A Social Marketing Approach to the ‘wicked’ problem of alcohol

Newcastle upon TyneNorth TynesideNorthumberland

Lynda SeeryPublic Health Lead for Substance Misuse

Starting point – available datasets

• Hospital Episode Data - detailed• A&E data - limited• Crime data• Service data• Strategic Assessment data• Health Needs Assessment data• Social Care Data

– Incapacity benefits– Housing data– Supported Housing data

Admissions data vs A&E data• There is a need to distinguish between the 2 sets of data – differences

• A&E attendance (i.e. injury, intoxication, physical problem)– Primary diagnosis– Contributory factor i.e. alcohol (coding issues)– Differing requirements of the data – i.e. cross referencing to

crime/violence

• Admitted to hospital – specific vs related alcohol admissions– Primary diagnosis– Conditions which arise or are further identified during hospital spell

(coding)• Mental health & behavioural disorders due to alcohol related

harm• Intoxication• Cirrhosis of the liver• Pancreatic disease

• Can be numerous codes during hospital stay

Analysis of hospital admissions

• complex indicator• requested dataset 1/7/2007 – 30/9/2009• all admissions within ‘specific’ set of codes • Highest number of admissions in these 3

categories– F10 mental & behavioural disorders due to

alcohol– K70 alcoholic liver disease– T51 intoxication

HES Records• postcode level• Specific codes - wholly attributable to

alcohol (main focus)

• 1411 admissions (707) patients• between 141 – 202 admissions each qtr• Costs = £2.5m• 943/1411 readmissions (66.8%)• 239/707 patients readmitted (33.8%)• 153 males & 86 females• 468/707 patients admitted once (66.2%)• age breakdown

NewcastleProportion of population in each age group. Newcastle population as a whole and Newcastle admissions 1/4/07 - 31/3/09

<15

<15

15-24

15-24

25-34

25-34

35-44

35-44

45-5445-54

55-64

55-64

65-74

65-7475-84

75-8485+ 85+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Newcastle population Newcastle admissions

North TynesideProportion of population in each age group. North Tyneside population as a whole and North Tyneside admissions

<15

<15

15-24

15-24

25-34

25-34

35-44

35-44

45-5445-54

55-64

55-64

65-74

65-7475-84

75-8485+ 85+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

North Tyneside population North Tyneside admissions

NorthumberlandProportion of population in each age group. Northumberland population as a whole and Newcastle admission 1/4/07 - 31/3/09

<15

<15

15-24

15-24

25-34

25-34

35-44

35-44

45-54

45-54

55-6455-64

65-74

65-7475-84

75-8485+ 85+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Northumberland population Northumberland admissions

Segmentation - understanding the patient layers

The ‘patient layers’ fall into the following categories:

• Patients admitted to hospital for 1 day or less (no overnight stay)

• Patients admitted only once

• Patients admitted once for intoxication / patients re-admitted for intoxication

• Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)

• Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas

• Patients with severe ongoing/end stage illness

Patients admitted once only for 1 day or 8 hours or less

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Newcastle PCT North Tyneside PCT Northumberland CT

Admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(patient admitted once for 1 day or less)

Stomach or Duodenum Disorders

Ingestion Poisoning or Allergies

Epilepsy

Syncope or Collapse

Gastrointestinal Bleed

Sprains, Strains, or Minor Open Wounds

Chronic Pancreatic Disease

Chest Pain

General Abdominal Disorders

Poisoning, Toxic, Environmental

Example of intoxication record

Codes listed

T40 (primary diagnosis)

poisoning by drugs, medicaments and biological substances

X620 intentional self harm

T51 intoxication/toxic effects of substances non medicinal as to source

S099 injuries to head

W19 fall

F101 harmful use

‘Frequent users’ or re-admissions to hospital

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Newcastle PCT North Tyneside PCT Northumberland CT

Re-admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(239 frequent users accounting for 943 admissions )

Stomach or Duodenum Disorders

Gastrointestinal Bleed

Chronic Obstructive PulmonaryDisease or Bronchitis

General Abdominal - DiagnosticProcedures

Pancreatic Disorders

Drainage of Ascites

Poisoning, Toxic, Environmental

General Abdominal Disorders

Chronic Liver Disorders

Chronic Pancreatic Disease

Example of re-admission recordCodes listed

K703 (primary diagnosis)

Diseases of the liver

F102 Dependence syndrome

I10X Hypertensive diseases

J459 Chronic lower respiratory diseases

R18X Symptoms and signs involving the digestive system and abdomen

Z720 Persons encountering health services in other circumstances

Z867 Persons with potential health hazards related to family and personal history and certain conditions influencing health status

Target groups• Initial target groups

– patients re-admitted for intoxication

- Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)

Significant 60

– Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas

North of Tyne 20

  Male Female

Newcastle 44 49

North Tyneside 22 22

Northumberland 17 25

Establishment of Community Alcohol Teams

What will Community Alcohol teams provide?

• Service primarily focused on service provision within the community setting, building capacity in tier 2 and enhancing tier 3 provision of specialist services

• Community / home detox support being developed (as appropriate)

• Assessment, expert clinical advice, managing health risk for those individuals with a dominant single condition i.e. alcohol

• Establishment of Community Open Clinics – development of ‘wrap-around’ services (provide monitoring of physical and mental health, alcohol counselling, assessment and advice regarding relapse prevention)

• Partner presence at Community Open Clinics: social care worker, housing advice, benefits advice, assertive outreach to support attendance at clinics.

• Venues will vary across the city - targeted areas across the city

• The establishment of a regular Community Open Clinic at Cyrenians work with vulnerable individuals with alcohol related problems including those experiencing social exclusion

Key areas of development• Multi agency care plans

– (individuals may have a single dominant condition i.e. alcohol but may be known to different agencies)

• Community Open clinics (walk in, self refer, referred into from any other service) – Professionals available at clinics, clinical & mental health staff,

social care, housing, benefits

• Assertive Outreach • Emerging workforce (i.e. new roles, liaison, co-ordination,

systems approach to service delivery)

• A&E – Alcohol Liaison Workers

• Wider use of IBAs (pragmatic approach - multi agency training)

BROADENING THE BASE OF “TREATMENT” FOR ALCOHOL PROBLEMS

• Most important change in treatment of alcohol problems over last 10-20 years: focus of intervention broadened from just “alcoholics” to much larger number of “excessive drinkers” (i.e., hazardous and harmful drinkers).

• Sufficient number of excessive drinkers show progressive deterioration to make early intervention and secondary prevention an essential part of national response to alcohol-related harm. Such an approach is likely to be highly cost-effective.

• For many types of problem, the major contribution to alcohol's costs to society comes from drinkers with less frequent and serious problems, cf. “the preventive paradox”

Community Open Clinics

– Professionals available at clinics, clinical & mental health staff, social care, housing, benefits

• Locations– City/Town centres– Community centres– Universities– ‘Peoples Kitchen’ (Newcastle)– Shopping Centres

2010 2015 2020 2025

A

B

C

Lead time for achieving outcomes & impacting on alcohol target

Gestation from input to outcome

Reducing the harm from alcohol - Alcohol-harm related hospital admission rates (NI 39)

Treatment – Integrated service approach to those individuals admitted to hospital

Treatment – Integrated service approach to those individuals admitted to hospital or those suffering from alcohol misuse

Brief & Extended Interventions

Prevention – education & communication

Heavier enforcement

Sensible drinking campaigns

Social Marketing - initiatives

How long will it take us to impact on our target?

How hard can it be?

•Pace

•Purpose

•Passion

Questions?