H arms and Health I nequalities Julia Miller What is the Healthy Places Healthy Lives Programme Funded by DH originally three years but reduced to one Partnered by LGID NST Marmot ID: 634138
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Reducing towards Alcohol Harms and Health Inequalities.Julia Miller Slide2
What is the Healthy Places, Healthy Lives Programme?Funded by DH – originally three years, but reduced to one! Partnered by LGID, NST, MarmotStarted Jan 2010 – end ?Developing partnerships to reduce health inequalitiesImplementing Marmot principles25 sites in EnglandInitiatives focus on teenage pregnancy, alcohol, obesity, community aspirations, CVD,diabetes, smoking, domestic abuse and more…Slide3
Why Alcohol?
Health
Crime
Employers
Alcohol related hospital admissions
(wholly and partially attributable to alcohol)
Outpatients, A&E, AmbulanceGP consultations, practice nurse consultationsSpecialist treatment servicesDependency servicesImpact on families £2.9
Offenders under the influenceYoung people committing criminal damageVehicle-related theftsCrime and Anti-Social BehaviourDomestic violence Fear of crime & impact on environment £8.0
Average employee absence (7.4 days per year)11 million working days annuallySickness absence (17 million annually)Poor and underperforming £1.7
Not including estimated costs to the economy of alcohol-related deaths and unemploymentSlide4
Key Features of Healthy Places Healthy LivesSlide5Slide6Slide7
LincolnSlide8
Work on supporting infrastructureSlide9
Infrastructure Development
Cementing partnerships
Think Tanks
Mapping alcohol services
Links
to commissioning
Links into
other local
strategies and Boards e.g
.
Child Poverty, Community SafetyLocal leadership & cementing partnershipsUnderstanding the wider determinants
Alcohol Strategy: Isle of Wight, Wolverhampton, Brighton, Gt YarmouthSlide10
City-wide
Intelligence, Wolverhampton
Terms of
Reference
Multiple
stakeholder engagement
Linking data
Analyst expertise
Gaining buy-in across the City
Model to support other strategic work Benefits
realisation, Gt Yarmouth & Waverney, WolvesEconomic modelling
Benefits realisationLinks to commissioningAmenable mortalityConvincing commissionersSlide11
Cost Effective InterventionsSlide12
Summary of the evidence of the effectivenessof
alcohol interventions
Source: WHO, Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm, 2009
Degree of Evidence
Evidence of action that reduces alcohol-related harm
Evidence of action that does not reduce alcohol-related harm
Convincing
Alcohol taxes
Restricting outlet density
Restricting days/hours of sale
Minimum purchase age
Random breath testing
IBA programmes
Treatment for alcohol use disorders
School-based education &
information
Probable
Minimum unit price
Restricting volume of commercial
communications
Enforcing restricted sale to
intoxicated/ under-age people
Training of alcohol servers
Consumer labelling and warning
messages
Public education campaigns
Limited
Suspending driving licenses
Workplace programmes
Community-based programmes
Campaigns funded by the alcohol
industrySlide13
Outline: Increased police presence. Voluntary ‘Street Pastors’ – street patrol and guidance. ‘Safe Havens
’ – alcohol free drinks, somewhere to wait, free call to taxi company. Temporary medical centre (on the spot first aid) and triage ambulance to relieve A&E pressure. Taxi enforcement officers to monitor unlicensed ‘plying for hire
’
activities.
Multi-agency visits to licensed premises to ensure compliance with licensing and safety conditions.
Impact (compared to same period, 2007/08):
29% reduction in violent crime
14% reduction in alcohol-related ambulance call-outs (28% reduction on New Year
’s Eve) 8% reduction in A&E attendances 125 visits to licensed premises by enforcement officers (leading to 1 prosecution and 3 license reviews) 12 taxi drivers were stopped for ‘
plying for hire’, of which, 10 were prosecuted, enforcing the ‘get home safely’ message. Fire Officers conducted 38 inspections across 24 premises. 23 required further action, relating to means of escape and insufficient fire risk assessments. Night Time Economy, ROI example:Keep It Safe, Wolverhampton
Return on Investment: Total budget was £218,786. Cost analysis indicated total savings to the emergency services alone of £235,000. This shows strong ROI before Wider social determinates are factored in.Slide14
Service Focused InterventionsSlide15
Brief InterventionsSlide16
Cardiff ModelContinual improvement and feedbackSlide17Slide18
Scratch card scores
Scores above 5 could indicate that drinking levels are harmful or hazardous to health
3438 Scratch cards have been given out
3322 Over the counter by pharmacies
110 NHS Health checks (Chamber Health)
3 Emergency Contraception
3 Other
Details from Arrest Referral not yet availableSlide19
Community FocusSlide20
Focussing on the wider social determinantsSlide21
Bilston East, WolverhamptonSlide22
Addressing Marmot Policy Areas Slide23Slide24
Lessons LearnedPartnerships take a while to mature and bed in with regular meetings between stakeholdersThe financial climate and the changing shift in staff has been problematic in some placesSome issues need to be solved at a national level eg incentivising the delivery of IBAsSlide25
HPHL into 2011New sites joiningNew Issues to discussTransforming CommunitiesSocial return on investmentRaising AspirationsNHS Institute is moving to Social Enterprise ModelWe would welcome discussions with potential new sites!Slide26
More informationWebsite - www.institute.nhs.uk/commissioning/general/healthy_places_healthy_lives.htmlFlyer - www.institute.nhs.uk/images/documents/Healthy%20Places%20Healthy%20Lives/62934%20NHS%20Healthy%20Places%20A5%20flyer.pdfjuliamiller@nhs.net HPHL Alcohol Lead 07903 218321