1. How big is the problem locally? Dr Stephen Willott GP and Clinical Lead for Drug Misuse & Alcohol NHS Nottingham City …& what are we doing about it?

2. How big is the problem? Alcohol related harm

4. Binge Drinkers 55 k Lower Risk Drinkers 200k Increased Risk Drinkers 45 k Higher Risk Drinkers 15 k Dependent Drinkers 10 k In a city of 300K adults…

5. Estimated proportions of drinkers in Nottingham Nottingham Citizens’ Survey Nottingham synthetic estimates England average 200920102011 Binge drinkers 33%24%20%25.0%20% Increasing risk drinkers 14%11%8%18.8%21% Higher risk drinkers 5%2% 8.5%7%

8. Alcohol related admissions per 100,000 for Nottingham vs England

9. Joint Strategic Needs Assessment Alcohol (2012)

10. Key Nottingham issues high density of pubs, clubs & off-licences significantly higher than average rate of alcohol related hospital admissions 20% of all violent crime in the city occurs within the city centre Problematic alcohol use amongst A8 nationals is becoming more Almost half of City residents perceive people being drunk or rowdy in the city centre as a problem

11. Gaps lack of robust data on the precise nature and prevalence of alcohol related ASB lack of data on alcohol misuse and what works for young people Streamlined treatment services and pathways need to be developed across the criminal justice system implications of health bodies becoming a responsible authority under the Licensing Act are not yet clear transition of alcohol commissioning to the local authority…

12. What are we doing about it? www.nottinghamcdp.com

13. Prevention Decade of Better Health

14. Prevention Decade of Better Health Education

15. Prevention Decade of Better Health Education reduce the proportion of adults who drink at harmful levels by 30% Licensing

17. Treatment Talking about alcohol Brief advice Seamless Alcohol pathway Alcohol Diversion Scheme Structured Treatment Detox Aftercare Alcohol intensive case management service Treating blood pressure

18. Local Alcohol Action Area Notts wide Making use of ED data ‘Cardiff Model’ More joined up ‘data sharing’

20. Attributable fractions of alcohol related admissions 2 NI39 admissions = Mental & behavioural disorders due to alcohol 2 X Hypertension10 X

21. Increased risks of ill health to harmful drinkers ConditionMenWomen Hypertension4 timesDouble StrokeDouble4 times Coronary heart disease1.7 times1.3 times Liver disease13 times Cancers of mouth, neck and throat 4 - 5.5 times Breast cancer-1.5 times Source: Anderson P.(2007) The Scale of Alcohol-related Harm. [Unpublished] Department of Health

22. What contributes most to Nottingham’s high alcohol related admissions? Main conditions that contribute: Hypertensive disease - responsible for 29% of the increase in NI39 admissions since 2002/3 Alcoholic liver disease Epilepsy Cardiac arrhythmias Mental & behavioural disorders – responsible for 47% of increase since 2002/3 Other Proportion of NI39 admissions 25% 22% 15% 9% 7% 22%