1. High Impact Changes

2. Prioritize alcohol within LAAs and NHS Operating Framework – Vital Signs Improve treatment Review pathways and access – NATMS Evidence based practice – Models of Care Implement IBA Health: A&E, Clinics, GPs Criminal Justice Develop activities to control alcohol misuse Identify local champions & build the case for investment Provide local implementation of national media campaigns

3. Mental Health 1. Treat home based care and support as the norm 2. Improve access to screening and assessment 3. Manage variation in service user discharge processes 4. Manage variation in access to all mental health services 5. Avoid unnecessary contact 6. Increase the reliability of interventions 7. Apply a systematic approach 8. Improve service user flow by removing queues 9. Use an integrated care pathway approach 10. Retain an effective workforce

4. Social Care 1) involvement 2) dignity and respect 3) meeting fundamental needs 4) accessible information and support 5) partnership working 6) personalised services 7) effective commissioning 8) flexibility/challenge/creativity 9) inclusion, and 10) carers as partners in care

5. Tobacco 1. Work in partnership 2. Gather and use the full range of data to inform tobacco control 3. Use tobacco control to tackle health inequalities 4. Deliver consistent, coherent and co- ordinated communication 5. An integrated stop smoking approach 6. Build and sustain capacity in tobacco control 7. Tackle cheap and illicit tobacco 8. Influence change through advocacy 9. Helping young people to be tobacco free 10. Maintain and promote smoke-free environments Excellence in tobacco control: 10 High Impact Changes to achieve tobacco control An evidence-based resource for local Alliances Prepared by the Tobacco Control National Support Team, May 2008

6. High Impact Changes Prioritize alcohol within LAAs and NHS Operating Framework – Vital Signs Improve treatment Review pathways and access – NATMS Evidence based practice – Models of Care Implement IBA Health: A&E, Clinics, GPs Criminal Justice Develop activities to control alcohol misuse Identify local champions & build the case for investment Provide local implementation of national media campaigns

7. High Impact Changes Prioritize alcohol within LAAs and NHS Operating Framework – Vital Signs Improve treatment Review pathways and access – NATMS Evidence based practice – Models of Care Implement IBA Health: A&E, Clinics, GPs Criminal Justice Develop activities to control alcohol misuse Identify local champions & build the case for investment Provide local implementation of national media campaigns

8. Point of Clarification Opportunistic alcohol case Identification and the delivery of Brief Advice (IBA) is the same as Screening and Brief Interventions for alcohol misuse (SBI)

9. Evidence for IBA There is a very large body of research evidence 56 controlled trials (Moyer et al., 2002) all have shown the value of IBA A recent Cochrane Collaboration review (Kaner et al., 2007) shows substantial evidence for IBA effectiveness For every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels (Moyer et al., 2002) This compares favourably with smoking where only one in twenty will act on the advice given (Silagy & Stead, 2003) –This improves to one in ten with nicotine replacement therapy.

10. Benefits of IBA IBA would result in the reduction from higher-risk to lower-risk drinking in 250,000 men and 67,500 women each year (Wallace et al, 1988). Higher risk and increasing risk drinkers who receive brief advice are twice as likely to moderate their drinking 6 to 12 months after an intervention when compared to drinkers receiving no intervention (Wilk et al, 1997). Brief advice can reduce weekly drinking by between 13% and 34%, resulting in 2.9 to 8.7 fewer mean drinks per week with a significant effect on recommended or safe alcohol use (Whitlock et al, 2004). Reductions in alcohol consumption are associated with a significant dose-dependent lowering of mean systolic and diastolic blood pressure (Miller et al, 2005). Brief advice on alcohol, combined with feedback on CDT levels, can reduce alcohol use and %CDT in primary care patients being treated for Type 2 diabetes and hypertension (Fleming et al, 2004).

11. The Numbers FACTSFIGURES PCTs152 Inc + High %22.6 Dep %3.6 Practices 8,261 GPs 33,364 ENGLANDPCTPRACTICEGP Total Population 53,588,218 352,554 6,487 1,606 Adult Population 43,580,873 286,716 5,275 1,306 Dependent drinkers 1,568,911 10,322 190 47 Increased and High Risk 9,849,277 64,798 1,192 295

12. IBA in A&E A study at St Mary’s Paddington showed that patients who received an intervention (Crawford et al, 2004): –Were drinking at significantly lower levels –Made 0.5 fewer visits to A&E A study in Liverpool supports having an alcohol liaison nurse in A&E working into the hospital. It suggests the post saved 40 admissions per year - much more than its cost (Royal College of Physicians, 2001)

13. Treatment Dependent drinkers cost the NHS double the cost of lower-risk drinkers Dependent drinkers represent a very high-risk group for hospital admissions UK Alcohol Treatment Trials (UKATT) –SBNT & MET –25% successful outcome – no alcohol-related problems –40% much improved – reduced problems by 66%