Overview of the Alcohol Service Provision in

North East Lincolnshire

Pauline BamgbalaHead of Substance Misuse and Sexual Health Commissioning

&Bill Geer

Reducing Re-offending Strategic Manager

North East Lincolnshire Population - 158,20016 – 64 yrs - 95,200Size - 192 sq kilometres

N E Lincolnshire

Alcohol Issues for North East Lincolnshire

Historical links to the fishing industrywith high levels of alcohol consumption

2nd highest alcohol related crime levelin Yorkshire and the Humber

Alcohol Issues for North East Lincolnshire

2 Town centres Grimsby and Cleethorpes 49th most deprived area IMD (2007)Low skill levels, high unemployment, low aspirationSignificant inequalities High levels of teenage pregnancySignificant inequalities – life expectancy for men variant of 10.8yrs between most deprived and most affluent deciles – 6.7 yrs for women

Alcohol Issues for North East Lincolnshire

Background to Service Provision

2 Town centres Grimsby and Cleethorpes 2003 & 2005 Public Health produced Substance Misuse Needs Assessment demonstrating alcohol misuse greater than substance misuse (significant poly use)2006 Public health produced an alcohol Needs AssessmentLocal Alcohol Reduction Strategy - 4 Task Groups

• Education and Awareness raising• Treatment• Crime and Disorder• Data and Information

Where were we – Pre 2008/09?

Combined drug and alcohol specialist service

One buildingNo separate funding, therefore very little serviceNo drivers – national or local to affect changeAlcohol clients with no substance misuse issues reluctant to attendNo in patient detoxLimited community detoxLittle or no involvement from Primary CareNo GP/practice staff training for screening or intervention work

What enabled change?

Comprehensive Needs Assessment – Highlight to strategic managers what was already know to practitionersPolicy Levers – PSA 25, NI 39, VSC 26Health & Treatment guidanceAlcohol Improvement ProgrammeInvestment (but still only short term!)

Where are we now?

Specialist Alcohol Service

Consultant ledDedicated GP Sessional inputNurse and Counseling input – Tier 3Dedicated Alcohol Counseling Team to support Primary CareOut of area In-patient DetoxCommunity Detox

Where are we now?

Primary Care Alcohol Service

Training for GP/ practice staffOpportunistic ScreeningBrief and extended InterventionsReferral to Specialist Alcohol Workers based within practicesAgreed pathways and referral systems

Where are we now?

Support to Secondary Care

A&E

Support to Consultants on Medical Wards

Patient referrals

Problems along the way

Lengthy delays due to CRB clearance (up to 4 months)

A&E – strong commitment, but lack of staff to fully implement screening

Information systems - incompatibility

Overview of N E LincolnshireAlcohol Intervention Programme

Aim of scheme is to provide a brief assessment and intervention to adults with alcohol problems

Arrest referral workers in Police custody suite 0730 x 22002.5 wte workers working within programme offices

NOVEMBER 2008 NOVEMBER 2009

How does the scheme work?

Voluntary referralIn custody suite

(Route 1)

Conditional Caution

(Route 2)

ConditionalBail

(Route 3)

Brief assessment and intervention – includes the AUDIT alcohol assessment, Alcohol Intervention Record and various

Interventions, including Group sessions Sessions last 45 minutes – 2 hours

Referral to specialistservices if required

Information regarding attendance isFed back to Courts, Probation

& Police

Evaluation

Scheme is to be independently evaluated

2 phases of evaluation:

Re – arrest data 6 months after completion of the intervention

Interviews with clients 6 months after completion of the intervention

Comparison group – those who would have been eligible for scheme but didn’t undertake the intervention

Final evaluation results for all schemes due end of 2010 / early 2011

North East Lincolnshire Alcohol Arrest Referral

Throughput April – September 2009

0

20

40

60

80

100

120

140

160

180

Apr May Jun Jul Aug Sep

Conditional Bail

ConditionalCaution

Voluntary

April 2009 – September 2009 data

Age breakdown Gender breakdown

High level of ‘binge drinking’ in lower age group with little knowledge or thought of immediate or longer term health issues. Lack of awareness of units of alcohol

90% of females unemployed with some Audit scoring 38 - 40

Ethnicity – 4.5% of local population but less than 0.5% of offenders referred to programme

Students tend to score 20 -24 on Audit

88%

12%

MaleFemale

0%

5%

10%

15%

20%

25%

30%

35%

40%

Series1 37% 35% 23% 5%

18-24yrs 25-34yrs 35-49yrs 50yrs+

Employment Status

More half of all clients assessed were unemployed at the time of intervention, this proportion is increasing

Employed 39%

Student2%

Retired1%

Long term ill4%

Unemployed54%

Employed

Unemployed

Student

Retired

Long term ill

High proportion of client group indicate drinking to higher levels to ‘reduce’ work place or unemployment stress factors rather than consideration of health factors

Level of drinkingDependent drinkers were the most represented group(38% of clients scored 20+)

No Risk18%

Hazardous31%Harmful

13%

Dependant 38%

No Risk

Hazardous

Harmful

Dependant

Audit < 2572%

Audit = / > 25

28%Audit < 25

Audit = / > 25 Level of drinking72% scoring 20+ were younger binge drinkers10% of total score 25+

Offence Types

Assault, Criminal Damage and other Public Disorder are the most common offence types driving the need for the Criminal Justice pathway to treatment outcomes..

Assault42%

Criminal Damage

9%

Public Disorder

30%

Drink Driving11%

Theft4% Drunk &

Disorderly4%

Assault

Criminal Damage

Public Disorder

Drink Driving

Theft

Drunk & Disorderly

During April to September 2009, 832 separate offenders received intervention by the programme. Between 35% and 40% of all arrests are alcohol related.

Link to Domestic Violence

Reporting rate of DV is estimated at a ratio of 1:35 NE Lincolnshire records average of 300 DV incidents per month 35 DV related arrests per month referred to the Alcohol Interventions Programme Programme staff receive DV specific training Attendance reported to MARAC Reporting for consideration of IDAP intervention.

Cost of Crime Assaults

Type Emotiona

l and Physical cost to Victim

LostOutput

HealthCosts

Criminal

JusticeCost

AverageCosts

Common Assault 240 20 - 270 540

Wounding 12,000 2,000 1,200 2,700 18,000

Serious Wounding

97,000 14,000 8,500 13,000 130,000

Homicide 700,000 370,000

630 22,000 1,100,000

Lessons learnt from North East Lincolnshire

Alcohol Interventions Programme

The intervention programme can draw people from Criminal Justice into treatment. A Primary Care Trust commissioned multi-agency team can provide both Health and Criminal Justice outcomes This group tends to drink at hazardous, harmful and dependency levels The individuals are unlikely to be engaged in other settings Referral pathways to GPs and specialist service are essential Referral pathways are also essential for other health needs Underlying needs such as benefits, housing, skills and employment can be addressed

Any Questions?Pauline BamgbalaHead of Substance Misuse and Sexual Health CommissioningPauline.bamgbala@nelctp.nhs.uk(01472) 625561 &

Bill GeerReducing Re-offending Strategic ManagerBill.geer@nelctp.nhs.uk(01472) 625567