Transcript Document

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
North East Lincolnshire
NE
Lincolnshire
Population - 158,200
16 – 64 yrs - 95,200
Size
- 192 sq kilometres
Alcohol Issues for North East Lincolnshire
Historical links to the fishing industry
with high levels of alcohol consumption
2nd highest alcohol related crime level
in Yorkshire and the Humber
Alcohol Issues for North East Lincolnshire
2 Town centres Grimsby and Cleethorpes
 49th 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
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
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
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!)
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
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
Where are we now?
Support to Secondary Care
A&E
Support to Consultants on Medical Wards
Patient referrals
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
Overview of N E Lincolnshire
Alcohol Intervention Programme
NOVEMBER 2008
NOVEMBER 2009
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
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
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
North East Lincolnshire
Alcohol Arrest Referral
Throughput
April – September 2009
180
160
140
Conditional Bail
120
100
80
Conditional
Caution
60
Voluntary
40
20
0
Apr May Jun
Jul Aug Sep
April 2009 – September 2009 data
40%
35%
12%
30%
25%
20%
15%
10%
5%
0%
Series1
88%
18-24yrs
25-34yrs
35-49yrs
50yrs+
37%
35%
23%
5%
Age breakdown
Male
Female
Gender 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
Employment Status
More half of all clients assessed were unemployed at the time
of intervention, this proportion is increasing
Unemployed
54%
Student
2%
Retired
1%
Long term ill
4%
Employed
Unemployed
Student
Retired
Long term ill
Employed
39%
High proportion of client group indicate drinking to higher
levels to ‘reduce’ work place or unemployment stress factors
rather than consideration of health factors
Level of drinking
Dependent drinkers were the most represented group
(38% of clients scored 20+)
No Risk
18%
Dependant
38%
Hazardous
Harmful
13%
Audit = / >
25
28%
No Risk
Hazardous
31%
Harmful
Dependant
Audit < 25
Audit < 25
72%
Audit = / > 25
Level of drinking
72% scoring 20+ were younger binge drinkers
10% of total score 25+
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..
Theft
4%
Drink
Driving
11%
Public
Disorder
30%
Drunk &
Disorderly
4%
Assault
42%
Assault
Criminal Damage
Public Disorder
Drink Driving
Criminal
Damage
9%
Theft
Drunk & Disorderly
During April to September 2009, 832 separate offenders
received intervention by the programme. Between 35% and
40% of all arrests are alcohol related.
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
Emotional
and
Physical
cost to
Victim
Lost
Output
Health
Costs
Criminal
Justice
Cost
Average
Costs
Common Assault
240
20
-
270
540
Wounding
12,000
2,000
1,200
2,700
18,000
97,000
14,000
8,500
13,000
130,000
700,000
370,000
630
22,000
1,100,000
Type
Serious Wounding
Homicide
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
Any Questions?
Pauline Bamgbala
Head of Substance Misuse and Sexual Health Commissioning
[email protected]
(01472) 625561
&
Bill Geer
Reducing Re-offending Strategic Manager
[email protected]
(01472) 625567