Alcohol and the impact on NHS services an opportunity not to be - - PowerPoint PPT Presentation

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Alcohol and the impact on NHS services – an opportunity not to be wasted

Sarah Hart

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Top 5 Risk Factors

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Why is alcohol an important issue to the CCG ?

Source: Public Health England (2016) Health matters: harmful drinking and alcohol dependence’

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Two methods of assessing alcohol related admissions and mortality

Alcohol-specific conditions (narrow measure)

Alcohol-specific conditions include those conditions where alcohol is causally implicated in all cases of the condition; for example, alcohol-induced behavioural disorders and alcohol-related liver cirrhosis. The alcohol-attributable fraction is 1.0 because all cases (100%) are caused by alcohol.

Alcohol-related conditions (broad measure)

Alcohol-related conditions include all alcohol-specific conditions, plus those where alcohol is causally implicated in some but not all cases of the outcome, for example hypertensive diseases, various cancers and falls. The attributable fractions for alcohol-related outcomes used here range from between 0 and less than 1.0.

Source: (Public Health Outcomes Framework, 2016)

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Recent alcohol mortality rate data shows decreases in Haringey in context of regional / national plateaus

8.3% decrease in DSR alcohol related deaths (2010-12 to 2011-13). Haringey now below England but still above London (27th lowest in London in 2013). 30% decrease in DSR alcohol specific deaths 2010-12 to 2011-13, now level with London and below England. 16th highest in London in 2011-13.

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However, hospital admission rates are increasing in Haringey, London and England

Total alcohol-related hospital admissions have increased by 29% from 2009 – 2014. 8% more than London with a 21% increase. London benchmarking for 2014/2015 shows alcohol-related admission rates are higher than our neighbours, London and England. Haringey the 6th highest in London.

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Alcohol specific admissions have plateaued in Haringey reflecting the national, regional trend, but remain high

Total alcohol-specific hospital admissions have remained steady from 2009 to 2015 but remain higher than London

• average. In the last 4 years

London has decreased by 7%, whilst Haringey has decreased by 4% in comparison. London benchmarking for 2014/2015 shows alcohol- specific admissions are higher than our neighbours . 4th highest in London.

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Increasing alcohol-related burden on England’s hospitals

• 2008/9 – 2013/14 A&E attendances rates – attendance rates of

alcohol poisoning doubled, from 72.7 to 148.8 per 100,000 population

• 35% of all Accident & Emergency (A&E) attendance and ambulance

costs may be alcohol related, increasing to 70% of A&E attendances at peak times on the weekends

• Inpatient admissions specific to alcohol 2005/06 to 2013/14, increased by

63%: there was a 143.3% increase in elective admissions (from 45.5 per 100,000 population to 110.8 per 100,000

population) 53.9% increase in emergency admissions (from 374.9 per 100,000 population to 577.1 per 100,000 population).

• In 2013/14, approximately 1 in 20 emergency admissions and 1 in

120 elective admissions were for alcohol-specific conditions

• 22-35%

2X

22 - 35% of GP visits estimated to be related to alcohol

63% rise

Sources: Nuffield Trust (2015), Department of Health (2008),

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Haringey drinking consumption patterns

Source: Local Alcohol Profiles for England - from PHOF 2014 August)

Harngey London England

Source: Adapted from Alcohol treatment performance report, NCL 2012.

57,000

115,000

Low risk drinkers

High risk drinkers (4%)

Increasing risk

35+ units a week 50+ units a week 15-35 units a week 22-50 units a week ≤ 15 units a week ≤ 22 units a week

9

Increasing risk drinkers (20%) Low risk drinkers

10, 000

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Tackling the burden of alcohol misuse?

Population level interventions Interventions through services Interventions through communities

Alcohol screening in A&E Alcohol nurses in primary care Alcohol workers in hospitals Alcohol community detoxification

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Need for population measures

Population-based approaches to reducing alcohol-related harms –

• Increased taxation
• minimum unit pricing
• restricting availability
• limiting marketing and

advertising.

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Systemic approach of interventions at community and service level in Haringey

Low to increasing risk Increasing and high risk

High risk and Dependent

Tier 1:

Building capacity in the key professionals to deliver a brief screen and brief advice

Tier 2:

Extended Brief Interventions

Tier 3:

Intensive support/ Specialist advice

• Alcohol CQUIN in A&E
• Health checks
• Training professionals i.e. GPs, A&E
• Don’t bottle it up website and drink coach
• Stalls/social marketing
• MECC and health champions
• IBA in police custody suites
• Hospital Link worker delivering outpatient interventions and on ward
• GP hubs Nurse
• Drug and alcohol services
• Hospital link worker supporting ward detox’s
• Community detoxification programmes
• Access to inpatient detoxification
• Harm reduction programme - those not ready to stop
• Abstinence day programme
• Counselling
• Primary care alcohol and Mental health counsellor

Source:

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North Middlesex Hospital Alcohol services

A&E CQUIN Link worker

• Repeat

attenders Alcohol Liaison service

• Teachable moment, 1:8

low risk will change behaviour.

• Strong evidence you can

catch alcohol related medical conditions early

• Supports CQUIN
• Alcohol interventions
• n medical wards 114

detoxification supported on wards through to community in 2014 Working with 30 repeat attendees, at NMH 53 people had 900 attendances/admissions in a year , 75% case load have a housing issue, 65% mental health