Angus Alcohol and Drugs Partnership. Strategy

Transcription

1 Angus Alcohol and Drugs Partnership Strategy

2 INDEX FOREWORD BY THE ALCOHOL AND DRUGS PARTNERSHIP CHAIR... 3 INTRODUCTION... 4 MAIN ACHIEVEMENTS FROM THE STRATEGY PERIOD... 5 STRATEGIC PRIORITIES FOR NATIONAL POLICY CONTEXT CURRENT SERVICE PROVISION NEEDS ASSESSMENT CROSS CUTTING THEMES SUMMARY APPENDIX APPENDIX

3 Foreword by the Alcohol and Drugs Partnership Chair Susan Wilson I am proud to present to you the Angus Alcohol and Drugs Partnership (ADP) strategy for As we all know, alcohol and drugs continue to cause problems across Scotland and in Angus itself. Angus ADP is determined to work towards reducing the harm associated with alcohol and drugs in our communities. Although headlines about alcohol and drugs are often negative, I do believe that there are some green shoots of hope that things can get better. Some of the data outlined in our strategy shows that alcohol and drug use has declined amongst young people. The very positive national drugs strategy The Road to Recovery has helped us focus our work in Angus and we are starting to see a focus on moving people out of services and heading towards a life free of substance misuse. In Angus, our ADP also enjoys positive relationships with other important strategic groups such as the Community Safety Partnership and the Children and Lifelong Learning Partnership. I am sure that these positive connections will continue to help us reduce the harm caused by substance misuse as we move forward. I sincerely hope that you find our strategy interesting and one that demonstrates a willingness to really tackle the issues of substance misuse within our communities. 3

4 Introduction This strategy sets out the high level direction and priorities of the Angus Alcohol and Drugs Partnership (ADP) for Angus ADP will work to reduce the harmful effects of substance misuse on the people of Angus by promoting the principles of recovery; ensuring we have effective treatment services and by promoting early intervention and prevention strategies. In this document we will outline our vision for the next three years and our main priority areas. We will also seek to outline the national policy context we are working in and how we will seek to deliver the aims of national policy at an Angus level. Angus ADP will seek to play a significant role within the Angus Community Planning Partnership (ACPP). Within the ACPP structure (See Appendix 1), Angus ADP reports directly to the Community Care and Health Partnership (CHPP), which is one of five thematic groups within the ACPP. Angus ADP has developed strong links to other strategic groups within the ACPP and will continue to maintain these positive relations by working closely with our ACPP colleagues. 4

5 The first section of our strategy starts with looking at the achievements made during our previous strategy. Main achievements from the Strategy Period In this section Angus ADP will highlight some of the main achievements attained during the period of the previous strategy Governance and Structure of Angus ADP: In 2010 a development day was held to look at the structure and governance arrangements. This resulted in the establishment of a new structure consisting of an overarching Strategy Group, which has overall responsibility for Angus ADP and four sub groups, which all report into the Strategy Group (See structure below). This new structure has been effective and allowed Angus ADP to work more efficiently. Recovery: In 2011, Angus ADP commissioned CAIR Scotland to deliver a recovery focused moving on service. Part of the contract was also awarded to Figure 8 consultancy who have been tasked to imbed the principles of recovery within the workforce. As part of Angus ADPs new structure we created a recovery and joint working sub group. They were tasked to promote an understanding of the values of recovery within the workforce and promote opportunities for people in recovery, which will support their recovery journey. Main achievements of the group have been to hold a recovery conference, a recovery month, a recovery café, establish the role of recovery champions, support both CAIR Scotland and Figure 8 to develop their recovery work, trained people in 5

6 recovery to become literacy and numeracy trainers and developed strong links with the Scottish Recovery Consortium. CAPSM: Angus ADP, in partnership with the Angus Child Protection Committee (CPC), has a joint sub group accountable to both committees known as the ADP/CPC. In 2009 this committee oversaw the establishment of a new and innovative initiative called Link-Up which aimed to establish new ways of working through a multi agency partnership to address the needs of families affected by parental substance misuse. An external consultant carried out simultaneous action research on behalf of the Scottish Government. The findings have been evaluated positively and encouraged early intervention with partners working collaboratively. Building on the success of the Link-Up initiative the ADP/CPC, in partnership with voluntary sector members of the ADP/CPC, Barnardo s, Tayside Council on Alcohol and Angus Carers were successful in securing funds from the Big Lottery to establish a similar service to Link-Up. This project is called Hopscotch and will open its doors in 2013 and will support families affected by parental substance misuse. The ADP/CPC also developed a robust outcomes tool for use by staff when working with families. This new tool, the Wellbeing Web, has attracted interest from across Scotland and beyond. Prevention: Angus ADP has supported NHS Tayside to deliver on the Alcohol Brief Intervention (ABI) HEAT standard H4. NHS Tayside was successful in meeting their HEAT H4 Standard and the ADP is now working with NHS Tayside and Tayside Council on Alcohol (TCA) to establish ABIs in non-nhs settings. Primary care is an area where (ABI) performance could be improved and the ADP will work with primary care colleagues to support delivery of ABIs. In 2010, Angus ADP established the post of an Alcohol and Drugs Prevention Officer, hosted by Tayside Police (now Police Scotland). This post has overseen a range of prevention work with young people and parents ranging from talks in schools to working with young people in youth clubs educating 6

7 them about the dangers of substance misuse. Some of Angus ADP voluntary sector members such as TCA and CAIR Scotland, through ADP funded projects, also delivered a range of prevention type initiatives in schools and youth clubs. Throughout the ADP continued to fund the Focus on Alcohol Angus (FoAA) initiative. Through FoAA a range of initiatives were delivered in a variety of settings including, schools, supermarkets, regional events and licensed premises, all of which aimed to change culture and encourage the citizens of Angus to consider their own relationship with alcohol. Enforcement and availability: Police Scotland have continued their pursuit of people dealing in illegal substances and continued to disrupt the supply chain of these substances. Police Scotland have also undertaken a range of exercises aimed at keeping young people safe from the harms of alcohol, these include operation dry-up and test purchase operations. The alcohol and drugs agenda will continue to be a priority for the police. Outcomes, Performance and Needs Assessment: During the period Angus ADP made considerable effort to improve the data received from treatment services. All services commissioned by Angus ADP now have set outcome targets agreed for their service and these outcomes are monitored regularly. In partnership with Dundee and Perth and Kinross ADPs, we invested in an information project called SUMIT (Substance Misuse Information Tayside). This initiative aims to supply the ADP with robust quality data on service outcomes and the patient journey. The first reports from SUMIT started to be generated by the end of 2012 and we hope this will greatly enhance the ADPs ability to make strategic decisions based on hard evidence. Performance: Significant effort has been put in by all services to improve access to treatment and support services and to deliver the challenging HEAT A11 target that by March 2013, 90% of people who need help with their drug or alcohol problem will wait no longer than three weeks for treatment and no clients will wait more than 6 weeks. 7

8 The target was achieved overall by NHS Tayside with 92.6% of clients waiting less than 3 weeks from referral to treatment in the quarter January to March The performance of all treatment in Angus ADP area was that 91.2% of clients began treatment within 3 weeks. Throughout the three year life of the target new referrals for treatment have remained steady at an average of 85 a month. Needs Assessment: At the end of 2011 Angus ADP, in partnership with Dundee ADP and Perth and Kinross ADP, appointed a part-time Needs Assessment Officer. Throughout 2012 they have been conducting a needs assessment of people with substance misuse problems who are either homeless or at risk of becoming so. We eagerly await the final report in The ADP anticipates that this needs assessment will further contribute to our understanding of the problems experienced by people with substance misuse issues and inform our future strategic direction. 8

9 Strategic Priorities for The table below shows the structure that Angus ADP fits into and how our sub groups and improvement work groups relate to the Angus ADP; how we fit into the local CPP structure and also our national reporting structure into the Scottish Government policy units. Scottish Government Angus Community Planning Partnership (SOA/Community Planning) Drug Policy Unit Alcohol Policy Unit National Core Outcomes Substance Misuse Annual ADP Reports Economic Development Partnership Children s & Learning Partnership Community Care & Health Partnership Community Safety Partnership Rural & Environment Partnership Angus Alcohol & Drugs Partnership RIE Hub Spokes Finance & Commissioning ADP/ CPC Recovery & Joint Working Focus on Alcohol (Angus) Community Ambassador Pharmacy CAPSM The main strategic priorities that will be taken forward by Angus ADP over will be: Closer Integration of Services: In 2012, Angus ADP held a rapid improvement event (RIE) to look at how services in Angus could work together more effectively and efficiently. A priority for Angus ADP will be to ensure that the ideas generated during the RIE are taken forward over the coming years. Recovery: We will ensure that the principles of recovery are promoted throughout Angus and that treatment services are recovery focused. However, the ADP recognises that universal services also play an important 9

10 role in many people s recovery. The ADP will therefore work to generate opportunities and support for recovery from universal services and resources and in local communities. Children Affected by Parental Substance Misuse (CAPSM): The issue of CAPSM will be a top priority in Angus and we will work to ensure effective interventions are available to families in need of support. Prevention: Angus ADP will work to ensure that there are a range of services and initiatives in Angus that can contribute towards preventing people from ever developing substance misuse problems. We will work to increase the reach and coverage of the national naloxone programme by increasing the number of kits supplied to people at risk of opiate overdose. We will continue to support the Tayside Drugs Deaths Group in their efforts to prevent drugs death in Angus. Alcohol: The HEAT 4 standard to deliver alcohol screening and brief interventions will continue as a priority area for Angus ADP. As an ADP, we will also support initiatives to engage with the wider community and encourage them to consider their levels of alcohol consumption. Outcomes, Performance and Needs Assessment: It is important that all substance misuse services are able to offer a high level of service to their service users. We will continue to monitor the performance and outcomes of local services and initiatives. Angus ADP will also continue to strive to ensure that strategic decisions are taken based on robust needs assessment data. The ADP will work to ensure high levels of compliance in the amount of data submitted to the national Scottish Drug Misuse Database (SDMD, held by the National Services Scotland Information Services Division, ISD, Scotland) so that it accurately reflects the number of people engaging with drug treatment services at local level and correlates with the information submitted to the 10

11 national Drug and Alcohol Treatment Waiting Times Database (DATWTD, also held by ISD Scotland). Locally we are aware of the emergence of new psychoactive substances (sometimes referred to as legal highs). We will seek to develop a local understanding of the prevalence and impact of new psychoactive substances. Enforcement and Availability: Police Scotland will continue their pursuit of people dealing in illegal substances and continued to disrupt the supply chain of these substances. Police Scotland will continue to undertake a range of exercises aimed at keeping young people safe from the harms of alcohol, these include operation total dry-up and test purchase operations. The alcohol and drugs agenda will continue to be a priority for the Police. 11

12 National Policy Context In April 2009 the Scottish Government launched a new framework for local partnerships on alcohol and drugs, jointly signed by the Scottish Government, NHS Scotland and the Convention of Scottish Local Authorities (COSLA). The framework confirmed the creation of new, dedicated partnerships on alcohol and drugs known as Alcohol and Drugs Partnerships (ADPs). These replaced the previous model of Drug and Alcohol Action Teams (DAAT). The framework states that ADPs will operate in each local authority area and should be firmly embedded within wider arrangements for community planning. Under the new framework, these new partnerships are responsible for developing local strategies for tackling alcohol and drugs misuse. Strategies should be based on a robust assessment of needs in their area; a transparent, evidence-based process for agreeing how funds should be deployed and a clear focus on the outcomes that this investment is achieving within their communities. Partnerships are to be embedded within local Community Planning Partnerships (CPPs) and targets for alcohol and drugs misuse services will be delivered through local single outcome agreements and will link to the government s national outcomes. In May 2008 the Scottish Government published the Road to Recovery outlining their vision for the future direction of drug services in Scotland. The central theme of the document is that drug services should be recovery focused. The Scottish Government outlines four main themes in the Road to Recovery: Recovery Services should enable people to move on from their drug use and realise their ambitions such as entry into education and employment. 12

13 Children Affected by Parental Substance Misuse (CAPSM) Highlights the need to ensure availability of quality support services for children and families affected by parental substance misuse. Enforcement and Availability Outlines the need to reduce supply and ensure appropriate criminal justice interventions that are recovery focused. Prevention Highlights the importance of educational information on drug misuse to be available to the public and the need for early intervention for young people and substance misuse education in school. Early in 2009 the Scottish Government published Changing Scotland s Relationship with Alcohol: A Framework for Action. The framework sets out the strategic vision for tackling alcohol misuse in Scotland. Four areas are identified as a priority: reduced alcohol consumption supporting families and communities promotion of positive public attitudes, positive choices improved treatment and support. In March 2009 Audit Scotland published a report on Drug and Alcohol Services in Scotland. Audit Scotland found wide variation in the range and accessibility of drug and alcohol services across Scotland and that spending decisions are often not based on evidence or on a full assessment of local need. In most areas money was disproportionately spent on drug services despite evidence that the prevalence of alcohol problems make alcohol the bigger problem. Audit Scotland found that there was inadequate focus on outcomes and very little information on whether or not services were achieving specific outcomes or measures of success. There have been two NHS HEAT (Health, Improvement, Efficiency, Access and Treatment) targets particularly relevant to the alcohol and drugs agenda. 13

14 Health improvement target H4 referred specifically to alcohol and required that each Health Board should Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11. The target was extended for a further year and then became a HEAT standard in 2012/13 when delivery in additional settings was also included. HEAT target A11 applied to all drug and alcohol services delivered or commissioned from public funding it required that By March 2013, 90% of people who need help with their drug or alcohol problem will wait no longer than three weeks for treatment and no clients will wait more than 6 weeks. The target was achieved nationally and locally by April The HEAT target refers to treatment but does not only apply to medical treatment. Other targeted interventions offered by agencies such as social work and the voluntary sector are included in the target. The target became a HEAT standard in April Several policy documents have been published with the aim to enhance services for people suffering with mental health problems and substance misuse problems. Mind the Gap, Closing the Gap, A Fuller Life all aimed to address this problem. The Scottish Government in Mental Health Scotland: Closing the Gaps Making a Difference, state three main aims: to improve the awareness of co-occurring mental health and substance misuse problems to improve support and service provision for people who have both mental health and substance misuse problems (and their carers) to reduce stigma and positively influence attitudes towards this care group. 14

15 Scotland s Mental Health Strategy recognises the strong links between alcohol consumption and mental health problems. Commitment 17 states: We will work with NHS Boards and partners to effectively link the work on alcohol and depression and other common mental health problems to improve identification and treatment with a particular focus on Primary care National Outcomes for Alcohol and Drugs Partnerships In 2012 the Scottish Government published seven national outcomes for ADPs (See Appendix 2). This was in recognition that across the country there was no consistent approach taken by ADPs on collecting outcomes. The seven national outcomes, which are accompanied by national indicators, will allow for comparisons to be made across the country. ADPs are encouraged to add their own local indicators to the national ones where they feel it is appropriate. 15

16 Current Service Provision Across Angus, alcohol and drug services are delivered by a wide range of organisations. NHS Tayside provides services for those experiencing alcohol and drug problems. Tayside Drug Problem Service (TDPS) offers prescribing treatment programmes, primarily methadone, to people experiencing opiate dependency. Methadone has been shown to be effective in reducing harm, improving health and allowing people to move away from a chaotic lifestyle. In Angus, the Tayside Alcohol Problem Service (TAPS) offers community based support to people experiencing problems with alcohol. Both TAPS and TDPS can also offer residential detoxification and a cognitive behaviour programmes. Angus Council has an Alcohol, Drugs and Blood Borne Virus team. This team offers assessment and care management support to assist individuals to reduce the harm caused by their alcohol or drug use. In Angus, a significant contribution to alcohol and drug services is made by the voluntary sector. Tayside Council on Alcohol (TCA) offer a range of counselling and group work interventions to adults and young people. CAIR Scotland s The Web Project is commissioned locally to deliver the Streets Ahead programme, which aims to reduce risk behaviour associated with substance use by targeting behavioural and attitudinal change amongst young people aged CAIR Scotland also delivers a recovery focused service called Eclips. This project aims to develop a recovery network across Angus allowing people in recovery to access a range of groups over and above their involvement with traditional treatment services. The groups available to people through Eclips range from therapeutic groups offering mutual support, to leisure and interest groups. A feature of Eclips is to develop peer mentors, who are people in recovery themselves and then take a lead in organising and hosting recovery groups. Research shows that people in recovery can greatly benefit from the mutual support of other people in recovery. 16

17 Angus Carers Centre provides emotional and practical support to carers and families who are caring for someone who is experiencing substance misuse problems. They also have a similar service available to young carers. The Volunteer Centre, through its volunteer academy, offers a range of employment training and volunteering opportunities to people recovering from alcohol and drug problems. Havilah, a faith based group, operate a drop in service based in Arbroath for people with substance misuse problems. People are offered a lunchtime meal, friendship and advice will see the establishment of the Hopscotch programme after a successful bid to the Big Lottery. This project will be led by Barnardo s Scotland in partnership with TCA and Angus Carers. Hopscotch will be an early intervention service aimed at working with families who are starting to need support due to parental substance misuse issues. The project will offer family group work, mentoring for the parents, befriending for children and therapeutic support for those in the family who are misusing substances. Clear outcomes from the government s national framework on Getting it Right for Every Child, will be identified utilising the Angus Wellbeing Web. Barnardo s will also in 2013, establish a Strengthening Families programme, aimed at families with children aged years, which will be funded through Angus ADP for two years. An initiative in Angus to address the harmful effects of alcohol began in October The Focus on Alcohol Angus initiative continues to deliver a range of initiatives that aim to get the people of Angus to consider how they use alcohol and encourage them to use it responsibly. Angus Council Criminal Justice Service offers a range of specific interventions for people with substance misuse problems. Drug Testing and Treatment Orders (DTTO) are used by the court as an alternative to a custodial sentence for people whose offences are clearly linked to their substance misuse. A DTTO will offer a methadone prescribing service as well as general support 17

18 aimed at helping an individual gain control over their life and reduce their offending. Angus Council Criminal Justice Service assist the courts by compiling social enquiry reports and monitoring a range of community based sentences such as probation, community service and the monitoring of long-term prisoners released on parole. A high percentage of people engaged with the Criminal Justice Service are experiencing substance misuse problems. A range of group work is offered to people to help them address their alcohol and/or drug misuse. 18

19 Needs Assessment Drugs The most recent estimates of the national and local prevalence of drug misuse were published in Estimating the National and Local Prevalence of Problem Drug Use in Scotland is an update to previous studies funded by the Scottish Government and the University of Glasgow and is produced by Information Services Division, Scotland. This study estimated 59,600 people are problem drug users in Scotland. Scotland s rate of drug use appears to be higher than in other similarly sized countries such as Ireland, Finland and Denmark (Road to Recovery, 2008). Figure 1 summarises the estimates of the prevalence of problem drug misuse in Angus compared to Tayside and Scotland. It is estimated that there are 59,600 problem drug users in Scotland as a whole, with 8.4% of these being in Tayside. The prevalence rate in Scotland is 1.71%, lower than the Tayside rate of 1.92%. Within Tayside, Angus (1.38%) had a lower prevalence than the overall Scotland rate. Figure 1: Estimates of the number of problem drug users (aged years) in Angus, Tayside and Scotland Number Prevalence rate (% per 100 of the population) Angus 1, Tayside 5, Scotland 59, Source: National and Local Prevalence of Problem Drug Use in Scotland 2009/10 19

20 In 2008/09, 246 new individuals were reported to the SDMD in Angus corresponding to a rate of 297 per 100,000 of the Angus population. This was higher than in previous years, which could be considered to be a positive result rather than negative. More than a third (37%) of individuals self-referred to specialist drug services, 34% were referred by Criminal Justice (DTTO, arrest referral, drug court, prison or other criminal justice setting) and a further 18% by a Health source. Almost two thirds (63%) of those Angus clients reported to the SDMD were aged under 30 years, the median age being 26 years. The National Investigation into Drug Related Deaths (DRD) (2005) commissioned by the Scottish Executive and conducted by the Centre for Addiction Research and Education Scotland (CARES) examined the social, clinical circumstances and service contacts of those dying as a result of a drug related death in Scotland in This investigation and subsequent Scottish Advisory Committee on Drug Misuse (SACDM) report and recommendations (2005) identified the need to establish a local standing Drug Deaths Monitoring and Prevention Group that involved key agencies to reduce deaths under the auspices of local Alcohol and Drug Partnerships (ADPs). The Tayside Drug Death Review and Working groups were set up in 2008 with the aim of understanding and preventing drug deaths. The National Drug Deaths Database was also launched in January 2009, acting on a recommendation that had come from the National Forum for Drug Related Deaths. Data collected for local analysis is also reported to the national database. In 2010, the latest available official figure for Angus, show there were 9 drug deaths. Figure 2 shows the trends in drug deaths for the last 10 years. Although each death is unfortunate, numbers are small and so caution should be taken when considering fluctuations in the data. An analysis of changes over time can also be done by grouping 5 years of data and then calculating the average annual number. Between and , the average number of annual deaths in Angus had risen from 2 to 8. The annual average rate for was 7 per 100,000 population. 20

21 Figure 2: Angus drug related deaths Number of deaths Year Source: GRO Scotland The percentage of pupils who reported having taken drugs in the month prior to the SALSUS (The Scottish Schools Adolescent Lifestyle and Substance Use Survey) survey can be used to monitor trends in the prevalence of drug use. Nationally, information on drug use has been collected since 1998 and until 2002, there had been no noticeable change in the prevalence. Between 2002 and 2006, there was a significant decrease in prevalence of drug use in the last month among both age groups and both sexes. The 2008 figures remained relatively stable on the 2006 figures with prevalence decreasing only among 13-year-old boys. Since 2008, prevalence has decreased further only among girls. 21

22 Figure 3 compares the percentage of pupils in Angus, Tayside and Scotland who had ever used drugs, used drugs in the last year and used drugs in the last month. Two percent of Angus 13 year olds and 17% of 15 year olds had ever used drugs. Of these, 1% of 13 year olds and 6% of 15 year olds had done so in the month prior to survey. This was lower than the proportion shown across Scotland. Figure 3: Percentage of pupils reporting using drugs ever, in the last year and in the last month 2010 Percentage (%) year olds 15 year olds 13 year olds 15 year olds 13 year olds 15 year olds Source: SALSUS 2010 Ever used drugs Used drugs in the last year Used drugs in the last month Angus Tayside Scotland 22

23 Alcohol Adult alcohol consumption is primarily measured by usual weekly consumption and daily consumption on the heaviest drinking day. Government guidelines recommend daily limits, as well as weekly drinking guidelines, to ensure that weekly recommended levels are not consumed in a few concentrated days. Daily recommended guidelines are that men should not consistently drink more than 3-4 units of alcohol per day and women no more than 2-3 units. Weekly guidelines are that men drink no more than 21 units and women no more than 14 units. It is also advised that people should have at least two alcohol free days during a week. Consumption data has been obtained from the most recent Scottish Health Survey published in September 2009 but due to a small sample size, there are no recent data available at a more local level. There is, however, information presented for Tayside from the 2003 Scottish Health Survey. Combined results from the 2008 and 2009 Scottish Health Surveys found that more than one in ten of the Scottish population (10% of men and 14% of women) reported that they did not drink. Of those who did report drinking, 11% of men and 8% of women reported consuming alcohol 5 or more days a week. A third of adults who reported less than two alcohol free days a week were aged between 55 and 74 years. Figure 4 shows the percentage of adults in Tayside and Scotland who drank over (and more than twice) the recommended daily limits (4 units for men and 3 units for women) on their heaviest drinking day in the week prior to the survey. Data for 2003 is compared to results found from the 2009 Scottish Health Survey. 23

24 Figure 4: Percentage of adults (aged 16+) who drank over the recommended daily limits; Tayside and Scotland 2003 compared to Scotland 2009 Percentage Consumed over 4 units Consumed over 8 units Consumed over 3 units Consumed over 6 units Men Women Source: Scottish Health Survey 2003 & 2009 Scotland 2003 Tayside 2003 Scotland 2009 In 2003, the proportion of adults in the general population exceeding daily limits in Tayside was very similar to that of Scotland as a whole with 46% of men and 36% of women drinking above safe limits and 29% of men and 18% of women consuming more than twice recommended limits (or binge drinking) on their heaviest drinking day. Results from the 2009 Scottish Health Survey suggest that the proportion of adults binge drinking has decreased over time. In a similar manner, the national average weekly alcohol consumption has decreased between 2003 and For men, the mean weekly consumption in 2003 was 20.3 units for Scotland and 20.5 units for Tayside compared to 17.5 in For women the figure fell from 9.1 units in 2003 for Scotland and 8.6 units in Tayside, to 7.8 in Alcohol consumption by age and deprivation (using the Scottish Index of Multiple Deprivation or SIMD) was analysed in detail in the 2009 survey. Mean weekly consumption by age group shows a slightly different pattern compared to binge drinking by age group. The results suggest that older age groups tend to spread their drinking out more throughout the week, drinking less on more days while younger people drink on fewer days, but drink at high levels on these days. 24

25 A larger proportion of those living in the most deprived areas of Scotland in 2009 reported not drinking at all in the week prior to the survey compared to those living in the least deprived areas. In addition, adults in the least deprived areas were more likely to exceed daily benchmarks for sensible drinking than those in more deprived areas. Figure 5 depicts weekly alcohol consumption across Scotland by deprivation category (SIMD quintile). Figure 5: Estimated weekly consumption level by drinking category 1 by gender and SIMD derivation quintile, age standardised, Scotland 2009 Percentage Hazardous Harmful Hazardous Harmful Men Women 1 (most deprived) (least deprived) 1 Hazardous drinking is defined as over 21 units a week for men and 14 units for women whilst Harmful is over 50 units for men and 35 units for women Source: Scottish Health Survey 2009 Alcohol consumption and experiences are drawn from The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS). The most recent survey to contain data for Angus as well as Tayside and Scotland, was conducted in

26 Figure 6 shows the frequency of drinking reported by 13 and 15 year olds in the SALSUS 2010 report and compares Angus to Tayside and Scotland. A lower proportion of pupils of both ages in Angus drank alcohol at least once a week than pupils across Scotland. Figure 6: Percentage of pupils that reported having an alcoholic drink at least once a week Percentage (%) Angus Tayside Scotland 13 year olds 15 year olds Source: SALSUS

27 All pupils who had ever had an alcoholic drink were asked whether they had ever been really drunk. Figure 7 compares the percentage of pupils in Angus, Tayside and Scotland who had been drunk at least once. Fifty-two percent of Angus pupils aged 13 and 72% aged 15, had ever been drunk. This was an increase in the proportions found in 2006 but this is possibly due to a change in the phrasing of the question from ever been really drunk to ever been drunk. Figure 7: Percentage of pupils that reported ever having been drunk 2006 and 2010 Percentage (%) year olds 15 year olds 13 year olds 15 year olds Angus Tayside Scotland Source: SALSUS 2006 &

28 Scotland s rising death rates are not part of a worldwide trend and are out of step with the rest of Europe and North America. Figure 8 below illustrates how Scotland s liver cirrhosis death rates compare with Europe, England and Wales. Figure 8: Scotland s Out of Step: Liver Cirrhosis Death Rates There is now a growing body of evidence that the relationship between price and alcohol consumption are strongly linked as illustrated in figure 9 below. Figure 9: Relationship between price and alcohol consumption Source: Tighe

29 A NHS Quality Improvement Scotland audit report published in November 2006, found that alcohol was a contributory factor in 11% of attendances to A&E departments across Scotland. This section shows attendances to the A&E department at Ninewells Hospital by Angus residents, where either an alcohol intoxication diagnosis was recorded or where the misuse of alcohol was recorded. In 2010/11, there were 583 alcohol related attendances to Ninewells Hospital by Angus residents, a rate of per 100,000 of the general population. The majority of these were children or young people, with a third being aged under 25 years old. Sixty percent of the presentations were male. Figure 10: Alcohol related presentations to A&E (Ninewells) by Angus residents 2010/11 70 Number of presentations Under Age Group Male Female Source: A&E Information Analyst 29

30 There is a clear deprivation gradient shown by alcohol related attendances to A&E as shown by Figure 11 with individuals from the most deprived areas accounting for more than 2.7 times the number of presentations by those from the most affluent areas. Figure 11: Angus alcohol related presentation rate to A&E (Ninewells) by deprivation 2010/ Rate per 100,000 popn (most deprived) (least deprived) SIMD quintile Source: A&E Information Analyst 30

31 Figures 12 and 13 examine the patterns of presentations at A&E with an alcohol related diagnosis by day of the week and month. Unsurprisingly, there are a higher number of attendances at the weekends. By contrast, there is no obvious pattern in attendance by month. Figure 12: Angus alcohol related presentations to A&E (Ninewells) by month 2010/11 Number of presentations Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Month Source: A&E Information Analyst Figure 13: Angus alcohol related presentations to A&E (Ninewells) by day of the week 2010/ Number of presentations Monday Tuesday Wednesday Thursday Friday Saturday Sunday Day of the week Source: A&E Information Analyst 31

32 Cross Cutting Themes Angus ADP recognises that alcohol and drugs is a cross cutting theme impacting on many agencies and partnerships. It is essential that in Angus we ensure that the issue of alcohol and drugs is viewed by partners as a cross cutting theme. To ensure this, Angus ADP membership has been constructed carefully to ensure senior representation from important agencies that have a clear link to supporting the ADPs aim to reduce the harm caused by alcohol and drugs in Angus. Within the Community Planning Partnership structure, Angus ADP reports directly to the Community Care and Health Partnership (CHPP) (See Appendix 1). However, we also have a link to the Community Safety Partnership and the Children s and Lifelong Learning Partnership. Angus ADP will continue to maintain the positive link to these important thematic groups. The Early Years Collaborative is an emerging piece of work both nationally and locally and we will seek to support this agenda and ensure its work impacts positively on the alcohol and drugs agenda. Angus ADP is also a member of the strategic groups listed below. These groups are recognised by the ADP as having clear links to alcohol and drugs issues and we will continue to play an active role in these partnerships. Tayside Drugs Death Group AVAWP - Angus Violence against Women Partnership Criminal Justice Services Partnership Substance Misuse Strategy Group Child Protection Committee Healthcare Advisory Forum Choose Life Angus Community Safety Partnership Tayside Community Justice Authority Angus Sexual Health and Relationship Group Angus Licensing Forum Child Health Strategy Group 32

33 Summary Thank you for taking the time to read Angus ADPs new strategy for We hope that you found it interesting and that it has given you a clear indication of the ADPs direction of travel over the next three years. As stated in the strategy, our main priorities will be to ensure a closer integration of services building on the rapid improvement event work. This will produce more efficient ways of working and improve outcomes for people in recovery seeking support. We will continue to support the recovery and CAPSM agendas through the work of our Recovery and Joint Working and ADP/CPC sub groups and through our commissioned services. Prevention and alcohol will also be main priorities for Angus ADP, as will ensuring appropriate enforcement and availability measures are taken. Our final priority area will be to focus on the outcomes and performance of services and to enhance our needs assessment data, all of which combined will allow Angus ADP to make strategic decisions based on robust evidence. As ever, there will be a range of other pieces of work that Angus ADP will take forward over the coming three years, but these areas will be where we will concentrate most of our efforts. 33

34 Appendix 1 Angus Community Planning Partnership 34

35 Appendix 2 CORE OUTCOMES FOR ALCOHOL & DRUG PARTNERSHIPS (ADPs) 1. HEALTH: People are healthier and experience fewer risks as a result of alcohol and drug use: a range of improvements to physical and mental health, as well wider well-being, should be experienced by individuals and communities where harmful drug and alcohol use is being reduced, including fewer acute and long-term risks to physical and mental health, and a reduced risk of drug or alcohol-related mortality. 2. PREVALENCE: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others: a reduction in the prevalence of harmful levels of drug and alcohol use as a result of prevention, changing social attitudes, and recovery is a vital intermediate outcome in delivering improved long-term health, social and economic outcomes. Reducing the number of young people misusing alcohol and drugs will also reduce health risks, improve life-chances and may reduce the likelihood of individuals developing problematic use in the future. 3. RECOVERY: Individuals are improving their health, well-being and lifechances by recovering from problematic drug and alcohol use: a range of health, psychological, social and economic improvements in well-being should be experienced by individuals who are recovering from problematic drug and alcohol use, including reduced consumption, fewer co-occurring health issues, improved family relationships and parenting skills, stable housing; participation in education and employment, and involvement in social and community activities. 4. FAMILIES: Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved life-chances: this will include reducing the risks and impact of drug and alcohol misuse on users children and other family members; supporting the social, educational and economic potential of children and other family members; and helping family members support the recovery of their parents, children and significant others. 35

36 5. COMMUNITY SAFETY: Communities and individuals are safe from alcohol and drug related offending and anti-social behaviour: reducing alcohol and drug-related offending, re-offending and anti-social behaviour, including violence, acquisitive crime, drug-dealing and driving while intoxicated, will make a positive contribution in ensuring safer, stronger, happier and more resilient communities. 6. LOCAL ENVIRONMENT: People live in positive, health-promoting local environments where alcohol and drugs are less readily available: alcohol and drug misuse is less likely to develop and recovery from problematic use is more likely to be successful in strong, resilient communities where healthy lifestyles and wider well-being are promoted, where there are opportunities to participate in meaningful activities, and where alcohol and drugs are less readily available. Recovery will not be stigmatised, but supported and championed in the community. 7. SERVICES: Alcohol and drugs prevention, treatment and support services are high quality, continually improving, efficient, evidence-based and responsive, ensuring people move through treatment into sustained recovery: services should offer timely, sensitive and appropriate support, which meets the needs of different local groups (including those with particular needs according to their age, gender, disability, health, race, ethnicity and sexual orientation) and facilitates their recovery. Services should use local data and evidence to make decisions about service improvement and re-design. 36