, 2009/10
intervals
2005/06
2008/09
Bolton
7.8
7.5-8.2
-34.3%
-18.0%
Bury
7.3*
6.9-7.7
-29.3%
-16.4%
Manchester
14.5*
14.2-14.9
-27.7%
-12.1%
Oldham
8.5*
8.1-8.9
-18.8%
-16.5%
Rochdale
11.5*
11.0-12.0
-8.5%
+4.0%
Salford
10.4*
10.0-10.9
-21.3%
-17.9%
Stockport
6.1*
5.8-6.4
-39.4%
-15.2%
Tameside
9.5*
9.1-9.9
-31.5%
-10.1%
Trafford
6.7*
6.3-7.0
-28.6%
-8.5%
Wigan
7.0*
6.7-7.3
-16.2%
-13.6%
Greater Manchester
8.9*
8.6-9.3
-25.7%
-12.3%
North West
7.8
7.7-7.9
-9.2%
England
8.1*
8.0-8.1
-6.3%
Data were unavailable for the North West and England prior to 2008/09. Greater Manchester figures are based on the
*
mean of its local authorities. The difference between the area shown and the North West overall is significant as the
95% confidence intervals do not overlap.
27
The impact of alcohol in Greater Manchester: report no. 8
8.3 Crime and offenders: alcohol-related violent and sexual crime
In 2009/10, the rate of alcohol-related reported violent crime was 5.8 per 1,000 in Greater Manchester,
similar to regional and national figures (Figure 12; Table 13).[1] Rates of alcohol-related reported sexual crime
were considerably lower at 0.1 per 1,000. Rates of alcohol-related violent and sexual crime have decreased
overall since 2005/06. This pattern also occurred regionally and nationally for alcohol-related violent crime
since 2008/09 whilst sexual crime rates rose. In the last year of data, nine authorities experienced decreases
in violent crime with the largest proportional decrease being in Bury. Only Rochdale reported an increase.
For sexual crime, five authorities experienced an increase and four a decrease. However, rates are small.
Four authorities had rates of alcohol-related violence in 2009/10 that were significantly higher than the
regional average (such as Manchester) and four had rates that were significantly lower (such as Stockport).
For sexual crime, two authorities had rates that were significantly higher (Bolton and Manchester).
10
9
8
7
6
5
4
3
2
1
0
Greater Manchester
North West
Financial year
2009/10
2008/09
2007/08
2006/07
England
2005/06
2009/10
2008/09
2007/08
2006/07
Rate per 1,000
10
9
8
7
6
5
4
3
2
1
0
2005/06
Rate per 1,000
Figure 12: Alcohol-related violent and sexual crime between 2005/06 and 2009/10[1]*
a) Violent crime
b) Sexual crime
Financial year
* Data were unavailable for the North West and England prior to 2008/09.
Table 13: Alcohol-related violent and sexual crime in Greater Manchester local authorities[1]
Crime per
1,000
population
2009/10
5.2
4.7*
8.9*
5.4
8.1*
6.5*
3.7*
6.4*
4.1*
4.9*
Violent crime
95%
% change
confidence
from
intervals,
2005/06
2009/10
5.0-5.5
-34.0%
4.4-5.0
-26.6%
8.6-9.1
-23.4%
5.1-5.7
-13.2%
7.7-8.5
+0.4%
6.2-6.9
-15.4%
3.5-3.9
-36.5%
6.1-6.8
-35.1%
3.8-4.4
-28.1%
4.6-5.1
-3.3%
% change
from
2008/09
Crime per
1,000
population
2009/10
0.2*
0.1
0.2*
0.1
0.2
0.1
0.1
0.1
0.1
0.1
Sexual crime
95%
% change
confidence
from
intervals,
2005/06
2009/10
0.1-0.2
+12.7%
0.1-0.2
-10.4%
0.2-0.3
-12.6%
0.1-0.2
-8.6%
0.1-0.2
-12.0%
0.1-0.2
-22.9%
0.1-0.1
-32.2%
0.1-0.2
-28.5%
0.0-0.1
-34.1%
0.1-0.2
+2.7%
% change
from
2008/09
Bolton
-6.9%
+8.5%
Bury
-18.6%
-2.9%
Manchester
-11.7%
+2.9%
Oldham
-12.9%
+8.6%
Rochdale
+13.1%
0.0%
Salford
-16.9%
+4.6%
Stockport
-9.8%
+2.4%
Tameside
-3.9%
-19.8%
Trafford
-5.3%
-3.7%
Wigan
-14.4%
-2.4%
Greater
5.8
5.5-6.1
-22.1%
-8.7%
0.1
0.1-0.2
-14.6%
-0.2%
Manchester
North West
5.5
5.4-5.5
-7.0%
0.1
0.1-0.1
+7.8%
England
5.8*
5.8-5.8
-4.3%
0.1
0.1-0.1
+5.6%
Data were unavailable for the North West and England prior to 2008/09. Greater Manchester figures are based on the
*
mean of its local authorities. The difference between the area shown and the North West overall is significant as the
95% confidence intervals do not overlap.
28
The impact of alcohol in Greater Manchester: report no. 8
8.4 Crime and offenders: alcohol confiscations (police intelligence; UPDATED DATA)
In 2010, there were 1,629 alcohol confiscations recorded by police in Greater Manchester, a decrease of 19%
from 2009 (n=2,006).[6] For both 2009 and 2010, the number of confiscations peaked in April to June in
Greater Manchester (Figure 13; Table 14). The highest number of confiscations in 2010 occurred in Tameside
police district (n=512), and the lowest was at the Airport (n=<5). Nine police districts experienced a decrease
in the number of alcohol confiscations performed between 2009 and 2010. The percentage change ranged
from a decrease of 2% in Salford to a decrease of 82% in South Manchester. In comparison, three police
districts experienced an increase in the same time period: Tameside by 5%, Rochdale by 28% and Trafford by
112%.
Figure 13: Number of alcohol confiscations in Greater Manchester in 2009 and 2010 by quarter[6]
700
600
Number
500
400
300
2009
2010
200
100
Oct-Dec
Jul-Sep
Apr-Jun
Jan-Mar
0
Quarter
Table 14: Alcohol confiscations in Greater Manchester police districts[6]
Airport
Bolton
Bury
Metropolitan
North Manchester
Oldham
Rochdale
Salford
South Manchester
Stockport
Tameside
Trafford
Wigan
Not known
Greater Manchester
Number, 2010
<5
106
8
9
37
85
55
247
12
132
512
36
387
<5
1,629
29
% change from 2009
-59.7%
-42.9%
-18.2%
-19.6%
-15.0%
+27.9%
-1.6%
-81.8%
-22.4%
+5.3%
+111.8%
-27.9%
-18.8%
The impact of alcohol in Greater Manchester: report no. 8
8.5 Crime and offenders: licensing-related incidents (police intelligence; UPDATED DATA)
In 2010, there were 2,735 licensing-related incidents i recorded by police in Greater Manchester, a decrease
of 22% from 2009 (n=3,504; Table 15).[6] For both 2009 and 2010, the number of incidents peaked in April to
June in Greater Manchester (Figure 14). The highest number of licensing-related incidents in 2010 occurred
in North Manchester police district (n=406), and the lowest was at the Airport (n=5). Eleven police districts
experienced a decrease in the number of licensing-related incidents between 2009 and 2010. The
percentage change ranged from a decrease of 2% in South Manchester to a decrease of 34% in Oldham. In
comparison, two police districts experienced an increase in the same time period: Rochdale by 13%, and the
Airport by 68% (although for the latter, numbers of incidents were small).
Figure 14: Number of licensing-related incidents in Greater Manchester in 2009 and 2010 by quarter[6]
1200
1000
Number
800
600
2009
400
2010
200
Oct-Dec
Jul-Sep
Apr-Jun
Jan-Mar
0
Quarter
Table 15: Licensing-related incidents in Greater Manchester police districts[6]
Airport
Bolton
Bury
Metropolitan
North Manchester
Oldham
Rochdale
Salford
South Manchester
Stockport
Tameside
Trafford
Wigan
Not known
Greater Manchester
Number, 2010
5
257
120
81
406
260
216
175
112
278
323
204
296
<5
2,735
i
% change from 2009
+66.7%
-24.4%
-27.3%
-32.5%
-24.8%
-34.3%
+12.5%
-26.5%
-1.8%
-18.2%
-18.0%
-32.9%
-17.1%
-21.9%
Licensing-related incidents: incidents that contravene the licensing laws, for example selling alcohol to minors; exceeding maximum
capacity, or inoperable CCTV systems all constitute violations.
30
The impact of alcohol in Greater Manchester: report no. 8
8.6 Crime and offenders: alcohol-related (police intelligence; UPDATED DATA)
In 2010, there were 59,769 alcohol-related incidents recorded by police in Greater Manchester, a decrease
of 13% from 2009 (n=68,337; Table 16).[6] For both 2009 and 2010, the number of incidents peaked in April
to June in Greater Manchester (Figure 15). The highest number of alcohol-related incidents in 2010 occurred
in Wigan police district (n=6,217), and the lowest was at the Airport (n=200). All police districts experienced
a decrease in the number of alcohol-related incidents between 2009 and 2010. The percentage change
ranged from a decrease of 0.1% in South Manchester to a decrease of 34% at the Airport.
Figure 15: Number of alcohol-related incidents in Greater Manchester in 2009 and 2010 by quarter[6]
25000
Number
20000
15000
10000
2009
2010
5000
Oct-Dec
Jul-Sep
Apr-Jun
Jan-Mar
0
Quarter
Table 16: Alcohol-related incidents in Greater Manchester police districts[6]
Airport
Bolton
Bury
Metropolitan
North Manchester
Oldham
Rochdale
Salford
South Manchester
Stockport
Tameside
Trafford
Wigan
Not known
Greater Manchester
Number, 2010
200
6,303
2,935
3,720
6,011
5,187
5,131
5,483
3,311
4,985
5,621
3,253
6,217
214
59,769
31
% change from 2009
-33.6%
-14.1%
-16.7%
-0.1%
-26.3%
-12.1%
-6.4%
-15.4%
-7.4%
-17.2%
-10.0%
-22.0%
-12.0%
-41.2%
-12.5%
The impact of alcohol in Greater Manchester: report no. 8
8.7 Crime and offenders: individuals on probation (UPDATED DATA)
Between April 2010 and December 2010, for 50% of individuals seen by Probation Services in Greater
Manchester, their offending was recorded as being linked with alcohol use, where data were available
(Figure 16; Table 17). This percentage has remained stable over the individual quarterly time periods. Salford
had the highest level of offending being related to alcohol (51%) in Greater Manchester whilst City and
Bolton had the lowest (both 50%); however none of these were significantly different from Greater
Manchester overall.
Figure 16: The percentage of offenders seeing Probation Services in Greater Manchester whose offending if
linked to their alcohol use from April to December 2010 (where data are available)
80
70
Percentage
60
50
40
30
20
10
Oct-Dec
Apr-Jun
Jul-Sep
0
Quarter
Table 17: The percentage of offenders seeing Probation Services in Greater Manchester local authorities
whose offending if linked to their alcohol use from April to December 2010 (where data are available)
Year to date
95% confidence intervals
Apr-Dec 2010
%
Bolton
49.7%
44.7-54.8
Bury
50.7%
45.5-55.8
City
49.8%
45.0-54.6
Oldham
50.5%
45.4-55.6
Rochdale
49.6%
44.7-54.5
Salford
51.0%
45.9-56.1
Stockport
50.7%
45.5-55.8
Tameside
50.5%
45.4-55.6
Trafford
50.1%
45.0-55.2
Wigan
50.3%
45.1-55.4
Other
48.1%
42.4-53.8
Greater Manchester
50.1%
48.6-51.6
Individuals ascribed to an “other” local authority are those in contact with a probationary service which covers more
than one local area (but are still based within Greater Manchester). No authorities had a significantly higher/lower
proportion of offending behaviour being linked with alcohol than Greater Manchester overall.
32
The impact of alcohol in Greater Manchester: report no. 8
8.8 Crime and offenders: summary
Alcohol-related crime, violent crime and sexual crime have decreased overall between 2005/06 and 2009/10
in Greater Manchester. This has typically been reflected in the local areas as well. Police intelligence also
showed decreases in the numbers of alcohol confiscations, licensing-related and alcohol-related incidents.
Manchester consistently had the highest levels of alcohol-related crime, violent crime and sexual crime in
Greater Manchester, and these rates were significantly higher than the North West. Using data from
Probation, for 50% of individuals seen by Probation Services in Greater Manchester, their offending was
recorded as being linked with alcohol use, where data were available.
9. Economic impacts
9.1 Methodology
Alcohol has a significant effect on the workplace, contributing to the loss of up to 17 million working days
per year due to alcohol-related sickness, and up to 20 million through reduced productivity in England and
Wales.[22]
Data on the economic impacts of alcohol are provided by LAPE.[1] The first dataset examined relates to the
rate of incapacity benefit claimants with a main medical condition of alcoholism in August 2009 for the
working age population (those aged 16 -64 years for males; those aged 16-59 years for females). To qualify,
claimants undertake a medical test of incapacity for work (known as the Personal Capability Assessment).
Therefore, the decision for a person to be eligible for incapacity benefits on the grounds of alcoholism would
be based on their ability to carry out the range of activities in the test or on the effects of any associated
mental health problems. Figures exclude the Employment Support Allowance (ESA), which was introduced in
October 2008. ESA is not currently available by medical condition and its introduction has led to a reduction
in the number of Incapacity Benefit claimants. The second dataset examines the proportion of employees
working in bars in Greater Manchester. No trend or demographic data are available for either indicator.
33
The impact of alcohol in Greater Manchester: report no. 8
9.2 Economic impacts: incapacity benefits claimants
In August 2009, there were 226 incapacity benefits claimants with a main medical reason of alcoholism per
100,000 working population in Greater Manchester, significantly higher than the rate in the North West and
England overall (Figure 17; Table 18).[1] In total four authorities had a significantly higher rate than regionally
(Manchester, Rochdale, Salford and Tameside), whilst three authorities had a significantly lower rate
(Stockport, Trafford and Wigan). The highest rate in Greater Manchester was in Manchester at 406 per
100,000, double the regional average and 3.5 times the national average. The lowest rate was in Trafford at
130 per 100,000.
Figure 17: Incapacity benefits claimants with a main medical reason of alcoholism in August 2009[1]
Rate per 100,000
250
200
150
100
50
England
North West
Greater
Manchester
0
Location
Table 18: Incapacity benefits claimants with a main medical reason of alcoholism in Greater Manchester
authorities in August 2009[1]
Claimants per 100,000 working
95% confidence intervals
population, August 2009
Bolton
201
179-224
Bury
196
171-223
Manchester
406*
384-428
Oldham
181
159-205
Rochdale
307*
277-339
Salford
326*
297-357
Stockport
152*
134-172
Tameside
231*
206-258
Trafford
130*
111-151
Wigan
132*
116-149
Greater Manchester
226*
203-251
North West
195
191-199
England
117*
115-118
Greater Manchester figures are based on the mean of its local authorities. The original sources only provide
percentages as a whole number rather than to one decimal place (as with the rest of the data supplied in this report).
*
Thus, the all of the values in the table have been formatted to no decimal places for consistency. The difference
between the area and the North West overall is significant as the 95% confidence intervals do not overlap.
34
The impact of alcohol in Greater Manchester: report no. 8
9.3 Economic impacts: employees in bars
In 2008, 2.1% of employees in Greater Manchester worked in bars (Figure 18; Table 19).[1] This is
approximately the same proportion as for the North West and England overall. For three authorities, the
proportions of employees working in bars were significantly higher than that found regionally (Bury,
Tameside and Wigan) and four had significantly lower proportions (Manchester, Salford, Stockport and
Trafford). Overall, Tameside and Wigan had the highest proportion of employees working in bars in Greater
Manchester (2.7%) whilst Salford had the lowest (1.3%).
North West
England
10
9
8
7
6
5
4
3
2
1
0
Greater
Manchester
Percentage of all employees
Figure 18: Employees working in bars in 2008[1]
Location
Table 19: Employees working in bars in Greater Manchester authorities[1]
Employees, % of all
95% confidence intervals
employees, 2008
Bolton
2.0
1.9-2.1
Bury
2.5*
2.4-2.6
Manchester
1.7*
1.6-1.7
Oldham
2.3
2.2-2.4
Rochdale
2.2
2.1-2.3
Salford
1.3*
1.3-1.4
Stockport
1.8*
1.8-1.9
Tameside
2.7*
2.6-2.8
Trafford
1.3*
1.3-1.4
Wigan
2.7*
2.6-2.8
Greater Manchester
2.1
2.0-2.2
North West
2.2
2.2-2.3
England
2.0*
2.0-2.0
*
Greater Manchester figures are based on the mean of its local authorities. The difference between the area and the
North West overall is significant as the 95% confidence intervals do not overlap.
9.4 Economic impacts: summary
In August 2009, there were 226 incapacity benefits claimants with a main medical reason of alcoholism per
100,000 working population in Greater Manchester, significantly higher than the rate in the North West and
England overall. In 2008, 2.1% of employees in Greater Manchester worked in bars, the same proportion as
for the North West and England overall.
35
The impact of alcohol in Greater Manchester: report no. 8
10.
Young people
10.1 Methodology
A number of datasets of refer to young people specifically. The definition of young people (and age range
examined) varies between source but all refer to individuals who are 18 years old or under. There are a
number of data sources that have been used to populate this section:
j
k
•
The Trading Standards survey has been used to highlight levels of consumption amongst young
people aged 14-17 years (binge j and frequent k drinking), their drinking locations (mainly consuming
in pubs or other similar locations, and mainly consuming outside), and access to alcohol (selfpurchase). Data were taken from a biannual survey led by Trading Standards in the North West
region.[27, 28] There were 6,847 responses from Greater Manchester in the latest 2009 survey. As a
survey, it is subject to the same limitations as discussed in Section 4.1. Data for Greater Manchester
do not include Rochdale (Rochdale uses other surveys to measure lifestyle issues such as alcohol
consumption and is not involved in the Trading Standards survey). The survey is cross-sectional
rather than longitudinal and does not follow individual students over time, but rather surveys a
cross-section of the population at repeated time points. Data relating to this section are discussed in
Sections 10.2-10.4.
•
Data from LAPE have been used to provide estimates of alcohol specific hospital admission for
2004/05 to 2008/09 for those aged under 18 years[1] For the methodological details, please see
Section 4.1. Data relating to this section are discussed in Section 10.5.
•
Data from the Office for National Statistics provide details of the prevalence of under 18 conceptions
from 2006 to 2009.[29-32] Whilst it is not known to what extent alcohol was involved in these
conceptions, alcohol consumption and sexual behaviour (such as unprotected sex, regretted sex, and
transmission of sexually transmitted infections) are known to be strongly related to each other. [33-36]
For example, 11% per cent of 15 to 16 year olds in the UK reported having engaged in unprotected
sex after drinking.[33] Data relating to this section are discussed in Section 10.8.
•
The effects of alcohol on education included in this report are taken from data published by the
Department for Children, Schools and Families (DCSF).[10, 11] The data display trends for 2005/06 2008/09 for unauthorised absence and exclusions (fixed term and permanent). Data at local
authority level do not identify the cause of the exclusion/absence so it is not known to what extent
alcohol was involved. However, in 2002, the Youth Justice Board indicated that 13-15% of
suspensions from school resulted from drinking alcohol on site.[37] Data relating to this section are
discussed in Sections 10.6-10.7.
Binge drinking is defined as drinking five or more drinks in one drinking session.
Frequent drinking is defined as drinking twice or more in one week.
36
The impact of alcohol in Greater Manchester: report no. 8
10.2 Young people: alcohol consumption
In total in 2009, 6,847 questionnaires from the Trading Standards survey were completed by pupils from
Greater Manchester (49% of the total sample).[28] Of the Greater Manchester sample, 18% reported drinking
alcohol twice a week or more, referred to here as frequent drinking (19% in the North West overall; Figure
19; Table 20). This represents a 21% decrease from survey respondents in 2007. All local authorities involved
in the survey saw a decrease in frequent drinking. The largest decrease seen was in Tameside (by 42%). The
highest levels of frequent drinking were seen in Bolton (22%); however it is not known whether such levels
were significantly different from the North West average as no confidence intervals were available. One
quarter of participants in 2009 in Greater Manchester reported a decrease in weekly binge drinking (26% in
the North West). Whilst prevalence of weekly binge drinking increased by 37% between 2007 and 2009 in
the North West overall, it decreased by 5% in Greater Manchester. Five authorities reported a decrease in
weekly binge drinking with the largest decrease being in Salford (by 35%); however, four authorities
reported an increase (the largest rise being seen in Bolton at 40%). Overall, the largest levels of weekly binge
drinking were found in Tameside and Oldham (both 29%), but it is not known whether such levels were
significantly different from the North West average as no confidence intervals were available.
40
35
30
25
20
15
10
5
0
Percentage
Percentage
Figure 19: Frequency of alcohol consumption in 2007 and 2009 amongst 14 to 17 year olds in Greater
Manchester and the North West[27, 28]
a) Frequent alcohol consumption
b) Weekly or more binge drinking
Greater
Manchester
40
35
30
25
20
15
10
5
0
North West
2007
2009
Greater
Manchester
Region
North West
Region
Table 20: Frequency of alcohol consumption amongst 14 to 17 year olds in Greater Manchester local
authorities[27, 28]
Frequent alcohol consumption
Weekly or more binge drinking
Variation from
% change
Variation from
% change
%, 2009
%, 2009
North West
since 2007
North West
since 2007
Bolton
22%
+3
-15%
28%
+2
+40%
Bury
19%
0
-27%
24%
-2
+14%
Manchester
14%
-5
-18%
19%
-7
-10%
Oldham
21%
+2
17%
29%
+3
+38%
Salford
17%
-2
-11%
24%
-2
-35%
Stockport
18%
-1
-10%
22%
-4
+22%
Tameside
19%
0
-42%
29%
+3
-28%
Trafford
18%
-1
-22%
24%
-2
-8%
Wigan
18%
-1
-33%
26%
0
-19%
Greater Manchester
18%
-1
-21%
25%
-1
-5%
North West
19%
-21%
26%
+37%
The original sources only provide percentages as a whole number rather than to one decimal place (as with the rest of
the data supplied in this report). Thus, the all of the values in the table have been formatted to no decimal places for
consistency. The sources do not provide 95% confidence intervals, so variation from North West has been provided
instead. Rochdale was not involved in the survey, so no data are available for this authority.
37
The impact of alcohol in Greater Manchester: report no. 8
10.3 Young people: drinking locations
In Greater Manchester, 28% of young people surveyed (aged 14-17 years) reported mainly drinking alcohol
in pubs, members clubs and clubs, and 31% reported mainly doing so outside in parks and on the street (28%
and 30% respectively for the North West overall; Figure 20; Table 21). The highest proportions of young
people mainly consuming alcohol in pubs and outside in Greater Manchester were identified in Oldham
(pubs: 36%; outside: 45%); however, it is not known whether such levels were significantly different from the
North West average as no confidence intervals were available. For both Greater Manchester and the North
West overall, there have been decreases in the proportions reporting that they mainly consumed alcohol in
pubs and outside between 2007 and 2009, and most authorities followed the same pattern. The highest
decreases were seen in Bury (36% decrease in the proportion reporting mainly drinking in pubs) and Salford
(35% decrease in mainly drinking outside). However, Oldham experienced an 80% increase in the proportion
reporting mainly drinking in pubs, and both Oldham and Stockport experienced a 13% and 16% increase in
mainly drinking outside (the only authorities to show an increase).
Figure 20: Frequency of main drinking location amongst 14 to 17 year olds by type of location and year of
survey in Greater Manchester and the North West[27, 28]
a) In pubs, members clubs, clubs
b) Outside in parks, on the streets
50
40
40
Percentage
Percentage
50
30
20
10
0
30
20
2007
10
2009
0
Greater
Manchester
Greater
Manchester
North West
Region
North West
Region
Table 21: Frequency of main drinking location amongst 14 to 17 year olds by type of location and year of
survey in Greater Manchester local authorities[27, 28]
Mostly drink in pubs, members clubs, clubs
Mostly drink outside in parks, on the streets
Variation from
% change
Variation from
% change
%, 2009
%, 2009
North West
since 2007
North West
since 2007
Bolton
30%
+2
-12%
31%
+1
-16%
Bury
27%
-1
-36%
20%
-10
-26%
Manchester
26%
-2
-21%
28%
-2
-24%
Oldham
36%
+8
+80%
45%
+15
+13%
Salford
19%
-9
-21%
33%
+3
-35%
Stockport
25%
-3
-7%
29%
-1
+16%
Tameside
32%
+4
-11%
31%
+1
-26%
Trafford
21%
-7
-22%
36%
+6
-5%
Wigan
33%
+5
-6%
30%
0
-21%
Greater Manchester
28%
0
-10%
31%
+1
-16%
North West
28%
-15%
30%
-19%
The original sources only provide percentages as a whole number rather than to one decimal place (as with the rest of
the data supplied in this report). Thus, the all of the values in the table have been formatted to no decimal places for
consistency. The sources do not provide 95% confidence intervals, so variation from North West has been provided
instead. Rochdale was not involved in the survey, so no data are available for this authority.
38
The impact of alcohol in Greater Manchester: report no. 8
10.4 Young people: accessing alcohol
In Greater Manchester in 2009, 28% of young people surveyed aged 14-17 years old reported buying alcohol
themselves (26% in the North West). This is a considerable decrease since 2005 (dropping by 29%) but the
proportion remained relatively stable between 2007 and 2009. This reflects patterns reported regionally
(Figure 21; Table 22). All local authorities in Greater Manchester have seen a decrease in self-purchase
between 2005 and 2009, the largest being in Salford where the proportion decreased by 59%. However,
since 2007, trends have varied by local authority: four authorities reported an increase (the largest in
Oldham by 150%) and five reported a decrease (the largest in Bury by 26%). In 2009, the largest proportion
of respondents in Greater Manchester to report self-purchase was in Oldham (40% of participants). However,
it is not known whether such levels were significantly different from the North West average as no
confidence intervals were available.
Figure 21: Frequency of self-purchase amongst 14-17 year olds by year of survey in Greater Manchester and
the North West[27, 28]
50
Percentage
40
30
2005
20
2007
10
2009
0
Greater Manchester
North West
Region
Table 22: Frequency of self-purchase amongst 14-17 year olds by year of survey in Greater Manchester local
authorities[27, 28]
Variation from
% change since
% change since
North West
2005
2007
Bolton
28%
+2
-22%
+4%
Bury
29%
+3
-26%
-26%
Manchester
38%
+12
-21%
+6%
Oldham
40%
+14
-2%
+150%
Salford
17%
-9
-59%
-19%
Stockport
20%
-6
-53%
-23%
Tameside
32%
+6
-22%
-16%
Trafford
23%
-3
-38%
+15%
Wigan
28%
2+
-20%
-3%
Greater Manchester
28%
+2
-29%
1%
North West
26%
-35%
-7%
The original sources only provide percentages as a whole number rather than to one decimal place (as with the rest of
the data supplied in this report). Thus, the all of the values in the table have been formatted to no decimal places for
consistency. The sources do not provide 95% confidence intervals, so variation from North West has been provided
instead. Rochdale was not involved in the survey, so no data are available for this authority.
%, 2009
39
The impact of alcohol in Greater Manchester: report no. 8
10.5 Young people: hospital admission
In 2006/07-2008/09, the rate of admission for alcohol specific hospital admission for under 18s was 101 per
100,000, similar to the North West overall but more than double the rate for England (Figure 22; Table 23).[1]
No authorities had rates that were significantly higher than the North West average; rates for three
authorities were significantly lower (Manchester, Stockport and Trafford). Tameside had the highest rate of
admission in Greater Manchester (although this was not significantly different from the North West overall)
whilst Trafford had the lowest. The rate of admission has decreased by 13% in Greater Manchester since
2004/05-2006/07, a greater decrease than those observed for the North West or England overall. Nine
authorities saw a decrease in this time (Tameside being the only exception, by 0.7%). The largest decrease
was in Manchester (by 25%).
Figure 22: Alcohol specific hospital admission for those aged under 18 years old from 2004/05 to 2008/09[1]
140
Rate per 100,000
120
100
80
Greater Manchester
60
North West
40
England
20
2006/072008/09
2005/062006/07
2004/052005/06
0
Year
Table 23: Alcohol specific hospital admission for those aged under 18 years old in Greater Manchester local
authorities[1]
Admission per 100,000,
% change from 2004/0595 % confidence intervals
2006/07-2008/09
2006/07
Bolton
105.6
91.3-121.4
-20.7%
Bury
90.5
74.7-108.6
-22.0%
Manchester
82.5*
72.2-93.7
-25.4%
Oldham
98.7
84.1-115.1
-19.6%
Rochdale
119.0
102.2-137.9
-3.7%
Salford
117.0
99.7-136.4
-8.1%
Stockport
81.8*
69.2-96.1
-16.3%
Tameside
123.4
106.0-142.8
+0.7%
Trafford
70.1*
57.1-85.3
-14.7%
Wigan
121.4
106.6-137.7
-1.1%
Greater Manchester
101.0
86.3-117.5
-12.8%
North West
109.2
106.2-112.3
-7.5%
England
64.5*
63.6-65.4
-7.6%
Greater Manchester figures are based on the mean of its local authorities. * The difference between the area and the
North West overall is significant as the 95% confidence intervals do not overlap.
40
The impact of alcohol in Greater Manchester: report no. 8
10.6 Young people: teenage conceptions (UPDATED DATA)
In 2009, the rate of under 18s’ conceptions in Greater Manchester was 49 per 1,000 women aged 15-17
years (Figure 23; Table 24).[32] Of these conceptions, the outcome for 49% was an abortion. Rates of
conceptions in Greater Manchester are higher than both the North West and England overall, and the
highest rates of under 18s’ conceptions in Greater Manchester were in Manchester and Tameside (67 and 60
per 1,000 respectively). However, it is not known whether such levels were significantly different from the
North West average as no confidence intervals were available. Rates of conceptions have shown an overall
decline in both the North West and England between 2006 and 2009, after peaking in 2007. Whilst no data
were available for Greater Manchester before 2008, the rates of conceptions also declined here between
2008 and 2009 (by 4.7%). Between 2008 and 2009, rates declined in six of the ten Greater Manchester
authorities, with the largest declines being reported in Bury and Trafford (by 19% and 14% respectively).
Conversely, rates increased in four authorities, the highest of which was seen in Stockport (rising by 4.2%).
60
50
40
Greater Manchester
30
North West
20
England
10
2009
2008
2007
0
2006
Rate per 1,000 women aged 15-17 years
Figure 23: Under 18 conception from 2006 to 2009[29-32]
Year
Table 24: Under 18 conception in Greater Manchester local authorities[29-32]
Rate per 1,000
Variation from
women aged 15-17, % change since 2006 % change since 2008
North West
2009
Bolton
47.9
-0.6%
-5.7%
+4.2
Bury
37.6
-24.0%
-19.0%
-6.1
Manchester
67.2
+0.3%
-3.7%
+23.5
Oldham
42.3
-4.9%
+3.7%
-1.4
Rochdale
47.7
-2.7%
-13.1%
+4.0
Salford
54.1
-8.0%
-8.5%
+10.4
Stockport
37.6
-6.9%
+4.2%
-6.1
Tameside
60.1
+10.5%
+0.7%
+16.4
Trafford
29.7
-5.1%
-14.4%
-14.0
Wigan
50.2
-5.1%
+0.6%
+6.5
Greater Manchester
48.8
-4.7%
+5.1
North West
43.7
-0.7%
-4.4%
N/A
England
38.2
-5.4%
-5.4%
-5.5
Data for Greater Manchester were first published in 2007. The sources do not provide 95% confidence intervals, so
variation from North West has been provided instead.
41
The impact of alcohol in Greater Manchester: report no. 8
10.7 Young people: persistent absenteeism in secondary schools
In 2008/09, 5% of enrolled pupils were defined as being persistently absent l in local authority maintained
secondary schools in Greater Manchester (Figure 24; Table 25).[10, 38] This has decreased by 35% since
2005/06 and by 13% since 2007/08, in line with decreases observed nationally and regionally. All Greater
Manchester local authorities have also seen decreases in the proportion of persistent absentees in the same
time period ranging from a 0.1% drop in Bury to a 32% drop in Salford. Of the Greater Manchester
authorities, the highest percentages of persistent absentees were seen in Manchester in 2008/09 at 10% of
those enrolled. This is approximately double the Greater Manchester, North West and England figures. In
fact, Manchester was the only authority in Greater Manchester to experience higher levels of persistent
absenteeism than experienced regionally. However, it is not known whether such levels were significantly
different from the North West average as no confidence intervals were available.
Figure 24: Persistent absentees in local authority maintained secondary schools in Greater Manchester from
2005/06 to 2008/09[10, 38]
15
Percentage
12
9
Greater Manchester
6
North West
England
3
2008/09
2007/08
2006/07
2005/06
0
Year
Table 25: Persistent absentees in local authority maintained secondary schools in Greater Manchester local
authorities[10, 38]
Percentage, 2008/09
% change from
% change from
Variation from
2005/06
2007/08
North West
Bolton
5.0%
-34.2%
-9.9%
-0.4
Bury
4.3%
-44.2%
-0.1%
-1.7
Manchester
10.1%
-25.7%%
-10.1%
+5.2
Oldham
5.5%
-25.7%
-4.8%
-0.2
Rochdale
4.7%
-29.9%
-17.1%
-0.3
Salford
3.8%
-62.4%
-31.7%
-0.4
Stockport
4.7%
-38.2%
-24.6%
0.2
Tameside
5.6%
-21.1%
-1.2%
-0.3
Trafford
4.0%
-16.7%
-4.5%
-1.8
Wigan
3.9%
-48.7%
-20.5%
-1.1
Greater Manchester
5.2%
-35.7%
-12.7%
-0.1
North West
5.4%
-31.6%
-9.9%
N/A
England
4.9%
-31.0%
-12.1%
-0.4
Greater Manchester figures are based on the mean of its local authorities. The sources do not provide 95% confidence
intervals, so variation from North West has been provided instead.
l
Persistent absence is defined as absence of more than 20% (authorised or unauthorised).
42
The impact of alcohol in Greater Manchester: report no. 8
10.8 Young people: exclusion in secondary schools
Five per cent of permanent exclusions and 2% of fixed term exclusions were recorded as being related to
alcohol and/or drugs in 2008/09 in England (7% and 3% respectively for the North West).[11] Overall in
Greater Manchester in 2009/10, 0.3% of pupils in local authority maintained secondary schools were
permanently excluded and 12% were excluded on a fixed term basis (including both alcohol-related
exclusions and exclusions for other reasons; Figure 25; Table 26). Between 2006/07 and 2008/09,
percentages of pupils excluded on a fixed term basis fluctuated in Greater Manchester, the North West and
England, peaking in 2007/08 but decreasing overall by 2008/09. In 2008/09, Bury had the highest percentage
of permanent exclusions (0.6%) and Manchester had the highest percentage of fixed term exclusions (18%);
however, it is not known whether such levels were significantly different from the North West average as no
confidence intervals were available.
20
18
16
14
12
10
8
6
4
2
0
Greater Manchester
North West
2008/09
Financial year
2007/08
England
2006/07
2008/09
2007/08
Percentage
20
18
16
14
12
10
8
6
4
2
0
2006/07
Percentage
Figure 25: School exclusion in local authority maintained secondary schools from 2006/07 to 2008/09[11, 39, 40]
a) Permanent exclusion
b) Fixed term exclusion
Financial year
Table 26: School exclusion in local authority maintained secondary schools Greater Manchester local
authorities[11, 39, 40]
Permanent exclusion
%,
2008/09
% change
from
2006/07
% change
from
2007/08
Fixed term exclusion
Variation
from
North
West
-0.1
+0.4
+0.1
+0.3
+0.1
+0.3
+0.1
+0.1
-0.1
*
%,
2008/09
% change
from
2006/07
% change
from
2007/08
Variation
from
North
West
+1.5
+2.2
+8.1
+2.3
+3.6
-2.4
+2.2
+2.7
+1.2
+1.6
Bolton
0.1%
-59.0%
-48.1%
10.9%
-18.1%
+43.9%
Bury
0.6%
-8.9%
-11.9%
11.6%
-12.6%
*
Manchester
0.3%
+13.8%
-25.6%
17.5%
-1.6%
-22.4%
Oldham
0.5%
+35.9%
-4.0%
11.7%
-4.4%
+327.1%
Rochdale
0.3%
-27.3%
-20.7%
13.0%
0.5%
-6.8%
Salford
0.5%
-21.0%
-23.5%
7.0%
-47.6%
-57.9%
Stockport
0.3%
+13.8%
-16.7%
11.6%
-26.0%
-39.9%
Tameside
0.3%
-14.9%
-18.5%
12.1%
-21.8%
-78.5%
Trafford
0.1%
-13.1%
+19.7%
10.6%
22.6%
-29.7%
Wigan
*
*
*
11.0%
-11.4%
-43.4%
Greater
0.3%
+1.2%
-16.5%
+0.1
11.7%
-13.4%
-32.6%
+2.3
Manchester
North West
0.2%
-16.3%
-17.8%
N/A
9.4%
-15.4%
-48.6%
N/A
England
0.2%
-23.7%
-18.4%
0.0
9.3%
-14.5%
-49.4%
-0.1
Greater Manchester figures are based on the mean of its local authorities. The sources do not provide 95% confidence
intervals, so variation from North West has been provided instead. * Figures were too low to calculate a percentage
and/or percentage change.
43
The impact of alcohol in Greater Manchester: report no. 8
10.9 Young people: summary
Overall, the data from the Trading Standards survey show a decreasing trend in frequent drinking, drinking in
pubs, drinking outside and self-purchase in 14-17 year olds in Greater Manchester. However, further data
are required to understand whether this is a long-term change. Across the indicators provided by the Trading
Standards survey, areas such as Oldham tended to have the highest levels of binge drinking, drinking in pubs,
drinking outside and self-purchase in Greater Manchester. However, without confidence intervals, it is not
possible to determine whether these differences were significant.
The rate of alcohol-specific hospital admission amongst under 18 year olds decreased by 13% in Greater
Manchester between 2004/05-2006/07 and 2006/07-2008/09, a greater decrease than those observed for
the North West or England overall. Nine authorities saw a decrease in this time. Overall decreases were also
reported for the incidences of under 18 conceptions, absenteeism and exclusion (fixed term and permanent).
11.
Alcohol treatment
11.1 Methodology
This section provides an overview of National Drug Treatment Monitoring System (NDTMS) data for Greater
Manchester for 2009/10. It shows the number of individuals in contact with structured alcohol treatment
services (tiers three and four) m with details of change in presentation since 2008/09, gender, age, referral
type, and discharge reason by Primary Care Trust (PCT) of residence (individuals are only counted once in a
PCT area but may have been resident in more than one PCT during the financial year). Latest data for the
year to date (April to December 2010) are also included.[9] In this section, 95% confidence intervals (95%CI)
have not been provided in the tables due to space restrictions but have been supplied in the text where
relevant.
m
The Department of Health classifies alcohol interventions and treatment (and associated services) into four tiers
[41]
according to need. Tier one services provide alcohol-related advice and interventions, brief interventions referrals
and screening. Tier two services provide alcohol-specific, brief interventions, open access outreach, non-care planned
interventions and referral. Tier three provides alcohol-specific community-based, care-planned assessment and
treatment. Tier four provides specialist residential treatment (these are care planned and include aftercare).
44
The impact of alcohol in Greater Manchester: report no. 8
11.2 Alcohol treatment: numbers in treatment (UPDATED DATA)
In 2009/10, there were 8,932 people in contact with structured treatment in Greater Manchester, an 11%
increase compared with 2008/09 (n=8,012).[9] Sixty-three per cent of these individuals were male, although
the proportion varied between PCT (Table 27). Individually, the numbers of both males and females in
contact with treatment have increased since 2008/09 (Figure 26). Seven of the ten PCTs in Greater
Manchester experienced an increase in numbers for males. The highest increase was seen in Heywood,
Middleton and Rochdale (by 31%). For females, seven PCTs reported an increase in numbers. The highest
increases were reported in Heywood, Middleton and Rochdale PCT (by 29%) and in Salford (by 25%). For
both males and females, Trafford experienced the largest decrease in Greater Manchester (29% and 18%
respectively). In 2009/10, Manchester PCT had the highest numbers of both males and females in treatment
(1,560 and 778 respectively), more than five times the number of those recorded in Trafford PCT (which had
the lowest numbers). In the financial year to date (April to December 2010), 8,111 people have been in
contact with structured treatment (64% male). Again, the highest proportions were reported in Manchester
PCT for both males and females.
Figure 26: Numbers in structured treatment in Greater Manchester from 2008/09 to 2009/10, by gender[9]
6000
Number
5000
4000
3000
Males
2000
Females
1000
0
2008/09
2009/10
Financial year
Table 27: Numbers in structured treatment in Greater Manchester Primary Care Trusts, by gender[9]
460
429
216
Males
% change
since
2008/09
+3.4%
+10.6%
-18.2%
Year to
date, AprDec 2010
396
334
211
733
+30.9%
1,560
420
620
352
620
220
5,630
+23.1%
+9.1%
+5.6%
-2.2%
+17.6%
-29.3%
+10.5%
Number,
2009/10
Ashton, Leigh and Wigan
Bolton
Bury
Heywood, Middleton and
Rochdale
Manchester
Oldham
Salford
Stockport
Tameside and Glossop
Trafford
Greater Manchester
45
409
271
153
Females
% change
since
2008/09
+18.6%
+23.2%
+4.8%
Year to
date, AprDec 2010
345
210
154
750
446
+28.5%
408
1,421
660
466
282
539
125
5,184
778
203
308
219
369
146
3,302
+20.2%
-1.5%
+24.7%
-6.8%
+6.6%
-18.4%
+13.2%
685
302
240
193
308
82
2,927
Number,
2009/10
The impact of alcohol in Greater Manchester: report no. 8
11.3 Alcohol treatment: characteristics of individuals in treatment (UPDATED DATA)
In 2009/10 in Greater Manchester, the most common age group for individuals in contact with structured
alcohol treatment services was 30 to 44 year olds (41%; 95% CI:40-42%) followed by 45-59 year olds (32%;
95% CI: 31-33%; Table 28). Five per cent were aged under 18 years (95% CI: 4.4-5.3%), 16% were aged 18 to
29 years (95% CI: 15-16%) and 6.3% were aged 60 or over (95%CI: 5.8-6.8%). However, the age of those in
treatment varied significantly by PCT. For example, in Manchester PCT only 2.3% (95% CI: 1.7-3.0%) of those
in structured treatment were aged under 18 (half of that observed for Greater Manchester overall)
compared with 10% in Bolton (95% CI: 8.1-13%) and Bury (95% CI: 7.4-14%). Overall, age groupings have
remained similar in the latest data for April to December 2010. The most common route into structured
alcohol treatment in Greater Manchester in 2009/10 was through a self-referral (33%; 95%CI: 32-34%; Table
29). Routes of referral varied significantly by PCT. Whilst in Bolton, 3.9% of referrals were self-referrals (95%
CI: 2.6-5.6%), this increased to 65% in Stockport (95% CI: 61-69%). Conversely, whilst in Stockport, 4.4% of
referrals were received through substance misuse services (95% CI: 2.9-6.4%), in Bolton, 66% were referred
in this way (95% CI: 63-69%; 16% for Greater Manchester overall; 95% CI: 15-17%). Overall, referral
pathways have remained similar in the updated data for April to December 2010.
Table 28: Age of those in structured treatment in Greater Manchester Primary Care Trusts
Ashton, Leigh and Wigan
Bolton
Bury
Heywood, Middleton and
Rochdale
Manchester
Oldham
Salford
Stockport
Tameside and Glossop
Trafford
Greater Manchester
% of those in treatment in 2009/10 (year to date, Apr to Dec 2010)
60 years and
Under 18 years
18-29 years
30-44 years
45-59 years
over
7.1% (3.8%)
15.4% (14.4%)
42.2% (46.6%)
28.5% (28.5%)
6.7% (6.7%)
10.3% (10.5%)
15.4% (17.3%)
41.7% (39.0%)
26.3% (28.5%)
6.3% (4.8%)
10.3% (14.5%)
16.3% (13.7%)
40.9% (37.5%)
28.7% (31.0%)
3.8% (3.3%)
4.7% (7.4%)
15.7% (13.9%)
42.9% (42.7%)
31.9% (30.6%)
4.7% (5.4%)
2.3% (1.9%)
5.1% (4.3%)
4.5% (3.5%)
3.9% (7.2%)
4.0% (3.5%)
3.6% (2.9%)
4.8% (4.9%)
12.9% (13.2%)
27.0% (22.1%)
15.0% (13.9%)
20.1% (22.3%)
12.9% (13.9%)
15.0% (15.9%)
15.6% (15.5%)
42.8% (40.8%)
32.6% (34.0%)
41.8% (45.8%)
38.5% (34.1%)
41.0% (37.8%)
34.7% (34.8%)
41.0% (40.1%)
34.5% (36.2%)
28.6% (29.6%)
34.6% (31.3%)
31.0% (31.4%)
35.3% (36.8%)
38.5% (38.6%)
32.3% (32.6%)
7.6% (7.9%)
6.7% (10.0%)
4.1% (5.5%)
6.5% (5.1%)
6.8% (7.9%)
8.2% (7.7%)
6.3% (6.9%)
Table 29: Referral route of those in structured treatment in Greater Manchester Primary Care Trusts
% of those in treatment in 2009/10 (year to date, April to December 2010)
Substance
Criminal Justice
General
Self
Other
misuse service
Service
practitioner
27.1% (22.7%)
6.0% (3.4%)
45.8% (54.7%)
3.1% (4.3%)
17.9% (14.9%)
65.9% (68.3%)
3.9% (4.1%)
3.9% (3.2%)
* (*)
25.9% (23.7%)
5.7% (7.4%)
13.0% (11.2%)
32.3% (42.2%)
24.2% (16.4%)
24.7% (22.7%)
Ashton, Leigh and Wigan
Bolton
Bury
Heywood, Middleton and
Rochdale
8.8% (10.7%)
7.1% (11.2%)
48.1% (40.2%)
10.2% (8.5%)
Manchester
9.4% (8.4%)
12.6% (12.6%)
21.3% (20.1%)
24.5% (24.1%)
Oldham
11.7% (8.3%)
13.6% (9.8%)
42.8% (35.3%)
13.1% (8.2%)
Salford
9.5% (9.7%)
9.7% (10.3%)
39.0% (39.9%)
15.7% (12.1%)
Stockport
4.4% (4.6%)
6.7% (6.1%)
65.1% (63.2%)
6.1% (6.1%)
Tameside and Glossop
18.1% (15.1%)
6.9% (12.2%)
29.6% (32.6%)
29.6% (26.6%)
Trafford
4.9% (7.7%)
13.4% (8.2%)
16.7% (10.1%)
29.0% (10.1%)
Greater Manchester
15.9% (14.5%)
9.3% (9.9%)
33.2% (33.1%)
16.5% (14.1%)
Other is undefined. * Proportions have been suppressed as numbers are less than five.
25.8% (29.4%)
32.2% (35.0%)
18.8% (38.4%)
26.0% (28.1%)
17.7% (20.0%)
15.8% (13.6%)
36.1% (63.8%)
25.0% (28.4%)
In 2009/10, there were 4,781 discharges from care in Greater Manchester. Forty-seven per cent of these
were care planned discharges (95% CI: 46-48%) whilst 48% were unplanned discharges (95% CI: 47-50%;
Table 30). Another 4.6% were referred on to other services (95% CI: 4.1-5.3%). Care planned discharges were
46
The impact of alcohol in Greater Manchester: report no. 8
significantly more common in trusts such as Trafford PCT (67%; 95% CI: 60-74%) and Bury PCT (59%; 95% CI%:
52-66%), than Greater Manchester overall. In comparison, unplanned discharges were significantly more
common in trusts such as Manchester PCT (59%; 95% CI: 56-62%) and Salford PCT (58%; 95% CI: 54-62%).
Between April and December 2010, there were 3,789 discharges in Greater Manchester. Over half of these
were care planned (53%; 95% CI: 52-55%), a significantly higher proportion than in 2009/10. Whilst changes
are evident between the data available for 2009/10 and those for April to December 2010, without data for
the full financial year of 2010/11, it is not possible to ascertain whether these are due to an actual change in
discharge patterns or are due to seasonal variations.
Table 30: Discharge reason for those exiting structured treatment in Greater Manchester Primary Care Trusts
% of those in treatment in 2009/10 (year to date, April to December 2010)
Care planned discharge
Unplanned discharge
Referred on
Ashton, Leigh and Wigan
54.7% (65.7%)
32.4% (26.1%)
12.9% (8.2%)
Bolton
53.0% (52.0%)
45.1% (46.1%)
1.8% (1.9%)
Bury
58.9% (71.4%)
39.3% (28.0%)
* (*)
Heywood, Middleton and Rochdale
48.5% (50.1%)
49.0% (47.1%)
2.5% (2.8%)
Manchester
36.6% (44.2%)
59.1% (52.8%)
4.2% (3.1%)
Oldham
53.6% (55.4%)
37.7% (35.8%)
8.7% (8.8%)
Salford
41.4% (55.6%)
58.1% (42.3%)
* (2.1%)
Stockport
52.9% (53.6%)
43.9% (43.2%)
3.2% (3.2%)
Tameside and Glossop
42.2% (54.6%)
51.0% (41.0%)
6.8% (4.4%)
Trafford
66.8% (65.7%)
23.7% (21.0%)
9.5% (13.3%)
Greater Manchester
46.9% (53.3%)
48.4% (42.6%)
4.6% (4.1%)
* Proportions have been suppressed as numbers are less than five.
11.4 Alcohol treatment: summary
In 2009/10, there were 8,932 people in contact with structured treatment in Greater Manchester, an 11%
increase compared with 2008/09. In general, these increases have been witnessed in the majority of PCTs in
Greater Manchester. In 2009/10, Manchester PCT had the highest numbers of both males and females in
treatment (1,560 and 778 respectively), more than five times the number of those recorded in Trafford PCT.
Analysis of the characteristics of those in treatment in Greater Manchester in 2009/10 shows that: 63% were
male; the most common age group was 30 to 44 year olds (41%); and the most common route of referral
was through a self-referral (33%). In 2009/10, there were 4,781 discharges from care in Greater Manchester
(with another 3,789 discharges in Greater Manchester between April and December 2010). However,
characteristics and experiences of those in treatment varied significantly between PCT.
47
The impact of alcohol in Greater Manchester: report no. 8
12.
References
1.
North West Public Health Observatory (2010). Local Alcohol Profiles for England. North West Public Health
Observatory, Liverpool John Moores University. (http://www.nwph.net/alcohol/lape/ Accessed 27 September
2010).
Jones L, Bellis M, Dedman D et al. (2008). Alcohol-attributable fractions for England: alcohol-attributable
mortality and hospital admissions. North West Public Health Observatory, Centre for Public Health Research
Directorate, Liverpool John Moores University, Liverpool.
Thomson SJ, Westlake S, Rahman TM et al. (2008). Chronic liver disease--an increasing problem: a study of
hospital admission and mortality rates in England, 1979-2005, with particular reference to alcoholic liver
disease. Alcohol and Alcoholism. 43 (4):416-22.
Deacon L, Hughes S, Tocque K et al. (2007). Indications of public health in the English regions 8: alcohol.
Association of Public Health Observatories, York.
Burrows M, Sanderson-Shortt K, Morleo M (2010). The impact of alcohol in Greater Manchester. September
2010. Centre for Public Health, Liverpool John Moores University, Liverpool.
Greater Manchester Police (2011). Alcohol-related incidents. Personal communication.
Greater Manchester Probation Trust (2011). Probation data. Personal communication.
Trauma and Injury Intelligence Group (2011). Numbers of assaults presenting of emergency departments in
Greater Manchester. Personal communication.
Centre for Public Health (2011). Numbers in alcohol treatment in Greater Manchester. Personal
communication.
Department for Children Schools and Families (2010). Pupil absence in schools in England, including pupil
characteristics:
2008/09.
Department
for
Education.
(http://www.education.gov.uk/rsgateway/DB/SFR/s000918/index.shtml. Accessed 7 March 2011).
Department for Education (2010). Permanent and fixed period exclusions from schools in England 2008/09.
Department for Education. (http://www.education.gov.uk/rsgateway/DB/SFR/s000942/index.shtml. Accessed
7 March 2011).
Cook P, Tocque K, Morleo M et al. (2008). Opinions on the impact of alcohol on individuals and communities:
early summary findings from the North West Big Drink Debate. Centre for Public Health, Liverpool John
Moores University, Liverpool.
Cook PA, Tocque K, Morleo M et al. (2009). Opinions on the impact of alcohol on individuals and communities:
early summary findings from the NorthWest Big Drink Debate. Appendix B: analysis at local authority level.
Centre for Public Health, Liverpool John Moores University, Liverpool.
Morleo M, Cook PA, Bellis MA (2011). Improving accuracy in recording alcohol consumption: a survey in
Greater Manchester. Centre for Public Health, Liverpool John Moores University, Liverpool.
Bellis MA, Hughes K, Cook PA et al. (2009). Off measure: how we underestimate the amount we drink. Alcohol
Concern, London.
Casswell S, Huckle T, Pledger M (2002). Survey data need not underestimate alcohol consumption. Alcoholism:
Clinical and Experimental Research. 26 (10):1561-7.
Stockwell T, Donath S, Cooper-Stanbury M et al. (2004). Under-reporting of alcohol consumption in household
surveys: a comparison of quantity-frequency, graduated-frequency and recent recall. Addiction. 99 (8):1024-33.
North West Public Health Observatory (2011). LAPE 2010: guidance and methods. North West Public Health
Observatory, Centre for Public Health, Liverpool John Moores University, Liverpool.
NHS Quality Improvement Scotland 2006 (2006). Understanding alcohol misuse in Scotland. Harmful drinking
two: Alcohol and assaults. NHS Quality Improvement Scotland 2006, Edinburgh.
Greater Manchester Transportation Unit (2010). Reported road casualty statistics: Greater Manchester 2009.
Greater Manchester Transportation Unit, Manchester.
Bennet T, Holloway K, Williams T (2001). Drug use and offending: summary results of the first year of the NEWADAM research programme. Home Office research findings 148. Home Office, London.
Strategy Unit (2003). Alcohol misuse: how much does it cost? Prime Minister's Strategy Unit, London.
Bellis MA, Anderson Z, Hughes K (2006). Effects of the Alcohol Misuse Enforcement Campaigns and the
Licensing Act 2003. Centre for Public Health, Liverpool John Moores University, Liverpool.
Flatley J, Kershaw C, Smith K et al. (2010). Crime in England and Wales 2009/10. Home Office, London.
Myhill A, Allen J (2002). Rape and sexual assault of women: the extent and nature of the problem. Home Office,
London.
Hough M, Hunter G (2008). The 2003 Licensing Act's impact on crime and disorder: an evaluation. Criminology
and Criminal Justice. 8 (3):239-60.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
48
The impact of alcohol in Greater Manchester: report no. 8
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
Ci Research Ltd (2007). Market research report for Trading Standards North West: alcohol survey of young
people. Ci Research Ltd, Wilmslow.
Auton C, Hoang L (2009). Market research report for Trading Standards North West. Ci Research Ltd, Wilmslow.
Office for National Statistics (2008). Conception statistics in England and Wales 2006 (provisional). Office for
National Statistics, Newport.
Office for National Statistics (2009). Conception statistics in England and Wales 2007 (provisional). Office for
National Statistics, Newport.
Office for National Statistics (2010). Conception statistics in England and Wales 2008 (provisional). Office for
National Statistics, Newport.
Office for National Statistics (2011). Conception statistics in England and Wales 2009 (provisional). Office for
National Statistics, Newport.
Hibell B, Guttormsson U, Ahlstrom S et al. (2009). The 2007 ESPAD report: substance use among students in 35
European countries. Swedish Council for Information on Alcohol and other Drugs.
Bellis MA, Morleo M, Tocque K et al. (2009). Contributions of alcohol use to teenage pregnancy. Centre for
Public Health Research Directorate, Liverpool John Moores University, Liverpool.
Cook PA, Harkins C, Morleo M et al. (2011). Contributions of alcohol use to teenage pregnancy and sexually
transmitted infection rates. Centre for Public Health, Liverpool John Moores University, Liverpool.
Bellis MA, Morleo M, Hughes K et al. (2010). A cross-sectional survey of compliance with national guidance for
alcohol consumption by children: measuring risk factors, protective factors and social norms for excessive and
unsupervised drinking. BMC Public Health. 10:547.
MORI (2002). Youth survey 2002. Research study conducted for the Youth Justice Board. MORI, London.
Department for Children Schools and Families (2009). Pupil absence in schools in England, including pupil
characteristics:
2007/08.
Department
for
Education.
(http://www.education.gov.uk/rsgateway/DB/SFR/s000832/index.shtml. Accessed 7 March 2011).
Department for Children Schools and Families (2008). Permanent and fixed period exclusions from schools in
England
2006/07.
Department
for
Education.
(http://www.education.gov.uk/rsgateway/DB/SFR/s000793/index.shtml. Accessed 7 March 2011).
Department for Children Schools and Families (2009). Permanent and fixed period exclusions from schools in
England
2007/08.
Department
for
Education.
(http://www.education.gov.uk/rsgateway/DB/SFR/s000860/index.shtml. Accessed 7 March 2011).
Department of Health, National Treatment Agency for Substance Misuse (2006). Models of Care for Alcohol
Misusers. Department of Health, London.
49
Centre for Public Health
Research Directorate
Faculty of Health and Applied Social Sciences
Liverpool John Moores University
2nd Floor, Henry Cotton Campus
15-21 Webster Street
Liverpool
L3 2ET
Tel: 0151 231 4535
Email: [email protected]
[email protected]
www.nwpho.org.uk
www.cph.org.uk
Published: June 2011
ISBN: 978-1-908029-65-2 (web version)
50