alcohol needs assessment v4

Alcohol Needs Assessment

ALCOHOL NEEDS ASSESSMENT – 2014

Acknowledgements

Members of the Steering Group

Sharon Ayrey London Borough of Newham

Wayne Brown London Fire Brigade

Jill Britton London Borough of Newham

Steve Bluemore London Metropolitan Police

Martin Clement London Borough of Newham

Greg Davis London Borough of Newham

Dezlee Dennis Probation Service

Margaret Eni-Olotu London Borough of Newham

Sarah.Garner Newham CCG

Fiona Hackland London Borough of Newham

Matthew Hooper London Borough of Newham

Hannah Lindsell Public Health England

Parag Manchanda London Borough of Newham

Sue Milner London Borough of Newham

Joanne Pealling London Borough of Newham

Simon Reid London Borough of Newham

James Ross Barts Health

Chrisa Tsiarigli London Borough of Newham

Kelly Simmons London Borough of Newham

Lee Walker North & East London Commissioning Support Unit

Mark Wood London Metropolitan Police

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ContentsAcknowledgements....................................................................................................2Contents......................................................................................................................3Executive Summary...................................................................................................7

Key Issues................................................................................................................7Key recommendations..............................................................................................8

Introduction................................................................................................................9Aim and objectives of the Alcohol Needs Assessment............................................9

Profile of London Borough of Newham...................................................................9General population profile........................................................................................9Alcohol specific profile............................................................................................10

Figure 1: Drug related issues that residents have noticed in their local area.....11

Policy Context..........................................................................................................12National context......................................................................................................12The Public Health Outcomes Framework...............................................................12Local context..........................................................................................................13

Scale of problem......................................................................................................14Alcohol use and health harms................................................................................14

Table 1: Alcohol-related admission and mortality estimates by ranks, within Newham and London.........................................................................................15Figure 2a. Mortality from chronic liver disease in men. (Trend chart)...............15Figure 2b Mortality from chronic liver disease in men. (Regional comparison)..15Figure 3: Alcohol-specific hospital admissions for men. (Regional comparison).............................................................................................................................16Table 2 - Number of alcohol specific admissions by age group and gender, Newham.............................................................................................................17Figure 4: Alcohol specific admissions rates, Newham.......................................17Table 3 - Number of alcohol specific admissions by ethnic group and gender, Newham.............................................................................................................18Table 4 - Number of alcohol specific re-admissions by age group and gender, Newham CCG....................................................................................................19Figure 5 - Alcohol specific re-admission rates, Newham...................................19Table 5 - Number of alcohol specific re-admissions by ethnic group and gender, Newham.............................................................................................................20Figure 6a: Alcohol-related hospital admissions (narrow) for men (Trend Chart)21Figure 6b Alcohol-related hospital admissions (narrow) for men (Regional comparison)........................................................................................................21Figure 7a: Alcohol-related hospital admissions (narrow) for women (Trend chart)............................................................................................................................22Figure 7b: Alcohol-related hospital admissions (narrow) for women (Regional comparison)........................................................................................................22Figure 8: Admission episodes for alcohol -related (narrow) admissions (Regional comparison)........................................................................................................22Figure9: Alcohol related admissions by ward.....................................................23Figure 10: Alcohol related admissions by ward..................................................23

Alcohol-related hospital re-admissions...................................................................24

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Figure 11: Alcohol related re-admission by ward...............................................24Figure 12: Alcohol related re-admissions by ward and ethnic group..................24

Associated costs.....................................................................................................25Summary................................................................................................................25Patterns of drinking in the borough........................................................................26

Figure 13: Abstainers synthetic estimate (Regional comparison)......................26Figure 14: Binge drinking (synthetic estimate) (Regional comparison)..............27Figure 15: Lower risk drinking (% of drinkers only) synthetic estimate (Regional comparison)........................................................................................................28Figure 16: Increasing risk drinking (% of drinkers only) synthetic estimate (Regional comparison).......................................................................................28Figure 17a: Higher risk drinking (% of drinkers only) synthetic estimate............29Figure 17b- Higher Risk drinking in Newham.....................................................29

Summary................................................................................................................30Alcohol use and crime............................................................................................31

Figure 18a: Alcohol-related recorded crimes (Trend chart)................................31Figure 18b: Alcohol related crime (Regional comparison).................................31Figure 19:a Alcohol-related violent crimes (Trend chart)...................................32Figure 19b: Alcohol-related violent crimes (Regional comparison)....................32Figure 20: Alcohol-related violent crimes...........................................................32Figure 21a: Alcohol-related sexual offences. (Trend chart)...............................33Figure 21b: Alcohol-related sexual offences. (Regional comparison)................33Figure 22: Alcohol-related sexual offences........................................................33

Alcohol use and Employment and Benefits............................................................34Table 6: Employment status at start of treatment – Newham with national comparison 2013-14...........................................................................................34Table 7: Benefit profile of the treatment population, 2012..................................34Table 8: Number of individuals in treatment recorded as being on benefits on 31st March 2012 (by type)...................................................................................35Table 9: Median length of time (years) claiming benefits between the start of benefit claim and 31st March 2012 (by type).......................................................35

Summary................................................................................................................36

Alcohol service provision in Newham....................................................................37Evidence Based Practice.......................................................................................37Identification and assessment of harmful drinking and alcohol dependence.........37

Figure 23: Proportion of patients scoring positive on AUDIT-C..........................38Specialist Alcohol Services in Newham - 2010-2014.............................................39

Table 10: Total spend on commissioned alcohol services 2010 - 2013.............40Data collection........................................................................................................40Newham adults in alcohol treatment......................................................................40

Fig.24: Number of individuals in alcohol treatment............................................41Fig.25: Age of individual clients in contact with treatment system.....................41Fig.26: Gender of individual clients in contact with treatment system................41Figure 27: Ethnicity of clients in touch with the alcohol treatment system.........42

Referral Sources.....................................................................................................42Figure 28: Referral sources of those in alcohol treatment..................................43

Other substances used..........................................................................................43Figure 29: Second and third drug used by those in primary alcohol treatment. .43Table 11: Primary drug users with alcohol recorded as their second or third misused substance.............................................................................................44

Alcohol consumption levels....................................................................................44Figure 30: Reported drinking days per month and units consumed per week...44

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Alcohol treatment interventions offered..................................................................45Table 12: Interventions offered in initial care plan..............................................45

Alcohol community detoxification...........................................................................46Alcohol in-patient detoxifications............................................................................46Alcohol residential treatment..................................................................................46Additional needs.....................................................................................................46

Figure 31: Mental health identification................................................................47Figure 32: Housing Status..................................................................................47Figure 33: Proportion of people living with children............................................47

Waiting times..........................................................................................................48Figure 34: Treatment waiting times....................................................................48

Alcohol treatment exits...........................................................................................48Figure 35: Treatment Exits.................................................................................49

SummaryStakeholder Views..................................................................................49Stakeholder Views..................................................................................................50

Other initiatives addressing alcohol in the borough............................................51Housing..................................................................................................................51Ambulance service.................................................................................................52

Figure 36: Alcohol-related Ambulance calls.......................................................53Figure 37: Correlation of ambulance call for binge drinking by off-licence premises.............................................................................................................53

London Fire Brigade...............................................................................................54Domestic and Sexual Violence...............................................................................54Metropolitan Police Service....................................................................................54

Figure 38 – Newham TNO v Alcohol 2009-2013................................................55Figure 39 –Proportion of alcohol related offences by month against total offences Newham versus total Metropolitan Police Service...............................56Figure 40: Trends of alcohol related offences grouped by crime types..............56

Probation................................................................................................................57Figure 41: Percentage of offender with an alcohol misuse problem..................57Table 13: Offence categories – all offenders compared with offender with alcohol misuse issues.........................................................................................58Table 14: Gender breakdown of offender and alcohol misuse offenders in 2010-11........................................................................................................................58Figure 42: Age breakdown of offenders and alcohol misuse offenders.............59Figure 43: Ethnic breakdown of offenders with an alcohol misuse problem......59

Licensing................................................................................................................60Table 15: Licensing activity................................................................................60

Uniform...................................................................................................................61Table 16: Service Requests...............................................................................61Figure 44: Volume of externally reported service requests by type...................62Figure 45: Volume of internally reported service requests by type....................62Table 17 – Ethnicity of perpetrator.....................................................................62Table 18 – Gender of perpetrator.......................................................................63Map 1: All Alcohol Service Requests.................................................................64Map 2: Street Drinking Service Requests only...................................................65

Summary................................................................................................................66

Gaps and commissioning priorities.......................................................................67Gaps in provision....................................................................................................67

Identification and assessment in all settings to identify harmful drinking and alcohol dependence...........................................................................................67

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Interventions for harmful drinking and alcohol dependence...............................67Commissioning priorities........................................................................................68

Integrated adult substance misuse service........................................................68

Conclusions and Recommendations.....................................................................71Key recommendations............................................................................................71

Glossary....................................................................................................................72Appendix One: Standards and Clinical Guidance.................................................74Appendix Two: NICE Pathway for alcohol-use disorders....................................75Appendix Three: AUDIT...........................................................................................76

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Executive Summary

The aim of this alcohol needs assessment is to gain a greater understanding of alcohol use and its impact across London Borough of Newham in terms of health, crime and social impact.

It develops understanding of the current responses to alcohol use across health, social care and criminal justice interventions in order to identify any gaps, unmet service user need and opportunities for development in Newham to support commissioning and service development.

Key IssuesThe following are the key issues surrounding alcohol use in Newham.

London Borough of Newham has higher than average rates of health-related harms as a result of alcohol use in its population. This is particularly true for men who are over-represented in alcohol-related mortality, alcohol specific and alcohol-related admissions to hospital.

This contrasts with self-reported levels of drinking gathered in the national General Lifestyle Survey and in the Newham Household Panel Survey. These show an overall pattern of low levels of drinking, including the lowest rate of binge drinking in England, and high levels of abstention. This disparity may be explained by selection bias in the surveys or by under-reporting of drinking levels by residents belonging to ethnic groups that have a prohibition on drinking alcohol for cultural or religious reasons.

The majority of people entering treatment for alcohol problems are dependent on alcohol by the time they make contact with the specialist alcohol service. Earlier opportunities to identify alcohol-related harms have not been taken in other health, social care and criminal justice settings. Alcohol users often present to treatment services with needs related to their use of other drugs.

These factors suggest that alcohol-related issues are not being identified either by individuals or by professionals until the point at which the individual is experiencing harm. This points to a need to improve screening and to provide education and information on alcohol and its related harms across the population. It also suggests that there may be a hidden population of residents not identified as having alcohol problems who remain hidden to data, making an assessment of need a complex activity. A focus on early intervention and prevention may have a positive impact upon reducing alcohol-related harms and their associated costs.

In general, the rates of alcohol-related recorded crime, alcohol-related violent crime and alcohol-related sexual offences in Newham have decreased. However, the rate of each of these types of crime remains higher than London and England averages. 30% of all offenders have an alcohol misuse problem and offenders with an alcohol misuse problem are more than likely than other offenders to have a mental health issue. Male, and are in the 18 – 40 age group.

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more likely to have a housing need.

The level of public nuisance has risen between 2011 and 2014.

Newham is a borough with a high level of multiple deprivation and this is reflected in the higher than national average of people entering treatment on benefits.

The numbers of rough sleepers with alcohol-related issues in the borough are increasing at the same time as hostel provision is being reduced.

These key issues are being addressed through: The commissioning of an integrated adult substance misuse service that has

been operational since July 2014 Undertaking work at the strategic and operational levels to improve responses

to the complex needs that accompany alcohol use in the borough through establishing relationships and joint working arrangements with the multiple agencies working with alcohol issues.

Key recommendations Develop strategic relationships within LBN and partner organisations to ‘drive’

partnership working, including partnerships with: Police Housing Health Fire Ambulance Licensing

Consider related areas of work that could benefit from a strategic approach to needs assessment.

Undertake work to develop and improve data collection to better inform strategic planning and commissioning. This should include data from primary and secondary care.

Monitor the integrated adult substance misuse service’s delivery of interventions against the requirement of the service specification.

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IntroductionThis alcohol needs assessment identifies the needs of the adult (18 and over) population of London Borough of Newham.

Aim and objectives of the Alcohol Needs AssessmentThe aim of this alcohol needs assessment is to gain a greater understanding of alcohol use and its impact across London Borough of Newham in terms of health, crime and social impact.

It develops understanding of the current responses to alcohol use across health, social care and criminal justice interventions in order to identify any gaps, unmet service user need and opportunities for development in Newham to support commissioning and service development.

Profile of London Borough of Newham

General population profileThe London Borough of Newham (LBN) has one of the youngest and most diverse populations in the country. It is also one of the most deprived boroughs with low levels of employment and high levels of income poverty. The health of Newham residents is more varied compared with the average for England.1

Newham has a substantial turnover in the local population. Less than half of the population were born in the UK (46.3% of residents). However, the majority of residents were either born in the UK, or have been resident in the UK for 10 years or more (69.4% of residents). The remaining residents (30.6%) have been resident for less than ten years.2

The majority of Newham residents were born in the UK (46.3% of residents), the next largest group was born in countries other than the EU (42.4% of residents) and the smallest group were born in other EU countries (11.3% of residents).3

Most people in the Borough are either Asian/Asian British (43.5 %), Black/African/Caribbean/Black British (19.6%), and around 3.4% belong to mixed and other ethnic groups. 29% of Newham residents are White, well below the London average (59.8%).4

Reflecting the diverse population, 24.3% of households do not have anyone in the household who had English as their main language. 5.1% of households have at least one person aged 3-15 with English as their main language. 70.6% of residents have an adult in their household with English as their main language.5

The most common languages other than English are Bengali (7.4% of residents), Urdu (4.4%) and Gujarati (3.3%). There are increasing numbers speaking Eastern European languages, with the most common being Lithuanian (2.7%) and Polish (2%).6

1 Public Health England (2014), Newham Health Profile 2014,2 Office for National Statistics (ONS) 2011 Census Table QS803EW Length of Residence in the UK.3 Office for National Statistics, (ONS) 2011 Census Table KS204EW Country of Birth, 20114 Office for National Statistics, (ONS) 2011 Census Table KS201EW Ethnic Group, 20115 Office for National Statistics, (ONS) 2011 Census Table KS206EW Household Language, 20116 Office for National Statistics, (ONS) 2011 Census Table QS204EW Main Language (detailed) 2011

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52.1% of the borough’s population are males, a higher proportion than the national (England) average of 49.2%.

The most important factor accounting for poorer health outcomes is socioeconomic deprivation.

Based on the Index of Multiple Deprivation (IMD)7, Newham is the 3rd most deprived local authority area in the country with more than 80% of its population living in an area included in England’s most deprived quintile Newham is the most deprived London Borough. 8

Newham has the 3rd worst life expectancy rate for males and 5th worst life expectancy rate for women in London. Life expectancy for men is lower than the England average. The life expectancy gap between the most and least deprived wards is 7.4 years for men and 6.6 years for women. This means that more people in Newham are dying early from potentially preventable conditions.9

7% of residents report that their day-to-day activities are limited a lot by a long-term health problem or disability, which is less than the England average of 8.3%.10

Newham has proportionally more children aged 0-10 (15%) than the England average (11.9%), a higher proportion of population aged 18-64 (68.1%) than the England average (62.3%) and a significantly lower proportion of population aged 65+ (6.6%) than the England average (16,4%). The average age of Newham residents is 31.4 years and the median is 29 years.11

Alcohol specific profileIn 2012 a consultation was undertaken with service users, carers, providers and professionals as part of the development of the Newham Substance Misuse Strategy. Newham residents took part in a workshop and completed a Newham residents’ panel survey (262 questionnaires were completed). Key points raised by residents were:

Drugs and alcohol are viewed as a problem in Newham by large proportions of the community.

People in Newham also directly experience the harms that come from drug and alcohol misuse

People are sometimes not aware or confident as to where they can access help for people with drug and alcohol problems.

70% of respondents to the Newham Household Panel Survey in 2013 thought people being drunk and rowdy in the street or other public places was a big worry.12

Figure 1: Drug related issues that residents have noticed in their local area

7 Index of Multiple Deprivation (IMD) 2010 8 Public Health England (2014), Newham Health Profile 2014, (http://www.apho.org.uk/resource/view.aspx?QN=HP_RESULTS&GEOGRAPHY=BB)9 Public Health England (2014), Newham Health Profile 2014 Link as above10 Office for National Statistics, (ONS) 2011 Census Table QS303EW Long-term Health Problem or Disability, 2011.11 Office for National Statistics, (ONS) 2011 Census Table KS102EW Age Structure, 2011.12 Understanding Newham 2013 Newham Household Panel Survey Wave 7 Survey Findings

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http://www.apho.org.uk/resource/view.aspx?QN=HP_RESULTS&GEOGRAPHY=BB


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85%78%

69%61%

45% 45%

12% 13%5%

Discardedalcohol

containers(glass /bottles /

cans) in thestreet

Peopledrinking

alcohol inthe streets

Peopleunder the

influence ofalcohol inthe streetsor parks

Peopledrinking

alcohol inparks

Alcoholrelated

violence oranti-socialbehaviour

People thatlook under18 years of

agedrinkingalcohol

People thatlook under18 years of

agepurchasing

alcohol

Other None of theabove


Policy Context

National contextThe Government Alcohol Strategy 2012 addresses both health and social harms describing coordinated actions across Government, including a strong package of health measures. Its key outcomes include achieving:

A change in behaviour so that people think it is not acceptable to drink in ways that could cause harm to themselves or others;

A reduction in the amount of alcohol-fuelled violent crime; A reduction in the number of adults drinking above the NHS guidelines; A reduction in the number of people “binge drinking”; A reduction in the number of alcohol-related deaths; and A sustained reduction in both the numbers of 11-15 year olds drinking alcohol

and the amounts consumed

In addition the following actions are included:

Including an alcohol check within the NHS Health Check for adults from April 2013.

Increasing the flexibility of the Alcohol Treatment Requirement imposed by the court as part of a community sentence.

Strengthening local powers to control the density of premises licensed to sell alcohol, including a new health-related objective for alcohol licensing for this purpose.

The Public Health Outcomes FrameworkThe 2013-2016 Public Health Outcomes Framework concentrates on two high-level outcomes to be achieved across the public health system:

increased healthy life expectancy reduced differences in life expectancy and healthy life expectancy between

communities

These outcomes are underpinned by public health indicators. The following indicators specifically relate to alcohol use.

1.13: Re-offending - ‘Tackling a person’s offending behaviour is often intrinsically linked to their physical and mental health, and in particular any substance misuse issues.’

1.8: Employment for those with a long-term health condition including those with a learning difficulty/disability or mental illness – ‘The strategy for public health takes a life course approach and this indicator provides a good indication of the impact limiting long term illness has on employment among those in the ‘working well’ life stage...[including] other health problems or disability’

2.10: Hospital Admissions as a result of self-harm – ‘With the risk of death by suicide being considerably higher among people who have self-harmed and with their high rates of mental health problems, and alcohol and substance misuse, it is essential that healthcare professionals address the experience of care by people who self-harm

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2.16: People entering prison with substance dependence issues who are previously not known to community treatment – There is significant evidence that treatment interventions for the management of substance misuse can help to reduce re-offending’

2.18: Alcohol-related admissions to hospital – ‘Alcohol misuse is the third-greatest overall contributor to ill health...’

4.6: Mortality from liver disease – ‘Most liver disease is preventable and much influenced by alcohol consumption and obesity prevalence, which are both amenable to public health interventions.’13

Local contextThe Newham Resilience Performance Management Framework sets out the borough’s approach to building community and personal resilience to develop skills, health and access to employment for its residents.

The recent recommissioning of Newham’s integrated adult substance misuse service focused upon the achievement of the following community and personal resilience outcomes.

Community Resilience

Reduction in the proportion of drug using criminal justice clients committing specific serious acquisitive crimes.

Reduced arrests of those in substance misuse treatment.

Personal resilience

Drug treatment leading to a reduction in chaotic living Successful completion of substance misuse treatment where requested by the

user. Reduced alcohol-related hospital admissions.

Newham’s approach to alcohol service provision is set out in its substance misuse commissioning strategy ‘Drug and alcohol services in Newham: The Way Forward 2013’. Newham’s priorities are to protect the broader community from harms associated with drugs and alcohol, and to provide the vulnerable people misusing substances in the borough with support to overcome their dependency. These priorities align with broader community concerns around drugs and alcohol and what service users want for themselves.

13 Department of Health (2012) Public Health Outcomes Framework Autumn

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Scale of problemEstimating the prevalence of alcohol-related harm requires data from a number of sources.

The Local Alcohol Profiles for England (LAPE) are produced by Public Health England. Modelled or synthetic prevalence estimates are based on population standardised data and, in some cases, self-reporting of levels of consumption of alcohol in the General Household Survey 2008 and 2009, which are then standardised to ONS population data.

Local data such as the Newham Household Panel Survey has gathered self-reported information about levels of alcohol consumption.

Alcohol use and health harmsA range of data for each borough is provided and compared with regional and national data. This data was refreshed in 2012 using revised methodologies. For this reasons care should be taken when comparing the estimates presented here with previous published estimates from LAPE.

LAPE provides data14 on mortality, alcohol-related and alcohol-specific hospital admissions, derived from hospital episode statistics 2012/13 and ONS mid-year 2012 population estimates. LAPE also provides synthetic estimates of the levels of drinking derived from a statistical model developed to estimate the percentage of abstainers, lower risk drinkers, increasing risk drinkers, higher risk drinkers and binge drinkers (see Glossary). Data is also collected on alcohol related crime.

Data from LAPE shows that Newham has higher than national and regional averages of:

Mortality from chronic liver disease in men Alcohol-specific hospital admissions for men Alcohol-related hospital admissions for men and women Admission episodes for alcohol -related admissions Abstainers Lower-risk drinkers.

Newham has lower than national and regional averages of: Mortality from chronic liver disease in women Alcohol-specific hospital admissions for women Increasing risk drinkers Higher risk drinkers Binge drinking.

14 The data is a directly age-standardised rate per 100,000 population (standardised to the European standard population).

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Table 1: Alcohol-related admission and mortality estimates by ranks, within Newham and London

Newham London Rank in London

Alcohol-specific hospital admissions (males) 2012/13 directly standardized per 100,000

603.57 529.04 12

Alcohol-specific hospital admissions (females) 2012/13 directly standardized per 100,000

156.67 188.09 25

Alcohol-related hospital admissions Broad (males) 2012/13 directly standardized per 100,000

2161.86 1784.05 4

Alcohol-related hospital admissions Broad (females) 2012/13 directly standardized per 100,000

1039.15 842.30 2

Alcohol-related hospital admissions Narrow (males) 2012/13 directly standardized per 100,000

660.21 557.10 8

Alcohol-related hospital admissions Narrow (females) 2012/13 directly standardized per 100,000

277.56 260.13 14

Alcohol-specific mortality (males) 2010/12 directly standardized per 100,000

12.90 12.10 14

Alcohol-specific mortality (females) 2010/12 directly standardized per 100,000

3.06 4.39 27

Mortality from chronic liver disease (males) 2010/12 directly standardized per 100,000

20.83 15.45 1

Mortality from chronic liver disease (females) 2010/12 directly standardized per 100,000

8.15 6.77 8

Data source: Local Alcohol Profile for England, PHE 2014

This data presents a contradictory picture of apparent low levels of risky drinking contrasted with higher than average levels of harm resulting from drinking

The content presented below shows all of the data related to the levels of alcohol-related harm in the borough and synthetic estimates for drinking patterns in population. Where available demographic information is also presented.

Chronic Liver Disease

Figure 2a. Mortality from chronic liver disease in men. (Trend chart)

Figure 2b Mortality from chronic liver disease in men. (Regional comparison).

Source: Local Alcohol Profile England 2014

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Newham has the third highest mortality rate due to chronic liver disease (including cirrhosis) in men in the London region at 20.83 per 100,000 population (CI 14.75 – 28.41) in 2010 – 2012. This shows a decrease from the peak in 2011 of 22.62 per 100,000 population (CI 16.26 – 30.46).

Alcohol is the primary contributor to chronic liver disease in England, so these levels of mortality indicate underlying high levels of harmful or dependent drinking in the population.

Alcohol-specific hospital admissions15

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

Figure 3: Alcohol-specific hospital admissions for men. (Regional comparison).


LAPE data shows that in 2012/13 Newham had a rate of 603.57 per 100,000 population (CI 550.6 – 660.27) for alcohol-specific hospital admissions for men. This is a reduction from the peak of 663.43 per 100,000 population (CI 606.73 – 723.42) in 2010/11. However, the large confidence intervals for this data suggest that this apparent reduction should be treated with caution.

Newham ranks 12th out of the 33 London local authority areas and 255th out of 326 local authority areas in England.

Table 1 shows the actual number of admissions by age group and gender in 2012-14. Figure 4 shows the rate per 10,000 population for the same period broken down by age and gender.

15 This does not include attendance at Emergency Departments

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Table 2 - Number of alcohol specific admissions by age group and gender, Newham

Source: Newham Clinical Commissioning Group

Figure 4: Alcohol specific admissions rates, Newham


Alcohol specific admissions for men constitute about 80% of all hospital admissions across the period 2012-2014. The age profile shows a steady increase in admissions of men until the 50-54 age band. However, the admissions rate peaks again in the 65-69 age band. The actual number of admissions shown in Table 1 also shows a peak of admissions for men in the 50-54 age band, with a slight increase again in the 65-69 age bands. It is likely that the data in Figure 4 is showing a rise in admissions for older age bands as an artefact of the relatively young population in Newham. In either case the data does show treatment need in an older population.

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Age group 2012/13 2013/14 Total 2012/13 2013/14 Total 2012/13 2013/14 Total> 16 3 3 1 1 3 1 416-19 3 3 6 1 2 3 4 5 920-24 4 3 7 4 16 20 8 19 2725-29 10 5 15 20 31 51 30 36 6630-34 3 12 15 61 46 107 64 58 12235-39 14 20 34 56 41 97 70 61 13140-44 13 17 30 61 66 127 74 83 15745-49 10 7 17 60 72 132 70 79 14950-54 14 19 33 70 69 139 84 88 17255-59 7 12 19 33 32 65 40 44 8460-64 6 5 11 22 23 45 28 28 5665-69 8 2 10 28 21 49 36 23 5970-74 2 4 6 9 3 12 11 7 1875-79 1 1 11 4 15 12 4 1680-84 6 7 13 6 7 1385 + 1 1 1 0 1Grand Total 98 109 207 443 434 877 541 543 1084

Female Male Persons


Table 3 - Number of alcohol specific admissions by ethnic group and gender, Newham


Table 3 shows the gender and ethnic breakdown of alcohol specific alcohol admissions in Newham. The data shows that the ethnic groups with the greatest number of admissions in 2012/13 and 2013/14 are White British (36%) or White: Any other White background (19%). The next largest ethnic group is Asian: Indian or British Indian (9.9%). 96% of admissions in this ethnic group are male. It is unlikely that this large difference in admission rates between British Indian men and women is entirely due to underlying differences in rates of harmful and dependent drinking. This may be explained by:

Clinicians not attributing behavioural disorders to an underlying alcohol issue in British Asian women

Minimisation, for cultural reasons, by the patient of drinking levels when giving a history.

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Ethnic group 2012/13 2013/14 Total 2012/13 2013/14 Total 2012/13 2013/14 TotalASIAN: Bangladeshi or British Bangladeshi 1 1 2 6 6 7 1 8ASIAN: Indian or British Indian 2 2 4 48 59 107 50 61 111ASIAN: Other Asian, British Asian, Asian Unspecif 3 1 4 23 26 49 26 27 53ASIAN: Pakistani or British Pakistani 2 2 17 8 25 17 10 27BLACK: African 8 5 13 28 25 53 36 30 66BLACK: Any other Black background 1 2 3 8 8 16 9 10 19BLACK: Caribbean 12 6 18 13 13 26 25 19 44MIXED: Other Mixed, Mixed Unspecified 1 1 1 5 6 1 6 7NOT STATED 3 4 7 17 27 44 20 31 51OTHER: Any other ethnic group 4 2 6 17 21 38 21 23 44Unknown 2 1 3 4 14 18 6 15 21WHITE: Any other White background 18 30 48 78 82 160 96 112 208WHITE: British (English, Scottish, Welsh) 38 47 85 165 136 301 203 183 386WHITE: Irish 6 5 11 18 10 28 24 15 39Grand Total 98 109 207 443 434 877 541 543 1084

Female Male Persons


Alcohol-specific hospital re-admissions

Table 4 - Number of alcohol specific re-admissions by age group and gender, Newham CCG


Table 3 shows the number of people previously admitted for an alcohol specific condition who have been readmitted in the 2012/13 and 2013/14 period. Comparison with the data in Table 2 shows that 799 of the 1,084 admissions shown in that period, were readmitted – a rate of 74%. Readmission rates were higher for men (77%). This level of readmission rate suggests that high levels of dependent is not being addressed satisfactorily on initial admissions.

Figure 5 - Alcohol specific re-admission rates, Newham


Figure 5 shows that readmission rates per 10,000 are highest for men in the 65-69 age band.

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Age group 2012/13 2013/14 Total 2012/13 2013/14 Total 2012/13 2013/14 Total20-24 1 2 3 1 2 325-29 3 2 5 14 19 33 17 21 3830-34 12 12 36 35 71 36 47 8335-39 17 22 39 36 21 57 53 43 9640-44 5 11 16 23 36 59 28 47 7545-49 11 1 12 62 68 130 73 69 14250-54 8 11 19 44 93 137 52 104 15655-59 6 6 26 36 62 26 42 6860-64 2 4 6 3 15 18 5 19 2465-69 2 2 4 42 25 67 44 27 7170-74 2 5 7 7 8 15 9 13 2275-79 4 9 13 4 9 1380-84 4 4 8 4 4 8Total 50 76 126 302 371 673 352 447 799

Female Male Persons


Table 5 - Number of alcohol specific re-admissions by ethnic group and gender, Newham


The ethnic group with the highest number of readmissions is White British. This is consistent with the high levels of alcohol related initial admissions in this group.

Alcohol-related hospital admissions16

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

Figure 6a: Alcohol-related hospital admissions (narrow17) for men (Trend Chart)


16 This does not include attendance at Emergency Departments.17 The narrow measure for alcohol related admissions is ‘primary diagnosis or any secondary diagnosis with an external cause’.

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Ethnic group 2012/13 2013/14 Total 2012/13 2013/14 Total 2012/13 2013/14 TotalASIAN: Bangladeshi or British Bangladeshi 0 4 63 67 4 63 67ASIAN: Indian or British Indian 1 1 40 19 59 40 20 60ASIAN: Other Asian, British Asian, Asian Unspecif 1 1 27 8 35 28 8 36ASIAN: Pakistani or British Pakistani 2 2 12 19 31 12 21 33BLACK: African 3 2 5 21 10 31 24 12 36BLACK: Any other Black background 2 5 7 7 12 19 9 17 26BLACK: Caribbean 6 6 9 4 13 15 4 19NOT STATED 2 1 3 6 9 15 8 10 18OTHER: Any other ethnic group 2 2 3 9 12 3 11 14Unknown 1 1 2 2 4 2 3 5WHITE: Any other White background 4 20 24 16 53 69 20 73 93WHITE: British (English, Scottish, Welsh) 25 37 62 142 151 293 167 188 355WHITE: Irish 7 5 12 13 12 25 20 17 37Total 50 76 126 302 371 673 352 447 799

MaleFemale Persons


Figure 6b Alcohol-related hospital admissions (narrow) for men (Regional comparison)

In 2012/13 Newham had a rate of 660.21 per 100,000 population (CI 602.99 – 720.6) for male alcohol-related hospital admissions. Although there has been yearly variation in this rate since 2008/09, the rate has remained within the confidence interval for 2012/13 for the last 5 years. Newham is has the eighth highest alcohol-related hospital admission rate in London.

Figure 7a: Alcohol-related hospital admissions (narrow) for women (Trend chart)

Figure 7b: Alcohol-related hospital admissions (narrow) for women (Regional comparison)

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LAPE data shows that in 2012/13 Newham had a rate of 277.56 per 100,000 population (CI 244.48 – 313.01) for female alcohol-related hospital admissions. Although there has been yearly variation in this rate since 2008/09, the rate has remained within the confidence interval for 2012/13 for the last 5 years.

Figure 8: Admission episodes for alcohol -related (narrow) admissions (Regional comparison)


In 2012/13 Newham had a rate of 620.04 per 100,000 population (CI 583.19 – 658.37). This is a reduction from the peak rate in 2010/11 of 652.41 (CI 614.52 – 601.78). Newham is has the ninth highest alcohol-related hospital admission rate in London.

It is likely that alcohol-related hospital admissions are under-reported as case management systems record a primary diagnosis. If a person with issues with alcohol is admitted is for a reason not defined as alcohol-related and/or their admission information does not include a condition considered to be alcohol-related then the admission will not be included in the data outlined above.

Figure9: Alcohol related admissions by ward

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Figure 10: Alcohol related admissions by ward

The hospital admission rates broken down by ward show a peak of admissions of people residing in Canning Town and Custom House ward. The ethnic breakdown presents a similar picture of the predominant ethnic group being admitted for alcohol-related reasons are White British.

Alcohol-related hospital re-admissions

Figure 11: Alcohol related re-admission by ward

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Figure 12: Alcohol related re-admissions by ward and ethnic group

Rates for alcohol-related readmissions to hospital show similar patterns in terms of the wards with the highest rates of readmissions and the ethnic profiles of the residents being readmitted. This also shows the high level of readmissions indicating that initial admissions have not contributed to reducing alcohol-related harm.

Associated costs Inpatient admissions cost twice as much as emergency department

admissions and almost four times as much as outpatient attendances The inpatient cost of the 55-74 age group, is over ten times greater than the

16-24 age group Newham spends four times more on the 25-74 year olds than on under 25s

and over 75 year olds Over 2.5 times more spent on partly alcohol-attributable inpatient admissions

ccompared to those that are wholly attributable It is estimated based on local data, each Emergency Department attendance

costs £123, in patient costs £1,700 and those in treatment cost £3,440 per patient

Summary

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Newham has higher than average rates of health-related harms as a result of alcohol use in its population.

There are specific issues for men who are over-represented in alcohol-related mortality, alcohol


Patterns of drinking in the boroughLAPE data on drinking patterns are synthetic estimates calculated using a multinomial logistic regression model using:

General Lifestyle Survey 2008 and 2009. Alcohol-specific hospital admissions 2007/08 to 2009/10 Index of Multiple Deprivation 2010, Department for Communities and Local

Government Beacon and Dodsworth P2 People and Places classification (People and Places

Trees)

Predicted probabilities from the model are applied to mid-2010 population data and are calculated for the adult population aged 16 years and over.

The synthetic estimates have some inherent data caveats. The General Lifestyle Survey (GLS) data are based on self-reported drinking behaviour and consumption making them prone to respondent bias. The GLS excludes people in institutions such as prisons or care homes, or those who are homeless who are likely to have a different pattern of alcohol consumption. In addition, not all participants selected for inclusion participated in the survey, possibly introducing selection bias.

Despite the data from LAPE demonstrating high levels of alcohol-related harm Newham also has the highest estimated level of abstainers in England at a rate of 35.15% (CI 24.4 - 42.65). It also has the lowest rate of binge drinking in England at 7.5% (CI 6.7 - 8.4) of the population.

Figure 13: Abstainers synthetic estimate (Regional comparison)


The most recent data available from LAPE is for 2009/10 which gives a synthetic estimate for the percentage of the population aged 16 years and over who report abstaining from drinking. The percentage for Newham was 35.15% of the population (CI 24.4 – 42.65). This is the highest percentage in England.

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Newham has higher than average rates of health-related harms as a result of alcohol use in its population.

There are specific issues for men who are over-represented in alcohol-related mortality, alcohol


Understanding Newham 2013 is the latest report of the Newham Household Panel Survey (NHPS). The NHPS is a longitudinal panel survey that has run for ten years which aims to understand changes in the resident population of the Borough and the consequent demands placed on the Council. Ipsos MORI spoke to 1,019 residents aged 16+ between May and September 2013.

Just over three-fifths of Newham residents (63%) say they do not drink alcohol.18 In 2011 the Health Survey for England reported that three-fifths of all adults in England (61%) drank alcohol in the last week.19 In comparison, only just over a third (37%) of Newham residents say that they drink alcohol. Furthermore, there has been no increase in the number of people who drink alcohol in Newham as in the previous Household Panel Survey, 36% of residents said that they drank alcohol.

These findings show a much higher estimate of abstainers in the borough than has been calculated by LAPE.

Figure 14: Binge drinking (synthetic estimate) (Regional comparison)


The synthetic estimate for binge drinking is taken from 2007-08 and estimates that the percentage of the population aged 16 years and over who report engaging in binge drinking is 7.5% (CI 6.7 – 8.4). This is the lowest level in London.

The substantial ethnic diversity in Newham could lie behind these self-reported high levels of abstention from alcohol. However, many individuals or households in Newham may have avoided formal contact with an official survey, so respondents to the NHPS may represent a skewed sample. This may have had the effect of overestimating the proportion of abstainers in Newham and underestimating the proportion of binge drinkers.

18 Understanding Newham 2013 Newham Household Panel Survey Wave 7 Survey Findings19 Health Survey for England 2011

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Figure 15: Lower risk drinking (% of drinkers only) synthetic estimate (Regional comparison)


The synthetic estimate for lower risk drinking is taken from mid 2009 and estimates that the percentage of the population aged 16 years and over who report engaging in lower-risk drinking is 75.79% (CI 50.25 – 98.61). Newham has the fourth highest level of lower risk drinking in London.

Figure 16: Increasing risk drinking (% of drinkers only) synthetic estimate (Regional comparison)


The synthetic estimate for increasing risk drinking is taken from mid 2009 and estimates that the percentage of the population aged 16 years and over who report engaging in increasing -risk drinking is 18.91% (CI 8.56 – 39.68). Newham has the eighth lowest level of increasing risk drinking in London.

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Figure 17a: Higher risk drinking (% of drinkers only) synthetic estimate


The synthetic estimate for higher risk drinking is taken from mid 2009 and estimates that the percentage of the population aged 16 years and over who report engaging in higher risk drinking is 5.3% (CI 1.36 – 19.89). This the lowest rate of higher risk drinking in London.

Figure 17b- Higher Risk drinking in Newham

Source – Local Alcohol Profile England 2014

Although Newham was ranked as the local authority with the least proportion of ‘Higher risk drinkers’ in its population, this was not statistically different from other boroughs in England. Caution is therefore needed in interpreting these estimates, most obviously because of the wide and overlapping confidence intervals reported.

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Summary

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The synthetic estimates produced by LAPE show a pattern of low levels of drinking and high levels of abstention from alcohol.

However, the synthetic estimates are based partly upon self-report in the General Lifestyle Survey, which may have introduced a bias to the results due to the population surveyed and cultural reasons for under-reporting drinking.

The NHPS may have introduced a similar bias in reporting of drinking behaviour.

The reported levels of drinking behaviour are subject to large and overlapping confidence intervals, which require that they are considered with caution.

The synthetic estimates and surveyed levels of drinking are in contrast to the levels of alcohol-related harm reported in the borough.


Alcohol use and crimeLAPE includes trend data on alcohol-related crime:

Alcohol-related recorded crimes Alcohol-related violent crimes Alcohol-related sexual offences.

Further data is also provided in the information provided by the probation service and London Metropolitan Police presented later in this document

Figure 18a: Alcohol-related recorded crimes (Trend chart)


Figure 18b: Alcohol related crime (Regional comparison)

In 2012/13 Newham had a crude rate of 10.59 alcohol-related crimes per 1,000 population (CI 10.23 – 10.96). This is a decrease since the peak rate in 2009/10 of 13.62 alcohol-related crimes per 1,000 population (CI 13.19 – 14.06). This is slightly higher than the London average of 9.0 per 1,000 of population respectively).20

20 Public Health England, Local Alcohol Profile for England – Newham data http://www.lape.org.uk/LAProfile.aspx?reg=X25001AA

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http://www.lape.org.uk/LAProfile.aspx?reg=X25001AA


Figure 19:a Alcohol-related violent crimes (Trend chart)


Figure 19b: Alcohol-related violent crimes (Regional comparison)

In 2012/13 Newham had a crude rate of 6.74 alcohol-related violent crimes per 1,000 population (CI 6.45 – 7.03). This is a decrease since the peak rate in 2009/10 of 8.34 alcohol-related violent crimes per 1,000 population (CI 8.0 – 8.68). This is slightly higher than the London average of 5.7 per 1,000 population.

Figure 20: Alcohol-related violent crimes

Source: Local Alcohol Profiles for England 2014

Figure 21a: Alcohol-related sexual offences. (Trend chart)

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Figure 21b: Alcohol-related sexual offences. (Regional comparison)

In 2012/13 Newham had a crude rate of 0.17 alcohol-related sexual offences per 1,000 population (CI 0.12 – 0.22). This is a decrease since the peak rate in 2010/11 of 0.21 alcohol-related sexual offences per 1,000 population (CI 0.16 – 0.26). Newham has a higher rate of alcohol-related sexual offences than London and the rest of England.

Figure 22: Alcohol-related sexual offences

Source: Local Alcohol Profiles for England 2014

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Alcohol use and Employment and BenefitsNationally employment outcomes for clients exiting alcohol treatment are low.

Table 6: Employment status at start of treatment – Newham with national comparison 2013-14

Employment status at start of treatment Local

n

% of new starts

National

n

% of new starts

Regular employment 79 24% 17387 21%

Unemployed/economically inactive 185 59% 32445 40%

Unpaid voluntary work 1 0% 247 0%

Long term sick or disabled 35 11% 16316 20%

In education 6 2% 672 1%

Other 3 1% 1859 2%

Not stated/missing 6 2% 11962 15%Source: PHE, NDTMS

Newham has a high rate of people entering treatment who are unemployed or economically inactive. This is a reflection of the higher than average levels of deprivation in the borough.

Table 7: Benefit profile of the treatment population, 2012

Employment status at start of treatment

Local

n

% of all in treatment on 30/3/12

National

n


Number of individuals in alcohol treatment on 31st March 2012

192 41996

Number of individuals in alcohol treatment recorded as being on benefits (of any type) on 31st March 2012

96 50% 22625 54%

Source: PHE, NDTMS

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Table 8: Number of individuals in treatment recorded as being on benefits on 31st March 2012 (by type)21

Benefit type Local

n


National

n


Jobseekers Allowance (JSA) 20 10% 3741 9%

Employment Support Allowance (ESA)

38 20% 10493 25%

Incapacity Benefit (IB) 30 16% 5834 14%

Income Support 30 19% 4932 12%

Disability Living Allowance (DLA) 23 12% 6809 16%

Other 4 2% 1159 3%Source: PHE, NDTMS

Table 9: Median length of time (years) claiming benefits between the start of benefit claim and 31st March 2012 (by type)22

Benefit type Local

n

National

n

Jobseekers Allowance (JSA) 0.45 0.41

Employment Support Allowance (ESA)

0.47 0.57

Incapacity Benefit (IB) 6.78 8.12

Income Support (IS) 6.04 6.10

Disability Living Allowance (DLA) 6.81 4.72

Other 0.96 4.48Source: PHE, NDTMS

Services users accessing treatment services in Newham are doing so at an earlier point after starting to claim some benefits (ESA, IB and IS). This may indicate that the deprivations associated with unemployment are having a severe impact upon their drinking behaviour and are escalating their levels of drinking and therefore harm.

Summary

21 Individuals are counted once under each type of benefit they received, as such percentages may sum to more than one hundred22 Length of time on benefits counted as the length of the benefits spell from the start until 31st March 2012, regardless of the length of time spent in treatment

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Rates of alcohol-related recorded crime, alcohol-related violent crime and alcohol-related sexual offence have decreased.

However, the rate of each of these types of crime remains higher than London and England averages.

“Higher levels of alcohol-related crimes and violent crimes are likely to be significantly linked to binge drinkers and the night-time economy. It is not possible to determine whether these drinkers are increasing risk, higher risk or dependent drinkers; however they are likely to be drinking.”

Public Health England (2014) Alcohol Data: JSNA Support Pack.

Newham has a higher than national average of people entering treatment on benefits. People entering treatment have also been on those benefits for a shorter period than average, possibly indicating that the progression of alcohol-related harms is faster in Newham than the national average.


Alcohol service provision in Newham

Evidence Based PracticeThere is a substantial evidence base for alcohol treatment and a large number of recommendations documented by the National Institute for Health and Clinical Effectiveness (NICE). This includes:

NICE Quality Standard QS11 - Alcohol dependence and harmful alcohol use (2011)

NICE Clinical Guideline 115 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (2011)

NICE Clinical Guideline 100 Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications (2010)

NICE Public Health Guidance 24 Alcohol-use disorders: preventing the development of hazardous and harmful drinking (2010)

Recommendations from these guidance documents include the provision of:

NICE Clinical Guideline 115 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (2011)

Identification and assessment in all settings to identify harmful drinking and alcohol dependence

Assessment in specialist alcohol services for all people scoring more than 15 on AUDIT

Interventions to promote abstinence and prevent relapse Psychological interventions for harmful drinkers and people with mild alcohol

dependence Assessment for and delivery of a community-based assisted withdrawal Assessment and management in specialist alcohol services if there are safety

concerns about a community-based assisted withdrawal. Interventions for conditions co-morbid with alcohol misuse

NICE Clinical Guideline 100 Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications (2010)

Hospital admission for medically assisted alcohol withdrawal for people in acute alcohol withdrawal

Services for people with decompensated liver disease requiring transplantation Services for people with pain related to chronic alcohol-related pancreatitis

Commissioned services in Newham at the time for which data is available (2010 -2013) covered most aspects of the recommendations set out in CG115.

Identification and assessment of harmful drinking and alcohol dependenceIn general practice (GP) surgeries identification and assessment activities for all new registrations were included in the Direct Enhanced Service payment to GPs from the Department of Health. Until April 2013 Newham Primary Care Trust (PCT) commissioned Healthy Lifestyles Check for those aged 40-64 years. Taken together

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these activities should produce a high but not total coverage of alcohol screening of those most at risk from hazardous and harmful drinking. Both of these enhanced payments to GPs involved GP practices in implementing the following pathway:

Conducting screenings using the AUDIT C tool Completing the next 7 questions of AUDIT 10 where there is a positive AUDIT C

result. Those scoring less than 15 son AUDIT 10 should have received a brief

intervention from the primary care practitioner Those scoring 15 or above were to be referred to specialist services.

The chart below is drawn from data collected by CEG and shows the proportion of patients who had a positive Audit score by GP practice in 2010/11 and 2011/12. The chart however excludes three practices in 2010/11 and one practice in 2011/12, that had very small numbers and showed a positive recording of 100%. This skewed the rest of the data.

Figure 23: Proportion of patients scoring positive on AUDIT-C

Source: NHS England; Newham CCG

This data is likely to show under-reporting as the AUDIT-C data was incorrectly collected during the period. There was wide variation of levels of completion of AUDIT-C between surgeries, with some not reporting any AUDIT-C completions despite have patient lists with eligible populations. The data on AUDIT-C positive results should therefore be treated with caution as reported positive scores may not reflect the true levels of alcohol-related harm in the population.

Since 2010 criminal justice settings had provision to conduct alcohol screening on arrestees for suspected drug-related offences, and from 2011 this was extended to include arrested for suspected alcohol-related offences.

A pilot of a screening and referral pathway was conducted in Newham University Hospital from 2010-2012. It included the following activities:

Implementation of the Modified Single Alcohol Screening Question (M-SASQ) screening tool for alcohol misuse

Implementation of a robust alcohol management and admission protocol

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Implementation of a robust referral pathway from the front-end of A&E to the Specialist Alcohol Nurses within the hospital

Improved data collection of alcohol-related presentations at A&E Enhanced care pathway from A&E to community based alcohol treatment

services

Specialist Alcohol Services in Newham - 2010-2014Local substance misuse commissioning teams have the responsibility for planning, managing and monitoring an effective alcohol treatment and recovery model. Commissioning teams are responsible for implementing national and local alcohol strategies, targets and guidance.

Alcohol services were commissioned by Newham Primary Care Trust until 2011-12 when the joint commissioning function was transferred to the Local Authority. From April 2013 the PCT was abolished and all contracts and responsibilities for commissioning were transferred to full Local Authority responsibility. Existing contracts were initially novated until a full commissioning process could be conducted. This was completed in July 2014 when a new integrated adult service was established. In the middle of this process one service was decommissioned and other services contracts were varied to pick up the work. It is fair to say that the alcohol treatment system has been unstable since 2011 when a former service went bankrupt.

Alcohol services were provided to a lesser or greater extent by the following services during the reporting period April 2010 - March 2013. Where a service was not provided for the whole of that period the dates that the service was in place are indicated.

Westminster Drug Project (WDP) – alcohol arrest referral 2011-2013 Criminal Justice Intervention Team (CJIT LBN – in house team) – whole period LBN social workers – whole period Drug and Alcohol Services London (DASL) main alcohol service with Community

Alcohol Team (CAT) - whole period East London NHS Foundation Trust (ELFT) – proportion of community drug

service (CDT) - whole period East London NHS Foundation Trust (ELFT) A&E initiative – whole period Foundation 66 care navigation service - commenced mid 2011 - decommissioned

Feb 2013 Spot purchasing of in-patient and residential rehabilitation services – whole

period

The following table estimates the total spend on alcohol commissioned services over the period. These figures are not exact as many services offer both drug and alcohol services. The amounts therefore have to be drawn from the proportion of activity dedicated to alcohol users and this applied to total spend with that service. This can only be approximate as any one service user’s actual costs may be substantially different from another even within the same service. This will be related to level of complexity, time in treatment etc.

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Table 10: Total spend on commissioned alcohol services 2010 - 2013

Service Name

% of work alcohol related

£ 2010-11 £ 2011-12 £ 2012-13

WDP 10% Not applicable £47,000 £47,000

CJIT 10% £47,000

LBN Social Work

60% £160,360

DASL - CAT 100% £620,120

DASL Day Programme

70% £109,200

ELFT CDT 10% £212,451

ELFT A&E 100% £121,713

F66 25% £205,156

In-patient Detox

60% £45,000

Residential Rehabilitation

60% £108,000

GP DES 100% £100,000

TOTAL £1,729,000

Data collectionAlcohol treatment services in England comply with the data reporting requirements of National Drug [and Alcohol] Treatment Monitoring System (NDTMS) as well as local contract monitoring requirements set by commissioners. NDTMS is part of Public Health England (PHE); it collects, collates and analyses alcohol treatment data submitted by treatment providers from across England. NDTMS reports performance data to local commissioners on local activity and also provides comparison data against other areas. NDTMS has been gathering this information for many years and therefore trend data is well established.

The data in this part of the report is drawn mainly from NDTMS reporting systems, supported by contract monitoring records where this was useful. It reports on adults 18 and over, data on children and young people is not represented here.

Newham adults in alcohol treatmentThe data reported for alcohol treatment covers the period April 2010 – March 2013 and is a combination of that supplied to NDTMS by all other the services operating in Newham as described above. This represents the alcohol treatment and performance data for the London Borough of Newham as a whole and not for any one service.

Figure 1 below shows the number of unique individuals who were in alcohol treatment in Newham: this included new presentations and those retained in treatment from previous years. The highest level was in 2010-11 with the average per annum for the three year period being 550 individuals.

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Fig.24: Number of individuals in alcohol treatment

Source: PHE, NDTMS

The peak age range for those seeking alcohol treatment was 25 – 54 (Fig.2), three quarters (76%) were male (Fig.3).

Fig.25: Age of individual clients in contact with treatment system

Source: PHE, NDTMS

Fig.26: Gender of individual clients in contact with treatment system

Source: PHE, NDTMS

The ethnic breakdown of people in alcohol treatment is shown in Figure 4. The majority of individuals were white British (45%), with 14% other white, followed by

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Asian Indian (8%), African (7%), Caribbean (6%), Irish (4%), Bangladeshi (2%), Pakistani (2%).

Figure 27: Ethnicity of clients in touch with the alcohol treatment system

Source: PHE, NDTMS

Referral SourcesData from the three years of the period April 2010 – March 2013 shown in Figure 5 shows that the majority of people entered treatment through self referral or recommendation from family or friends (69%, 53% and 45% for 2010/11, 2011/12 and 2012/13 respectively), or via referrals from other substance misuse services which was the second highest referral source in 2012-13. The referrals from substance misuse services can largely be discounted as this data represents referrals between local agencies at a time when one agency acted as the main entry point and redirected service users to other local services dependent on need.

In 2010-11 there was a significant minority of referrals from health and mental health services. However, this has since declined rapidly and there have been no significant levels of referrals from professionals from any sector since, with none reaching the 50 per year mark of previous referrals from health and mental health services. To some extent this may be due to miscoding of referral sources in NDTMS as around 50 people per year in 2011-12 and 2012-13 were not coded.

We also know from NDTMS that approximately 6% (23/408), 3% (11/358) and 8% (31/385) of referrals into alcohol treatment in 2010/11, 2011/12 and 2012/13 respectively were from the criminal justice route.

However alcohol arrest referral data shows that in 2010/11 290 drug users were also screened for alcohol use. In 2011/12 (first year of full figures) 599 drug users were also screened for alcohol and 59 (9.9%) were identified as suitable for referring to treatment. Of this group of 59, 32 (54%) were referred into treatment as part of a required assessment23 (indicating that they also had drug use issues), and 9 (15%) were referred voluntarily, a total of 41 referrals to alcohol treatment of drug users who required an assessment for treatment for their alcohol use.

In 2012/13 screening for alcohol use by the police commenced. Data for the total number of screens undertaken is not available, but 47 people were identified with an

23 Required Assessment is a condition of bail that the police can make but only to drug users.

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AUDIT score of 16+. Of these 47, 38 (81%) were referred for alcohol treatment.24 Note that these criminal justice referral levels do not correlate with the numbers of people entering treatment via the criminal justice route. This shows that attrition from identification to assessment is taking place.

It is clear that majority of people entering treatment do by self-referral, greater professional referrals will increase proactive engagement opportunities with service users to help them make the difficult first step into treatment.

Figure 28: Referral sources of those in alcohol treatment

Source: PHE, NDTMS

Other substances usedFigure 29: Second and third drug used by those in primary alcohol treatment

Apart from cannabis use, and very low levels of cocaine, there is little reported additional drug use by alcohol users. Services are required to report individuals with any level of heroin and crack cocaine use as primary drug users rather than primary alcohol users. Therefore the small numbers reported does not represent the extent of additional heroin and crack use in alcohol users. Heroin and crack cocaine use is reported in way due to the per capita funding allocated to crack and heroin users paid by the Pooled Treatment Budget at the time of reporting. It is important therefore to consider service users identified as having primary drug use needs who were recorded as having secondary and tertiary alcohol needs, as this may include service users with high levels of alcohol need (see Table 6). From this primary drug use data 24 Data from Arrest Referral Service contract monitoring reports.

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020406080

100

2010-11 Secondary Drug2010-11 Third Drug2011-12 Secondary Drug2011-12 Third Drug2012-13 Secondary Drug2012-13 Third Drug


it can be shown that an additional 151 – 184 alcohol users were receiving alcohol treatment per annum.

Table 11: Primary drug users with alcohol recorded as their second or third misused substance

2010/11 2011/12 2012/13

Total number of drug users 1312 1221 1174

Second drug: alcohol 111 (8.5%) 91 (7.5%) 110 (9%)

Third drug: alcohol 50 (4%) 62 (5%) 74 (6%)

Alcohol users in this cohort 151 153 184

Alcohol consumption levelsAt treatment entry individuals are asked to identify their alcohol consumption over the last 28 days, both in terms of number of days drinking and the average units consumed per day. This was a new reporting requirement introduced in 2011-12. It can clearly be seen in Figure 26 that a significant proportion of people entering treatment are drinking every day (52% in 2011/12 and 44% in 2012/13) and that their consumption peaks at 20-29 units per day, amounting to at least 140 units per week. This is far in excess of recommended unit intake and indicates that the majority of those presenting for treatment are likely to be alcohol dependent.

Figure 30: Reported drinking days per month and units consumed per week

Source: PHE, NDTMS

2012/13 has seen a small increase (2%) in people presenting for alcohol treatment who had not consumed alcohol at all in the 28 days prior to presenting for treatment.

Alcohol treatment interventions offeredTable 7 shows the alcohol treatment interventions that were offered and included in a service user’s care plan at treatment entry point. It should be noted that people can access more than one intervention and so the total number of interventions does not

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equal the number of people entering treatment. In addition the date only captures interventions on the initial care plan, not any that may be offered subsequently after a care plan review. As such it better represents the level of treatment need at entry point rather than people’s access to the suite of interventions. Being offered higher level interventions such as in-patient treatment or residential rehabilitation at initial care planning indicates late entry to treatment as these interventions are only offered to those with the highest levels of dependence and accompanying complex needs. It can be seen over the 3 year reporting that these interventions have been offered increasingly less often at initial care plan (8%, 7% and 4% in 2010/11, 2011/12 and 2012/13 respectively).

Table 12: Interventions offered in initial care plan

Source: PHE, NDTMS

The number of individuals commencing each intervention type at least once in their most recent treatment journey broken down by gender. Clients are counted once for each intervention type they receive.

There has been a steady increase in the offer of structured day programmes, other structured treatment (likely to be counselling), pharmacological interventions and psychosocial interventions from 2010/11 to 2012/13. This may be due to changes in the configuration of alcohol treatment services at this time and the increased use of cheaper community based interventions instead of in-patient and residential services.

Alcohol treatment requirements (ATR) were introduced April 2012. These are dispensed by the court as part of a community sentence. ATR deliver coercive treatment to ‘dependent drinkers’ with the specific aim of tackling levels of alcohol consumption and reducing alcohol related crime. In 2012/13 42 people started ATRs, with 39 (92%) successfully completing their treatment.

Alcohol community detoxification25 In 2012/13 community detoxification was delivered to 129 people with 79 (61%) completing detoxification. Community detoxification was provided by the specialist 25 Local contract monitoring report 2013-14

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alcohol service in partnership with the service user’s GP who prescribed the medication. In 2013/14 this number had risen to 210 people, with 204 (97%) completing their detoxification. This is a rise in both the number of detoxifications being delivered and a significant improvement in successful completions of alcohol detoxification.

We do not have data for community detoxifications completed by general practitioners not in partnership with the specialist community alcohol service.

Alcohol in-patient detoxificationsIn 2013/14 27 people started an in-patient detoxification with 22 (81%) completing treatment.

Alcohol residential treatmentPeople with complex needs can be referred to residential treatment following their detoxification. In addition, some people leaving prison settings who are alcohol free request and meet the criteria for residential services.

In 2013/14 23 people with a primary alcohol problem started a residential rehabilitation programme, of these 13 (56%) completed the full programme. Residential treatment is highly intensive and challenging and there is a high drop-out rate. However evidence shows that people have learned coping skills even when they do not complete the full programme.26

Additional needsIn 2011-12 three new reporting requirements were added to NDTMS; mental health needs, housing need and people living with children; data is only available for these two years.

Figure 9 shows the level of mental health need identified at alcohol treatment entry (year to date) to be 33 (9%) and 44 (11%) in 2011-12 and 2012-13 respectively.

Figure 31: Mental health identification

Source: PHE, NDTMS

26 In-patient and residential service data is derived from local spreadsheets held by commissioners

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Dual Diagnosis identified at treatment start (From New Treatment journeys YTD): - Only

for 2011-13

33 42

0

50

2011-12 2012-13

Dual Diagnosisidenti fied attreatment start(From New


Figure 32: Housing Status

Source: PHE, NDTMS

In 2011-12 85 (24%) people were identified with a housing problem at treatment entry (year to date), of these 30 (8%) were of No Fixed Abode. In 2012-13 a similar number, 86 (22%), had housing problems, of which 43 (11%) had No Fixed Abode, indicating an increased level of this housing problem (see Figure 28).

Figure 33: Proportion of people living with children

Source: PHE, NDTMS

NDTMS captures the number of people that live with, or have significant contact with, a child at alcohol treatment start. This includes those who are parents, step-parents or living in a household with children. The proportion of new treatment journeys with this status fell by 10% between from 133 (37%) in 2011-12 to 103 (27%) in 2012-13. However the numbers remained relatively stable suggesting that more people without children were in treatment rather than that those in treatment with children fell significantly.

Waiting timesThe National Treatment Agency for Substance Misuse, now subsumed into Public Health England, sets a national target for alcohol treatment of no longer than 21 days from date of referral to being offered a first intervention. Performance has improved with regard to waiting times from 84% in 2010-11 to 94% in 2012-13 of people waiting less than 21 days. Locally, services report that everyone would be seen within 21 days if it were not for a small number that request counselling services at the weekend for which there is more limited capacity.

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Number of Individuals Living with Children or Other Child Contact at Treatment Start (From

New Treatment journeys YTD):

37%27%

0%20%40%

2011-12 2012-13

Number ofIndividuals Livingwith Children orOther Child Contact


Figure 34: Treatment waiting times

Source: PHE, NDTMS

Alcohol treatment exitsServices work towards ensuring that people leave alcohol treatment in a planned way with no alcohol use or only occasional use27, to ensure that they are in the best place to maintain their abstinence. The proportion of planned exits, compared to all unplanned exits including transfers, varied from about half to nearly two thirds across the years (48%, 64%, and 54% respectively for 2010-11, 2011-12 and 2012-13).

Unplanned exits data shown in Figure 13 indicate treatment dropouts and, much more rarely deaths in treatment, we do not have any data on number of deaths.

Transferred not in custody is a negative exit as this indicates that the person was not picked up by the transferred to agency within 21 days, therefore the individual was left unsupported increasing the risk of lapse or relapse.

Very few people were taken into custody when already engaged in alcohol treatment.

Figure 35: Treatment Exits

27 Definition of planned exit from NDTMS

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227 208

350

182

92

10 3

206

136

423

050

100150200250

Planned Exits UnplannedExits

Transferred -Not in cutody

Transferred -in custody

2010-112011-122012-13

TreatmentExits


Source: PHE, NDTMS

Summary

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The identification of alcohol-related issues in primary care, hospital and other health and social care setting requires improvement.

Anecdotally there is evidence that there is provider selection of the use of screening tools, with alcohol screening not being conducted with members of ethnic groups not thought to drink alcohol for cultural and/or religious reasons. This selection may also extend to older age groups and to women. This may mean that alcohol-related harms are not being picked at an early stage and may, in some cases, progress to dependent drinking.

The majority of those in treatment are aged 25-54 and are male (76%).

White British is the largest ethnic group seen in alcohol services.

Self-referral is the most common referral route highlighting a need for improved referral and care pathways between substance misuse and other services.

Alcohol users often present to treatment services with needs related to their use of other drugs.

The majority of those presenting to alcohol treatment services are alcohol dependent.

There has been a rise in the number of: community detoxifications taking place successful completions of alcohol treatment. planned exits from treatment

There is an increasing level of housing need in service users.

Waiting times have improved.


Stakeholder Views

Three key groups were asked a set of 10 questions. These were services users (the ACOUNT group), primary care practitioners and hospital consultants/academics.

The questions were:

1. How can we better prevent excessive alcohol consumption in Newham? 2. How can we further develop the role of primary care (e.g.

GPs/pharmacists/dentists) in preventing and treating alcohol problems? 3. How can we further develop the role of A&E and secondary care (e.g.

GPs/pharmacists/dentists) in preventing and treating alcohol problems4. How can we better engage the entire hidden population’ in order to improve

access into alcohol treatment services for the indigenous and non-indigenous population?

5. How can we reduce the drop-out rates from alcohol treatment services? 6. How can we improve on the housing problems for people with drug and/or

alcohol issues? 7. How can we ensure that those affected by someone else’s alcohol problems

(carers) are supported? 8. How can we improve on improve health outcomes for people with alcohol

problems? 9. How can we ensure that there are better employment opportunities for people

with drug and/or alcohol problems 10. Is there anything else or any gaps in alcohol services in Newham that you would

like to add that would improve outcomes for people with alcohol problems?

The recurrent themes in stakeholder responses included:

More enforcement e.g. clamping down on drug dealing, more Police presence, restricting alcohol trading.

More education/awareness raising regarding the risks of substance misuse. More support for people to gain employment e.g. by working with Employers/Job

Centre Plus. More training opportunities for carers of people who misuse alcohol. More support for people to retain their jobs through a support group or mentor. More advice on alcohol from housing providers e.g. through leaflets or skilling

them up. More training for primary care professionals on alcohol misuse More support for carers e.g. a support network (and its advertisement) Better advertisement of alcohol services to promote engagement into services

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Other initiatives addressing alcohol in the borough

HousingHousing related support is low level support that enables someone to live independently in their accommodation or to enable people to gain independence in order to live independently. The housing need data sample is derived from face to face, holistic customer needs assessments where the customers are in receipt of package of housing related support provision.

A range of services were assessed including services for older people – such as sheltered, hostels for homeless people, supported accommodation for people with mental health support needs or accommodation for people with a learning disability.

At present the above system under assessment (non-statutory accommodation) is made up of 371 commissioned units across 5 services (4 low need and 1 medium need service).

20 mental health services (238 units28 of provision); 9 learning disability services (100 units of provision); 40 older persons’ services (1210 units of provision).

Though Newham does not have direct access hostels, Anchor House is the closest thing to direct access in the borough i.e. people can approach themselves for immediate, direct access to services. There is also a Floating Support service that specialises in supporting offenders and substance misuse issues however these customers have not been assessed due to the quick turnaround of service users and we are unable to provide data in respect to these customers’ needs.

In 2013-14 a period of decommissioning took place across the borough reducing the volume of hostel places available to people by approximately 40%. As a result there has been a decrease in the numbers of customers able to access hostel accommodation.

Rough sleeping increased during 2011/12. The street count figure recorded in the CHAIN data reported approximately 202 rough sleepers across the borough. In 2013/14 the borough was ranked 9th highest in London with over 202 rough sleepers located across the borough. This is an increase from 2010 when Newham had 38 rough sleepers and was ranked 16th highest borough in London.

This increase is thought to be due to individuals who have arrived in the UK with, or who have later developed, a substance dependency (drug and/or alcohol). Many have resorted to criminal activities to support their lifestyles, ranging from shoplifting to robbery.29 These individuals are unable to access hostel accommodation in Newham due to lack of local connection, lack of knowledge about service or because their needs are too complex to be met by the service.

28 a unit is a person29 Evaluation report: operation Alabama Stratford town centre rough sleeping response

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Profile of those requiring support

Men require supported accommodation more than women, at 62% of the population accommodated in hostels. The most prevalent age group of the cohort 25-44

The division of types of support needs amongst those accommodated in supported accommodation has stayed quite steady over the last two years – i.e. there has been no sudden increase in the numbers of people with alcohol support needs approaching hostels; however, hostel managers have fed back that needs are increasingly more complex and they are unable to meet these

Given the volume of rough sleeping in the borough and the number of rough sleepers with alcohol support needs it would appear that there is a lack of appropriate outreach provision to identify and assess these individuals and facilitate engagement with appropriate support services.

Furthermore given the level of problematic alcohol use in the rough sleeping population in the borough one would expect a higher saturation of people with an alcohol support need to be accommodated in hostels. The relatively small volume (96 people out of 360 units) indicates that the types of support services offered in hostels is not able to manage large volumes of customers with Alcohol Support needs beyond that of a low / medium level.

Ambulance serviceAmbulance call-out volumes have been steadily rising over the last few years as part of a broader increase in demand for emergency services. The estimated cost of an ambulance call out was £23030 in 2011.

Locally, Newham CCGs budget allocation for Ambulance services is just over £10.5m or £33 per head 31.

The graph below shows the number of the ambulance calls for binge drinking by ward (2013-14).

30 Department of Health - Transforming Ambulance services 31 Newham Patient Prospectus 2013/ 14

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Figure 36: Alcohol-related Ambulance calls

Source: London Ambulance Service

The graph below shows the relationship between number of off-license alcohol premises (2014), and ambulance calls for binge drinking (2013-14) by ward.

Figure 37: Correlation of ambulance call for binge drinking by off-licence premises

Source: LB Newham, London Ambulance Service

The scatter plot graph shows a relatively strong linear correlation of off-license alcohol premises and ambulance calls for binge drinking of 0.67. Stratford ward ranks top in all three indicators and accounted for 20% of ambulance all calls post Olympics.

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London Fire BrigadeThe data relates to Primary Fires within Newham over the last 5-year period (1/4/2009 – 3/3/2014). This is relevant in terms of costs to Newham Council , estimated to be about £1 million per fire incident in terms of resource reallocation, housing and other forms of services and support offered

Please note this is based on a question asking crews whether they suspect there is impairment due to alcohol. There is no evidence nor any quantitative data collected (except in the case of fatalities where the blood alcohol measure is obtained). Detailed data on people is limited to those who are casualties.

Over a 5 year period, of 2523 primary fires, 15% was alcohol related of which 4% was fatal or 2 deaths per annum

About half of all alcohol related accidental fires was caused by cooking The commonest age group of victims was 20-49 Most affected ethnic group was white British, followed by’ other white’, Asian then

Black Caribbean Those impacted were mostly males, about 1.5 times more than females. No data of impact on children was provided

Domestic and Sexual ViolenceThe data shows that there are few referrals from substance misuse services to Domestic and Sexual Violence (DSV) services. In the period 2012-2014 there were fourteen referrals made by substance misuse services. There is not enough data to provide any analysis.

Metropolitan Police ServiceTwo flags are used when referring to alcohol related offences based on either

Suspect/Accused had been drinking prior to committing offence Victim had been drinking prior to the offence.

Reports can contain either one or two of the set features codes. For the purposes of this report if a crime record has both features it has only been counted once.

The data used has been drawn from METSTATS and is based on financial years from 2009 through to 2014 and includes the preset fields32 of:

Financial Year Borough Name Total Notifiable Offences (TNO) Alcohol TNO Violence Against the Person Sexual Offences Robbery Burglary Theft & Handling Stolen Goods Fraud & Forgery

32 Full definition of crime types available upon request.

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Criminal Damage Drugs Other Notifiable Offences

The Metropolitan Police Service has seen a year on year reduction of total recorded offences since 2009 with reductions of between -1% (n=5870) and -9%(n=72658). Across the five years of data total offences flagged as alcohol related represent between 3% and 5%of the total - an average of 4%. Records have shown reductions in alcohol related offences since the financial year 2011 through to 2013 with the most significant year on year reductions between 2011 to 2012 of -11% (n=4255) and -22% (n=7551).

Figure 38 – Newham TNO v Alcohol 2009-2013

Source: Metropolitan Police Service

Across the five year period, Newham has ranked in the top ten of all thirty-three London Boroughs; 4th and 7th for total offences and 5th and 7th for alcohol related offences.

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0

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fy09-10 fy10-11 fy11-12 fy12-13 fy13-14

Newham BoroughTotal Offences and Alchol related offences

Financial Years 2009 - 2013

Total offences

Alcohol offences


Figure 39 –Proportion of alcohol related offences by month against total offences Newham versus total Metropolitan Police Service.


Figure 40: Trends of alcohol related offences grouped by crime types.


Discussion with the Police has also revealed that the screening question used in custody suites asks an arrestee to self-identify whether they have an alcohol problem. This will lead to under-reporting and low levels of referral to the integrated substance misuse service.

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Newham Borough New ham versus Metropolitan Police Service -

proportion of alcohol related offences against total offences. Financial Years 2009 - 2013 by month

1%

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Metropolitan Police Service

Newham Borough alcohol offences grouped by crime typeFinancial Years 2009 - 2013

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Other Notif iableOffencesViolence Against thePerson


ProbationThis section highlights those service users that had assessments completed on them between January 2011-December 2011 by the probation service in Newham. Alcohol is identified as a criminogenic need (that is, alcohol is a contributing factor to offending behaviour).

Probation service uses the Offender Assessment System (OASys) to assess risk and identify needs, but OASys is unable to distinguish between those drinking at dependency levels and those whose drinking is at increasing and higher risk levels.

Where alcohol is identified as a criminogenic need Probation Officers use the AUDIT tool to assess drinking levels. If a service user scores 20+ on AUDIT they will be referred to external alcohol treatment services for a further assessment, and if this is at the Pre-Sentence Report stage, service users may have an Alcohol Treatment Requirement proposed as part of a Community or Suspended Sentence Order. For those service users drinking at increasing and higher risk levels (6-19) a Brief Advice session will be delivered by the Probation Officer, with extended brief advice offered throughout their supervisory period.

The chart below shows the percentage of offenders with an alcohol misuse problem from January to December 2011. There were a total of 1,412 offenders from January 2011 until December 2011 in Newham, of which 420 (30%) had an alcohol misuse problem.

Figure 41: Percentage of offender with an alcohol misuse problem

Source: London Probation Service

Table 8 shows the percentage breakdown by offence category. This breakdown is for both the total offender population and those offenders identified with an alcohol misuse problem.

The commonest type of offence was violence for both types of offender was violence against the person (35%).

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Table 13: Offence categories – all offenders compared with offender with alcohol misuse issues

Jan – Dec 2011

Offence Category Total Offender Population

Alcohol Misuse OffendersBurglary 6% 6%

Criminal Damage 1% 3%

Drug Offences 12% 4%

Fraud & Forgery 5% 1%

Indictable Motoring Offences 1% 1%

Other indictable 8% 6%

Other summary offences 4% 4%

Robbery 11% 11%

Sexual Offences 6% 9%

Summary Motoring Offences 5% 8%

Theft and Handling 14% 10%

Violence against the person 26% 35%

Not known 1% 0%


Table 14: Gender breakdown of offender and alcohol misuse offenders in 2010-11

Jan – Dec 2011

Gender Total Offender Population

Alcohol Misuse Offenders

Male 92% 95%

Female 7% 5%

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Figure 42: Age breakdown of offenders and alcohol misuse offenders


Alcohol related offenders are predominately male, greater than (10:1) and the majority of alcohol misuse offenders are aged between 18 and 40 (77%). After this age the incidence of offending decreases, in both the total and alcohol misusing offender populations.

Figure 43: Ethnic breakdown of offenders with an alcohol misuse problem


The ethnic breakdown shows population trends as data on the prevalence of which drinking shows. The largest ethnic group is White British.

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From January 2011 until December 2011, 548 out of 1,412 (39%) of all offenders had a mental health problem. In those offenders with an alcohol misuse problem 217 out of 420 (52%) had a mental health problem.

In the period January to December 2011 25% of all offenders and 31% of offenders with an alcohol misuse problem had an accommodation need. This suggests that alcohol misusing offenders have greater levels of housing need than the general offending population.

LicensingThe aim of licensing in Newham is to Reduce Alcohol Related Street Crime by reducing supply to perpetrators. It’s objectives include:

High Intensity Testing Programme of Off Licences Permitted Hours (before / after) Under Age Sales On Sales Duty Evaded / Counterfeit Conditions e.g. High ABV / Single Cans / DPS Drunk and Disorderly Designated Public Places Orders

Since 2009 the activities of Licensing in Newham has had the following impact

Alcohol related crime on premises down by 86% Counterfeit Alcohol down from 80% to 10% Under Age Sales down from 20% to 7%

However, in the same period the rate of alcohol related street crime has increased by 55% in the 12 months to March 2014.

Over the last two years Licensing has undertaken the following activity:

Table 15: Licensing activity

Licensing Activity 2012/13 2013/14

Hearings 82 80

Reviews 8 22

Refused Applications 17 11

Revocations 5 7

Expedited Review 0 3

Appeals 14 16

Uniform The following data is taken from the London Borough of Newham’s Uniform service request (SR) module. Note that noise service requests were not included within this

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data set. The date parameter was between 01/04/2011 and 31/03/2014 and was received from both internal and external sources (i.e. was received from the general public or from LBN officers) and met one or more of the following criteria:

Primary code equalled ‘Street Drinking’ or ‘Urinating in Public Areas’ Secondary code equalled one of the above The details (or descriptions) section of the Uniform service request contained one

of the following terms

Alcohol Beer Wine Vodka Lager

Spirits Drank Bottle Cans Booze

Paper cup Plastic Cup Intoxicat* Liquor

A total of 4,981 service requests (SRs) met the criteria above out of 70,301 total SRs in the time period (7%). The breakdown per financial year is shown below.

Table 16: Service Requests

Source: Newham Uniform

The volume of SRs received during the time period has increased year on year both overall and specifically for those alcohol related. There were 81% more alcohol related SRs received during the financial year 2013/14 when compared with 2011/12. Whilst the volume of alcohol related SRs is rising, so too is the proportion of these service requests as a whole, with 5.58% observed in 2011/12 increasing to over 8% during 2013/14. This could be due to better targeting and more efficient identification and reporting of SR’s.

Of the 4,981 alcohol related SRs 2,216 were received from external sources (44.5%) and 2,765 were from internal sources (55.5%).

The following figure depicts the SR type for those received from external sources only. Bearing in mind the search criteria it is no surprise that ‘Street Drinking’ and ‘Urinating in Public Areas’ both feature within the top 4 (545 ranked 1st and 221 ranked 4th respectively). Other SR types to feature significantly are ‘Rowdy and Inconsiderate Behaviour (400, 2nd) and ‘Drugs misuse / dealing nuisance’ (357, 3rd). This indicates alcohol related nuisances within the borough are associated with other substance misuse related SRs.

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2011/12 2012/13 2013/14Alcohol Related SRs 1183 1660 2138Total Number of SRs 21204 22476 26621Percentage 5.58% 7.39% 8.03%


Figure 44: Volume of externally reported service requests by type


The following chart depicts SRs identified proactively by LBN employees, most commonly by CCTV operators (1,296). In addition 1,031 fixed penalty notices (FPNs) were issued as a part of the criteria identified previously. Street drinking SRs and urinating in public SRs feature most prominently, however littering and rowdy / inconsiderate behaviour also feature within the top 4 most common SR types.

Figure 45: Volume of internally reported service requests by type


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Table 17 – Ethnicity of perpetrator

Ethnicity External % Internal % Grand Total %

Afro-Caribbean 45 8.5% 139 10.1% 184 9.7%

Arab/North African 5 0.9% 0.0% 5 0.3%

Asian 114 21.6% 247 18.0% 361 19.0%

Dark European 26 4.9% 160 11.7% 186 9.8%

Ethnicity unknown 19 3.6% 12 0.9% 31 1.6%

Mixed ethnicities 117 22.1% 200 14.6% 317 16.7%

Oriental 2 0.4% 1 0.1% 3 0.2%

White European 201 38.0% 612 44.6% 813 42.8%

Grand Total 529 100.0% 1371 1900Source: Newham Uniform

The following table presents the gender of the perpetrator which clearly indicates that alcohol related ASB recorded within the London Borough of Newham is predominantly committed by men. Data for this statistic was only recorded in 43% of the total SRs.

Table 18 – Gender of perpetrator

Gender External

% Internal % Grand Total %

Female 43 5.4% 50 3.7% 93 4.3%

Male 612 77.2% 1098 80.3% 1710 79.1%

Mixed group 138 17.4% 220 16% 358 16.6%

Grand Total 793 100.0% 1368 100.0% 2161 100.0%Source: Newham Uniform

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Map 1: All Alcohol Service Requests

Key

Red = Ext

Blue = Int


The map shows multiple hotspots, most commonly for externally reported SRs in yellow/orange/red. The south eastern-most hotspot is located in Fisher / Edward Streets in Canning Town. This is an area that has regularly had reported issues of street drinking and has featured on the TEG tasking meetings. Groups congregate within this area and drink regularly, reasons for which are unknown at the time of writing.

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Map 2: Street Drinking Service Requests only

Key

Red = Ext

Blue = Int


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Summary

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The numbers of rough sleepers with alcohol-related issues in the borough are increasing at the same time as hostel provision is being reduced.

An improved care pathway is needed between Domestic and Sexual Violence Services and Substance Misuse Services.

Stratford is a hot spot for ambulance calls and alcohol related service requests

While alcohol-related offences are reducing, Newham has a higher than average levels of offences for London.

30% of all offenders have an alcohol misuse problem.

Offenders with an alcohol misuse problem are

more than likely than other offenders to have a mental health issue. male and are in the 18 – 40 age group. More likely to have a housing need.

The proportion of service requests related to alcohol has increased over the period 2011-14.

The perpetrators of offences resulting in service requests re predominantly White European and are male or are part of a mixed group.


Gaps and commissioning priorities

Gaps in provisionIdentification and assessment in all settings to identify harmful drinking and alcohol dependence

A key issue in Newham is the lack of early screening for alcohol-related harms. This is a contributory factor to the high levels of alcohol-related harm in parts of the population as risky drinking is not being identified until the point where people have developed a dependence on alcohol.

The use of screening tools such as AUDIT-C is not consistent amongst health and social care services in Newham. Consequently, appropriate interventions are not being offered at a point in a person’s drinking behaviour when alcohol-related harms can be mitigated by the delivery of Information and Brief Advice. As AUDIT-C also triggers the use of more in-depth screening tools which may identify harmful or dependent drinking, inconsistent use may also mean that these levels of alcohol-related harm are not being recognised. This will contribute to the high levels of alcohol-related harm seen in Newham’s population.

Anecdotally there also appears to be an element of self-selection on the part of professionals as to who to ask to complete an AUDIT-C. Professionals appear to be screening ‘out’ members of specific ethnic groups, namely those from Asian ethnic groups; older people, and women in general. Given the numbers of hospital admissions for British Asian men and men aged between 65-69 this also appears to result in delayed identification of alcohol-related harm in these populations and therefore increases in alcohol-related harms.

It is also likely that awareness development work may need to be undertaken with community groups to raise awareness about alcohol-related harm and safer drinking.

Professionals will need training, or in the case of GPs incentivisation via the NHS Health Check programme, to implement AUDIT-C universally across the population.

In some cases, such as with the Police, this may require changes to the screening questions used in custody suites as the current question asks people to self-identify whether they have an alcohol problem. Work is currently underway to pilot the use of AUDIT-C in custody suites.

Interventions for harmful drinking and alcohol dependence.

Locally available evidence shows a strong correlation between alcohol use and the presence of other needs or behaviours. This includes:

Mental Health Domestic and Sexual Violence Housing Need and Homelessness Unemployment

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Offending, including violent crime and sexual offences Anti-social behaviour.

Data shows that the majority of people self-referred to alcohol services. The high level of multiple needs however suggests that people have been in touch with other services or organisations. Opportunities for referral from those organisations at an earlier stage of a person’s alcohol use may therefore have been missed.

Joint working and pathways of care are needed between health, social care and criminal justice organisations.

Commissioning prioritiesThis section of the JSNA is being written at the point where a new integrated adult community substance misuse service has been commissioned. Many of these commissioning priorities were laid out in the specification for that service. Commissioners now need to manage the performance of the service provider in meeting the requirements of the specification to address the issues set out in this document.

Integrated adult substance misuse service

In July 2014 a new integrated adult substance misuse service took over the provision of services to both alcohol and drug misusers in Newham.

Services for alcohol users were recommissioned as the previous alcohol services had not been effective in developing sources of referrals for new presentations. They were also not delivering against targets for planned exits. There had not been adequate liaison with staff in Accident and Emergency departments, so routes out of A&E were not well utilised. The Recovery Capital Programme, peer mentoring, SMART and carer’s services had not demonstrated their effectiveness.

Improvements were needed to:

Penetration rates into hard-to-reach/hard-to-hear populations of alcohol users Provision to non-Opiate and Crack User (including alcohol users) Retention rates and treatment effectiveness The rate of planned exits and successful completions of alcohol treatment Referral pathways and interagency working The service focus on recovery and resilience outcomes The use of new technologies, such as web-based interventions, to deliver

prevention and treatment interventions.

The specification for the integrated adult service had a strong focus on recovery from the beginning and throughout a service user’s treatment journey. It also integrates the provision of alcohol and drug interventions into one service. As there are high numbers of people seeking help for alcohol who also use other substances it is now possible for them to access help for all of their substance use needs from the same service.

The integrated adult service is expected to ‘mainstream’ drug and alcohol service provision in Newham to improve service uptake and the effectiveness of a service

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user’s treatment journey. The service is expected to develop community engagement and promote the service with the local community and with mainstream service providers. This includes:

Hostels and housing support Sexual Health Services Domestic and Sexual Violence Services Maternity Services Acute Community Hospitals Adult social care teams Children and young people social care teams Probation, Integrated Offender Management and other criminal justice agencies Employment and volunteering services Education and training services.

The provider of the service is expected to provide leadership to the local system and to play a pivotal role in developing capacity and developing skills in both the local treatment system and to general providers who may work with substance users.

The integrated adult substance misuse service encompasses:

Comprehensive assessment, risk assessment, recovery planning (utilising ITEP mapping) and 1:1 evidenced based key working sessions.

Community based drug and alcohol provision as described in NICE guidance, including community detoxification and support to General Practitioners providing alcohol detoxifications

Criminal justice provision Interventions to promote abstinence and prevent relapse Assessment and referral to in-patient detoxification provision Social care function, including safeguarding adult investigations and

management Community Care Assessments and Management for residential rehabilitation. Integration and joint working with a range of non-substance misuse support

services.

The service uses a stepped approach to provision ensure that the intensity of the drug and alcohol interventions offered to service user is linked to the severity of their needs. The service also segments service users into groups with similar needs or other characteristics to support the development of recovery capital, engagement with the service and other agencies and the provision of person-centred care.

Hospital Liaison

Commissioners have been working with the CCG and Newham University Hospital on the development of the pilot Rapid Assessment, Interface and Discharge (RAID) team, based in the Emergency Department and Urgent Care Centre at Newham University Hospital. The RAID team includes two Band 7 nurses specialising in substance misuse. The initiative aims to reduce the number of hospital admissions

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due to alcohol use, to offer brief interventions in the Emergency Department and to liaise with the integrated adult community substance misuse service.

The integrated adult community substance misuse service will be providing alcohol liaison nurses 3 days a week, who will work with the RAID staff to ‘pick up’ and provide interventions to people with alcohol misuse related needs, including the continuation in the community of alcohol detoxification regimes started in the in-patient wards, thus reducing the length of hospital stays and releasing beds.

LBN commissioners have also funded the use of Drink and Drugs Meters in the Emergency Department. These are iPads pre-loaded with an application that uses AUDIT to determine levels of drinking risk and gives feedback on the health harms someone may experience as a result of this. This is effectively delivery of a brief intervention.

Taken together the RAID team and alcohol liaison nurses from the integrated adult community substance misuse service will reduce the length of hospital stays and, through early identification and delivery of Brief Interventions, reduce the number of ‘frequent flyers’ returning to the hospital as a result of untreated alcohol problems.

GPs are commissioned to deliver NHS Health Checks to targeted priority groups. Work is currently underway to ensure the effectiveness of this by updating the standard tool used by GPs when they use the alcohol section of the survey. This includes using an up-to-date version of AUDIT-C, better information about alcohol unit values, and adding a pathway depending on a patient’s AUDIT-C score.

Employment and Education

The integrated adult community substance misuse service includes the delivery of a ‘readiness to work’ course for service users. Work is also underway to develop links with Job Centre Plus.

Links are also being made with local further and higher education establishments.

The integrated adult community substance misuse service is also commissioned to offer out of working hours provision to ensure that those who are in work can access services in the evening and at weekends.

Offending

Work is underway with the Police Force to pilot the use of AUDIT-C in custody suites. Arrangements have also been made to consider the use of conditional bail orders or other arrest disposal methods to mandate offenders to make contact with the substance misuse service and, via the established pathways, mental health or housing services.

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Conclusions and RecommendationsWork has begun to develop a treatment system which meets the complex alcohol-related needs of Newham residents.

Key recommendationsWith regard to the development of the newly commissioned integrated adult community substance misuse service the recommendations are:

Monitor delivery of interventions against the requirement of the specification.

Develop strategic relationships within LBN and partner organisations to ‘drive’ partnership working.


Broader recommendations across the partners to the JSNA are:

Develop strategic relationships within LBN and partner organisations to ‘drive’ partnership working, including partnerships with: Police Housing Health Fire Ambulance Licensing


Undertake work to develop and improve data collection to better inform strategic planning and commissioning. This should include data from primary and secondary care.

Monitor the integrated adult substance misuse service’s delivery of interventions against the requirement of the service specification.

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Glossary

Alcohol-related conditions: 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

Alcohol-specific conditions: 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.

Alcohol Dependence: A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use. Someone who is alcohol-dependent may persist in drinking, despite harmful consequences. They will also give alcohol a higher priority than other activities and obligations.

Binge drinking: Consumption of more than twice the daily recommended amount of alcohol in a single drinking session. Eight or more units for men and six or more units for women.

Brief intervention: This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention – see also below). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists.

Harmful use: A pattern of alcohol consumption that is causing mental or physical damage.

Hazardous use: A pattern of alcohol consumption that increases someone's risk of harm.

Higher risk drinking: Consumption of more than 50 units of alcohol per week for males and more than 35 units of alcohol per week for females.

Increasing risk drinking: Consumption of between 22 and 50 units of alcohol per week for males and between 15 and 35 units of alcohol per week for females.

Lower risk drinking: Consumption of fewer than 22 units of alcohol per week for males and fewer than 15 units of alcohol a week for females.

Treatment: A programme designed to reduce alcohol consumption or any related problems. It could involve a combination of counselling and medicinal solutions.

UK government drinking guidelines: Guidelines set by the UK government on how much alcohol may be consumed without a serious impact on health. The guidelines recommend that men should not regularly drink more than 3–4 units of alcohol per

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day, and women should not regularly drink more than 2–3 units of alcohol per day. In terms of weekly limits, men are advised to drink no more than 21 units and women no more than 14 units per week. Anyone who has drunk heavily in one session is advised to go without alcohol for 48 hours, to give their liver and other body tissues time to recover.

Unit: In the UK, alcoholic drinks are measured in units. Each unit corresponds to approximately 8 g or 10 ml of ethanol. The same volume of similar types of alcohol (for example, 2 pints of lager) can comprise a different number of units depending on the drink's strength (that is, its percentage by volume concentration of alcohol).

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Appendix One: Standards and Clinical Guidance

NICE Quality Standard QS11 - Alcohol dependence and harmful alcohol use

NICE Guideline 51 Drug Misuse: Psychosocial Interventions

NICE Guideline 115 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

NICE Guideline 100 Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications

NICE Clinical Guidance 120 Psychosis with coexisting substance misuse: Assessment and management in adults and young people

NICE Public Health Guidance 24 Alcohol-use disorders: preventing the development of hazardous and harmful drinking.

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Appendix Two: NICE Pathway for alcohol-use disorders

The NICE pathway for alcohol-use disorders, produced in 2011, sets out action for both prevention and for diagnosis and management of alcohol-use disorders.

Source: National Institute for Health and Care Excellence

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http://pathways.nice.org.uk/pathways/alcohol-use-disorders

SCORE


Appendix Three: AUDIT

This is one unit of alcohol…

…and each of these is more than one unit

AUDIT – C

QuestionsScoring system

Your score

0 1 2 3 4

How often do you have a drink containing alcohol?

Never

Monthly

or less

2 - 4 times per month

2 - 3 times per week

4+ times per week

How many units of alcohol do you drink on a typical day when you are drinking?

1 -2 3 - 4 5 - 6 7 - 9 10+

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?

Never

Less than monthly

Monthly Weekly

Daily or almost daily

Scoring:

A total of 5+ indicates increasing or higher risk drinking.

An overall total score of 5 or above is AUDIT-C positive.

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SCORE


Score from AUDIT- C (other side)

Remaining AUDIT questions

QuestionsScoring system

Your score

0 1 2 3 4

How often during the last year have you found that you were not able to stop drinking once you had started?

NeverLess than monthly

Monthly Weekly


How often during the last year have you failed to do what was normally expected from you because of your drinking?


Monthly Weekly


How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?


Monthly Weekly


How often during the last year have you had a feeling of guilt or remorse after drinking?


Monthly Weekly


How often during the last year have you been unable to remember what happened the night before because you had been drinking?


Monthly Weekly


Have you or somebody else been injured as a result of your drinking?

No Yes, but not in the

Yes, during the

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TOTAL = =


last year

last year

Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?

No

Yes, but not in the last year

Yes, during the last year

Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk,

16 – 19 Higher risk, 20+ Possible dependence

TOTAL Score equals

AUDIT C Score (above) +

Score of remaining questions

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alcohol needs assessment v4

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