Transcript Practice Based Commissioning

Alcohol misuse in Derbyshire 2009
Reducing alcohol-related harm and
health inequalities from alcohol misuse
Reducing alcohol-related harm and health inequalities from alcohol misuse are the
responsibilities of;
• The local Derbyshire Drug and Alcohol Action Team (DAAT) partnership
• The Derbyshire Partnership Forum’s Local Area Agreement
Developments in the last year
A new Drug and Alcohol Strategy 2009-13 was launched in 2009 with the
aim of achieving the following outcomes;
• Fewer hospital admissions related to alcohol, particularly in the under
18 year olds in North Derbyshire
• Lower treatment wait times
• Fewer people developing alcohol-related problems
• Less alcohol-related crime and anti-social behaviour.
Developments in the last year
•
DAAS opened a new countywide adult service for tier 2 open access
treatment in April 2009
•
Training on identification and brief advice provided for tier 1 staff
•
DAAT opened tender process for tier 3 adult treatment services for
implementation from 1 January 2010
•
(Set up a?) Young people’s specialist substance misuse treatment service
(tier 3)
•
Additional targeted alcohol and drug workers (tier 2) embedded in each
Children and Younger Adult (CAYA) district
•
Universal provision of tier 1 interventions within partner organisations
•
DAAT commissioned prevention, education and community safety initiatives
E.g. the marketing campaign, the Strengthening Families Project (SFP) and
the BeSafe pilots.
Information to support commissioning
In the last year two key analyses have been undertaken:
1) A children and young people’s health needs assessment – to
investigate the reasons for the high under 18s alcohol-specific
admission rates in Derbyshire County
2) Local analysis of Hospital Episode Statistics (HES) – to explore
patterns of alcohol-related admissions in Derbyshire by age, gender,
local authority and reason for admission.
NB. Findings from these analyses, along with the implications for
commissioning, are detailed in the following sections of this presentation.
Alcohol and admissions to hospital Definitions
• Alcohol-specific admissions only include conditions caused wholly
by alcohol (e.g. alcoholic liver disease or alcohol overdose);
• Alcohol-related admissions include all the alcohol-specific
conditions, plus those that are caused by alcohol in some, but not
all, cases (e.g. breast cancer and road traffic accidents).
Young people and alcohol Derbyshire health needs assessment
Young people and alcohol
Alcohol consumption patterns developed during adolescence can
influence consumption in later life.
It is therefore important to understand the frequency and level of
alcohol consumed locally in order to understand;
• how drinking patterns may develop
• what interventions may be needed to achieve the best possible
health outcomes
• To help us to plan for future treatment demand.
Young people and alcohol
Alcohol-specific admissions for under 18s in Derbyshire 2002/3–07/8
•
There are approx 168,000 young people in Derbyshire under 18 years of age
(approx 20% of the population)
•
Over three years from 2005/6 to 2007/8 there were 377 hospital admissions
specifically related to alcohol (or 74.7 per 100,000 young people per year).
Under 18 alcohol-specific admissions by local authority in
Derbyshire 2007-08 with 95% confidence intervals
Figure 1
• High Peak, Chesterfield, Bolsover
and North East Derbyshire are
respectively ranked 2nd, 3rd, 4th
and 5th highest of the 40 local
authorities in the East Midlands
300
Males
Females
250
Rate per 100,000
• The alcohol-specific hospital
admission rate in Derbyshire was
lower than the England average,
but some local authority areas in
Derbyshire were significantly
higher than England
Under 18 Alcohol-specific Admissions
200
150
100
50
0
Amber
Valley
Bolsover Chesterfield Derbyshire Erew ash
Dales
South Derbyshire
High Peak North East
Derbyshire Derbyshire
Source: HES data, Department of Health, analysed by Derbyshire County PCT
Under 18 alcohol-specific admissions in Derbyshire
by MSOA
Figure 2
Source: HES data, Department of Health, analysed by Derbyshire County PCT
Aggregated number of under 18 alcohol-specific
admissions in Derbyshire 2002-2008
•
Figure 3
Nearly twice the number of girls
than boys aged 14 and 15 are
admitted into hospital relating
to alcohol
Aggregated number of under 18 alcohol-specific admissions in Derbyshire 2002-2008
Total (summed) admissions (small numbers <5 excluded)
110
Male
100
•
•
Some young children (under
the age of 6) are also admitted
into hospital, mostly because of
methanol poisoning (NB.
numbers are too small to
present)
For adolescent girls the peak in
admissions is at age 15
Total number of admissions
Female
90
80
70
60
50
40
30
20
10
•
For boys the peak in
admissions is into early
adulthood (data not shown).
0
1
2
3
4
Source: HES data, Department of Health, analysed by Derbyshire County PCT
5
6
7
8
9
Age
10
11
12
13
14
15
16
17
Research findings –
Alcohol and young people
Every Child Matters survey Derbyshire 2007 (School Health Education Unit, SHEU)
829 Year 8 and 10 pupils were asked a range of questions within the five outcome categories
of Every Child Matters;
• 41% of students said that they drank alcohol on at least one day in the week
• 6% said they bought it from an off-licence.
TellUs3 survey Derbyshire 2008
• 11% of young people (pupils from years 6, 8 and 10) said that they had been drunk three
or more times in the past four weeks. This is nearly twice the national figure of 6%.
• 67% of pupils thought the information they received regarding alcohol was good enough
• 25% thought they needed better information and advice.
Qualitative analysis
The Derbyshire health needs assessment included focus group work with young people and
with service providers to gather their views and experiences.
Main recommendations for commissioning
children and young people’s
alcohol services
Commissioning children and young people’s
alcohol services – recommendations
The JNSA made fifteen recommendations which include the following:
Develop a cross-agency agreement and key desired outcomes for alcohol harm
reduction in young people;
- To be led by the DAAT Children’s Joint Commissioning Group (JCG) and overseen by
the Children and Younger Adults Trust
- Agencies to include; the police, community safety, trading standards, CAYA (youth
service/ connexions), targeted youth support, safeguarding children and DAAT.
Develop a streamlined, integrated commissioning of services plan to meet the
agreed outcomes;
- To include universal, targeted and treatment services
- The DAAT Children’s JCG to lead on the development of this with clear governance
arrangements in place for accountability and reporting to the Children and Younger
Adults Trust.
Commissioning children and young people’s
alcohol services – recommendations cont.
The DAAT Children’s JCG should review the current commissioning
arrangements for the targeted alcohol and drugs service in order to
ensure:
• fail safes for referral management;
• the delivery of evidence-based interventions;
• consistent service management and performance reporting across districts
and providers (Youth Service, Connexions, Looked After Children and
Youth Offending Services);
• its capacity is responsive to potential future changes in demand.
This should be developed and monitored by the DAAT Children’s JCG with
Exception reporting to the Children and Younger Adults Trust.
Alcohol-related admissions in all ages
Alcohol-related admissions in all ages
As part of the Derbyshire Local Area Agreement, Derbyshire County
PCT and Derbyshire County Council are monitored on alcohol-related
admission rates (LAA indicator NI39).
This indicator measures the rate of alcohol-related hospital admissions
per 100,000 population.
• Provisional data for 2008/09 show the actual rate of admissions in
Derbyshire was 1688 per 100,000 (16,004 admissions) compared to
the target rate of 1600. This is an increase of 12% from 2007/08.
Alcohol-related admission rates and LAA
targets in Derbyshire
Figure 4
alcohol-related admission rate per 100,000 pop
NI39 Alcohol-related admission rates for Derbyshire - comparison
of actual and projected with target
(Projections for 2009-10 and 2010-11 based on linear trend;
2008-09 data is provisional)
2000
1500
1000
500
0
2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11
1600
Target
Actual
1045
1133
1305
1341
Projected
Source: Department of Health, analysed by Derbyshire DAAT
1364
1504
1680
1753
1730
1828
1688
Alcohol-related admissions
in all ages cont.
Local analysis of HES data for alcohol-related admissions
(2002/03-07/08)
A detailed analysis of HES data – by age, gender, diagnosis on
admission and local authority of residence has been undertaken in
order to understand alcohol-related health inequalities in Derbyshire
And to inform future commissioning decisions.
Alcohol-related admission rates by age
group in Derbyshire 2007-08
•
Figure 5
Males have a significantly
higher rate of alcohol-related
admissions (1866 per 100,000)
compared with females (1142)
Alcohol-related admissions by age group 2007-08
120
Males
•
Both male and female
admission rates increases with
age, but the gap between males
and females widens from 45
years onwards
Over 85s have the highest rates
due to the increasing number of
admissions for alcohol-related
chronic diseases.
Crude rate per 1000
•
100
Females
80
60
40
20
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
The rise in admission rates with
age (particularly from age 45
onwards) emphasises a need to
focus on binge drinking and
longer-term drinking that builds
morbidity over time.
5-9
•
0-4
0
Source: HES data, Department of Health, analysed by Derbyshire County PCT
Alcohol-related admission rates
by local authority 2002/03-07/08
•
In 2007/08 Chesterfield had
the highest local authority rate
of alcohol-related admissions
(1902 per 100,000),
significantly higher than the
Derbyshire average.
Bolsover was also significantly
higher than the county
average at 1744 per 100,000.
Figure 6
Alcohol-related admissions by local authority, 2002/03 - 2007/08
2000
1800
1600
1400
Admission rates (DSR) per 100,000
•
1200
1000
Amber Valley
800
Bolsover
Chesterfield
600
Derbyshire Dales
Erewash
400
•
High Peak
All districts within Derbyshire
have seen increases in alcohol
admissions over the past six
years, with South Derbyshire
showing the biggest increase.
North East Derbyshire
200
South Derbyshire
0
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
Source: HES data, Department of Health, analysed by Derbyshire County PCT
Alcohol-related admissions 2007/08
in Derbyshire
Source: HES data, Department of Health, analysed by
Derbyshire County PCT.
Top 6 diagnostic groups for alcoholrelated admissions 2002/03 – 2007/08
Figure 8
The three biggest sources of
alcohol-related hospital
admissions for Derbyshire are;
• cardiac arrhythmias (18%)
• mental and behavioural
disorders due to the use of
alcohol (12%)
6000
Number of alcohol-related admissions
• hypertensive disease (37% of
admissions)
Top 6 Diagnostic Groups for Alcohol-related Admissions: 2002/03 - 2007/08
5000
4000
3000
2000
1000
0
2002/03
2003/04
2004/05
2005/06
2006/07
Hypertensive Diseases
Cardiac arrhythmias
Mental & behavioural disorders due to use of alcohol
Epilepsy and Status Epilepticus
Alcoholic liver disease
Ethanol
Source: HES data, Department of Health, analysed by Derbyshire County PCT
2007/08
Recommendations for reducing
alcohol-related admissions
Recommendations
Reduction of alcohol-related admissions can only be effective if actions
encompass the broader aspects of reducing alcohol-related harm comprising;
treatment, community safety and prevention and education:
•
Action to minimise harm caused by alcohol should be included and embedded in
strategies at a local level (e.g. Local Strategic Partnerships, children’s partnerships),
include a focus on geographic/socio-economic areas of high admissions and link to
other lifestyle work on smoking, obesity, sexual health, physical activity, mental health
promotion, heart disease and services for older people
•
Develop education and communication around sensible drinking, the impact of alcohol
and local alcohol service information, utilising innovative communications best practice
(e.g. social marketing approaches; utilising “peer educator” approaches)
•
Develop effective ways to highlight the dangers of binge drinking, particularly in young
people and their families and work with parents/ guardians and young people to help
clarify the potential dangers of alcohol to young people.
Recommendations cont.
•
Partners should ensure front-line staff receive training on simple assessment, brief
interventions and the provision of advice and information. (Frontline staff should
include police officers, housing, probation, voluntary sector workers and health
trainers)
•
-
Work with partners to consider measures to reduce alcohol-related crime such as;
supporting the VALs (Violence, Alcohol harm, Licensing groups)
providing leisure facilities for those in recovery
diversionary activities for young people (e.g. Positive Activities agenda)
promoting good alcohol workplace policies, including disseminating safer drinking
messages to staff)
•
Screening and brief interventions should be offered to hazardous and harmful
drinkers who attend primary care and other NHS settings such as A&E departments,
sexual health clinics or fracture clinics
•
Ensure alcohol liaison workers are in place in hospital wards and A&E
•
GPs and other primary care staff should be given appropriate training and support to
provide screening and brief interventions.
Recommendations cont.
•
Screening and brief interventions offered in non-NHS settings such as social
services, criminal justice settings, prisons, housing, education and voluntary sector
organisations
•
Undertake review of current treatment system to ensure that the needs of AACCE
users (alcohol, amphetamine, cannabis, cocaine, ecstasy), particularly those aged
18-25, are being adequately met
•
Undertake needs assessment to identify requirement for access to housing and
housing support for those with alcohol problems and on the path to recovery,
including those leaving prison
•
Utilise “good practice” resources nationally and across our East Midlands region e.g.
http://www.alcohollearningcentre.org.uk; http://www.hubcapp.org.uk
Contributors: Alison Pritchard, Diane Steiner, Liz Orton,
Nicki Richmond, Mary Hague