Alcohol data: JSNA support pack

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1 Alcohol data: JSNA support pack Technical definitions for the data to support planning for effective alcohol prevention, treatment and recovery in

2 THE TECHNICAL DEFINITIONS The data in the JSNA support pack is taken from two different sources. The first section presents data from the Local Alcohol Profiles for England (LAPE) (http://www.lape.org.uk/) and provides a summary of various alcohol related harm indicators. The second section focuses on structured treatment for dependent drinkers and uses treatment data from the National Drug Treatment Monitoring System (NDTMS). LAPE data Alcohol use has health and social consequences borne by individuals, their families, and the wider community. In 2006 the North West Knowledge and Intelligence Team (the former North West Public Health Observatory) gathered routine data and intelligence from a range of sources (including the Department of Health and the Home Office), to provide a national indicator set intended to inform and support local, sub-national and national alcohol policies. The Local Alcohol Profiles for England (LAPE) have been published on an annual basis since then and contains 26 alcohol-related indicators for every local authority. These indicators provide measures to help prioritise and target local areas of concern. In the alcohol JSNA we report on 13 of the 26 indicators within the following sections; Hospital admissions due to alcohol Mortality and month of life s lost Alcohol and crime For each indicator within the LAPE section, we report on the average alcohol-related harm for the nearest neighbour group. The nearest neighbour group is based on the 2009 CIPFA nearest neighbour, an approach which groups each local area with 15 other areas that are similar across a range of demographic, socio-economic and geographic variables. For further information on how the nearest neighbour groups are formed please visit; Where a local area is also the Upper Tier Local Authority (UTLA) the LAPE section appears as follows. There are two comparator groups: nearest neighbour and national. For each comparator group, the levels of alcohol-related harm across the nearest neighbour group and nationally, is split into four equal quartiles. Where the alcohol-related harm of the local area falls within the upper quartile, then the local area has the least amount of harm in relation to their nearest neighbour/national, and the quartile cell will be labelled as one and coloured in green. Where the alcohol-related harm of the local area falls into the second quartile, then the local area has the lower amount of harm in relation to their nearest neighbour/national, and the quartile cell will be labelled as two and coloured in yellow. Where the alcohol-related harm of the local area falls within the third quartile, then the local area has increasing levels of harm in relation to their nearest neighbour/national, and the quartile cell will be labelled as three and coloured in orange. Where the alcohol-related harm of the local area falls within the fourth quartile, then the local area has the most amount of harm in relation to their nearest neighbour/national, and the quartile cell will be labelled as 4 and coloured in red. Where a local area is made up of several Lower Tier Local Authorities (LTLA) the LAPE section appears as follows. There are two comparator groups: nearest neighbour and national. For each comparator group, the levels of alcohol-related harm across the nearest neighbour group and nationally, is split into four equal quartiles.

3 Where the alcohol-related harm of the local area falls within the upper quartile, then the local area has the least amount of harm in relation to their nearest neighbour/national levels, and the indicator cell will be coloured in dark green. Where the alcohol-related harm of the local area falls into the second quartile, then the local area has the lower amount of harm in relation to their nearest neighbour/national levels, and the indicator cell will be coloured in light green. Where the alcohol-related harm of the local area falls within the third quartile, then the local area has increasing levels of harm in relation to their nearest neighbour/national levels, and the indicator cell will be coloured in yellow. Where the alcohol-related harm of the local area falls within the fourth quartile, then the local area has the most amount of harm in relation to their nearest neighbour/national levels, and the indicator cell will be coloured in orange. If the local area has a level of harm that is 1 standard deviation above the national then the cell is coloured in dark pink and if it is 2 standard deviations above it is colour in red. The direction of travel arrows within the national comparison group table, show whether the level of alcohol related harm in the local area has increased/decreased since the earlier reported period. Where cells appear with S the data has been suppressed to prevent disclosure. For mortality data counts below 3 have been suppressed and for hospital admissions data counts below 6 have been suppressed. Further suppression has been applied to prevent disclosure through subtraction. National Drug Treatment Monitoring System (NDTMS) data Data form the National Drug Treatment Monitoring System refers to clients in structured treatment for alcohol misuse in England. The NDTMS has been formally collecting data on individuals in structured treatment who cite alcohol as their primary problematic substance since 1 st April 2008 and the data in this pack refers to clients in treatment during In addition to the definitions provided below, detailed information on the data items contained in NDTMS can be found in the business definitions for adult alcohol treatment providers: Please note that percentages in the report may not sum to 100% due to rounding. Technical definitions for all items in the JSNA pack are provided in the following table: LAPE DATA ITEMS Hospital admissions due to alcohol Alcohol-specific hospital admissions under 18 Persons admitted to hospital due to alcohol-specific conditions, under 18 year olds, crude rate per 100,000 population Hospital admissions are based on the number of people admitted to hospital for alcohol specific conditions during 2010/11 to 2014/15. Data source of indicator; Knowledge and Intelligence Team (North West) from hospital episode statistics 2012/13 to 2014/15. Office for National Statistics mid-year

4 population estimates 2010, 2011 and Does not include attendance at Accident and Emergency departments. Trend data is based on 2010/11 to 2012/13, 2011/12 to 2013/14 and 2012/113 to 2014/15. Alcohol Specific Hospital Admissions Persons admitted to hospital due to alcohol-specific conditions, all ages, all genders, per 100,000 population. Hospital admissions are based on the number of people admitted to hospital for alcohol-specific conditions during 2014/15. Data source for indicator: Knowledge and Intelligence Team (North West) from hospital episode statistics 2014/15. Office for National Statistics mid-year population estimates Does not include attendance at Accident and Emergency departments Trend data is based on 2012/13, 2013/14 and 2014/15 Alcohol-related hospital admissions (broad and narrow measure) Persons admitted to hospital due to alcohol-related conditions (broad measure [primary diagnosis or any secondary diagnosis] and narrow measure [primary diagnosis or any secondary diagnosis with an external cause]), all ages, all genders, per 100,000 population Hospital admissions are based on the number of people admitted to hospital for alcohol-related conditions during 2014/15. Data source for indicator; Knowledge and Intelligence Team (North West) from hospital episode statistics 2014/15. Office for National Statistics mid-year population estimates Does not include attendance at Accident and Emergency departments. Trend data is based on 2012/13, 2013/14 and 2014/15 Alcohol-related hospital episodes (broad and narrow measures) Admission episodes for alcohol-related conditions (broad measure [primary diagnosis or any secondary diagnosis] and narrow measure [primary diagnosis or any secondary diagnosis with an external cause]), all ages, per 100,000 population Data source of indicator:

5 Knowledge and Intelligence Team (North West) from hospital episode statistics 2014/15. Office for National Statistics mid-year population estimates Does not include attendance at Accident and Emergency departments. Trend data is based on 2012/13, 2013/14 and 2014/15 Mortality and months of life lost Months of life lost (males and females) An estimate of the increase in life expectancy at birth that would be expected if all alcohol-related deaths among males/females aged less than 75 years were prevented. Months of life lost due to alcohol is based on three consecutive years of mortality data ( ) Data sources for indicator: Knowledge and Intelligence Team (North West) from England and Wales life expectancy tables for males and females (from Office for National Statistics), alcohol-related deaths from the Public Health Mortality File for males/females aged less than 75 years and the Office for National Statistics mid-year population estimates for Trend data is based on 2010/11, 2011/12 and 2012/13 Alcohol-specific mortality Deaths from alcohol-specific conditions, all ages, all genders, per 1,000 population. Alcohol-specific mortality is based on three consecutive years ( ) of mortality data. Data sources for indicator: Knowledge and Intelligence Team (North West) from the Public Health Mortality File for and Office for National Statistics mid-year population estimates for Trend data is based on 2009/ /11, 2009/ /12 and 2010/ /13. Mortality from chronic liver disease Deaths from chronic liver disease including cirrhosis (International Classification of Diseases, version 10: K70, K73-K74), all ages, all genders, per 1,000 population. Mortality from chronic liver disease is based on three years ( ) of mortality data. Data sources for indicator:

6 Knowledge and Intelligence Team (North West) from the Public Health Mortality File for and Office for National Statistics mid-year population estimates for Trend data is based on 2009/ /11, 2009/ /12 and 2010/ /13. Alcohol-related mortality Deaths from alcohol-attributable conditions (all ages, all genders), crude rate per 1,000 population Alcohol-related mortality is based on one year (2013) of mortality data. Data sources for indicator: Knowledge and Intelligence Team (North West) from the Public Health Mortality File for and Office for National Statistics mid-year population estimates for Trend data is taken from the years 2011, 2012 and NDTMS DATA ITEMS Where gender splits have been provided these are calculated using the total number of men and the total number of women as the denominators. Waiting times data items Waiting under 3 weeks/over six weeks to start treatment Routes into treatment data items Source of referral into treatment The number of clients who waited less than 22 days or more than 42 days between the first appointment offered (or earliest intervention start date if missing) and the date referred to that intervention. Any waiting times greater than 2 years are considered to be data recording errors and are discounted. % are calculated out of all first interventions commenced in the year for clients latest treatment journey crossing in the year. For all clients who commenced a new treatment journey in , the first non-missing referral source of the latest journey commenced. If the more than one referral source is recorded with the same triage and referral date this is classified as mismatching and counted under missing.

7 Demographics and headline treatment data items Number of adults in alcohol treatment in Number of adults starting alcohol treatment in Age and gender of all adults in alcohol treatment in Female clients who were pregnant during alcohol treatment Client is currently receiving care from mental health services for reasons other than substance misuse This is the total number of adults (aged 18-99) citing alcohol as their primary problematic substance and who were in structured treatment at any point in the year The total number of adults citing alcohol as their primary problematic substance and who started a new treatment journey 1 during the year The % is the proportion of clients starting treatment in the year out of all clients in the treatment at any point during the year. The proportion of clients in treatment in by age group and gender. Age is calculated as age at the start of the year (1 st April 2014) or at triage if the client entered treatment after the year start. The number and proportion of all women in treatment in who stated they were pregnant at the new presentations. The number and proportion of all individuals in treatment in who self-reported that they were receiving care from a mental health service for reasons other than substance misuse at any point during their latest treatment journey. Drinking levels Drinking at higher risk levels in the 28 days prior to entering treatment Units consumed in the 28 days prior to entering treatment The number of women who cited drinking 140 units or more in the 28 days prior to treatment and the number of men drinking 200 units or more. % are calculated out of the total clients in treatment in the year with completed data rather than the total treatment population. For all clients in treatment in , the total number of units consumed in the 28 days prior to entering treatment. Calculated by multiplying the typical number of units consumed on a drinking day by the number of days consumed alcohol in the 28 prior to treatment. Taken from the record with the highest units per month in the client s latest treatment journey. 1 A treatment journey is defined as a period of treatment, consisting of one or more concurrent or serial episodes of treatment (either within one provider or across a number of different providers) with a break of no more than 21 days between episodes. An episode of treatment is a set of interventions (or types of treatment) with a specific care plan at a single agency. A client may attend one or more intervention during a single episode.

8 Alcohol dependent cohort and adjunctive drug use Any citation of a drug other than alcohol as either a second or third substance at the assessment. Other substance use in addition to alcohol Interventions data items Local high level interventions by setting Pharmacological intervention type (sub intervention) Residential Rehabilitation data items Number of adults who attended residential rehabilitation Length of time in treatment Length of time in treatment Besides alcohol only category, 3 broad categories are provided: alcohol and opiates, alcohol and nonopiates and finally alcohol, opiates and non-opiates. There are also 3 other categories of clients who in addition to alcohol cited crack, cocaine or cannabis. As clients may cite more than one additional substance they can be counted in more than one group. The number of pharmacological, psychosocial and recovery support high level interventions occurring in the client s latest treatment journey in Clients are counted once per setting/intervention combination so may be listed multiple times under different combinations. However the total individual subtotal counts individuals only once. Local data only is provided for this item. The number of individuals in treatment in the year who had a pharmacological intervention recorded in their latest treatment journey occurring in where the sub intervention type was a) withdrawal and b) relapse prevention. Local and national data is provided. The number of adult alcohol users who have been to residential rehabilitation during their latest treatment journey. For all clients leaving treatment in the year, the length of time between the earliest triage and latest discharge dates of their treatment journey (plus one day to account for clients who were in treatment for a single day). This is broken down in to less than1 month, between 1 and 3 months, between 3 and 6 months, between 6 and 9 months, between 9 and 12 months and 12 months and over. The proportion of clients for each category is shown. The average length of time in treatment is also shown as average days spent in treatment. Safeguarding Data Items Adults receiving alcohol treatment who are in contact with children Whether or not the client is a parent or lives with children. This is calculated using a combination of the parental status (whether the client has a child and whether or not they live with that child) and the children (the number of under 18 year olds who live in the same household as the client at least 1 night per week) variables in NDTMS.

9 Employment & benefits Employment status at the start of treatment Number of individuals in alcohol treatment on 31 st March 2012 Number of individuals in alcohol treatment on 31 st March 2012 recorded as being on benefits (of any type) on the 31 st March 2012 Number of individuals in alcohol treatment on 31 st March 2012 recorded as being on benefits on the 31 st March 2012 (by type) Median length of time (years) claiming benefits between the start of benefit claim and 31 st March 2012 (by type) Number of individuals in alcohol treatment who left successfully in Of those successful completions, those who at the point of discharge: were on benefits/were not on benefits For all clients who commenced a new treatment journey in , the first non-missing employment status of the latest journey commenced. If the more than one employment status is recorded with the same triage and referral date this is classified as mismatching and counted under missing. The number of clients aged (at triage) in treatment on 31 st March This figure differs from treatment data in the rest of the report due to the time lag involved in collating and matching benefits data to NDTMS treatment information. The number of clients who were in structured alcohol treatment on 31 st March 2012 and had an active benefit claim open on 31 st March The benefit may be of any type and individuals are counted once regardless of the number of benefit claims they had. The number of clients who were in structured alcohol treatment on 31 st March 2012 and had an active benefit claim open on 31 st March Individuals are counted once under each type of benefit they received, if they received multiple benefits of the same type the earliest claim is reported. The median number of years spent on benefits for individuals in treatment on 31 st March 2012 who had an active benefit claim open on 31 st March This is calculated from the start of the benefit claim to the 31 st March Individuals are counted once under each type of benefit they received, if they received multiple benefits of the same type the earliest claim is reported. The number of individuals aged (at triage) who left alcohol treatment in a planned way (had a successful completion) between 01,04,11 and 31,03,12. Of those successful completions in (definition above) the number who had an active benefit, of any type, open on the date of discharge from treatment, and those who did not have an active benefit open. % here are calculated out of the total number of successful completions in

10 Housing and homelessness data items Accommodation status at the start of treatment Number of decisions taken by the Local Authority on homelessness applications Treatment Outcomes Total individuals leaving alcohol treatment in Individuals leaving alcohol treatment successfully in as a proportion of all in treatment and as a proportion of all exits Clients completing treatment successfully (between 01/01/14 and 31/12/15) and not returning within 6 months. For all clients who commenced a new treatment journey in , the first non-missing accommodation status of the latest journey commenced. If the more than one accommodation status is recorded with the same triage and referral date this is classified as mismatching and counted under missing. The number of decision taken in the Local Authority on homelessness applications in as a rate per 1,000 households. Note that this includes both positive and negative decisions in order to capture the demand on Local Authority housing provision. This is the total number of adults (aged 18-99) citing alcohol as their primary problematic substance who left treatment at any point in the year % are calculated out of all clients in treatment in the year. The figures are also displayed as proportion by gender. The number of clients who left treatment in the year and whose discharge reason (taken from the last episode from which the client was discharged in the journey) was planned (either alcohol free or an occasional user). % are provided out of both all in treatment and of all the exits in the year. The figures are also displayed as proportion by gender. The number of people completing treatment successfully (as per the definition above) between 01/01/14 and 31/12/15 and who did not return to treatment in the 6 month period after leaving. This data is offset by six months in comparison to the rest of the report to allow a six month window for representations to occur. % are calculated out of all clients in treatment in The figures are also displayed as proportion by gender.

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