Alison Challenger, Director of Public Health, introduced the themed discussion on reducing alcohol harm in the City.

 

Louise Lester, Specialty Registrar, gave a presentation on the key issues in Nottingham and how partners are trying to address them.  She highlighted the following information:

 

(a)  Alcohol harm is a significant issue nationally.  Estimates show that 10.4million adults drink at levels that increase their risk of health harm and of these 595,000 may need treatment for alcohol dependence.  It is estimated that there are 5515 dependent drinkers in Nottingham City.

 

(b)  The consequences are significant, for example there are over 60 medical conditions where alcohol is a factor.  It impacts on mortality and early death rates, and also has wider impacts, for example on levels of domestic violence.

 

(c)  There are over 20 Public Health Outcomes Framework indicators used to report on alcohol harms and Nottingham is under-performing on the majority of these (however that is not dissimilar to other areas in the region).  The primary measure of the impact of alcohol harm on a population is alcohol admissions to hospital.

 

(d)  In the City, there were 2463 alcohol specific (100% attributable to alcohol) admissions and 2539.16 alcohol related (less than 100% attributable to alcohol) admissions in 2015/16.  The estimated cost of the alcohol related admissions was £4.72million but that is likely to be a significant under-estimation because it does not include treatment costs, Emergency Department attendances, the costs to East Midlands Ambulance Service of transporting patients, primary care, social care and the wider system.

 

(e)  There is a £3 social return on every £1 invested in alcohol treatment.

 

(f)  Action that has been taken by Nottingham City Council includes training for some staff on delivering Identification and Brief Advice (IBA) as part of Make Every Contact Count; signing the Alcohol Declaration; working with alcohol licensing; co-location of an IAPT (Improving Access to Psychological Therapies) provider with the Nottingham City substance misuse service.

 

(g)  An action plan to reduce alcohol related harm has been developed which includes actions to:

  i.  increase population understanding of risk and harm

  ii.  influence national and local policy

  iii.  take a systematic approach to IBA

  iv.  identify alcohol champions in key organisations

  v.  include alcohol as a priority for employee health and wellbeing

  vi.  improve communication of identified alcohol risk between some key parts of the system

  vii.  case manage High Volume Service Users in the Emergency Department

  viii.  agree and embed pathways for service users with co-existing mental health and substance misuse issues

 

Apollos Clifton-Brown, Operations Manager Nottingham Recovery Network, Clean Slate and Wellness in Mind gave a presentation about Identification and Brief Advice (IBA), including demonstrating IBA in action.  He highlighted the following information:

 

(h)  IBA is a simple 5 minute intervention.

 

(i)  IBA should help people understand units, understand risk levels, know where they sit on the risk scale, know the benefits of cutting down; and include tips for cutting down. 

 

(j)  Evidence suggests that it is the most effective method of reducing alcohol consumption.

 

(k)  It enables people to know how to ask questions and talk about alcohol consumption.

 

(l)  Partners are currently discussing how to embed IBA in general services.

 

(m)Although IBA is already a simple intervention it can be made quicker if that is easier and can also be tailored to particular services.

 

(n)  IBA scratchcards have been developed as another way of carrying out IBA but this doesn’t include the discussion element which is most valuable.

 

Rachel Carter, Internal Verifier and Learning Lead, gave a presentation about transformative learning theory which is used at the Nottingham Recovery Network and Clean Slate Academies in the City.  She highlighted the following information:

 

(o)  There are two Academies operating in the City – Nottingham Recovery Network and Clean Slate.  The two Academies take a slightly different approach and Clean Slate is criminal justice based.

 

(p)  Programmes are based on transformative learning theory which uses education as a vehicle for recovery e.g. to change attitudes, change emotional responses.  A bespoke journey is created for each student to support achievement of qualifications and promote personal development and personal growth.

 

(q)  There is a higher percentage of students with learning difficulties than in the general population and students are supported to overcome such barriers to education.

 

(r)  87 students have been awarded accredited certificates and qualifications so far in 2018 and there are currently 67 students across both Academies.  Lots of students progress onto become volunteers within the service and there are currently 20 volunteers working.

 

(s)  The Nottingham Recovery Network (NRN) Academy is based in the Wellbeing Hub and most students are referred by other NRN workers.  Clean Slate also gets referrals from probation services in the City.

 

Caroline Shaw, Nottingham University Hospitals NHS Trust, outlined that dealing with the impact of alcohol harm is an important part of Nottingham University Hospital’s work, both in the Emergency Department and dealing with the longer term consequences of alcohol harm.  One of NUH’s Liver Specialists is an alcohol champion within the organisation and they are working to identify champions in other clinical areas, especially the Emergency Department.  The Trust’s focus is on identifying individuals and signposting them to appropriate support.  There is an inpatient CQUIN for advice and support in admission areas and it is also a focus in pre-operation assessment.  Caroline also outlined that a health needs assessment is now part of employee appraisals.  This includes looking at alcohol, exercise and smoking and information and support is provided to staff.

 

During discussion the following points were made:

 

(t)  Identification of the problem is key to supporting individuals. 

 

(u)  The Clinical Commissioning Partnership has introduced consideration of alcohol use in pre-surgery screening.

 

(v)  Adult social care is noticing the direct and indirect impacts of alcohol harm.  IBA conversations are held but it would be useful to tailor IBA for use in specific services.

 

(w)Alcohol and/or drug use is not a barrier to accessing talking therapies and NICE criteria are clear on access to Improving Access to Psychological Therapies (IAPT) services.  There is a CQUIN relating to substance misuse and it has been agreed to accept more complex patients than NICE guidance requires.

 

(x)  In the Suffolk Integrated Care System, all health and social care workers have to make a contribution the prevention agenda as part of their appraisal.  There could be scope to work with Health Education England to require the Nottingham workforce to take action in relation to reducing alcohol harm as part of their appraisal process.  This would be relatively low cost and potentially have a significant impact.

 

(y)  It would be helpful to make the data ‘real’ at Care Delivery Group level so that people understand the extent of alcohol issues in their local population.

 

(z)  Consideration should be given to working with schools as part of Personal, Health and Social Education.

 

(aa)  Training on carrying out IBA is available but there are capacity limitations.

 

RESOLVED to

 

(1)  ask Board Members to:

  i.  sign the Alcohol Declaration

  ii.  identify alcohol champions within their organisation

  iii.  consider how to embed Identification and Brief Advice (IBA) in their organisation and, where appropriate:

a)  speak to Nottingham Recovery Network about getting support in embedding the approach and to register interest for IBA training

b)  speak to Nottingham City Council Public Health Team to register interest in accessing IBA scratchcards

 

(2)  consider how to measure success in reducing harm from alcohol; and

 

(3)  seek input from Nottinghamshire Healthcare NHS Foundation Trust on their perspective on reducing alcohol harm.