1. Overview of the Alcohol Service Provision in North East Lincolnshire Pauline Bamgbala Head of Substance Misuse and Sexual Health Commissioning & Bill Geer Reducing Re-offending Strategic Manager

2. North East Lincolnshire Population - 158,200 16 – 64 yrs - 95,200 Size - 192 sq kilometres N E Lincolnshire

3. Alcohol Issues for North East Lincolnshire Historical links to the fishing industry with high levels of alcohol consumption 2 nd highest alcohol related crime level in Yorkshire and the Humber

4. Alcohol Issues for North East Lincolnshire 2 Town centres Grimsby and Cleethorpes  49 th most deprived area IMD (2007)  Low skill levels, high unemployment, low aspiration  Significant inequalities  High levels of teenage pregnancy  Significant inequalities – life expectancy for men variant of 10.8yrs between most deprived and most affluent deciles – 6.7 yrs for women

5. Alcohol Issues for North East Lincolnshire Background to Service Provision 2 Town centres Grimsby and Cleethorpes  2003 & 2005 Public Health produced Substance Misuse Needs Assessment demonstrating alcohol misuse greater than substance misuse (significant poly use)  2006 Public health produced an alcohol Needs Assessment  Local Alcohol Reduction Strategy - 4 Task Groups Education and Awareness raising Treatment Crime and Disorder Data and Information

6. Where were we – Pre 2008/09? Combined drug and alcohol specialist service  One building  No separate funding, therefore very little service  No drivers – national or local to affect change  Alcohol clients with no substance misuse issues reluctant to attend  No in patient detox  Limited community detox  Little or no involvement from Primary Care  No GP/practice staff training for screening or intervention work

7. What enabled change?  Comprehensive Needs Assessment – Highlight to strategic managers what was already know to practitioners  Policy Levers – PSA 25, NI 39, VSC 26  Health & Treatment guidance  Alcohol Improvement Programme  Investment (but still only short term!)

8. Where are we now? Specialist Alcohol Service  Consultant led  Dedicated GP Sessional input  Nurse and Counseling input – Tier 3  Dedicated Alcohol Counseling Team to support Primary Care  Out of area In-patient Detox  Community Detox

9. Where are we now? Primary Care Alcohol Service  Training for GP/ practice staff  Opportunistic Screening  Brief and extended Interventions  Referral to Specialist Alcohol Workers based within practices  Agreed pathways and referral systems

10. Where are we now? Support to Secondary Care  A&E  Support to Consultants on Medical Wards  Patient referrals

11. Problems along the way  Lengthy delays due to CRB clearance (up to 4 months)  A&E – strong commitment, but lack of staff to fully implement screening  Information systems - incompatibility

12. Overview of N E Lincolnshire Alcohol Intervention Programme  Aim of scheme is to provide a brief assessment and intervention to adults with alcohol problems  Arrest referral workers in Police custody suite 0730 x 2200  2.5 wte workers working within programme offices NOVEMBER 2008 NOVEMBER 2009

13. How does the scheme work? Voluntary referral In custody suite (Route 1) Conditional Caution (Route 2) Conditional Bail (Route 3) Brief assessment and intervention – includes the AUDIT alcohol assessment, Alcohol Intervention Record and various Interventions, including Group sessions Sessions last 45 minutes – 2 hours Referral to specialist services if required Information regarding attendance is Fed back to Courts, Probation & Police

14. Evaluation  Scheme is to be independently evaluated  2 phases of evaluation:  Re – arrest data 6 months after completion of the intervention  Interviews with clients 6 months after completion of the intervention  Comparison group – those who would have been eligible for scheme but didn’t undertake the intervention  Final evaluation results for all schemes due end of 2010 / early 2011

15. North East Lincolnshire Alcohol Arrest Referral Throughput April – September 2009

16. April 2009 – September 2009 data Age breakdownGender breakdown High level of ‘binge drinking’ in lower age group with little knowledge or thought of immediate or longer term health issues. Lack of awareness of units of alcohol 90% of females unemployed with some Audit scoring 38 - 40 Ethnicity – 4.5% of local population but less than 0.5% of offenders referred to programme Students tend to score 20 -24 on Audit

17. Employment Status More half of all clients assessed were unemployed at the time of intervention, this proportion is increasing High proportion of client group indicate drinking to higher levels to ‘reduce’ work place or unemployment stress factors rather than consideration of health factors

18. Level of drinking Dependent drinkers were the most represented group (38% of clients scored 20+) Level of drinking 72% scoring 20+ were younger binge drinkers 10% of total score 25+

19. Offence Types Assault, Criminal Damage and other Public Disorder are the most common offence types driving the need for the Criminal Justice pathway to treatment outcomes.. During April to September 2009, 832 separate offenders received intervention by the programme. Between 35% and 40% of all arrests are alcohol related.

20. Link to Domestic Violence  Reporting rate of DV is estimated at a ratio of 1:35  NE Lincolnshire records average of 300 DV incidents per month  35 DV related arrests per month referred to the Alcohol Interventions Programme  Programme staff receive DV specific training  Attendance reported to MARAC  Reporting for consideration of IDAP intervention. Cost of Crime Assaults Type Emotional and Physical cost to Victim Lost Output Health Costs Criminal Justice Cost Average Costs Common Assault24020-270540 Wounding12,0002,0001,2002,70018,000 Serious Wounding97,00014,0008,50013,000130,000 Homicide700,000370,00063022,0001,100,000

21. Lessons learnt from North East Lincolnshire Alcohol Interventions Programme  The intervention programme can draw people from Criminal Justice into treatment.  A Primary Care Trust commissioned multi-agency team can provide both Health and Criminal Justice outcomes  This group tends to drink at hazardous, harmful and dependency levels  The individuals are unlikely to be engaged in other settings  Referral pathways to GPs and specialist service are essential  Referral pathways are also essential for other health needs  Underlying needs such as benefits, housing, skills and employment can be addressed

22. Any Questions? Pauline Bamgbala Head of Substance Misuse and Sexual Health Commissioning Pauline.bamgbala@nelctp.nhs.uk (01472) 625561 & Bill Geer Reducing Re-offending Strategic Manager Bill.geer@nelctp.nhs.uk (01472) 625567