1. A Social Marketing Approach to the ‘wicked’ problem of alcohol Newcastle upon Tyne North Tyneside Northumberland Lynda Seery Public 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 Codes listed T40 (primary diagnosis) poisoning by drugs, medicaments and biological substances X620intentional self harm T51intoxication/toxic effects of substances non medicinal as to source S099injuries to head W19fall F101harmful use

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

13. Example of re-admission record Codes listed K703 (primary diagnosis)Diseases of the liver F102Dependence syndrome I10XHypertensive diseases J459Chronic lower respiratory diseases R18XSymptoms and signs involving the digestive system and abdomen Z720Persons encountering health services in other circumstances Z867Persons with potential health hazards related to family and personal history and certain conditions influencing health status

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 MaleFemale Newcastle4449 North Tyneside22 Northumberland1725

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?