Cheshire West and Chester: Alcohol summary
The World Health Organisation estimates that alcohol misuse accounts for almost 9% of the
global disease burden, surpassed only by tobacco and high blood pressure. The impact of
alcohol misuse is wide ranging, encompassing alcohol related illness and injuries as well as
significant social impacts including crime and violence, loss of productivity in the workplace and
homelessness1.
For the National Health Service alone, the estimated financial burden of alcohol misuse is
around £2.7 billion per year in hospital admissions, attendance at accident and emergency,
and in primary care. The overall cost to society of alcohol related harm is estimated to be £21
billion a year2.
Over the last 20 years, alcohol consumption has increased, with more women and children
drinking, and more alcohol being purchased from off-licenses and supermarkets for
consumption at home. However, national surveys also show a lack of awareness of sensible
drinking guidelines and the harm that drinking in excess of these limits can cause. Nationally,
one in four adults drink above the recommended limits with a corresponding increase in alcohol
related problems3.
Key messages
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A higher percentage of Cheshire West and Chester residents aged 16 and over drink
alcohol compared to the England average. Estimates suggest more 65,000 people are
increasing or higher risk drinkers (definition of page two).
Significantly more people in Cheshire West and Chester are thought to binge drink
compared to the England average; this is statistically significant for each of the four
localities.
Alcohol contributes to a reduction in the life expectancy of residents in Cheshire West and
Chester. This reduction is 12.3 months in men aged under 75, and 6.1 months in women
aged under 75. These figures are higher than the England averages.
In the 10 year period 2001-2003 to 2011-2013, early death rates from liver disease in
Cheshire West and Chester have seen a 22% increase. For those in deprived areas the
increase is almost 35%.
There are around 2,000 alcohol related accident and emergency attendances at the
Countess of Chester Hospital each year. Attendees are more likely to be male, aged 15 to
34, and seen at the weekend between the hours of 12am and 2:59am.
Alcohol was linked to 30% of all assaults and deliberate self-harm, accident and emergency
attendances in 2011/12.
Alcohol related crime in Cheshire West and Chester fell by 23% between 2008/09 and
2012/13.
Those at particular risk of alcohol dependency include men, those living in areas of high
deprivation, the lesbian, gay and bisexual population, those who are homeless, offenders,
those with poor mental wellbeing and vulnerable young people.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Visit: www.cheshirewestandchester.gov.uk/ISNA
Contact: [email protected]
Section one: Drinking behaviours
Latest estimates from the Local Alcohol Profiles for England (LAPE) suggest that around 87% of
Cheshire West and Chester residents aged 16 and over drink alcohol (237,300 people). This is a
higher percentage of people than the England average.
Drinking behaviour in Cheshire
West and Chester
Higher
risk
7%
Increasing
risk
21%
Lower
risk
73%
Of those that drink alcohol, 72.5% engage in
lower risk drinking (fewer than 22 units per week
for men and 15 units per week for women). 20.7%
of people engage in increasing risk drinking, and
the remaining 6.8% of people are classed as
higher risk drinkers. A higher risk drinker is a
man who drinks more than 50 units of alcohol per
week, or a woman who drinks more than 35 units
of alcohol per week.
There are an estimated 65,300 people who are
increasing or higher risk drinkers in Cheshire
West and Chester. The percentage of increasing
risk drinkers is higher than the England average
and the percentage of higher risk drinkers is
lower. Neither are statistically significant. People
who are higher risk drinkers are at greater risk of
developing alcohol related ill-health.
Source: Local Alcohol Profiles for England (2014); based on ONS 2013 mid-year population estimates.
The most recent estimates of drinking behaviours for each postcode in England were calculated by
the Alcohol Learning Centre. Across Cheshire West and Chester, the data suggest that the highest
proportion of higher risk drinkers are located in Ellesmere Port, where 15% of people live in
postcodes considered higher risk. This equates to approximately 7,300 people aged 16 plus. Rural
locality has the lowest estimates of high risk drinking at 1% or around 700 people aged 16 plus.
Local Alcohol Profiles for England also estimated the percentage of people who engage in binge
drinking in 2007-08. Binge drinking is defined as a man who drinks eight or more units of alcohol,
or a woman that drinks six or more units of alcohol, on their heaviest drinking day in the last week.
Locally,
24% of people aged 16 and over
.
were estimated to be binge drinkers. This is
significantly higher than the England average
of 20%. This equates to around 64,000 binge
drinkers in Cheshire West and Chester. The
locality with the highest proportion was
Chester (27%, approximately 18,000 people).
Ellesmere Port, Northwich and Winsford and
Rural localities all had binge drinking
estimates of around 22%. All four localities
had rates of binge drinking that were
significantly higher than the England average.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Percentage of people who binge
drink
England
20%
North West
23%
Cheshire West
and Chester
24%
0%
5%
10% 15% 20% 25%
Source: Local Alcohol Profiles for England (2014);
ONS 2013 mid-year population estimates.
Page 2 of 26
Alcohol Summary July 2015
Section two: Accident and emergency presentations
All alcohol related attendances at
Countess of Chester hospital - Cheshire
West and Chester residents between
2007/08 and 2011/12
3000
6%
% of attendances
Between 2007/08 and 2011/12, around
45,000 to 50,000 Cheshire West and
Chester residents attended the accident
and emergency department at the
Countess of Chester Hospital. Alcohol
related attendances accounted for
around 5% of these attendances over the
period; over 2,000 alcohol related
attendances each year.
5%
2500
4%
2000
3%
1500
2%
1000
Number of attendances
For a period of time up to 2011/12, the Countess of Chester hospital collected information on
whether accident and emergency attendances were related to alcohol. The data provided some
understanding of local issues. More recently the hospital has been collecting information based on
the Cardiff Model4, and results are anticipated to be included in future analyses.
The proportion of attendances linked to
500
1%
alcohol remained constant between
0
0%
2007/08 and 2011/12. However, the
number of overall attendances at
accident and emergency increased by
9%. Alcohol related attendances also
% of attendances
Number of attendances
increased by nearly 200 additional
Source: Countess of Chester Hospital
attendances in 2011/12 compared to 2007/08.
Over half of alcohol related accident and emergency attenders present with an injury; either cuts,
bruises, fractures or poisoning.
Alcohol related accident and emergency attendances
Nothing abnormal
2011/12 by diagnosis
detected
5%
Other conditions
including cardiac,
respiratory etc.
9%
Diagnosis
not classifiable
15%
Psychiatric
conditions
8%
Gastrointestinal
conditions
6%
Cuts, bruises,
fractures etc.
34%
Number = 2,391
Poisoning
23%
Source: Countess of Chester Hospital
The cause of the injury is also recorded (patient group), though this may be difficult to determine
and could influence why the majority of attendances cause of injury is coded as ‘other/not known’.
In 2011/12, alcohol was linked to 30% of all assaults and deliberate self-harm attendances.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 3 of 26
Alcohol Summary July 2015
Number of attendances
Alcohol related accident and emergency attendances 2011/12 by
patient group and diagnosis
1800
1600
1400
1200
1000
800
600
400
200
0
Nothing abnormal detected
Diagnosis not classifiable
Other conditions including
cardiac, respiratory etc.
Psychiatric conditions
Gastrointestinal conditions
Poisoning
Road
traffic
accident
Assault Deliberate Other Other/not
self harm accident known
Patient group
Cuts, bruises, fractures etc.
Alcohol impacts on accident and
emergency throughout the day
but particularly at night. Between
00:00 and 02:59 a person is
most likely to present at accident
and emergency with an alcohol
related injury. 24% of all alcohol
related attendances presented
during this three hour period in
2011/12.
% of attendances
Source: Countess of Chester Hospital
30%
25%
20%
15%
10%
5%
0%
The proportion of all attendances
that were alcohol related in
2011/12 also peaked between
00:00-02:59am when almost
one in every five attendances
(18%) was alcohol related.
% of all alcohol attendances
Alcohol related attendances as a % of all attendances
Source: Countess of Chester Hospital
Number of attendances
Weekends see higher numbers
of alcohol related attendances.
During 2011/12, nearly half of
the alcohol related attendances
(41%) occurred on Saturday or
Sunday.
Alcohol related accident and emergency
attendances by time of day - 2011/12
Alcohol related attendances to accident and
emergency by day of the week - 2011/12
600
500
400
300
200
100
0
485
300
298
252
265
507
284
Source: Countess of Chester Hospital
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 4 of 26
Alcohol Summary July 2015
The age profile of people attending
accident and emergency for alcohol
related problems differs to the general
profile of accident and emergency
attenders.
Younger age groups are more likely to
attend accident and emergency for
alcohol related issues. In 2011/12 half
(48%) of all attenders where alcohol was
considered a factor were aged between
15 and 34. This age group also made up
the majority (73%) of attenders for
alcohol related assault.
Accident and emergency admissions
are generally evenly split between men
and women with 51% of attenders were
men in 2011/12. Attenders with
problems related to alcohol are more
likely to be male. In 2011/12, of
attenders for problems related to alcohol
63% were male, and 82% of alcohol
related assault attendances were men.
Although males accounted for more
alcohol related attendances in 2007/8
and 2011/12, in more recent years the
proportion of females attending for
alcohol related reasons has shown a
slight increase.
100%
Accident and emergency attendances by
age group - 2011/12
80%
60%
40%
20%
0%
All attendances Alcohol related Alcohol related
assault
00-14 15-24 25-34 35-44 45-54 55-64 65+
Source: Countess of Chester Hospital
Accident and emergency attendances by
gender - 2011/12
100%
80%
60%
40%
20%
0%
All attendances Alcohol related Alcohol related
assault
Male Female
Source: Countess of Chester Hospital
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Accident and emergency attendances by
Index of deprivation 2010 quintiles - 2011/12
All attendances
Alcohol related
Quintile 1 (most deprived)
Quintile 3
Quintile 5 (least deprived)
Alcohol related
assault
Quintile 2
Quintile 4
The proportion of accident and
emergency attendances linked
to alcohol was consistently
higher for people living in more
deprived areas of Cheshire
West and Chester over 2007/82011/12. In 2011/12, residents
from our more deprived areas
(quintiles one and two) made up
over half of all alcohol related
attenders.
Residents of our most deprived
areas (quintile one) accounted
for 41% of all alcohol related
assault attendances in 2011/12.
Source: Countess of Chester Hospital
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 5 of 26
Alcohol Summary July 2015
Section three: Hospital admissions
Alcohol related conditions include all alcohol specific conditions (e.g. alcoholic liver cirrhosis or
alcoholic induced behaviour disorders) plus those that could be caused in some part by alcohol
(e.g. certain cancers, hypertensive diseases and unintentional injuries). Alcohol attributable
fractions are applied to hospital episode statistics to estimate the impact of alcohol on hospital
admissions. See section 11 – appendix for further detail and changes to definitions.
Women had 694 alcohol related
admissions in 2013/14, a rate of 404
admissions per 100,000 population.
This is an increase on the previous
year but remains significantly lower
than the England female rate of 465.
Alcohol related hospital admissions in
Cheshire West and Chester have fallen
since 2008/09, from 570 admissions
per 100,000 population, to 561
admissions per 100,000 in 2013/14.
Rates have been lower than England
rates throughout this 6 year period.
Cheshire West and Chester has seen a
drop of 2% in all alcohol related
hospital admissions compared to a 5%
increase nationally.
Admission episodes for alcohol-related
conditions 2013/14
900
800
700
600
500
400
300
200
100
0
Male
Male
Female
Female
Cheshire
West and
Chester
England
Cheshire
West and
Chester
England
Source: Local Alcohol Profiles for England, 2015
Directly standardised rate
per 100,000
Men have a higher rate of alcohol
related admissions then women.
Around two thirds (63%) of Cheshire
West and Chester’s alcohol related
admissions to hospital in 2013/14
were male. Men had 1,165
admissions, a rate of 736 admissions
per 100,000 population. This is lower
than the previous year and is
significantly lower than the England
rate of 835.
Directly standardised rate per
100,000
There were 1,859 alcohol related hospital admissions for Cheshire West and Chester residents in
2013/14 (based on the narrow definition used in the public health outcomes framework. Refer to
section 11 page 25 for definition). At a rate of 561 admissions per 100,000 population, this is
significantly lower than the England rate of 645.
Admission episodes for alcohol related
conditions - persons annual trend
800
600
400
200
0
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Cheshire West and Chester - Persons
England - Persons
Source: Local Alcohol Profiles for England, 2015
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 6 of 26
Alcohol Summary July 2015
800
600
400
200
0
Source: Local Alcohol Profiles for England, 2015
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
CWAC - Female
England - Female
CWAC - Male
England - Male
Alcohol related hospital admissions 2012/13
(old definition)
Ellesmere Port
Northwich &
Winsford
Rural
Chester
2,500
2,000
1,500
1,000
500
0
NHS West
Cheshire
NHS Vale Royal
Data for 2012/13 provides an
indication of which areas within
Cheshire West and Chester
experienced higher rates of hospital
admissions as a result of alcohol.
1000
England
Cheshire West &
Chester
Local data are not yet available to
replicate the new ‘narrow’ definition
used in the public health outcomes
framework. However, the old
definition is very close to the broad
measure published within Local
Alcohol Profiles for England.
Admission episodes for alcohol related
conditions- gender annual trend
Directly standardised rate per
100,000 people
In contrast, admission rates for
women increased by 5% in
Cheshire West and Chester from
386 per 100,000 populations in
2008/09 to 404 admissions per
100,000 in 2013/14. This is an
increase of 5% and follows a
similar trend to the England rate
which increased by 7% over the
same time period.
Directly standardised rate
per 100,000 people
The trend is different for men and
women. Admission rates for men
have fallen from 775 admissions
per 100,000 population in 2008/09,
to 736 admissions per 100,000 in
2013/14, a drop of 5% compared
to a 4% increase for England.
Localities
Source: Hospital Episode Statistics 2012/13, Health and
The locality with the highest rate of
Social Care Information Centre.
hospital admissions due to alcohol is
Ellesmere Port. The rate here is 23% higher than the overall Cheshire West and Chester rate and
is significantly higher than any other locality in Cheshire West and Chester as well as the England
average.
High rates are not limited to Ellesmere Port however. There are small areas across the borough
that experience significantly high rates of alcohol related admissions. These are often amongst our
most deprived areas.
Of the ten lower super output areas (LSOA) (small areas) with the highest admission rates in
Cheshire West and Chester, eight are LSOAs considered amongst the 20% most deprived in
England. A further two are among the 40% most deprived. These areas include Whitby,
Westminster, Wolverham and Rivacre in Ellesmere Port and Central Chester, Blacon and Lache in
Chester and Winnington in Northwich.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 7 of 26
Alcohol Summary July 2015
Top 10 lower super output
areas
Locality
Number of
admissions
Rate of
admissions
per 100,000
Whitby West L3
Chester Station L2
Westminster and Central L5
Statistical
significance
compared to
England
High
High
High
Ellesmere Port
49
5,184
Chester
86
4,463
Northwich and
97
4,453
Winsford
North Blacon L3
Chester
59
4,203
High
Wolverham and Stanlow L5
Ellesmere Port
73
4,042
High
Winnington and North Witton Northwich and
80
4,005
High
L2
Winsford
Lache Park L1
Chester
59
3,922
High
North Rivacre L4
Ellesmere Port
53
3,869
High
Chester Central L1
Chester
99
3,735
High
Wolverham and Stanlow L2
Ellesmere Port
38
3,677
High
Source: Hospital Episode Statistics 2012/13, Health and Social Care Information Centre
All alcohol admissions
IMD Q3-Q5
IMD Q1-Q2
Cheshire West
and Chester
England
IMD Q3-Q5
IMD Q1-Q2
Cheshire West
and Chester
3000
2500
2000
1500
1000
500
0
England
Locally calculated data for
2012/13 shows that for our
population living in areas
ranked in the 40% most
deprived in England, the rate of
admission is 50% higher than
the Cheshire West and Chester
average. For alcohol specific
conditions, our most deprived
population are twice as likely to
be admitted to hospital as the
borough average.
Hospital admissions due to alcohol - financial
year 2012/13
Directly standardised rate per
100,000
People who live in areas of
high deprivation are more likely
to be admitted to hospital due
to alcohol related conditions.
Alcohol specific
admissions
Source: Hospital Episode Statistics 2012/13, Health and Social Care
Information Centre
There are relatively small numbers of alcohol specific admissions for young people aged under 18
so rates are calculated for three year pooled periods.
In the period 2011/12-2013/14, 85 people aged under 18 were admitted to hospital for alcohol
specific conditions in Cheshire West and Chester. The rate of 41.9 admissions per 100,000 is
higher than the England rate of 40.1 per 100,000 but is not statistically significant.
Since 2006/07-2008/09, the rate of alcohol specific hospital admissions for those under 18 years
old fell by 55% in Cheshire West and Chester, this compares to a drop of 41% nationally.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 8 of 26
Alcohol Summary July 2015
Directly standardised rate per
100,000
Alcohol specific hospital admissions - under 18s
100
90
80
70
60
50
40
30
20
10
0
2006/07 - 08/09 2007/08 - 09/10 2008/09 - 10/11 2009/10 - 11/12 2010/11 - 12/13 2011/12 - 13/14
Cheshire West and Chester
England
Source: Local Alcohol Profiles for England 2015
Section four: Alcohol related deaths
In Cheshire West and Chester, an
estimated 12.3 months of life
were lost in life expectancy at
birth for men, because of alcohol
related deaths in people aged
under 75 during 2011-13. This is
higher than the England average
of 12.0 months.
Months of life lost due to alcohol - under 75
three year pooled
15
Months of life lost
Alcohol contributes to a reduction
in the life expectancy of residents
in Cheshire West and Chester
contributing to earlier death from
a number of conditions5.
The equivalent estimate for
women is 6.1 months of life lost,
this is also more than the England
average of 5.6 months.
10
5
0
2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13
Female - Cheshire West and Chester
Male - Cheshire West and Chester
Female -England
Male - England
Source: Local Alcohol Profiles for England 2015
During the calendar year 2013, estimates using the alcohol attributable fractions suggest there
were 164 alcohol related deaths in Cheshire West and Chester. Of these, around 45 deaths were
specifically caused by alcohol (based on 2011-13 deaths).
Alcohol specific mortality has remained fairly static in England since 2006-2008, with a mortality
rate of approximately 16.6 per 100,000 population for males and 7.5 per 100,000 for females.
Alcohol specific outcomes include those conditions where alcohol is causally implicated in all
cases of the condition; for example, alcohol-induced behavioural disorders and alcohol related
liver cirrhosis. The alcohol attributable fraction is 1.0 because all cases (100%) are caused by
alcohol.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 9 of 26
Alcohol Summary July 2015
Alcohol specific mortality trend
Directly standardised rate per
100,000
Cheshire West and Chester
rates have been consistently
higher than the national
average. For the period 200608 to 2008-10, alcohol specific
mortality was significantly
higher than England for men.
However alcohol specific
mortality for men in Cheshire
West and Chester has reduced
and more recently is not
significantly different to
England.
25
20
15
10
5
0
2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13
Male - Source:
CWAC Local Alcohol Profiles
Malefor
- England
England 2015
Female - CWAC
Female - England
Alcohol specific mortality rates
Source: Local Alcohol Profiles for England 2015
for females in Cheshire West
and Chester have fluctuated. The rate for the period 2011-13 was higher than the previous three
year period and was significantly higher than England.
During 2010-12, Cheshire West and Chester had an average of 44 alcohol specific deaths a year:
• Most were people aged under 75 (97%)
• Two thirds were men (66%)
• The majority of deaths were from alcoholic liver disease (87%)
Directly standardised Rate per
100,000
Alcoholic liver disease accounts for a large proportion of alcohol specific deaths. On average, 37
people under the age of 75 (22 men and 15 women), die each year in Cheshire West and Chester
from alcoholic liver disease. At a rate of 11.9 per 100,000 population, this is significantly worse
than the England rate of 8.7 per 100,000.
Under 75 mortality rate from alcoholic liver disease (ICD10 K70) 2011-2013
20
18
16
14
12
10
8
6
4
2
0
Cheshire England - Cheshire England Cheshire England West and
male
West and female
West and persons
Chester Chester Chester male
female
persons
Source: Public Health England Liver Disease profiles 2014
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 10 of 26
Alcohol Summary July 2015
Whilst the majority of alcohol harm is seen in men, there is concern for women in Cheshire West
and Chester. Women have a significantly higher rate of premature death from alcoholic liver
disease than the England average. There are also signs that the risk for women is increasing.
Between 2010-12 and 2011-13 the rate increased from 8.1 to 9.3 per 100,000 while the rate for
men decreased from 16.1 to 14.6 per 100,000.
Alcoholic liver disease deaths account for two thirds of all premature liver disease deaths in
Cheshire West and Chester. Local analysis of liver disease mortality provides some understanding
of communities who are most at risk.
Since 2001-2003, death rates from liver disease have been increasing in England in contrast to
the rest of Europe where liver disease death rates are falling. Alcohol is the most common
cause of liver disease in England. Alcoholic liver disease accounts for over a third of liver
disease deaths. The more someone drinks above the lower risk guideline, the higher their risk of
developing liver disease. The UK is one of the few European countries where alcohol
consumption has risen in the last 50 years
England
Cheshire West
and Chester
West Cheshire
CCG
Vale Royal CCG
Northwich and
Winsford
Rural
Ellesmere Port
In Cheshire West and Chester the
rate of premature mortality from
liver disease is similar to the
England average but there are
significant differences within the
borough.
Liver disease all persons under 75 mortality
by locality 2011-2013
40
35
30
25
20
15
10
5
0
Chester
During the three years 2011-2013,
there were 173 deaths in Cheshire
West and Chester of people aged
under 75 from liver disease, an
average of 58 deaths per year.
Around two thirds (63%) of these
local premature deaths were from
alcoholic liver disease.
Directly standardised rate per
100,000
Liver disease deaths in the under 75s are monitored by Public Health England (PHE) in the public
health outcomes framework (PHOF). Most liver disease is preventable and much is influenced by
alcohol consumption and obesity prevalence, which are both amenable to public health
interventions. Alcoholic liver disease accounts for a large proportion of all liver disease deaths in
the younger, under 75, age group.
During 2011-13, Ellesmere Port
Source: Primary care mortality database, ONS Mid year
locality recorded a mortality rate of
population estimates
27.8 deaths per 100,000 population
aged under 75 from liver disease, significantly higher than the England average. In contrast, Rural
locality recorded a rate of 11.0 per 100,000, the lowest in Cheshire West and Chester, and
significantly lower than both the borough and England rates.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 11 of 26
Alcohol Summary July 2015
In the 10 year period between 2001-2003 and 2011-2013, liver disease mortality for people aged
under 75 in Cheshire West and Chester increased by 23% from 15.4 deaths per 100,000 to 18.8
per 100,000. The England rate for the same time period increased by 13% from 15.8 to 17.9 per
100,000 population.
Locally since 2001-2003, Ellesmere Port locality has seen the largest increase in premature liver
disease mortality in Cheshire West and Chester, with a 73% increase from 16.0 deaths per
100,000 population in 2001-2003 to 27.8 in 2011-2013. However the latest 3 year pooled data
shows a slight decrease since peaking in 2010-2012, at 32.2 deaths per 100,000 population.
Liver disease mortality in Ellesmere Port locality has been significantly higher than the England
rate since 2008-2010.
Rural locality has seen the only decrease in liver mortality rates in Cheshire West and Chester,
with a 3.6% decrease between 2001-2003 and 2011-2013.
Liver disease all persons under 75 mortality - trend by local authority
locality (ICD codes B15-B19, C22, I81, I85, K70-K77, T86.4)
Directly standardised rate per
100,000
40
30
20
10
0
Chester
Rural
Cheshire West andChester
Ellesmere Port
Northwich and Winsford
Source: ONS Annual death extract, ONS Mid-year population estimates
There is a link between premature mortality from liver disease and relative levels of deprivation in
the community. Mortality rates are significantly higher in more deprived areas of Cheshire West
and Chester compared with less deprived areas. Local areas considered amongst the 20% most
deprived in the country (quintile1) experience significantly higher rates than the England average.
Areas considered amongst the least deprived 20% deprived in England (quintile 5) experience
significantly lower mortality from liver disease than the England average.
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
Page 12 of 26
Alcohol Summary July 2015
Directly standardised rate per
100,000
Liver disease all persons under 75 mortality by deprivation 2011-2013
60
50
40
30
20
10
0
Q1
most
deprived
Q2
Q3
Q4
Q5
least
deprived
Cheshire England
West
and
Chester
IMD quintiles
Source: Primary care mortality database, ONS mid-year population estimates, IMD 2010
There is increasing inequality in liver disease mortality as rates have increased most in our more
deprived areas. Liver disease mortality in the under 75s, in the more deprived areas (quintiles 1
and 2) of Cheshire West and Chester, has seen a 34.6% increase between 2001-2003 and 20112013. Rates have remained significantly higher than the national rate throughout this 10 year
period.
Directly standardised rate per 100,000
For men, the rate remains significantly high in more deprived areas but there has been a slight
decrease in mortality rates over more recent time periods.
Cheshire West and Chester, liver disease, male, under 75 mortality by
deprivation
60
50
40
30
20
10
0
2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 20112003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Cheshire West and Chester Q1-Q2
Cheshire West and Chester Total
Linear (Cheshire West and Chester Q1-Q2)
Cheshire West and Chester Q3-Q5
England
Linear (Cheshire West and Chester Q3-Q5)
Source: Primary care mortality database, ONS Mid-year population estimates, IMD 2010
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Alcohol Summary July 2015
Directly standardised rate per 100,000
Women living in the more deprived areas of Cheshire West and Chester have experienced
increasing rates of early death from liver disease, widening the inequality gap.
Cheshire West and Chester, liver disease, female, under 75 mortality by
deprivation
25
20
15
10
5
0
2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 20112003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Cheshire West and Chester Q1-Q2
Cheshire West and Chester Total
Linear (Cheshire West and Chester Q1-Q2)
Cheshire West and Chester Q3-Q5
England
Linear (Cheshire West and Chester Q3-Q5)
Source: Primary care mortality database, ONS Mid-year population estimates, IMD 2010
Section five: Alcohol related crime
Cheshire West and Chester’s
alcohol related crime rate of 4.86
crimes per 1,000 people is
significantly lower than the England
rate of 5.74 per 1,000. The rates for
alcohol related violent and sexual
crimes are not significantly different
than England.
Of alcohol related crimes, 77% were
violent in Cheshire West and
Chester. Nationally, 68% of alcohol
related crimes were violent. In
addition, 2% of alcohol related
crimes were sexual crimes in
Cheshire West and Chester, similar
to the national rate.
Part of Cheshire West and Chester’s
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Crude rate per 1,000
population
Estimates published in the Local Alcohol Profiles for England suggest that in 2012/13 there were
1,602 crimes in Cheshire West and Chester attributable to alcohol. Of these crimes, 1,235 were
classified as alcohol-attributable violent crimes (77%).
7
6
5
4
3
2
1
0
Alcohol related recorded crime by type
2012/13
Alcohol related Alcohol related Alcohol related
recorded crime violent crime
sexual crime
Cheshire West and Chester
England
Source: Local Alcohol Profiles for England 2014
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Alcohol Summary July 2015
Alcohol related crime in Cheshire West and Chester fell by 23% between 2008/09 and 2012/13.
Nationally, the rate fell by 21% in the same time period. The rate of alcohol related violent crime
fell by 17% in Cheshire West and Chester compared to 18% nationally. The rate of alcoholattributable sexual crime did not change in Cheshire West and Chester compared to a 3%
increase nationally in the same time period.
Crude rate per 1,000
Alcohol related crime trend
6
5
4
3
2
1
0
2008/09
2009/10
2010/11
Cheshire West and Chester: Violent crime
Cheshire West and Chester: Other crime
2011/12
2012/13
England: Violent crime
England: Other Crime
Source: Local Alcohol Profiles for England (2014)
Recorded incidents of
domestic violence have
reduced in Cheshire West
and Chester from 1,383 in
2009/10 to 1,141 in
2013/14.
Percentage of all recorded domestic violence
involving alcohol in Cheshire West and Chester
60%
49%
50%
44%
40%
43%
37%
40%
Incidents involving alcohol
appear to account for a
large proportion of the
reduction. In 2009/10, there
were 678 incidents, almost
half (49%) of all recorded
domestic violence, that
involved alcohol. This had
reduced to 423 incidents, or
37%, in 2013/14.
30%
20%
10%
0%
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2009/10
2010/11
2011/12
2012/13
2013/14
Source: Child and Vulnerable Adult Database (CAVA)
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Alcohol Summary July 2015
Section six: At risk groups
Whilst alcohol dependence can affect anyone, those most vulnerable with a background of
trauma, abuse, neglect and poverty are disproportionality affected (Cheshire West and Chester
Health and Wellbeing Strategy, 2015)6.
Alcohol specific mortality trend
Directly standardised rate per
100,000
Age and gender
Men account for two out of
every three alcohol specific
deaths, two out of three alcohol
related admissions to hospital
and two out of three alcohol
related accident and emergency
attendances during 2011-13.
The impact of alcohol on the
health of both men and women
appears to be reducing with the
exception of women living in our
more deprived areas.
25
20
15
10
5
0
2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13
Male - CWAC
Female - CWAC
Male - England
Female - England
Liver disease mortality analysis
Source: Local Alcohol Profiles for England 2015
in Cheshire West and Chester
indicates that rates for women are higher than the England average and have been increasing in
our more deprived areas.
The impact of alcohol is seen in younger age groups with the majority of alcohol specific deaths in
people under the age of 75. Younger age groups are also more likely to attend accident and
emergency for alcohol related issues. In 2011/12 half (48%) of all attenders where alcohol was
considered a factor were aged between 15 and 34. This age group also made up the majority
(73%) of attenders for alcohol related assault.
Under 18s
In the period 2011/12-2013/14, 85 people aged under 18 were admitted to hospital for alcohol
specific conditions in Cheshire West and Chester. The rate of 41.9 admissions per 100,000 is
higher than the England rate of 40.1 per 100,000 but is not statistically significant.
Since 2006/07-2008/09, the rate of alcohol specific hospital admissions for those under 18 years
old fell by 55% in Cheshire West and Chester, this compares to a drop of 41% nationally.
Deprivation
People who live in areas of high deprivation are more likely to drink at high risk levels and
experience the adverse effects on their health. Ellesmere Port has the highest estimate of high
risk drinkers within the locality populations. Hospital admissions are significantly higher in our
more deprived areas, with our most deprived population twice as likely to be admitted to hospital
for alcohol specific conditions compared to the borough average.
Alcohol contributes to a reduction in life expectancy and premature mortality from liver disease is
significantly higher in our more deprived areas. The inequality gap is widening for women.
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Alcohol Summary July 2015
Locality
Ellesmere Port locality is highlighted in a number of indicators of alcohol harm, as experiencing
significantly worse levels of harm than the England average. Liver disease mortality has been
increasing between 2008-10 and 2010-12 and has been significantly higher during this time. 201113 has seen a drop in the mortality rate for Ellesmere Port although the locality remains
significantly higher than England.
The locality with the highest rate of hospital admissions due to alcohol is Ellesmere Port, with a
rate of 2,191 per 100,000 people. This is 23% higher than the overall Cheshire West and Chester
rate and is significantly higher than England.
Lesbian, gay and bisexual population
Nationally, around 41% of lesbian, gay and bisexual (LGB) people drink alcohol three or more
days a week compared to around 35% of the general population7. Binge drinking is almost twice
as common for LGB people. Alcohol consumption is sometimes used as an unhealthy ‘coping’
mechanism for those who have experienced, or fear, rejection and homophobia. Those who have
experienced a hate crime are even more likely to engage in behaviours that pose a risk to their
health.
Homelessness
Alcoholism can be a cause of homelessness, but those who are homeless are at an increased risk
of escalating substance misuse and may not access the support they need. National trends show
that alcohol is the most prevalent drug dependency amongst the homeless population as alcohol
dependency has increased and heroin dependency has declined8. Alcohol has a significant
impact on a homeless individual’s ability to access temporary accommodation. In Cheshire West
and Chester, drug and alcohol misuse was given as one of the main reasons for individuals being
excluded from supported accommodation9.
Vulnerable young people
In a 2013 national survey, 39% of 11 to 15 year olds had drank alcohol at least once and 9% had
drunk alcohol in the last week. This demonstrates a downward trend since 2003 when 61% of
pupils had drank alcohol at least once and 25% had drunk alcohol in the last week10.
However, there are children and young people who are at higher risk of drinking alcohol and of
regularly drinking alcohol. Young people belonging to more than one vulnerable group are most at
risk, including children in care, care leavers, young offenders, homeless youth, those affected by
domestic abuse, those displaying anti-social behaviour, persistent truants, those excluded from
school, those not in education, employment or training (NEET) and those with parents or carers
who are substance misusers.
Offenders
Nationally, there is a high level of need in relation to alcohol and drug misuse amongst offenders.
In 2012, across Cheshire 60% of offenders in the community had alcohol assessed as a problem
that contributed to their offending behaviour. 47% of offenders in the community had current
alcohol misuse issues, 52% had binge drinking problems and 53% had a history of alcohol related
violence. 53% of offenders entering prison had alcohol misuse needs. Female offenders had the
most serious levels of current alcohol misuse problems, binge drinking and associated needs.
Alcohol is a key factor in re-offending11.
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Alcohol Summary July 2015
Mental wellbeing score
Poor mental wellbeing
According to the Mental Health
Foundation, alcohol problems are more
common among people with severe
mental health problems. This does not
necessarily mean that alcohol causes
severe mental illness but that those with
severe mental illness are more likely to
drink alcohol to deal with difficult feelings
or symptoms of mental illness. Alcohol
can however make existing mental health
problems, such as depression, worse. In
the North West Mental Wellbeing Survey
(2012/13), people classed as high risk
drinkers had lower mental well-being
compared to lower risk and increasing risk
drinkers12.
Mean mental wellbeing score by alcohol
consumption 2012/13 - North West
35
30
25
20
15
28.16
27.89
10
25.25
5
0
Lower risk Increasing risk Higher risk
drinker
drinker
drinker
Alcohol consumption
Source: North West Mental Wellbeing Survey, 2013
Section seven: Alcohol treatment services
This section refers to the number of adults (18 and over) in contact with alcohol treatment
providers and general practitioners in Cheshire West and Chester and England in 2013/14, and the
proportions of clients exiting treatment who completed treatment having overcome their
dependency.
The data reports figures based on adults whose treatment falls within the definition of the National
Treatment Agency for substance misuse’s ‘Model of Care’ as “treatment following assessment and
delivered according to a care plan, with clear goals, which is regularly reviewed by the client”. This
does not include clients in prisons.
From 1 February 2015, Cheshire West and Chester has a single provider delivering alcohol
treatment services.
According to the National Drug Treatment Monitoring system, there were 627 people engaged in
alcohol only treatment during the financial year 2013/14 in Cheshire West and Chester borough.
Of these, 67% were new presentations to treatment. This compares to a rate of 72% of new
presentations in England. 44% of all new presentations to alcohol services in Cheshire West and
Chester were referred by ‘themselves, family and friends’; the rate for this referral source in
England is 45%.
Region
Cheshire West and Chester
England
% of new presentations
referral source: ‘self,
family and friends’
627
67%
44%
87,943
72%
45%
Source: National Drug Treatment Monitoring System, 2013/2014
Number engaged
in treatment
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% of new
presentations
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Alcohol Summary July 2015
Waiting times
For the financial year 2013/2014, 99% of
people received treatment within three
weeks of engaging with local alcohol
services compared to 93% of all people
engaging with services in England.
Region
Cheshire West and Chester
England
% of waiting
times under three
weeks
99%
93%
Source: National Drug Monitoring System, 2013/2014
Discharges
Between April 2013 and March 2014, 382 people in Cheshire West and Chester exited treatment.
66% of people discharged from treatment did so through a planned exit (253 people) compared to
28% of unplanned discharges. This compares to 62% of planned exits and 30% unplanned exits
from treatment in England for the same period.
Successful completions
Successful completions are the proportion of the total treatment population that have successfully
completed treatment leaving the treatment system i.e. they have been successfully discharged
from all treatment providers involved in their treatment journey.
Region
Cheshire West
and Chester
England
Number in
treatment
Number of
successful
completions
% of successful
completions
627
253
40%
87,943
34,561
39%
The proportion of clients
successfully completing
treatment in Cheshire
West and Chester is
40% in line with the
national rate.
Source: National Drug Treatment Monitoring System
Latest completion period: 1 April 2013 to 31 March 2014
Re-presentations
Re-presentations measure the number of clients that successfully complete treatment and
subsequently re-present to treatment, anywhere in England, within six months. Re-presentation
rates are used as a proxy measure of recovery as it is assumed that those clients who do not represent to treatment have maintained their recovery. However, re-presenting to treatment should
not necessarily be viewed as purely negative. The fact that clients re-engage with support when
they need it should be viewed as a positive reflection of the local treatment system.
10% of people in Cheshire
West and Chester successfully
completed treatment and
subsequently re-presented
themselves within six months;
this is lower than the national
rate of re-presentations.
Region
Cheshire West and Chester
England
% of clients re-presenting to
services within 6 months of
successful completion
10%
12%
Source: National Drug Treatment Monitoring System
Latest completion period: 1 April 2013 to 30 September 2014,
re-presentations up to 31/03/2014
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Alcohol Summary July 2015
Alcohol consumption on a monthly basis
The amount of alcohol consumed on a monthly basis (in the last 28 days) varies between clients
of the alcohol rehabilitation centre in Cheshire West and Chester. Of all clients, 4% had abstained
from alcohol, 64% had consumed between 1-199 units and 3% had consumed 1000 units or more.
Region
Cheshire West and
Chester
England
Abstinent
1-199
units
200399
units
400599
units
4%
64%
11%
7%
600-799 800-999
units
units
4%
5%
1000+
units
3%
7%
19%
19%
20%
11%
9%
12%
Source: National Drug Treatment Monitoring System, 2013/2014
Demographics of clients
55% of clients in treatment were male, compared to the national rate of 62% male. 93% were
white British, compared with 86% nationally (reflecting the ethnic group make up of Cheshire West
and Chester).
11% of all new presentations to alcohol treatment services in Cheshire West and Chester
identified that they had an urgent housing need, compared to 3% nationally. 86% of clients did not
have a housing need in the borough.
Region
No fixed abode – Housing
No
Other housing
Urgent housing
problem
housing
problem/not
problem
problem
answered
Cheshire West and Chester
11%
2%
86%
1%
England
3%
8%
84%
5%
Source: National Drug Treatment Monitoring System quarter four, 2013/2014
22% of new clients were parents living with their children, this compares to 20% of all new clients
in England recorded as parents living with their children.
Region
Parent
living with
own
children
Other child
contact –
living with
children
Other child
contact- Parent
not living with
children
Not a
parent/no
child
contact
Cheshire West and
22%
5%
28%
43%
Chester
England
20%
6%
27%
45%
Source: National Drug Treatment Monitoring System quarter four, 2013/2014
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Blank
response
3%
2%
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Alcohol Summary July 2015
Section eight: Local initiatives and strategies
Cheshire West and Chester Health and Wellbeing Strategy 2015-20
Supporting everyone to live a healthy lifestyle is a high level outcome in the Health and Wellbeing
Strategy along with improving mental health and wellbeing, giving every child the best start in life
and older people having the best possible quality of life. Alcohol abuse is a key issue that can
impact upon each of these outcomes, affecting the health, wellbeing and quality of life of all
residents - personally, as part of a family or in the wider population.
The approach being taken by Cheshire West and Chester is:
• Prevention and early detection to tackle unhealthy behaviours before they become harmful
• Identifying and reducing health inequalities to close the inequalities gap
• Working with partners in the public, voluntary and community sectors to tackle shared
challenges and find shared solutions; building a stronger foundation to deliver efficient and
effective services
• Decisions about services and programmes to be based upon the best available evidence
• Changing personal behaviour by empowering individuals to make healthy choices
Key objectives specifically around alcohol misuse include:
• Work closely with families to provide early interventions and prevention programmes
• Provide a high quality substance misuse service for children, young people and adults
• Support a recovery focused system that empowers individuals to sustain their own
recovery.
Cheshire West and Chester Integrated Early Support Strategy
The Integrated Early Support Strategy delivered by the Children’s Trust takes a ‘whole family’
approach, recognising that the problems of individuals impact upon the family unit. The focus of
the strategy is intervening in a joined up way at the earliest possible stage to tackle problems
emerging for children, young people, vulnerable adults and families, or with a population most at
risk of developing problems.
Key objectives related to alcohol misuse include:
• Identify, support and respond to domestic abuse and its effects on children and adults to
reduce incidents and impact on domestic abuse on communities by challenging
perpetrators – alcohol is a key influencing factor
• Ensure that people who ‘miss out’ in the early years are offered an integrated early support
offer to address issues such as substance misuse and wider issues such as housing
• To use innovative, integrated commissioning approaches to service improvement and
redesign which looks at service user led pathways
Sub-regional Alcohol Strategic Group
A sub regional Alcohol Strategic Group was set up in 2014, to develop and test opportunities to
reduce alcohol related harm sub-regionally. Key work streams include the review of referral
pathways to alcohol services for victims and offenders, developing and commissioning a coordinated Cheshire education programme, supporting the implementation of minimum unit price in
Cheshire, implementing the ‘Cardiff Model’ in Accident and Emergency departments and Police
custody suites, and exploring the implementation of the ‘Ipswich Model’ voluntary restriction on
sale of high strength alcohol in targeted areas.
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Alcohol Summary July 2015
Cumulative Impact Policy (CIP) for Chester City area
The Council introduced a Cumulative Impact Policy (CIP) for the Chester City area in 2014. This
is to address the potential impact on the promotion of the licensing objectives as a result of the
concentration of premises within an area. The licensing objectives are:
• the prevention of crime and disorder
• public safety
• the prevention of public nuisance
• the protection of children from harm
This Policy requires all new applications for a premises licence to sell alcohol, and in some cases
existing ones, to demonstrate how their premises or proposed premises will not have a detrimental
effect on the licensing objectives within the area covered by the policy. In 2013 the consultation
results for the policy identified high levels of concerns about issues happening late at
night. However, there has been a steady increase in the number of concerns raised about issues
during daylight hours, in particular issues caused by “street drinkers”. This is in not only in the CIP
area but also in other areas, most notably within Ellesmere Port Town Centre. It is likely that the
next review of the CIP and the Council’s Statement of Licensing Principles will reflect this.
Responsible Drinking Zones
Chester city centre is a responsible drinking zone meaning that the Police and Community Safety
Wardens have the power to remove alcohol from people deemed to be causing, or likely to cause,
a nuisance whilst drinking in public. The intention is to reduce incidents of alcohol related crime
and disorder within the city centre.
ArcAngel Scheme
A number of Chester City centre pubs, bars and nightclubs have agreed a set of standards for
serving alcohol that adhere strictly to drinking regulations. Staff receive training to minimise the
risk of alcohol related crime by discouraging excessive drinking.
Cardiff Model
The Cardiff Model pilot has been successfully rolled out with the Countess of Chester hospital
accident and emergency department now collecting details of alcohol related violent incidents.
This then allows the analysis to identify trends and hotspots within the city centre.
Street Pastors
The Street Pastors Scheme which started in West Cheshire in 2011, operates in Chester City
centre and Ellesmere Port every Friday and Saturday night, plus bank holiday Sundays and race
nights until around 3am. Street Pastors are local Christians who receive training from the police
and specialist services e.g. drug awareness, to go out into the local area to provide assistance
where needed.
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Alcohol Summary July 2015
Section nine: Evidence of what works
Commissioning guidance from the Department of Health (2010)13, identified interventions to
reduce alcohol-related harm that were calculated as being most effective and cost-effective.
These are called ‘high impact changes’; practical measures that can be implemented at a local
level and have been extensively used across the NHS and local government.
High impact changes include:
• Working in partnership
• Improving the effectiveness and capacity of specialist services
• Increasing the number of alcohol liaison nurses
• Increasing the use of alcohol harm identification and brief advice
• Promotion of national campaign messages locally
The 2013 report ‘Helping service users to engage with treatment and stay the course’14 informs us
that service users are most likely to drop out in the early stages of treatment. The nature,
organisation and approach of the service, and the attitudes and behaviours of staff and the
interventions they provide can have a positive influence on retention. Evidence shows that the
following can make a difference to positive engagement:
• Make key information visible and easy to understand
• The first point of contact must be welcoming and non-judgemental
• Run a formal induction
• The environment must be inviting and promote a positive culture
• Send reminders, if possible personal and encouraging
• Provide rapid access to prescribing treatment and appointments
• Remove barriers to access including transport, flexibility and childcare
• Be culturally sensitive and embrace equality and diversity
• Recovery should be visible
• Provide outreach services, particularly to high risk groups such as released prisoners and
those who are homeless
• Use motivational therapeutic style interviewing alongside treatment
Public Health England (2013)15 emphasises the use of structured therapeutic work with service
users which includes goal setting, identifying wider problems, minimising harm, and skills training
to build and maintain recovery in the community. This is supported though the provision of
information and building social support such as mutual aid. The aim is to empower the client and
sustain the recovery process preventing relapse.
There is evidence that mutual aid groups such as “12 step” has a positive impact on substance
misuse outcomes if the attendee actively participates in the group16. Therefore treatment staff
should routinely provide service users with information about mutual aid groups, or set up a group,
alongside structured treatment. Mutual aid can also reduce rates of relapse and re-presentation.
Evidence shows that non-medical prescribers improve patient’s access to medicines and provides
the opportunity to improve treatment programmes and pathways17. Promoting non-medical
prescribers offers commissioners a mechanism to enhance the flexibility of local care by
increasing the availability and responsiveness of prescribing interventions thereby improving the
experience of service users. However, non-medical prescribers must not prescribe outside of their
area of competence and should work alongside suitable qualified medical practitioners as part of a
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Alcohol Summary July 2015
multidisciplinary team, particularly when working with patients with complex medical and
psychiatric problems.
Any clinical services commissioned must have effective safeguards in place. Safe and effective
alcohol and drug services need staff with the necessary skills, or access to appropriate expertise,
to meet all the needs of the population, including those with very complex needs. Research has
demonstrated that employing an addiction specialist doctor is a vital resource to local alcohol and
drug recovery systems18. Alongside other key job roles including clinical governance, innovation,
championing recovery and training; addiction specialist doctors work with people with the most
severe and complex needs. They also liaise with a range of services and professionals including
social care, criminal justice, housing, medical, psychiatric, employment, children and families.
Section ten: Recommendations
Health First: An evidence-based alcohol strategy for the UK19 recommends the following:
• Support the campaign for a minimum unit price of alcohol
• Local Authorities should control the number, density and opening hours of all licensed
premises
• All alcohol advertising and sponsorship should be prohibited
• All health and social care professionals should be trained to routinely provide early
identification and brief alcohol advice to their clients
• People who need support for alcohol problems should be routinely referred to specialist
alcohol services for comprehensive assessment and appropriate treatment
• The law prohibiting the sale of alcohol to people who are already drunk should be
actively enforced
• Wherever alcohol is sold, a soft drink which is cheaper than the cheapest alcoholic drink
should be available
• Local authorities should use by-laws to improve community safety by creating alcoholfree public spaces where alcohol consumption is prohibited
• Every acute hospital should have a specialist multi-disciplinary alcohol care team tasked
with meeting the alcohol-related needs of those attending the hospital and preventing
admissions
Evidence also recommends:
• Services consider their approach, environment, attitude and behaviour of staff to
increase the retention of service users
• The use of structured therapeutic work with service users to sustain the recovery
process
• The provision of information about, or setting up of, mutual aid groups such as 12 step.
Service users should be routinely directed to these groups alongside structured
treatment
• Promotion of non-medical prescribers to work alongside qualified medical practitioners
as part of a multidisciplinary team
• Having an addiction specialist doctor working as part of a multidisciplinary team
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Alcohol Summary July 2015
Section eleven: Appendix – changes to methodology
Changes to the methodology used to produce the Local Alcohol Profiles for England 2015
Much of the data used to produce this summary comes from the Local Alcohol Profiles for
England, updated for 2015. There have been a number of changes to the methodologies used to
calculate certain indicators presented in the Local Alcohol Profiles for England 2015.
Changes to the alcohol attributable fractions – In 2014, the alcohol attributable fractions that are
applied to mortality and hospital admission data were updated to take into account new
epidemiological evidence for the association between alcohol consumption and health-related
outcomes. This exercise resulted in some important changes to the number of health conditions
and external causes that are identified as being alcohol related and also a recalculation of the
attributable fractions for some of the existing health measures.
Changes to the alcohol related hospital admission and admission episodes for alcohol related
conditions indicators – In 2013 Public Health England announced that the current indicator for
admission episodes for alcohol related conditions (previously National Indicator 39) would be
supplemented by a new indicator. The Local Alcohol Profiles for England 2015 includes both the
old (broad) indicator and the new (narrow) indicator. The broad indicator considers all codes
(primary and any secondary codes) that are recorded in relation to a patient’s admission record,
and if any of these codes has an alcohol-attributable fraction then that admission would form part
of the alcohol related admission total. The narrow indicator seeks to count only those admissions
where the primary code has an alcohol-attributable fraction. Although alcohol-attributable fractions
exist for external cause codes (such as 27 per cent of assaults), these cannot be recorded as a
primary code so the new indicator also includes admissions where the primary code does not
have an alcohol-attributable fraction but where one of the secondary codes is an external cause
code with an alcohol-attributable fraction. This represents a narrower measure.
Changes to the European standard populations – In 2009 the European standard population was
revised in recognition that the European population is ageing. This methodological change will
cause age standardised mortality/hospital admission rates to increase, in most cases, because the
new European standardised population is weighted towards older ages and most deaths/hospital
admissions occur at older ages.
Changes to the base geography – The base geography for each indicator in the Local Alcohol
Profiles for England 2015 have been updated from the 2001 lower super output areas to 2011
lower super output areas.
Changes to the cause of death calculation in the mortality indicators – In previous years the
mortality indicators were solely based on the underlying cause of death, however three wholly
alcohol attributable conditions weren’t permitted as entries within this field. To resolve this issue all
cause of deaths fields have been searched for these conditions: ethanol poisoning, methanol
poisoning, toxic effect of alcohol in the Local Alcohol Profiles for England 2015.
Changes to the alcohol related crime indicators presented in the Local Alcohol Profiles for England
2015 (crime indicators have been omitted from the 2015 update) – The Office for National
Statistics has redesigned the classifications used to present police recorded crime statistics.
These changes have been made to improve the understanding of crime statistics and to align
police recorded crime with other crime datasets.
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Alcohol Summary July 2015
As a result of these changes data presented in the Local Alcohol Profiles for England 2014
should not be compared with data published in previous versions. Data for previous years
has been recalculated in line with recent changes.
References
1. World Health Organisation, February 2011, Alcohol Fact sheet
2. Home Office, The Government’s Alcohol Strategy, March 2012
3. Rethinking Drinking, Cheshire West and Chester Alcohol Harm Reduction Strategy 2010-13
4. Cardiff model
5. Alcohol-attributable fractions for England: Alcohol-attributable mortality and hospital
admissions, Liverpool John Moores University, North West Public Health Observatory,
2008
6. Cheshire West and Chester Health and Wellbeing Strategy 2015-20, 2015
7. Buffin, J, Roy, A, Williams, H and Winter, A. Part of the Picture: lesbian, gay and bisexual
people's alcohol and drug use in England (2009-2011), 2013
8. Hidden Needs. Identifying Key Vulnerable Groups in Data Collections: Vulnerable Migrants,
Gypsies and Travellers, Homeless People and Sex Workers, 2014, Aspinal, P, University of
Kent
9. Cheshire West and Chester Homelessness Strategy 2010-15, 2010, Cheshire West and
Chester Council
10. Smoking, drinking and drug use among young people in England in 2013, 2014, Health and
Social Care Information Centre
11. Health needs assessment of offenders in the community: Cheshire East, Cheshire West
and Chester, Warrington and Wirral, 2013, NHS Cheshire Warrington and Wirral
12. North West Mental Wellbeing Survey 2012/13, 2013, Public Health England
13. Department of Health Guidance, 2010, Signs for improvement – commissioning
interventions to reduce alcohol related harm
14. Turning evidence into practice: Helping service users to engage with treatment and stay the
course, 2013, Public Health England
15. Routes to recovery via the community: Mapping user manual, 2013, Public Health England
16. Turning evidence into practice: Helping clients to access and engage with mutual aid,
National Treatment Agency, 2013, Public Health England
17. Non-medical prescribing in the management of substance misuse, July 2014, Public Health
England
18. The role of addiction specialist doctors in recovery orientated treatment systems: A
resource for commissioners, providers and commissioners, 2014, Public Health England
19. Health First: an evidence-based alcohol strategy for the UK, 2013, University of Stirling
Part of Cheshire West and Chester’s
Integrated Strategic Needs Assessment
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Alcohol Summary July 2015