1. NHS North Yorkshire and York Safer and Sensible Drinking and Promoting Health and Wellbeing George Lee: Senior Commissioning Manager

2. Aims of this Presentation Offer an NHS perspective on the risks of over drinking, or the misuse of alcohol Highlight some of the general impacts on health and local issues for Harrogate and District. Aspirations for the future, what

3. Alcohol and The NHS Perspective Recognition that the greater the level of exposure to alcohol over a life time, the greater the risks of ill health and associated personal and societal harms Alcohol related hospital admissions are increasing The costs of providing treatment are increasing, and are not sustainable

4. How big is the issue? 153,000 drinking above low risk 29,300 drinking at harmful levels 16,200 dependent drinkers

5. Hospital Admissions AcuteChronic Accidental poisoning by and exposure to alcohol Alcoholic gastritis/ myopathy/polyneuropathy Toxic effects of alcoholAlcoholic cardiomyopathy Intentional self-harm/Event of undetermined intent Alcohol-induced pseudo-Cushing's syndrome Drowning/Fall injuriesDegeneration of nervous system due to alcohol Firearm injuriesAlcoholic liver disease and Liver cirrhosis Inhalation of gastric contents/Inhalation and ingestion of food causing obstruction of the respiratory tract Gastro-oesophageal laceration-haemorrhage syndrome/ Oesophageal varices work/machine injuriesAcute and chronic pancreatitis Air/space/road/water transport accidents (driver/rider/passenger) Malignant neoplasm of lip/ oral cavity/ pharynx/oesophagus Accidental excessive coldEpilepsy and Status epilepticus AssaultCardiac arrhythmias Spontaneous abortionHypertensive Disease

6. Attributable Fractions mainly chronic degenerative conditions in which alcohol is associated with a relatively modest increase in risk, such that overall less than 20% of cases are estimated to be attributable to alcohol Malignant neoplasm of breast Malignant neoplasm of colon Malignant neoplasm of liver and intrahepatic bile ducts Malignant neoplasm of rectum Heart failure Haemorrhagic stroke

7. Local Issues Alcohol Hospital Specific Admissions under 18s Alcohol Hospital Specific Admissions females Hazardous drinking (synthetic estimate) Binge drinking (synthetic estimate)

8. NHS Priorities Work with partners to promote safer drinking Extend treatment provision for Tiers 1,2 and 3 Identification and brief advice in primary care A and E workers Health liaison worker in hospitals

9. Stepped Care Pathway