1. South West Public Health Observatory SOUTH WEST PUBLIC HEALTH SCIENTIFIC CONFERENCE2011 Alcohol Attributable Hospital Admissions in the South West Laura Juett - Regional Alcohol Manager, DH South West Paul Brown – Deputy Director, SWPHO SOUTH WEST PUBLIC HEALTH SCIENTIFIC CONFERENCE 2011 2 nd February 2011

2. South West Public Health Observatory Outline Background and context – Laura Methodology – Paul Results – Paul Intelligence into action – Laura Questions - All

3. South West Public Health Observatory Background and context

4. South West Public Health Observatory Consumption Synthetic estimates - population aged 16 and over –20.1% engaging in increasing risk drinking –5.8% engaging in higher risk drinking 2008 General Lifestyle Survey - 28% men and 19% of women drinking above recommended limits. 7% of men and 5% of women drinking at higher risk levels In 2009 alcohol 70% more affordable than 1980 1992 – 2008 purchases of wine brought into the home have increased by 59% Overall trend of increasing strength of alcoholic drinks

5. South West Public Health Observatory What's the problem? Costs health service £2.7bn p.a. Up to 35% of all A&E attendance and ambulance costs alcohol-related Alcohol implicated in 6,000 babies born p.a. with FASD c. 25% of child protection cases 39,000 reports of serious sexual assaults During 2009 there were 150,445 prescription items for drugs for the treatment of alcohol dependency an increase of 46% since 2003

6. South West Public Health Observatory What's the problem? During 2008/09 there were over 36,000 crimes in the South West attributable to alcohol Drink-driving is estimated to account for more than 168 serious injuries and around 50 road deaths in the South West each year 2008/09 there were 12,252 individuals in contact with structured alcohol treatment in the South West

7. South West Public Health Observatory Strategic Framework Public Service Agreement - PSA 25 – Reduce the harm caused by alcohol and drugs National Indicator 39 – to reduce the trend in the increase of alcohol related hospital admissions National Alcohol Improvement Programme - established to support a reduction in admissions SW Programme – priority to improve the understanding of the issues and ‘make it more people’s business’

8. South West Public Health Observatory Methodology

9. South West Public Health Observatory

10. Important Technical Information Alcohol specific harm, alcohol related harm and alcohol attributable harm alcohol specific harm is harm wholly attributable to the use of alcohol, alcohol related harm, is harm partially attributable to or related to the use of alcohol alcohol attributable harm is harm caused either wholly or partially by the use of alcohol. Alcohol-Attributable Fraction (AAF) is applied to all admissions for alcohol attributable harm and range between -0.26 and 1. The lower the AAF, the harm caused is considered to be less attributable to the use of alcohol. An AAF of 1 indicates that the harm is wholly attributable to alcohol (alcohol specific) and will account for 1 whole admission. An AAF of less than 1 indicates that the harm is partially attributable to alcohol (alcohol related) and will account for part of a whole admission. Total alcohol attributable admissions are the sum of all admissions wholly due to alcohol (AAF = 1) plus the sum of all the parts of admissions which were partially attributable to alcohol (AAF < 1). Therefore the number of individuals admitted, will be more than the number of admissions.

11. South West Public Health Observatory

12. Results

13. South West Public Health Observatory Alcohol attributable hospital admissions in the South West completed during 2008/09

14. South West Public Health Observatory Alcohol Specific

15. South West Public Health Observatory Directly standardised rates of alcohol specific admissions, per 100,000 population, South West Local Authorities, 2008/09

16. South West Public Health Observatory Percentage of alcohol specific hospital admissions by regional IMD quintile, South West, 2008/09

17. South West Public Health Observatory Percentage breakdown of individuals who contributed to alcohol specific hospital admissions by age and sex, South West, 2008/09

18. South West Public Health Observatory Ethanol poisoning, breakdown of individuals by age and sex, South West, 2008/09

19. South West Public Health Observatory Alcohol attributable

20. South West Public Health Observatory Alcohol attributable hospital admissions, directly standardised rates, per 100,000 population, South West Local Authorities, 2002/03–2008/09

21. South West Public Health Observatory Crude rates of alcohol attributable hospital admissions, South West MSOAs, 2008/09

22. South West Public Health Observatory Breakdown of alcohol attributable admissions by cause, South West, 2008/09

23. South West Public Health Observatory Intelligence into Action

24. South West Public Health Observatory Intelligence into action Commissioning of health interventions for targeted groups: –Identification and brief advice –Alcohol Liaison Nurse –Building capacity re specialist treatment Supports the case for broader involvement e.g., Pharmacies and Primary Care QIPP Not just health who can have impact on AAHA Opportunity for greater focus on alcohol within new Public Health arrangements

25. South West Public Health Observatory … and on our website www.swpho.nhs.uk

26. South West Public Health Observatory Keep in touch Register on our website – www.swpho.nhs.ukwww.swpho.nhs.uk Join our mailing list –Quarterly newsletter (SWPHOcus) –Monthly email alerts for new website content Contact us info@swpho.nhs.uk

27. South West Public Health Observatory The who, why and where of end of life in the South West Presentation to SW Scientific Conference Andy Pring February 2011

28. South West Public Health Observatory NEOLCIN Website www.endoflifecare-intelligence.org.uk

29. South West Public Health Observatory Number of deaths Source : ONS, South West GOR

30. South West Public Health Observatory Deaths in England and Wales Source : Gomes and Higginson; Where people die (1974–2030): past trends, future projections and implications for care., Palliative Medicine 2008; 22: 33–41

31. South West Public Health Observatory Estimated future population Source : ONS, South West GOR

32. South West Public Health Observatory Trends by age

33. South West Public Health Observatory Trends by age

34. South West Public Health Observatory Trends by age

35. South West Public Health Observatory Trends by age

36. South West Public Health Observatory Trends by age

37. South West Public Health Observatory Changing causes of death Source : ONS, South West GOR

38. South West Public Health Observatory Trend in cause of death, South West Source : ONS, South West GOR

39. South West Public Health Observatory Trend in cause of death, South West Source : ONS, South West GOR

40. South West Public Health Observatory Trend in cause of death, South West Source : ONS, South West GOR

41. South West Public Health Observatory Trend in cause of death, South West Source : ONS, South West GOR

42. South West Public Health Observatory Trend in cause of death, South West Source : ONS, South West GOR

43. South West Public Health Observatory Place of death Source : ONS, South West GOR

44. South West Public Health Observatory Place of death

45. South West Public Health Observatory Combine Own residence, care home and nursing home Source : ONS, South West GOR

46. South West Public Health Observatory Distribution of place of death by and cause of death Source : ONS, South West GOR

47. South West Public Health Observatory Further work.... Patterns of hospital admission near end of life Admissions from nursing homes End of life care plans

48. South West Public Health Observatory In summary The population of the South West is set to grow and age The number of deaths each year is likely to increase An increasing number of people will die in advanced old age

49. South West Public Health Observatory www.swpho.nhs.uk www.endoflifecare-intelligence.org.uk