Alcohol data: JSNA support pack. Key data to support planning for effective alcohol prevention, treatment and recovery in

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1 Key data to support plaig for effective alcohol prevetio, treatmet ad recovery i Croydo (usig latest available data)

2 ABOUT THIS JSNA SUPPORT PACK The health harms associated with alcohol cosumptio i Eglad are widespread, with aroud 9 millio adults drikig at levels that pose some level of risk to their health. Because of the breadth of the problems, this pack provides a rage of alcohol related data i relatio to differet levels of alcohol related harm ad data about the local alcohol treatmet system. Idicators i the first sectio describe the extet of alcohol related problems at a local level. Data i this sectio has bee take from the Alcohol Profiles for Eglad (LAPE) ad comparisos to local ad atioal bechmarks are provided. The Alcohol Profiles for Eglad ca be foud at: To fully uderstad how your local alcohol system is respodig to these problems, additioal local ad atioally held data ca be used. Data relatig to local areas' targeted alcohol prevetio itervetios, such as idetificatio ad brief advice (IBA), are ot collected atioally, but should be available at a local level ad a list of wider data sources is refereced at the ed of the pack. Key performace iformatio about adult alcohol cliets i your local alcohol treatmet system i is the preseted, alogside atioal data for compariso. The data is take from the Drug Treatmet Moitorig System (NDTMS) ad reflects activity reported for idividuals i structured alcohol treatmet. Detailed iformatio relatig to the methods used i calculatig all data items i this pack is available i the supportig documet 'Techical defiitios for the data to support plaig for effective alcohol prevetio, treatmet ad recovery i '. LOCAL DATA TO REDUCE ALCOHOL RELATED HARM The followig sectio uses data from the Alcohol Profiles for Eglad (LAPE) to make comparisos agaist atioal ad local bechmarks usig a earest eighbour approach. The earest eighbour approach groups each local area with 15 other areas that are similar across a rage of demographic, socio-ecoomic ad geographic variables. Utilisig a 'earest eighbour' approach allows like-for-like comparisos of areas ad ca reveal patters i the data that would ot otherwise be see whe oly makig comparisos agaist a atioal bechmark. It is therefore importat to cosider both atioal ad earest eighbour comparisos whe iterpretig your data. All data has bee divided ito four equal groups (quartiles) i order to allocate levels of harm. Quartile oe, show i dark gree, is idicative of lower levels of alcohol related harm compared to the bechmark. Quartiles two ad three idicate icreasig levels of harm respectively, ad areas i quartile four (show i red) suggest areas have the highest levels of harm compared to the bechmark. There are two bechmarks i this data pack. The first is at local level ad demostrates which quartile your area falls ito withi your earest eighbour group, the secod is at atioal level ad shows which quartile your area falls ito withi all local authorities i Eglad. The areas idetified as the 15 earest eighbours for Croydo are: Efield, Redbridge, Ealig, Baret, Hilligdo, Harrow, Houslow, Bexley, Waltham Forest, Bret, Merto, Sutto, Greewich, Bromley, Harigey Page 2 of 11

3 HOSPITAL ADMISSIONS DUE TO ALCOHOL The data below reflects the geeral impact of alcohol o populatio health. Alcohol-related hospital admissios ca be a result of regular alcohol use above lower-risk levels as well as chroic heavy drikig ad are most likely to be foud i icreasig-risk drikers, higher-risk drikers, depedet drikers ad bige drikers. Health coditios i which alcohol plays a causative role ca be classified as either 'alcohol-specific' or 'alcohol-related'. The first two idicators below refer to alcohol specific coditios, where alcohol is causally implicated i all cases, e.g. alcohol poisoig or alcoholic liver disease. The followig four idicators are for alcohol-related coditios which iclude all alcohol-specific coditios, plus those where alcohol is causally implicated i some but ot all cases, for example high blood pressure, various cacers ad falls. - Alcohol specific hospital admissio - uder 18s, gives a crude idicatio of the direct health impact of alcohol o that group. Withi the four idicators relatig to alcohol-related coditios, there are two types of measure; broad ad arrow. For example: - The third item, alcohol-related hospital admissios (broad measure), is a idicatio of the totality of alcohol health harm i the local adult populatio. - The fourth item, alcohol-related admissios (arrow measure), shows the umber of admissios where a alcohol-related illess was the mai reaso for admissio or was idetified as a exteral cause. This defiitio is more resposive to chage resultig from local actio o alcohol ad is icluded as a idicator i the Public Health Outcomes Framework (PHOF). To address the harm reflected i this data, successful plas will employ what is kow to work i terms of: effective prevetio; health improvemet itervetios for those at risk; treatmet ad recovery services for depedet drikers; ad actio to reduce bige drikig ad reduce the harm caused by bige drikers. 1 Least amout of harm 2 Lower harm levels 3 Higher harm levels 4 Most amout of harm Alcohol-specific hospital admissio - uder 18s 2010/ /13 All geders, crude rate per 100,000 Measure Nearest Neighbour Group Measure Alcohol-specific hospital admissio 2012/13 All geders, stadardised rate per 100,000 Alcohol-related hospital admissios - broad 2012/13 All geders, stadardised rate per 100,000 Alcohol-related hospital admissios - arrow 2012/13 All geders, stadardised rate per 100,000, PHOF idicator Admissio episodes for alcohol-related coditios - broad 2012/13 All geders, stadardised rate per 1000 Admissio episodes for alcohol-related coditios - arrow 2012/13 All geders, stadardised rate per 1000 Page 3 of 11

4 MORTALITY AND MONTHS OF LIFE LOST The data reflects the level of chroic heavy drikig i the populatio ad is most likely to be foud i higher-risk drikers ad depedet drikers. High rates of alcohol specific mortality ad mortality from chroic liver disease are likely to idicate a sigificat populatio who have bee drikig heavily ad persistetly over the past years (obesity is also a key factor for liver disease). While alcohol misuse is the largest sigle cause of liver disease, obesity is a growig sigificat causal factor. Broadly speakig alcohol-related deaths make up aroud 3 of all deaths. Of these, about a third are alcohol-specific deaths e.g. from alcohol poisoig, alcoholic liver disease, alcoholic pacreatitis. The remaiig alcohol-related deaths are from coditios partially related to alcohol, roughly two thirds of which are from chroic coditios e.g. Haemorrhagic stroke, Cardiac arrhythmias, Maligat eoplasm of oesophagus, with the remaider caused by acute cosequeces such as road traffic accidets or itetioal self-harm. 1 Least amout of harm 2 Lower harm levels 3 Higher harm levels 4 Most amout of harm Moths of Life Lost Measure Nearest Neighbour Group Measure Moths of life lost - males Moths of life lost -females Measure Nearest Neighbour Group Measure Alcohol-specific mortality All geders, stadardised rate per 1000 Mortality from chroic liver disease All geders, stadardised rate per 1000 Alcohol-related mortality 2012 All geders, stadardised rate per 1000 ALCOHOL AND CRIME The data reflects the level of crime liked to drikig i the populatio ad is most likely to be foud i bige drikers, higher-risk drikers ad depedet drikers. Higher levels of alcohol-related recorded crimes ad violet crimes are likely to be sigificatly liked to bige drikers ad the ight-time ecoomy. It is ot possible to determie whether these drikers are icreasig risk, higher risk or depedet drikers however they are likely to be drikig problematically. 1 Least amout of harm 2 Lower harm levels 3 Higher harm levels 4 Most amout of harm Alcohol ad Crime Alcohol-related recorded crime All geders, crude rate per 1000 Measure Nearest Neighbour Group Measure Alcohol-related violet crime All geders, crude rate per 1000 Page 4 of 11

5 DATA FROM YOUR LOCAL ALCOHOL TREATMENT SYSTEM The followig sectio provides detailed iformatio o idividuals who are i cotact with structured alcohol treatmet. The data has bee take from the Drug Treatmet Moitorig System (NDTMS) ad refers to idividuals who were i treatmet durig ad cited alcohol as their primary problematic substace. ly, wome make up 36 of the adults i alcohol treatmet. Wome presetig to treatmet ofte experiece poor metal health, domestic violece ad for mothers, who make up 54 of wome i treatmet, the challege of beig a loe paret. Some of the data preseted here is split by geder to help local plaig cosider ad meet wome s eeds i recovery services. PREVALENCE ESTIMATES The Departmet of Health has commissioed a project, led by Sheffield Uiversity, to develop a model to estimate the umber of idividuals who would access specialist alcohol treatmet services ad require differet types of treatmet optios i Eglad each year at both atioal ad local levels. I the immediate-term, it is hoped local areas will develop their ow estimates of their alcohol-depedet populatios as well as makig use of ay previously supplied iformatio they fid useful. WAITING TIMES This sectio provides iformatio relatig to the legth of time cliets waited to access alcohol treatmet for the first itervetio they received. People who eed alcohol treatmet eed prompt help if they are to recover from depedecy ad keepig waitig times low will play a vital role i supportig recovery from alcohol depedecy. of iitial waits of iitial waits of cliets waitig uder 3 weeks to access treatmet Idividuals waitig uder three weeks to start treatmet Idividuals waitig over six weeks to start treatmet ROUTES INTO TREATMENT The table below shows the routes ito alcohol treatmet. Uderstadig these gives a idicatio of the levels of referrals from crimial justice (ad other sources) ito specialist treatmet. Crimial Justice System (CJS) meas referred through a arrest referral scheme, via a Alcohol Treatmet Requiremet (ATR), priso or the probatio service. Source of referral ito treatmet: of ew starts Geder Split (M/F ) of ew starts Geder Split (M/F ) of referrals to treatmet by source Self-referral Crimial Justice System (CJS) GP Hospital/A&E Social Services All other referral sources Missig Page 5 of 11

6 DEMOGRAPHICS AND HEADLINE TREATMENT FIGURES The atioal average age of cliets i alcohol treatmet is 43 ad although there are more me tha wome i treatmet, the age distributio for both geders is very similar. This sectio shows iformatio about people who were i alcohol treatmet i Specifically: all those i treatmet; those who started i the year; the umber of people i drug treatmet who also have a alcohol problem; a geder split; the umber of pregat wome ad the umber beig treated for a co-exitig metal illess. Number of adults i alcohol treatmet i startig treatmet i Number ad proportio of adults startig alcohol treatmet i i drug treatmet citig alcohol use Number ad proportio of adults i drug treatmet i who cite additioal problematic alcohol use Age ad geder of all adults i alcohol treatmet i Geder split (M/F ) Age ad geder of cliets i treatmet L Male N Male L Female NFemale of all i treatmet of all i treatmet pregat female cliets Female cliets who were pregat durig alcohol treatmet Cliet is curretly receivig care from metal health services for reasos other tha substace misuse Yes of all i treatmet of all i treatmet * receivig care from metal health services No Icomplete data * of cliets with completed data SAFEGUARDING The data below shows the umber of adults i alcohol treatmet who live with childre; those who are parets but do ot live with childre; those without childre or child cotact ad people for whom there is icomplete data. This last item is icluded to help you cosider the possible hidde populatio(s) of alcohol-depedet parets, or those with childcare resposibilities i cotact with local treatmet services. Over a quarter of the Eglish treatmet populatio has a child livig with them at least some of the time. Livig with childre (ow or other) of all i treatmet Geder Split (M/F) of all i treatmet Geder Split (M/F) livig with childre Parets ot livig with childre Not a paret/o child cotact Icomplete data 4 2 Livig with childre (ow or other) Parets ot livig with childre Not a paret/o child cotact Icomplete data Page 6 of 11

7 EMPLOYMENT AND BENEFITS The first data item below shows self-reported employmet status of adults i your treatmet system whe they started treatmet. All subsequet items show the beefit profile of your i-treatmet populatio o 31 March 2012 (take from a match betwee treatmet ad local market system data used by Jobcetre Plus). Employmet is key to sustaiig recovery. However, atioally, employmet outcomes for cliets exitig treatmet remai low. Improvig job outcomes for this group requires improved multi-agecy resposes; achievable through good joit workig betwee Jobcetre Plus ad Work Programme Providers. Employmet status at the start of treatmet: of ew starts of ew starts of ew presetatios by employmet status Regular employmet 10 Uemployed/ecoomically iactive 8 Upaid volutary work Log term sick or disabled I educatio Other Not stated/missig Beefit profile of the treatmet populatio of all i treatmet o 31/03/12 of all i treatmet o 31/03/12 of idividuals i treatmet who are o beefits Number of idividuals i alcohol treatmet o 31st March 2012 Number of idividuals i alcohol treatmet o 31st March 2012 recorded as beig o beefits (of ay type) o the 31st March 2012 Number of idividuals i treatmet recorded as beig o beefits o 31st March 2012 (by type)*: Jobseekers Allowace (JSA) Employmet Support Allowace (ESA) Icapacity Beefit (IB) Icome Support (IS) Disability Livig Allowace (DLA) Other of claimats by beefit type JSA ESA IB DLA Other Media legth of time (years) claimig beefits betwee the start of beefit claim ad 31st March 2012 (by type)*,**: Media legth of time (years) claimig beefits by type Jobseekers Allowace (JSA) 5 Employmet Support Allowace (ESA) Icapacity Beefit (IB) Icome Support (IS) Disability Livig Allowace (DLA) Other 0 JSA ESA IB IS DLA Other Number of idividuals i alcohol treatmet who left successfully i successful completios successful completios of successful completios who had a history of beig o beefits Of those successful completios, those who at the poit of discharge: were o beefits were ot o beefits * idividuals are couted oce uder each type of beefit they received, as such percetages may sum to more tha oe hudred ** legth of time o beefits couted as the legth of the beefits spell from the start util 31st March 2012, regardless of the legth of time spet i treatmet Page 7 of 11

8 HOUSING AND HOMELESSNESS The first data item below shows self-reported housig status of adults whe they started i your treatmet services. The secod, the overall umber of homelessess decisios made, to give a sese of housig eed i your area. A safe, stable home eviromet eables people to sustai their recovery; isecure housig or homelessess threates it. Addictio ad homelessess do ot exist i isolatio. People experiecig both are likely to have a rage of eeds cuttig across health ad social care, substace use ad crimial justice. The Joit Strategic Needs Assessmet (JSNA) ad Joit Health ad Wellbeig Strategy (JHWS) ca be used to idetify ad commissio across these iterdepedecies. Egagig with local housig ad homelessess agecies ca help esure that the full spectrum of homelessess is uderstood ad picked up: from statutorily homeless; sigle homeless people, rough sleepers ad those at risk of homelessess. Accommodatio status at the start of treatmet: Urget housig problem (NFA) Housig Problem (ot urget) Noe Other of ew starts of ew starts with a housig problem Missig Housig problem (ot urget) Urget Housig problem (NFA) Number of decisios take by the Authority o homelessess applicatios Rate per 1000 i treatmet Rate per 1000 i treatmet Decisios take by LA (rate per 1000 i treatmet) 0 0 DRINKING LEVELS AND ADDITIONAL SUBSTANCES USED This sectio shows the umber of people i treatmet drikig at higher risk levels, the umber of uits cosumed i the 28 days prior to treatmet ad the umber of people usig additioal substaces to alcohol. Higher risk drikig is defied here as wome drikig more tha 140 uits per moth ad me drikig more tha 200 uits per moth ad is i lie with the Govermet's defiitio of weekly higher risk cosumptio levels (50 uits per week for me ad 35 uits per week for wome). Drikig at higher risk levels icreases the risk of alcohol related disease. For example, the risk of liver disease is icreased by 13 times. Risk of coroary heart disease is icreased by 1.7 times for me ad 1.3 times for wome. Although the majority of cliets cite usig alcohol i the moth prior to treatmet, 7 atioally cite o alcohol use. There are several reasos why this could be the case: they may have bee referred to treatmet directly from the crimial justice system or they may be i treatmet to maitai abstiece ad prevet relapse. Additioal use of opiates ad crack are metioed here as they are ofte used by cliets with the most complex problems. Caabis is also show separately as it is the most commo additioal substace cited by alcohol cliets i treatmet. of all i treatmet * of all i treatmet * * drikig at higher risk levels Drikig at higher risk levels i the 28 days prior to eterig treatmet Uits cosumed i the 28 days prior to eterig treatmet: Over 600 Missig usig additioal substaces Other substace use i additio to alcohol of all i treatmet ** of all i treatmet ** 10 8 Additioally usig opiates or crack 6 Additioally usig caabis 4 Additioally usig other drugs (ot opiates, crack or caabis) 2 Opiates/crack Caabis Other drugs * ote: proportios here are calculated out of total cliets with completed data rather tha all cliets i treatmet ** ote: cliets may cite more tha oe additioal substace ad are couted oce uder each relevat category Page 8 of 11

9 INTERVENTIONS We kow that the types of itervetio delivered to service users will have a impact o their achievemet of recovery outcomes. The table below shows i detail what treatmet staff i your area do with service users, ad i what settigs. High Level Itervetios Pharmacological Psychosocial Recovery Support Total Idividuals Settig: Commuity Ipatiet uit Primary care Residetial Recovery house Youg perso settig Missig Total idividuals Pharmacological Itervetio Type (sub itervetio): Idividuals with a pharmacological itervetio where the itetio is withdrawal Idividuals with a pharmacological itervetio where the itetio is relapse prevetio RESIDENTIAL REHABILITATION The data below shows the umber of adult alcohol users i your area who have bee to residetial rehabilitatio durig their latest period of treatmet (as a proportio of your whole treatmet populatio ad agaist the atioal proportio). Structured alcohol treatmet mostly takes place i the commuity, ear to users families ad support etworks. However, i lie with NICE recommedatios, a stay i residetial rehab is appropriate for the most serious cases, ad local areas are ecouraged to provide this optio as part of a itegrated recovery-orietated system. attedig residetial rehabilitatio of all i treatmet of all i treatmet Number of adults who atteded residetial rehab LENGTH OF TIME IN TREATMENT NICE Guidace (CG115) suggests that harmful drikers ad those with mild alcohol depedece might beefit from a package of care lastig three moths while those with moderate depedece might eed a six moth package ad those with severe depedece or those with complex eeds may eed a package of care lastig up to a year. The legth of a typical treatmet period was aroud 6 moths, although atioally 1 of cliets remaied i treatmet for more tha oe year. Retaiig cliets for their full course of treatmet is importat i order to icrease the levels of successful treatmet completio ad reduce rates of early treatmet drop out. Coversely, havig a high proportio of cliets i treatmet for more tha a year may idicate that they are ot movig effectively through ad out of the treatmet system. of treatmet exits by legth of time i treatmet Uder 3 moths of all exits of all exits 10 Over 1 year 10 Over 1 year 3 to 6 moths 6 to 12 moths 5 6 to 12 moths 3 to 6 moths 5 6 to 12 moths 3 to 6 moths Over 1 year Average (media) days i treatmet Uder 3 moths Uder 3 moths Page 9 of 11

10 TREATMENT OUTCOMES The followig sectio relates to cliets completig their period i treatmet i , ad whether they completed successfully ad did ot retur withi 6 moths. The Govermet's alcohol strategy states that icreasig effective treatmet for depedet drikers will offer the most immediate opportuity to reduce alcohol-related admissios ad costs to the NHS. Although there is o sigle measure of effective treatmet for alcohol depedecy, the followig data demostrates how well the curret system is workig i treatig those who are receivig structured treatmet. The successful completios data provides a idicatio of the effectiveess of the treatmet system i your area. A high umber of successful completios ad a low umber of represetatios to treatmet idicate that your treatmet services are respodig well to the eeds of those i treatmet. of all i treatmet Geder Split (M/F) of all i treatmet Geder Split (M/F) Total idividuals leavig alcohol treatmet i of all i treatmet who left i Idividuals leavig alcohol treatmet successfully i of all i treatmet who completed successfully of all exits of all exits Idividuals leavig alcohol treatmet successfully i , as a proportio of all exits Idividuals leavig alcohol treatmet successfully (betwee 1st Ja 2013 ad 31st Dec 2013) ad ot returig withi 6 moths * of all i treatmet i 2013* of all i treatmet i 2013* of all i treatmet who completed successfully ad did ot retur withi 6 moths *ote that i order to allow for a 6 moth represetatio period, the i treatmet populatio time period refers to the caledar year rather tha the fiacial year. Therefore figures will differ from other sectios of the report. Please ote that the percetages give i this pack are rouded to the earest per cet. Totals may ot add up to 100 due to roudig. Page 10 of 11

11 ADDITIONAL DATA TO REDUCE WIDER ALCOHOL RELATED HARM The followig liks provide iformatio regardig additioal data sources relatig to wider alcohol related harm which may be available to you either locally or via atioal surveys or data collectio systems. Primary ad Secodary Care Data NHS Health check Everyoe betwee the ages of 40 ad 74, who has ot already bee diagosed with oe of these coditios or have certai risk factors, will be ivited (oce every five years) to have a check to assess their risk of heart disease, stroke, kidey disease ad diabetes. Data is available o a quarterly basis o the umber of people eligible for the health check, ad o appoitmets offered ad received by authorities sice 2011/12. Alcohol-related risk reductio scheme Ehaced Service (ES) The GP Extractio Service (GPES) used to moitor how may ewly registered patiets i a practice have bee offered alcohol-related risk reductio screeig usig either the Fast Alcohol Screeig Test (FAST) or Alcohol Use Disorders Idetificatio Test Cosumptio (AUDIT-C) tool. GPES is a ew system ad full implemetatio is o-goig. To fid out how to access data i your area cotact your local CCG. Hospital Episode Statistics (HES) HES is a data warehouse cotaiig details of all admissios, outpatiet appoitmets ad A&E attedaces at NHS hospitals i Eglad. It cotais admitted patiet care data from 1989 owards, outpatiet attedace data from 2003 owards ad A&E data from 2007 owards. To fid out how to access data i your area cotact your local CCG. Wider Public Health Data Public Health Outcomes Framework (PHOF) A collectio of outcomes idicators coverig the full spectrum of public health. Data is preseted uder four domais: 'wider determiats of health', 'health improvemet', 'health protectio' ad 'healthcare ad premature mortality'. Comparisos with a bechmark ad tred data are provided ad iformatio is updated o a quarterly basis. Health ad Social Care Iformatio Cetre, Statistics o Alcohol Eglad, 2014 A aual report actig as a referece poit for health issues relatig to alcohol use ad misuse. Combies the results from several atioal surveys icludig: the 'Opiios ad Lifestyle Survey' ad 'Smokig drikig ad drug use amog youg people i Eglad'. Health Profiles for Eglad, 2014 Summary health iformatio to support local authority members, officers ad commuity parters to lead for health improvemet. Updated aually ad available i a data tool or as a summary PDF documet. Alcohol Profiles for Eglad (LAPE) Profiles cotaiig 26 alcohol-related idicators for every local authority. The majority are also available for all Public Health Eglad (PHE) cetres i Eglad ad former govermet office regios. Updated aually. ONS Alcohol-related deaths i the Uited Kigdom latest figures for alcohol-related deaths i the UK, its four costituet coutries ad regios of Eglad. Comparisos are made betwee 2012, the latest year, ad previously published data from 2002 owards. Further Alcohol Treatmet Data Drug Treatmet Moitorig System Performace Reports A collectio of reports available o a mothly, quarterly ad aual basis, providig detailed iformatio o cliets i structured alcohol ad drug treatmet from the NDTMS. Access is partially restricted ad grated to PHE staff, commissioers ad local authorities. https://www.dtms.et/reports.aspx# RESTRICTED STATISTICS You are remided that the alcohol data provided i this documet are official statistics to which you have privileged access i advace of release. Such access is carefully cotrolled ad is provided for maagemet, quality assurace, ad briefig purposes oly. Release ito the public domai or ay public commet o these statistics prior to official publicatio plaed for 29th October 2014 would udermie the itegrity of official statistics. Ay accidetal or wrogful release should be reported immediately ad may lead to a iquiry. Wrogful release icludes idicatios of the cotet, icludig descriptios such as "favourable" or "ufavourable". If i doubt you should cosult Joatha Kight, via who ca advise. Please prevet iappropriate use by treatig this iformatio as restricted, refrai from passig iformatio o to others who have ot bee give prior access ad use it oly for the purposes for which it has bee provided. If you ited to publish figures from the JSNA after 29th October 2014 you must restrict figures less tha 5 ay associated figures to prevet deductive disclosure. The restricted status of this data will be lifted after the release of the Alcohol Aual Report o 29th October Page 11 of 11

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