Middlesbrough Alcohol Harm Reduction Strategy 2010-2013

Middlesbrough Alcohol Harm Reduction Strategy 2010-2013

Foreword Mayor Ray Mallon 1. Introduction This strategy aims to reduce the actual and potential harm caused by alcohol misuse to individuals and communities whilst ensuring that alcohol can be enjoyed safely and responsibly. It is founded on hard evidence both locally and nationally and has been shaped by experts in the field, led by people who have the best interests of Middlesbrough at their heart. There is no doubt that Middlesbrough, in common with most other towns and cities, has a problem with the harm that can arise from the misuse of alcohol. This strategy sets out precisely the scale and nature of the problem, and so provides the first steps in addressing the problem. Middlesbrough is a place that faces up to its challenges and moves forward The strategy looks at passive drinking : The effect that the misuse of alcohol by some people can have on the lives of others, whether they be the children of misusing parents or residents afraid to go out for fear of the groups of people drinking in a local open space The effect that an evening economy that is dominated by excessive drinking may have on the vitality and sustainability of the town centre The drain on the health services and on policing that alcohol misuse causes. The misuse of alcohol has a huge impact on Middlesbrough. Levels of alcohol related-harm in the borough are among the highest in the country. Both adults and young people are more likely to be admitted to hospital for alcohol related harm than in most other areas. Drinking is a major cause of crime and disorder and thousands of children are living with a parent with an alcohol problem. The North East, and Middlesbrough in particular, are areas with a tradition of heavy drinking. Alcohol plays a positive part in many people s lives and contributes to the economic well-being of the local community. However, these positives come at a significant cost. In particular, the combination of high levels of alcohol use with relative social deprivation causes an intensity of problems not seen in more affluent areas. This strategy is seeking a step change in local attitudes to alcohol to reduce harm now and to prevent these damaging patterns being passed on to future generations. The aim of this strategy is: To reduce the actual and potential harm caused by alcohol misuse to individuals and communities whilst ensuring that alcohol can be enjoyed safely and responsibly. The Strategy was commissioned by Middlesbrough s Local Strategic Partnership it is owned by the entire town. It acknowledges that this is a problem that many would consider too hard to deal with or would consider that it was for someone else to sort out. Again that is not the Middlesbrough way of doing business. Reconciling the need to reduce consumption but support the local economy, the ridiculously cheap retailing of alcohol with the desire of the public to pay no more than they need, are difficult issues. But doing nothing and accepting the status quo is not an option. This is a problem that together we must address. However, this will require assertive and coordinated action on many fronts. Health care services, police, retailers and young people s services among others will need to join together to form a partnership to champion change. Ray Mallon, Mayor of Middlesbrough.

Our objectives are to: Increase knowledge and understanding of alcohol and its related harms Promote more responsible attitudes to alcohol and responsible drinking Reduce the level of alcohol related health problems including alcohol related injuries and accidents Protect children, young people and families from the negative impact of alcohol Ensure treatment services for people with alcohol problems and their families or carers are appropriate, effective and accessible Reduce the rate of alcohol related crime, disorder and anti-social behaviour Promote a responsible licensed trade Reduce the economic impact of alcohol. A particular objective is to promote a vibrant evening economy in Middlesbrough which is more balanced and which has less emphasis on alcohol consumption as an activity. The evening economy is an important contributor to the local economy and it is important not to lose that benefit. The key to this will be diversifying local leisure and cultural activities to reduce the reliance on alcohol as the primary driver of the town s evening economy. Alongside this, we are keen to champion the case for a minimum price for a unit of alcohol. We believe that this will have benefits for both the public and the on-licensed trade. This strategy replaces and refreshes the borough s 2007 Alcohol Strategy. It is the result of a partnership between a range of bodies including the primary care trust, police, local authority, the probation service, as well as local voluntary organisations and housing services. It builds on extensive research and consultation including: An alcohol needs assessment Consultation events with service providers, service users and key stakeholders This strategy sets out the evidence of need, reviews local action to date and sets out a performance management and delivery structure. A separate action plan will be published which will identify how the targets will be achieved. We have separated this from the strategy so that it can function as a living document which can be revised and updated as required over the life of this strategy. Both the strategy and the action plan are structured around the themes of Middlesbrough s Sustainable Community Strategy: Stronger communities social marketing & public education Supporting children & young people Safer communities & sustainable environments tackling crime, anti-social behaviour Health and well being alcohol treatment services Enhancing the local economy diversifying the evening economy in the town and promoting responsible retailing

2. The strategic context Alcohol is recognised as a national public health priority. The current Government strategy on tackling alcohol problems in England: Safe, Sensible, Social. The next steps in the National Alcohol Strategy was published in 2007. The long-term goal of the strategy is to minimise the health harms, violence and anti-social behaviour associated with alcohol, while ensuring that people are able to enjoy alcohol safely and responsibly. The national strategy has led to a number of other initiatives which inform local activity. The Department of Health has published a number of pieces of guidance on alcohol in recent years including seven high impact changes to be targeted by health services. These include the roll out of identification and brief advice training. In 2009 the Chief Medical Officer published Guidance on the Consumption of Alcohol by Children and Young People. This offers information and advice to parents on the boundaries to set around alcohol consumption. The guidance clearly states that an alcohol free childhood is the best option in terms of health and positive social interaction for young people. In June 2010 NICE (National Institute for Health and Clinical Excellence) published Public health guidance 24: Alcohol-use disorders: preventing harmful drinking. This set out a range of measures to reduce alcohol related harm including a minimum price for alcohol and the use of identification and brief advice. In the criminal justice field a range of powers now exist to control the impact of alcohol. These include Drink Banning Orders and Designated Public Place Orders. This strategy also links to local strategies, of which the key ones are: Town Centre Strategy Community Safety Strategies Economic Strategy Primary Care Trust (PCT) Delivery Plans The Statements of Licensing Policy 2008-2011 Domestic violence strategies. Policing Plans Children and Young People s Plan.

3. The national impact of alcohol 4. Local evidence Nationally, the annual human and financial cost of alcohol misuse is huge and includes: 22,000 preventable deaths which are associated in some way with alcohol misuse Around half of all violent crimes (1.2 million) and a third of all reported incidents of domestic abuse (360,000) 7.3 billion spent tackling alcohol related crime and disorder Up to 70% of A&E admissions at peak times 95 million spent on specialist alcohol treatment Over 126,000 admissions to hospital for mental and behavioural disorders resulting from alcohol misuse: a rise of 75% over the past ten years Up to 1.3 million children affected by parental alcohol problems More than one in five men, one in six women and one in seven 16-24 year olds having had unsafe sex after drinking too much alcohol, increasing their risk of pregnancy and disease 31.5 million days lost to the workforce 19,000 alcohol related sexual assaults. Alcohol needs to be promoted, sold and enjoyed responsibly in order to minimise the huge toll it takes on health services, criminal justice systems and the workplace. The Department of Health estimates the scale of Middlesbrough s alcohol problems thus: Increasing Risk Drinkers 24,277 High Risk Drinkers 6,860 Dependent Drinkers 3,773 Numbers alone mean very little without comparisons. The Government sponsored North West Public Health Observatory (NWPHO) provides fifteen statistical indicators of adult alcohol related harm broken down by local authority area. Each indicator can rank Middlesbrough in comparison with the 326 local authorities in the country. The table below sets out the data. Middlesbrough rank out of 326 local authorities in England (1 lowest 326 highest rate of problems) Male - Alcohol related months of life lost Female - Alcohol related months of life lost Male - Alcohol-specific mortality Female - Alcohol-specific mortality Male - Mortality from chronic liver disease Female - Mortality from chronic liver disease Male Alcohol-attributable mortality Female -Alcohol-attributable mortality Alcohol-specific hospital admission, under 18s Male Alcohol-specific hospital admission Female Alcohol-specific hospital admission Male Alcohol-attributable hospital admission Female Alcohol-attributable hospital admission NI39 Alcohol related Hospital admissions Alcohol related recorded crimes Alcohol related violent offences Alcohol related sexual offences Middlesbrough ranks 309 out of 326 269 / 326 302 / 326 278 / 326 294 / 326 264 / 326 264 / 326 178 / 326 293 / 326 318 / 326 322 / 326 318 / 326 321 / 326 322 / 326 292 / 326 297 / 326 297 / 326

On almost every indicator Middlesbrough is above average, and for many is among the highest in the country. (It should be noted, however, that the most recent figures have shown an improvement over the previous period). More significantly these figures are in an area which has a non-white black and minority ethnic population (8%) which is above average for the region. Non-white populations tend to have significantly lower levels of drinking and therefore tend to reduce the expected levels of harm. The NWPHO figures for harm will largely be the result of the drinking patterns of 92% of the local population and suggests that the white population has a higher rate of harm than even these figures indicate. In Middlesbrough, all of these are well above the national average (2008/9 figures). For violence offences the borough has a rate of 30.5 offences per 1,000 population: this is in the top 20% for the country. Sexual offences are 1.48 per 1,000 population, again in the top 20%. Criminal damage is 33.05 offences per 1,000 population and is one of the highest in the country. Local probation service assessments show that alcohol was a contributory factor in offending for 74% of those who committed criminal damage, 63% of violent offenders and 23% of burglary offenders. Since April 2008 alcohol services have been reporting data to the National Alcohol Treatment Monitoring System: part of the National Drug Treatment Monitoring System. Data is now available and the table below provides data on Middlesbrough, England, neighbouring boroughs and representative areas from around the country. Crime related costs are over 18 million pounds per year Costs the local health service over 7.3 million pounds per year Barnsley Darlington Doncaster Hartlepool Liverpool Manchester Middlesbrough Redcar Rotherham England Again this data confirms an above average rate of alcohol related harm, although in part the high rate of service use may be because of the quality of local service provision. There are three groups of crimes which are particularly associated with alcohol: Criminal damage Violence Sexual offences. Population (,000) 223.5 99.3 290.3 91.1 436.1 452.0 138.4 139.5 253.3 50,762.9 NDTMS alcohol clients in treatment April 2009 - March 2010 748 398 925 349 1561 2341 795 573 961 115,246 Rate per 1,000 of population 3.35 4.01 3.19 3.83 3.58 5.18 5.74 4.11 3.79 2.27 77,000 working days are lost each year Alcohol Related Harm in Middlesbrough Leads to 46 sexual assaults per year The same pattern emerges with young people. North West Public Health Observatory data in combination with some crime and survey data suggests that Middlesbrough has high levels of alcohol related problems among under 19s. The rate of alcohol-specific hospital admission for under 18s is the 34th highest of the 326 authorities in England. Teenage pregnancy rates, fire-setting and criminal damage are all high locally and are all associated with alcohol consumption. Some local indicators suggest that this situation may be improving and efforts are certainly being made in this direction, but it is too early to be certain whether this is a permanent change or a statistical fluctuation. A significant number of young people will also be affected by the alcohol problems of their parents. Government data suggests that between 780,000 and 1,300,000 young people will fall into this category nationally. This equates to at least 2,500 children locally.

5. Alcohol and Middlesbrough s economy 6. The local response Alcohol is a key component of the British economy: Scotch whisky alone accounts for 2% of British exports. Close to 700,000 people are employed in the alcohol industry. As a result the production, distribution and sale of alcohol can make a significant contribution to a local economy. On the other hand the effects of alcohol consumption also impose a significant economic burden in terms of health care, policing, fire service and other such costs. In Middlesbrough the contribution of alcohol to the local economy may be even more significant because of the town s vibrant evening economy which draws customers from surrounding areas. Statistics bear this out, in the town 3% of all employees are employed in bars: this is well above the national average. However, this economic benefit comes at a price. Policing, accident and emergency and street cleaning services all bear the cost of supporting the evening economy. The production, distribution and sale of alcohol may contribute as much as 65 million pounds to the local economy, but the costs will be well over 50 million. A key element of this strategy is, therefore, to diversify the evening economy in order to retain the economic benefits but reduce the costs imposed by drinking. This will mean developing alternative forms of entertainment whether that be cultural events, sporting events, restaurants or other activities which are less alcohol focused. Alongside this the partnership will join regional and national efforts to develop a minimum price for alcohol. This is in line with the NICE guidance published in June 2010. If necessary, Middlesbrough will lead those efforts. A minimum price per unit of alcohol will deter the sale of cheap, high strength drinks such as the white ciders which can be particularly attractive to young people or street drinkers. This will reduce anti-social behaviour and improve health. Moreover it will also protect the on-licensed trade from the effects of cheap loss leader sales of alcohol by the off-trade. However, we recognise that a minimum price must be enforced on, at least, a sub-regional or regional basis. If the borough goes it alone, it will significantly damage local retailers and benefit those in neighbouring areas. We will seek to work with Balance, the regional alcohol team, on this issue. The partnership of agencies working in Middlesbrough has already begun to respond to alcohol related harm and to the needs of problem drinkers. The following sections set out what we have done so far. (i) The local response developing stronger communities through social marketing The national alcohol strategy is supportive of the use of public education and social marketing to change attitudes to alcohol. Various initiatives have been undertaken in the borough, but there has not been an ongoing, multi-agency, coordinated campaign. We are clear that this is a very high priority if we are to create significant cultural change. (ii) The local response supporting children and young people We have a good network of services for young substance misusers. Platform, the specialist service, is well-regarded and client numbers support this picture. Platform has also delivered basic drug and alcohol awareness to up to 500 frontline workers in over 30 services across Middlesbrough. Work is going on in schools, often with the support of Platform. However, we are concerned that the quality of this work needs to be assured and that there is a clear move towards demonstrating learning outcomes and achieving agreed standards. Alcohol work in the Youth Service, Child and Adolescent Mental Health Services, Youth Offending Services and Connexions is also well-regarded. However, we believe that this needs to be strengthened. This would include work to improve screening and recording, clarity about when to refer and the extent of the role to be played by generic agencies, such as schools, in supporting young drinkers. We recognise the need for specific work with families and young people who have been admitted to hospital. Hospital admissions data clearly supports this and suggests a need for a referral pathway from hospital into local specialist services for young people and possibly a link worker post.

Test purchasing is being undertaken by both the police and local authority trading standards teams. However, they conduct these operations in inconsistent ways in relation to the Regulation of Investigatory Powers Act 2000. Trading standards refer to the LACORS guidance and use younger test purchase volunteers than those used by the police; this may lead to a skewing of the results across these agencies. Nonetheless, results are achieved from both sets of work and demonstrate that enforcement is a valuable tool. Overall our rate of licence reviews and enforcement is high although more work is still needed. Significant work had been done to ensure diversionary and recreational activities are available for young people. Work has also been undertaken to address street drinking by young people. Operation Corkscrew targets young people found drinking in public places. The process involves disposal of the alcohol and a letter being sent to the home of the young person. If more than one letter is sent then the young person is referred onto Platform but could currently lead to an Acceptable Behaviour Contract or Anti-Social Behaviour Order. We believe that this approach could be enhanced by greater linkage between crime and disorder agencies and young people s services such as the youth service. A multi-agency group focusing on individual young people rather than on locations would be of benefit. Alcohol misuse affects not just the drinker, but the family around them. Many children can just about cope, but for others, their parents drinking can lead to feelings of isolation and guilt and poor performance at school. Children of problem drinkers can experience long-term psychological damage into adulthood. Services to support both young carers and chronic-drinking parents are too scarce. In some cases where a parent s drinking has become so debilitating, their children have been forced into caring roles. (iii) The local response developing safer communities and environments We have a number of mechanisms which ensure good management of the evening economy and the Night Time Economy Tactical Plan includes a variety of proposals for further improving the situation. We have a number of data sharing and risk management processes such as the town centre Problem Solving Group, a premises Risk Register which is discussed at an On-Licence Forum meeting which precedes the Pubwatch meeting and the sharing of A&E data. However, one gap is the lack of a health representative on the Problem Solving Group. It is vital that any strategy which targets the development of the town centre links across to local health strategies. Town centre premises have good security. We have a cumulative impact zone in the town centre and designated public place orders have been used. We recognise that alcohol related fires, both deliberate and accidental, are a significant problem; however, Cleveland Fire Service is taking great strides to tackle this and is a model of good practice in the national context. It is recognised nationally that alcohol treatment services need to link across to the criminal justice system. In Middlesbrough an arrest referral scheme has been developed in the custody suite and the probation service are rolling out Alcohol Treatment Requirements and an Offender Behaviour Module targeting drinkers. However, there are two clear gaps in this area: prisons and domestic violence. No pathway exists from the prison system into alcohol treatment and care. This is a significant gap that we need to address and which will reduce offending.

A clear link exists between alcohol misuse and domestic violence. We need to do more work on this, in particular: Developing services targeting perpetrators with alcohol problems Ensuring support for victims with alcohol problems Building links between alcohol services and domestic violence services. (iv) The local response Enhancing the local economy diversifying the evening economy in the town Middlesbrough has a significant evening economy which is seen as important to economic regeneration. The cultural facilities on offer in the town centre act as a vibrant sub-regional hub. People coming in to the town centre at night should be seen as a positive that needs to be managed and supported, rather than prevented or discouraged. However, we need to diversify the evening economy to offer more than just drinking in licensed premises. The Town Centre Management Team is adopting a proactive stance in relation to the evening economy. We have agreed to establish an Evening Economy Working Group as a sub-group of the Middlesbrough Town Centre Partnership to help lead on the diversification agenda and adopt a proactive approach to planning future developments. A particular local concern is irresponsible drinks promotions. Although the Licensing Authority is taking steps to manage this, examples of very cheap promotions can still be found. We need to deter this. The national alcohol strategy envisaged more information about alcohol at the point of sale. More work will be done on this locally. Alcohol pricing is a particular concern. Cheap promotions of alcohol and low priced, high strength drinks such as the white ciders present a problem both locally and nationally. Middlesbrough is considering how to support national drives to introduce a minimum price for alcohol. Pubwatch and an Off-Licence Forum have been developed in the town. The latter is a model of good practice in the national context. Pubwatch was well-regarded but we are concerned about levels of attendance. Best Bar None is also working well locally. The borough has a licensing policy; however, it contains no measures against which to assess its impact and effectiveness. It also fails to read across to health strategies related to alcohol. The third version of the policy due to be published in 2011 will offer us an opportunity to address this. Health and, in particular, alcohol treatment services will be consulted on the policy. Use has been made of the representation and review powers under the current Licensing Act, however, we need to make greater efforts to publicise these powers to the general public. It is also important to monitor the pattern of public representations and reviews to ensure that people from more socially excluded communities are making as much use of their rights as people from other areas. (v) The local response health and well being alcohol treatment Middlesbrough has a good range of alcohol treatment services. A recent Department of Health National Support Team visit viewed the treatment services as an example of good practice: The latest National Alcohol Treatment Monitoring System data identifies the equivalent of 1,130 people going through the system each year which is above the Department of Health guide figure of 20% of potential Tier 3 clients accessing services each year. Nationally recognised work is being undertaken within the hospital where the PADS team work with drinkers. Families First s management of the community care budget is a model of good practice.

The biggest gaps in our treatment services are at Tier 1, i.e. Enabling non alcohol specialists to identify, intervene with and refer problem drinkers. We recognise that more work needs to be done to train all generic workers. GPs and primary care staff should be a priority for such training. We also need to offer primary care financial incentives to work with this group through the Locally and Directed Enhanced Scheme. We are developing a response to meet the needs of problem drinkers who also have a mental health problem. However, we also need to ensure that we target clients who are difficult to engage in treatment. Services for homeless drinkers need further investigation. Mixed views have been expressed on the significance of this problem, but it would appear to require further research. 7. A delivery and performance management structure A strong strategic framework is an essential part of the response to alcohol. This is such a significant and cross-cutting issue that it needs to be overseen at the highest level. Therefore, the leadership for tackling alcohol misuse will lie with the Local Strategic Partnership (LSP). The six LSP themed Action Groups will each contribute actions to an alcohol action plan which they will be responsible for delivering. Each group will have a member who is named as lead on this issue. Local Strategic Partnership Alcohol Strategy Group (Chair from LSP) LSP Action Group: Children s Trust Alcohol Action Plan LSP Action Group: Stronger Communities Alcohol Action Plan LSP Action Group: Health & Social Care Alcohol Action Plan LSP Action Group: SMP Alcohol Action Plan LSP Action Group: Local Economy Alcohol Action Plan LSP Action Group: Environment Alcohol Action Plan We will also establish a specific alcohol strategy group with membership from a range of agencies. The identified leads on each of the six LSP action groups will also be linked into the strategy group. We will work to ensure that the private sector (i.e. the alcohol industry and associated sectors) are engaged with the partnership. The strategy group will be responsible to the LSP and will monitor and assist the LSP action groups in developing and implementing their part of the action plan. The strategy group will report on progress to the LSP on a regular basis. In the early stages this work will be supported by Alcohol Concern, the national agency on alcohol misuse. However, in the long term an effective coordination structure will be built into the strategy group to support the implementation of our agenda.

Beyond this, we will develop a network of alcohol champions. These will be current staff in existing services such as social care, housing, police and others who will have a brief to push the alcohol agenda forward in their service. They would meet quarterly with the alcohol strategy lead to review progress. It will be vital that these champions are supported by their own agencies in taking on this role. We also recognise the need to develop clear local measures of success. These should be outcome focused. For example, are crime levels falling, are health outcomes improving or are children safer? The alcohol strategy group will develop a set of outcome measures across health, community well-being, child safety and licensing which will enable the impact of this strategy to be measured effectively. In addition, we will be developing a data collection strategy which identifies what data will be gathered, how it will be shared and the indicators to be monitored. Particular attention should be paid to monitoring patterns of alcohol use among young people. 8. Moving forward The following sections set out the partnership s key areas for activity in tackling alcohol misuse. The LSP action groups will then translate these into an action plan with specific goals and targets. The partnership will work to secure adequate resources to support this work and we will consider what work can be undertaken locally and what should be done at a Tees or North East regional level. (i) Moving forward Stronger communities our aims in social marketing Lead: Stronger Communities Group Our starting point will be the development of an assertive communication and social marketing strategy to tackle the underlying drinking culture in the area. This will include a co-ordinated approach to the publicity of treatment services and initiatives to target workplaces. We will have clear and consistent messages, using appropriate language, to promote a more responsible attitude to drinking alcohol. This strategy will: Challenge attitudes to alcohol Improve knowledge about alcohol Raise awareness of the local harm caused by drinking Promote parental responsibility in the supply of alcohol to young people Encourage retailer responsibility Provide information about alcohol at the point of sale Market alcohol services Promote alcohol education in the workplace especially among public sector employers. On this agenda we will work closely with Balance, the regional alcohol team, in order to benefit from both the economies of scale and the impact of regional or sub-regional campaigns.

(ii) Moving forward Our aims in responding to children and young people Lead: Children and Young People s Trust a. Education We will ensure that education regarding the use and misuse of alcohol becomes an entitlement for all and is delivered as part of a risk and resilience model, by trained teachers/professionals in: Schools (primary and secondary), targeted through the PSHEe element of the enhanced healthy schools model Further education colleges and 6th form schools Informal settings e.g. in youth centres, at events and through outreach and detached work, the rave bus, and other diversionary activity. We will review, and where possible, ensure that such education remains consistent, relevant, up-to-date and effective. As part of the communication strategy we will communicate key alcohol messages to groups of young people and communities that are most vulnerable to becoming heavy drinkers. We will continue to develop a social norms approach to education and awareness amongst young people. This emphasises that most young people do not misuse alcohol. There is a strong evidence base to support such an approach and we have already made significant progress locally in this area. b. Early Intervention We will maximise targeted youth support to introduce processes to better identify those young people who have begun to misuse alcohol and deliver effective early interventions. We will work in partnership to develop a wide range of local resources for use by professionals in delivering brief interventions. This would include work to improve screening and recording, clarity about when to refer and the extent of the role to be played by generic agencies, such as schools, in supporting young drinkers. We will further develop clear pathways to specialist treatment for those young people whose use of alcohol becomes problematic with specific pathways for those attending A&E or being admitted to hospital due to alcohol misuse. c. Parent and carers We will increase the involvement of parents and carers in the ongoing development of the response to alcohol. We will develop and communicate key messages aimed at supporting parents and carers in dealing with alcohol use by their children. d. Specialist treatment for young people We will continue to provide effective specialist treatment for young people who misuse alcohol at a level where it is affecting their lives or the lives of others, and we will work towards the continual improvement of pathways into such treatment.

e. Enforcement We will work with the trade to ensure that all licensed premises fulfil their legal obligation to protect children and young people, and will promote, and encourage licensees to use, a common proof-of-age scheme aimed at preventing the sale of alcohol to young people under the age of 18 years. We will test compliance with age related legislation through coordinated, intelligence led enforcement activity and will ensure appropriate action is taken in respect of licensing. In addition, we will test compliance with premises licence conditions in relation to proof of age schemes and the provision of staff training in relation to underage sales and responsible alcohol retailing. We will ensure that intelligence led enforcement activity is aimed at reducing alcohol related crime and disorder and drinking in public places by young people, and that those involved receive a brief intervention, their parents are informed and, where appropriate, they are referred into the treatment services. We will support this with better links between crime and disorder agencies and young people s services such as the youth service. A multiagency group focusing on individual young people rather than on locations will be established. f. Hidden harm We recognise that alcohol misuse affects not just the drinker, but the family around them. We will work to meet the needs of this group. In particular we will roll out the Think Family approach. We will work closely with our Children and Young People s Trust partners and in particular the Stay Safe themed group of the Trust to ensure we maintain a strong, coordinated approach to protecting children and young people from the harm associated with adult drinkers. (iii) Moving forward Safer communities & environments our aims in addressing alcohol related crime and disorder Lead: Safer Middlesbrough Partnership & Environment Action Group Much good work has been undertaken to manage alcohol-related crime and disorder. The partnership will continue and enhance that work by: Continuing to build links between the criminal justice and health agendas Ensuring that a single local person monitors and reports on the use of powers such as the Designated Public Place Orders Developing services targeting victims and perpetrators of domestic violence with alcohol problems Building links between alcohol services and domestic violence services Developing a care pathway from the prison system into alcohol treatment Continue our work to deter irresponsible drinks promotions.

(iv) Moving forward Enhancing the local economy diversifying and enhancing the evening economy in the town Lead: Local Economy Group The partnership will seek ways to diversify the evening economy to provide an offer attractive to individuals from a range of backgrounds and wanting different experiences. We wish to see a range of offers beyond alcohol consumption including cultural events, sporting events and restaurants. We recognise that tackling alcohol misuse and diversifying the evening economy may have an impact on the takings of the on-licensed trade. However, we will also be supporting or leading efforts to set a minimum price per unit of alcohol in line with NICE guidance. Although, the primary aim of this is to reduce harm, we believe that this will also help the on-trade by reducing loss leader promotions in the off-trade. In addition we will: Ensure that information about people s rights to make representations and seek reviews under the current Licensing Act is widely disseminated and that data on the use of these powers is recorded and monitored Ensure that health services and, in particular, alcohol treatment services are consulted on the Licensing Policy Ensure good Pubwatch attendance Continue to deter irresponsible drinks promotions Develop local training to help licensed premises staff to understand the law, the effects of alcohol and particularly to have the skills to refuse service to drunken people Work to improve transport in the night time economy Ensure that any strategy which targets the development of the town centre must read across to local health strategies and vice versa. (v) Moving forward Health and social care our aims in developing treatment and care Lead: Health & Social Care Group Middlesbrough s alcohol treatment services have been praised both locally and nationally. However, we recognise the need to continue to develop and improve the response to problem drinkers. We will develop a programme of Tier 1 training in alcohol identification and brief advice. As part of this consideration will be given to commissioning general practitioners (through the development and implementation of a Local Enhanced Service) to provide evidence based support to people with alcohol problems. We also aim to offer better aftercare for problem drinkers. In addition a more assertive approach is required to helping those with alcohol problems. The majority of problem drinkers will not voluntarily seek help for their problems and, therefore, services should develop care pathways and outreach capacity for people who are difficult to engage in services or who drop out of treatment. Therefore the following steps will be taken: Health and social care commissioners will clarify pathways for people with alcohol related dementias and the numbers of people with such conditions will be monitored Alcohol service commissioners will develop clear guidance on how to respond to clients who enter alcohol services but seem resistant to change or are unwilling to engage Research into the needs of homeless problem drinkers will be undertaken.