Starting point – available datasets

1. A Social Marketing Approach to the ‘wicked’ problem of alcohol Newcastle upon TyneNorth TynesideNorthumberlandLynda SeeryPublic Health Lead for Substance Misuse

2. Starting point – available datasets • Hospital Episode Data - detailed • A&E data - limited • Crime data • Service data • Strategic Assessment data • Health Needs Assessment data • Social Care Data • Incapacity benefits • Housing data • Supported Housing data

3. Admissions data vs A&E data • There is a need to distinguish between the 2 sets of data – differences • A&E attendance (i.e. injury, intoxication, physical problem) • Primary diagnosis • Contributory factor i.e. alcohol (coding issues) • Differing requirements of the data – i.e. cross referencing to crime/violence • Admitted to hospital – specific vs related alcohol admissions • Primary diagnosis • Conditions which arise or are further identified during hospital spell (coding) • Mental health & behavioural disorders due to alcohol related harm • Intoxication • Cirrhosis of the liver • Pancreatic disease • Can be numerous codes during hospital stay

4. Analysis of hospital admissions • complex indicator • requested dataset 1/7/2007 – 30/9/2009 • all admissions within ‘specific’ set of codes • Highest number of admissions in these 3 categories • F10 mental & behavioural disorders due to alcohol • K70 alcoholic liver disease • T51 intoxication

5. HES Records • postcode level • Specific codes - wholly attributable to alcohol (main focus) • 1411 admissions (707) patients • between 141 – 202 admissions each qtr • Costs = £2.5m • 943/1411 readmissions (66.8%) • 239/707 patients readmitted (33.8%) • 153 males & 86 females • 468/707 patients admitted once (66.2%) • age breakdown

6. Newcastle

7. North Tyneside

8. Northumberland

9. Segmentation - understanding the patient layers • The ‘patient layers’ fall into the following categories: • Patients admitted to hospital for 1 day or less (no overnight stay) • Patients admitted only once • Patients admitted once for intoxication / patients re-admitted for intoxication • Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers) • Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas • Patients with severe ongoing/end stage illness

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

11. Example of intoxication record

12. ‘Frequent users’ or re-admissions to hospital

13. Example of re-admission record

14. Target groups • Initial target groups • patients re-admitted for intoxication - Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers) Significant 60 • Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas North of Tyne 20

15. Establishment of Community Alcohol Teams

16. What will Community Alcohol teams provide? • Service primarily focused on service provision within the community setting, building capacity in tier 2 and enhancing tier 3 provision of specialist services • Community / home detox support being developed (as appropriate) • Assessment, expert clinical advice, managing health risk for those individuals with a dominant single condition i.e. alcohol • Establishment of Community Open Clinics – development of ‘wrap-around’ services (provide monitoring of physical and mental health, alcohol counselling, assessment and advice regarding relapse prevention) • Partner presence at Community Open Clinics: social care worker, housing advice, benefits advice, assertive outreach to support attendance at clinics. • Venues will vary across the city - targeted areas across the city • The establishment of a regular Community Open Clinic at Cyrenians work with vulnerable individuals with alcohol related problems including those experiencing social exclusion

17. Key areas of development • Multi agency care plans • (individuals may have a single dominant condition i.e. alcohol but may be known to different agencies) • Community Open clinics(walk in, self refer, referred into from any other service) • Professionals available at clinics, clinical & mental health staff, social care, housing, benefits • Assertive Outreach • Emerging workforce(i.e. new roles, liaison, co-ordination, systems approach to service delivery) • A&E – Alcohol Liaison Workers • Wider use of IBAs (pragmatic approach - multi agency training)

18. BROADENING THE BASE OF “TREATMENT” FOR ALCOHOL PROBLEMS • Most important change in treatment of alcohol problems over last 10-20 years: focus of intervention broadened from just “alcoholics” to much larger number of “excessive drinkers” (i.e., hazardous and harmful drinkers). • Sufficient number of excessive drinkers show progressive deterioration to make early intervention and secondary prevention an essential part of national response to alcohol-related harm. Such an approach is likely to be highly cost-effective. • For many types of problem, the major contribution to alcohol's costs to society comes from drinkers with less frequent and serious problems, cf. “the preventive paradox”

19. Community Open Clinics • Professionals available at clinics, clinical & mental health staff, social care, housing, benefits • Locations • City/Town centres • Community centres • Universities • ‘Peoples Kitchen’ (Newcastle) • Shopping Centres

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

21. How hard can it be? Pace Purpose Passion

22. Questions?