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Alcohol-related harm is a major health problem. Reducing alcohol-related harm is one of the key indicators in health improvement.
Facts about alcohol
31% of men and 16% of women in England drink alcohol in a way that presents increasing risk or potential harm to their health and wellbeing. This proportion is higher for the 15 to 64 age group.
The Global Burden of Disease Study 2013 revealed that, in England, alcohol misuse is the biggest risk factor for early death, ill health and disability for those aged 15 to 49 years. For all ages it is the fifth most important.
Up to 17 million working days are lost annually through absences caused by drinking; up to 20 million are lost through loss of employment or reduced employment opportunities.
The Health and Social Care Information Centre reports here are over one million alcohol-related hospital admissions every year.
2010 to 2015 government policy: harmful drinking reported that 10.4 million adults regularly drink above the lower-risk alcohol guidelines.
Core principles for healthcare professionals
Healthcare professionals should:
- know the needs of individuals, communities and population and the services available
- think about the resources available in health and wellbeing systems
- be aware that different degrees of alcohol misuse will require different levels of intervention and understand specific activities that can prevent, protect, and promote
Healthcare professionals should be aware of the interventions at population level, which include:
- Health and Wellbeing Boards including alcohol in their Joint Strategic Needs Assessment (JSNA) and commissioning services to address the needs of the population
- adhering to commissioning standards available for alcohol services (see NICE quality standards)
- representing public health and other health concerns in local alcohol licensing process and decisions
- providers collecting data on patients that are experiencing alcohol problems
- sharing appropriate data between health, social care and community safety organisations to target prevention activity and co-ordinate care
Community health professionals and providers of specialist services can have an impact by:
- developing targeted social marketing and public health campaigns to encourage lower-risk drinking in the population
- ensuring local ‘Making Every Contact Count’ initiatives include alcohol screening
- ensure local health trainers screen for alcohol misuse and support peers to reduce drinking to lower-risk levels
- getting to know the local alcohol support and treatment services and how to make referrals to them, using the national listing on NHS Choices
- running health clinics in alcohol treatment services
- commissioning hospital based alcohol services to provide co-ordinated hospital care, discharge planning and community care to promote treatment compliance and reduce the need for re-admission
- identifying regular and high users of NHS services for better co-ordinated care and assertive community treatment
- commissioning community-based, alcohol outreach workers, to work with regular attendees and vulnerable groups such as street-drinkers
Family and individual level
Healthcare professionals can have an impact on an individual level by:
- providing alcohol screening (using validated tools) and brief, structured advice to individuals drinking above lower-risk levels using training resources and e-learning courses
- ensuring that alcohol screening and brief advice is delivered effectively in line with NHS Health Check guidance and for patients registering with GPs in line with GMS contract requirements and guidance for General Medical Services (PDF, 1.2MB, 101 pages)
- directing individuals drinking above lower-risk levels to appropriate support material on alcohol learning resources including One You Drinks Tracker and identification and brief advice tool
- providing extended interventions to those who do not respond to brief intervention
- referring those with alcohol dependence to specialist alcohol treatment service and supporting individuals to attend appointments and engage in treatment
- checking patients with alcohol problems are registered with a GP and receive primary health care, vaccinations and screening programmes
- providing holistic health assessments for people undergoing alcohol treatment
The primary measure of the impact of alcohol harm on a population is Public Health Outcomes Framework indicator 2.18 alcohol-related admissions to hospital. The harm caused by alcohol misuse is so far reaching, it also impacts significantly on another 22 indicators in the framework.
Improving the wider determinants of health indicators include:
- first-time entrants to the youth justice system (1.4)
- 16 to 18 year olds not in education, employment or training (1.5)
- sickness absence rate (1.9)
- killed or serious injured casualties on England’s roads (1.10)
- domestic abuse (1.11)
- violent crime (including sexual violence) (1.12)
- statutory homelessness (1.15)
Health improvement indicators include:
- low birth weight of term babies (2.1)
- emotional wellbeing of looked-after children (2.08)
- hospital admissions as a result of self-harm (2.10)
- excess weight in adults (2.12)
- people entering prison with substance dependence issues who are previously not know to community treatment (2.16)
- alcohol-related admissions to hospital (2.18)
- take-up of the NHS Health Check programme by those (2.22)
- falls and injuries in the over 65s (2.24)
Healthcare public health and preventing premature death indicators include:
- infant mortality (4.1)
- mortality from causes considered preventable (4.3)
- mortality from all cardiovascular diseases (including heart disease and stroke) (4.4)
- mortality from cancer (4.5)
- mortality from liver disease (4.6)
- suicide (4.10)
- emergency readmissions within 30 days of discharge from hospital (4.11)
- hip fractures in over 65s (4.14)
PHE’s Fingertips combines a series of products that provide local data alongside national comparisons to support local health improvement including local alcohol profiles for England (LAPE) which provide information for local government, health organisations, commissioners and other agencies to monitor the impact of alcohol on local communities, and to monitor the services and initiatives that have been put in place to prevent and reduce the harmful impact of alcohol. The alcohol profiles comprise the following indicators.
Mortality indicators include:
- months of life lost due to alcohol (1.01)
- alcohol-specific mortality (2.01)
- mortality from chronic liver disease (3.01)
- alcohol-related mortality (4.01)
Hospital admissions indicators include:
- persons admitted to hospital for alcohol-specific conditions (6.01)
- persons admitted to hospital for alcohol-related conditions (Broad) (7.01)
- persons admitted to hospital for alcohol-related conditions (Narrow) (8.01)
- admission episodes for alcohol-related conditions (Broad) (9.01)
- admission episodes for alcohol-related conditions (Narrow) (10.01)
Age groups indicators include:
- persons under 18 admitted to hospital for alcohol-specific conditions (5.01)
- admission episodes for alcohol-related conditions (Narrow) - under 40s (10.06)
- admission episodes for alcohol-related conditions (Narrow) - 40 to 64 yrs (10.07)
- admission episodes for alcohol-related conditions (Narrow) - over 65s (10.08)
Alcohol-related conditions indicators include:
- admission episodes for alcohol-related cardiovascular disease conditions (Broad) (9.03)
- admission episodes for mental and behavioural disorders due to use of alcohol condition (Broad) (9.04)
- admission episodes for alcoholic liver disease condition (Broad) (9.05)
- admission episodes for alcohol-related unintentional injuries condition (Narrow) (10.03)
- admission episodes for mental and behavioural disorders due to use of alcohol condition (Narrow) (10.04)
- admission episodes for intentional self-poisoning by and exposure to alcohol condition (Narrow) (10.05)
- incidence rate of alcohol-related cancer (13.01)
Other impact indicators include:
- claimants of incapacity benefits - working age (11.01)
- alcohol related road traffic accidents (12.01)
Treatment indicators include:
- number in treatment at specialist alcohol misuse services (14.01)
- successful completion of treatment for alcohol (15.01)
- proportion waiting more than 3 weeks for alcohol treatment (16.01)
The Everyday Interactions Measuring Impact Toolkit provides a quick, straightforward and easy way for health care professionals (HCPs) to record and measure their public health impact in a uniform and comparable way.
The alcohol impact pathway is recommended for healthcare professionals to record and measure actions undertaken as part of routine care which impact on adult obesity.
Examples of good practice
Public Health England’s alcohol learning resources provides online resources and learning for commissioners, planners and practitioners working to reduce alcohol-related harm. A number of organisations have provided details of local alcohol initiatives to share knowledge and practice across England.
NICE pathways set out a structured approach to identify alcohol-related harm through the use of risk factors, screening tools and effective interventions.
Alcohol-use disorders: prevention (PH24) is one of 3 pieces of NICE guidance addressing alcohol-related problems among people aged 10 years and older.
Alcohol-use disorders: diagnosis and management (QS11) covers the care of children (aged 10 to 15 years), young people (aged 16 to 17 years) and adults (aged 18 years and over) drinking in a harmful way and those with alcohol dependence in all NHS-funded settings.
Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (CG115) is evidence-based advice on the diagnosis, assessment and management of harmful drinking and alcohol dependence in adults and in young people aged 10 to 17 years.
Alcohol-use disorders: diagnosis and management of physical complications (CG100) covers the care of adults and young people (aged 10 years and older) who have any physical health problems that are completely or partly caused by alcohol use.