Alcohol Improvement Program – “What’s over the hill?” Chris Heffer, Deputy Director Drugs & Alcohol December 2009

Alcohol 2 We still face major challenges in preventing illnesses which are rooted in people’s lifestyle choices Lifestyle challenges such as alcohol misuse, smoking and obesity cost the NHS at least £9.4bn annually (of £100bn budget), society £37.3bn annually and cause 140,000 preventable deaths each year Though rates are dropping, 8.5m (21%) of the general population still smoke; half of these are routine and manual workers 10m are drinking at increasing risk levels; 2.5m drinking at twice recommended levels; 6% of all NHS admissions are alcohol related, increasing by c.80,000 every year An estimated 330,000 problem drug users, 209,000 of which are in treatment 30m (62%) of the adult population are overweight or obese; by 5, 22% of children are overweight or obese, rising to 33% by age 11 Only 40% of men and 28% of women achieve recommended weekly levels of physical activity; The challenge: to find an effective and appropriate role for Government in supporting individual behaviour change, but on a mass scale

Alcohol 3 …And many of these behaviours can overlap in individuals Lower risk/ Abstinent Increasing risk Higher risk Moderately Dependent Severely dependent Smoking Increasing/h igher risk drinkers High BMI 9% 8% 30% 4% 7% 10% 3% 22% 24% 49% Source: Healthy Foundations survey data, DH

Alcohol 4 We know alcohol misuse is costly to society and individuals  Levels of consumption risen 60% since 1970s, although may have plateau-ed −10m drinking above recommended limits, with 3m drinking above 2x limits −1m+ dependent on alcohol  6% of all hospital admissions are alcohol related −In total, there were 863,000 alcohol-related hospital admissions in 07/08 −Rising by around 70,000 admissions p.a.  Up to 35% of all A&E attendance and ambulance costs may be alcohol-related.  Alcohol misuse costs the health service £2.7bn p.a.  Alcohol implicated in −6,000 babies born p.a. with FASD −Over 7,000 women miscarrying −Up to 1.3m children affected at home −c. 25% of child protection cases −39,000 reports of serious sexual assaults

Alcohol 5 But not always a popular subject with people! Proportion expressing preference to change behaviour Source: Professor Theresa Marteau, Kings College London % drink less lose weight stop smoking

Alcohol 6 Meaning we have quite a challenge to slow the rise in admissions Alcohol admissions 0 100, , , , , , , , ,000 1,000, /032003/042004/052005/062006/072007/08 Alcohol attributable (e.g, violence, digestive, cancer, hypertensive, cardiac arrhythmia) Alcohol specific (e.g. liver disease, mental health, alcohol poisioning) Hospital Admissions +11.2% p.a % p.a. Alcohol Related Hospital Admissions, by cause, 2002/3 – 2007/8 Projection Planned Source: HES data

Alcohol 7 So what do we do about it? “politics is the art of choosing between the disastrous and the unpalatable” JK Galbraith

Alcohol 8 Overall approach to tackling health harms from alcohol in England To succeed in tackling health harms from alcohol, we need to support change in behaviour of millions of people in England, with a consistent approach: Give individuals the advice and support they need to make healthy choices Create an environment in which the healthy choice is the easier choice Identify, advise and treat rapidly and effectively those at risk Ensure proper prioritisation and alignment of government to tackle harm Social marketing and segmentation Unit and health labelling on products POS information Drinkaware and the Campaign for Smarter Drinking Pricing and taxation Advertising regulation Mandatory code for alcohol retailing Underage sales and disorder measures Coalition for Better Health Identification and Brief advice Direct Enhanced Service (DES) on alcohol advice for new patients Specialist treatment services National and regional support PSA indicator on hospital related admissions Alcohol learning centre Regional support to early implementer PCTs

Alcohol 9 The Alcohol Improvement Programme (AIP) covers a wide range of areas Evidence  Local Level Data (e.g. NW PHO local profiles)  Tools and Guidance  A new National Treatment Monitoring System  The SIPS research programme (covering IBAs in A&E, primary care and probation)  High Impact Changes Support/ Training  Regional Alcohol Managers  Alcohol Learning Centre  National Support Team visits (NST)  “Ready reckoner” tool to support investment in reducing hospital admissions  A programme integrating alcohol training into undergraduate medical curricula (6,000 p.a.)  Alcohol Certificate course for Primary Care practitioners  An e-learning module for IBA in primary care  Harmful drinkers social marketing strategy Implementation  20 Early implementer PCTs receiving extra £3m p.a.  A £8m Directed Enhanced Service to identify higher risk drinking in newly registered GP patients aged 16 and over, in all PCTs

Alcohol 10 So what next for alcohol and the AIP? Challenges  Using data well −PCT plans −Specialist treatments/ Read codes −Segmentation of individuals −Outcomes −Costs  Clear delivery chain −Tier 3 −Indicator −Partnerships - RDPHs/ SHAs/ GOs/ CDRPs/ DATs, etc. −Future Performance frameworks  Funding pressures −Locally on treatment services −Regionally on support – RAMs, EIs, NST −Nationally on research, education and social marketing −Evidence of cost effectiveness Opportunities  RAMs up and running and supporting PCTs  Build the “business case” around investment in alcohol and in prevention  Liver strategy announced  SIPS program reports next year  Embedded in medical training programs  New social marketing strategy for February  NHS workforce as exemplar  Improve services for offenders  Work with industry – maybe IBAs in every workplace?

Alcohol 11 Changes? FROM:  National  Central  Mass interventions  Health gain  Individual  NHS  Performance Management TO:  “Frontline”  Done once  “Personalisation”  Cost effective  Family/ society  Partnerships  Prioritisation and outcomes

Alcohol 12 Final message We are all in this together, so let’s make sure we all do the right thing…