REPORT TO: Cabinet DATE: WARDS CONTACT OFFICER: …...IMPLICATIONS: Budget/Policy Framework:...

REPORT TO:

Cabinet

DATE:

17 April 2008

SUBJECT:

Alcohol Abuse Working Group Report

WARDS AFFECTED:

All

REPORT OF:

Scrutiny and Review Committee - Health and Social Care Alcohol Abuse Working Group

CONTACT OFFICER:

Janet Borgerson Scrutiny Officer 0151-934 2176

EXEMPT/ CONFIDENTIAL:

No

PURPOSE/SUMMARY: To formally present to Cabinet the report of the Alcohol Abuse Working Group, formed by the Scrutiny and Review Committee - Health and Social Care, which reviews issues relating to Alcohol Abuse affecting the health of residents across Sefton.

REASON WHY DECISION REQUIRED: The attached report was considered by the Scrutiny and Review Committee - Health and Social Care, at its meeting of 4 March 2008 (Minute 90 refers) and is presented to the Cabinet for information and formal support, in respect of the statements and recommendations contained within the report (Page 25).

RECOMMENDATION(S): It is recommended that the Cabinet: (1) Approve the recommendations contained within the report (page 25); and (2) The NHS Trusts be formally apprised of the Scrutiny and Review

Committee’s views. KEY DECISION: No

FORWARD PLAN:

No

IMPLEMENTATION DATE:

Following the expiry of the ‘call in’ period for the Minutes of the Meeting.

ALTERNATIVE OPTIONS: N/A

IMPLICATIONS:

Budget/Policy Framework:

Financial:

CAPITAL EXPENDITURE

2006/ 2007 £

2007/ 2008 £

2008/ 2009 £

2009/ 2010 £

Gross Increase in Capital Expenditure

Funded by:

Sefton Capital Resources

Specific Capital Resources

REVENUE IMPLICATIONS

Gross Increase in Revenue Expenditure

Funded by:

Sefton funded Resources

Funded from External Resources

Does the External Funding have an expiry date?

Y/N

When?

How will the service be funded post expiry?

Legal:

N/A

Risk Assessment:

N/A

Asset Management:

N/A

CONSULTATION UNDERTAKEN/VIEWS

Corporate Objective Monitoring:

Corporate Objectives

Positive Impact

Neutral Impact

Negative Impact

1. Creating a Learning Community √

2. Creating Safe Communities √

3. Jobs and Prosperity √

4. Improving Health and Well-Being √

5. Environmental Sustainability √

6. Creating Inclusive Communities

√

7. Improving the Quality of Council Services and Strengthening local Democracy

√

8 Children and Young People √

LIST OF BACKGROUND PAPERS RELIED UPON IN THE PREPARATION OF THIS REPORT Findings and conclusions within the report have relied on information from:

• Witnesses named in ‘Acknowledgements’ (Page 1 of report); and

• Documents in the list of ‘References’ (Pages 27-28 of report).

THIS PAGE INTENTIONALLY LEFT BLANK

Meeting: SCRUTINY AND REVIEW COMMITTEE (HEALTH AND SOCIAL CARE)

Date of Meeting: 4 MARCH 2008 Title of Report: ALCOHOL ABUSE WORKING GROUP DRAFT REPORT

Report of: C.J. Elwood Legal Director

This report contains Yes No

CONFIDENTIAL Information/

√

Contact Officer: Janet Borgerson (Telephone No.) 0151 934 2176

EXEMPT information by virtue of paragraph(s)............ Of Part 1 of Schedule 12A to the Local Government Act, 1972 (If information is marked exempt, the Public Interest Test must be applied and favour the exclusion of the information from the press and public).

√

Is the decision on this report DELEGATED?

√

PURPOSE OF REPORT To formally present the draft report of the Alcohol Abuse Working Group. REASON WHY DECISION REQUIRED The Working Group has made a number of recommendations requiring consideration and, if appropriate, forwarding to the Cabinet and NHS partners for further action.

RECOMMENDATIONS (2) That the Committee notes the report of the Alcohol Abuse Working Group; (3) That the Committee supports the recommendations contained within the

report; and (4) That the report be forwarded to Cabinet / NHS partners for further

consideration.

Corporate Objective Monitoring Corporate Objective

Positive Impact

Neutral Impact

Negative Impact

1. Creating a Learning Community √

2. Creating Safe Communities √

3. Jobs and Prosperity √

4. Improving Health and Well-Being √

5. Environmental Sustainability √

6. Creating Inclusive Communities

√

7. Improving the Quality of Council Services and Strengthening local Democracy

√

8 Children and Young people √

Financial Implications

CAPITAL EXPENDITURE

2006/ 2007 £

2007/ 2008 £

2008/ 2009 £

2009/ 2010 £

Gross Increase in Capital Expenditure

Funded by:

Sefton Capital Resources

Specific Capital Resources

REVENUE IMPLICATIONS

Gross Increase in Revenue Expenditure

Funded by:

Sefton funded Resources

Funded from External Resources

Does the External Funding have an expiry date? Y/N When?

How will the service be funded post expiry?

There are no financial implications arising out of this report. Departments consulted in the preparation of this Report Sefton Public Health Sefton Environmental Protection List of Background Papers relied upon in the preparation of this Report

• Autoglass, Datamonitor, October 2007.

• British Medical Association (BMA) Guide Notes, Binge Drinking, arch 2005.

• Cabinet Office – The Strategy Unit, National Alcohol Harm Reduction Strategy-Interim Analysis Executive Summary, September 2003.

• Daily Mail, Binge-drinking epidemic increases as alcohol related A&E admissions soar, 15 October 2007

• Department of Health, Sensible Drinking: The Report of an Inter-Departmental Working Group, 1995 (www.dh.gov.uk)

• Department of Health (DoH), National Alcohol Harm Reduction Strategy – The Consultation, October 2002.

• John Moore University/Sefton Primary Care Trust, Investigating drinking behaviours and alcohol knowledge amongst people resident in the Linacre and Derby wards of Sefton: interim report, August 2007.

• Nursing and Midwifery Council, Modernising nursing careers – adapting to change, November 2007.

• Royal College of Physicians, New coalition calls for tougher measures on alcohol, 13 November 2007.

• Sefton Alcohol Harm Reduction Strategy Group, Sefton Alcohol Harm Reduction Strategy, February 2007

• Sefton Metropolitan Borough Council, Guidelines for Handling Alcohol Abuse in the Workplace, April 2001.

• Sefton Metropolitan Borough Council, Alcohol Abuse Meeting Notes, November 2007.

• Sefton Safer Stronger Communities Partnership, ’Booze Losers’ Leaflet.

• Southport and Ormskirk Hospital NHS Trust, Alcohol Related Episodes – Complete Data, January 2008.

• Scrutiny and Review Committee (Health and Social Care) – Sefton Metropolitan Borough Council, Minutes of meeting held at Town Hall, Southport on 3 July 2007 (Item No. 22), July 2007

• North West Regional Alcohol Harm Reduction Strategic Group/John Moore University-Centre for Public Health/Trading Standards North West/Department of Health/Government Office for the North West, Patterns of risky alcohol consumption in North West teenagers and their implications for preventing alcohol-related harm September 2006.

• Telegraph, Hospitals admit 500 binge drinkers each day, 31 December 2007.

• Touquet R and Paton A, Tackling Alcohol Misuse at the Frontline, British Medical Journal ; 333:510-511, 9 September 2006.

• Valentine G and Holloway S, Drinking Places: Where People Drink, Joseph Rowntree Foundation, November 2007.

• www.thinkroadsafe.gov.uk (15/11/07)

• www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Alcoholmisuse/Alcoholmisusegeneralinformation/DH_4062199 (November 2007)

SEFTON M.B.C.

SEFTON COUNCIL

SCRUTINY AND REVIEW COMMITTEE Health and Social Care

Alcohol Abuse Working Group

FINAL REPORT

February 2008

Contents Page Acknowledgements 1 Forward 3 Introduction 5-6 Methodology 7 Findings 9-21 Key National Findings (9-10) Key Local Findings (10-12) Alcohol Related Admissions to A&E (13-16) What we are doing (17-21) Conclusions 23-24 Recommendations 25 References 27-28 Appendix A

- Recommended alcohol drinking allowances 29-30 Appendix B

- Guide to the effects of alcohol on your body and mind 31-33

Appendix C

- Scrutiny Scoping Document 35-40

Appendix D

- Guidelines for Handling Alcohol Abuse in the Workplace 41-44 Appendix E

– Are you poisoning yourself? 45-48 Appendix F

– Tips for cutting down 49-50

1

Acknowledgements The Working Group would like to thank all those people who took part in the research carried out by the Alcohol Abuse Working Group, and kindly contributed to the quality information gathered for this report. A warm thanks goes out to staff at Sefton Council, who went out of their way to involve the Working Group in current events and informing Members on local initiatives and policies in place to combat the abuse of alcohol. A special thanks is extended to those key people who continuously linked into the Working Group with updates on local services, new initiatives and models of good practice to be replicated and mould future strategies. These people have also been invaluable to the research and include Dr Janet Atherton, the Director of Public Health for Sefton, Rod Thomson, Consultant in Public Health (Acting), Sefton PCT and SAHRS Member and Peter Moore, Assistant Director of Environmental Protection.

2


3

Forward Alcohol can be a problem when consumed in excessive amounts, and over recent years alcohol abuse has become more of a concern; with the North West having the highest level of harmful drinking rates in England (29%) and more specifically, Sefton having the 6th highest level of binge drinking (23%). Furthermore, Sefton is a unique borough with diverse characteristics, which is accompanied by areas of depravation that suffer higher levels of alcohol consumption and related harm. Some of the more historically affluent parts of Sefton, such as Southport, have also changed over recent years. Once considered as a retirement town where tourists visited during the holiday season and weekends, it has now become an all year-round attraction and a haven for pubs and clubs, attracting volumes of people from all age groups. As a Metropolitan Council, we have a degree of control over most matters related to the health and social care of our community, including scrutinising services involved in the use of alcohol and its abuse. There has been a great deal of work done locally and nationally to raise awareness of alcohol abuse, but what have we done locally to inform and educate the people in our community, which we are all concerned about. With this in mind, the Scrutiny and Review Committee – Health and Social Care, set up a Working Group to consider what is happening nationally and most importantly, what we are doing locally, and considered any weaknesses that could be improved.

Cllr Anthony Hill Cllr Carmel Preston Cllr Veronica Webster

Cllr Barry Griffiths Cllr Patricia Hardy

4


5

Introduction Alcohol has always played an important role in British society and most people enjoy alcohol in a wide range of social occasions, drink sensibly and cause no harm to themselves or others. Moderate amounts of alcohol can act as a relaxant and help you feel less anxious. In fact some research actually recommends having the odd tipple or two, for example, the Department of Health suggests one or two small drinks each day for men over 40 and women who have been through the menopause, to help prevent coronary heart disease (DOH, 1995). The amount of research into alcohol related events has become more prevalent in recent years and it is now estimated that nearly one in three adults in the UK are risking their health by drinking more than the recommended daily amount of alcohol (Appendix A - recommended drinking allowances). Along with drinking excessive amounts of alcohol comes a less pleasant aspect, which can lead to serious consequences for the drinkers themselves, for their families and friends, and for the community as a whole. And this is a legitimate area of concern for the Government (DoH, Oct 2002). The negative impacts of excessive alcohol consumption are reported regularly in the media, for example, reports of more than 500 people per day being admitted to hospitals in England after drinking too much alcohol; statistics released estimate that nearly 13 million Britons drink too much (Telegraph, December 2007); and binge-drinkers flooding A&E departments, which has increased by more than a quarter over the last few years, especially amongst women (Daily Mail, October 2007). These media reports reflect stark news of the way the British nation could be heading, which can have devastating short-term and long-term effects on our bodies and minds (refer to Appendix B). Long-term, the abuse of alcohol can physically damage our body, increase the risk of getting certain diseases and make other diseases worse. In the short-term, alcohol acts as a depressant of the nervous system and suppresses the part of your brain that controls judgement. Some of these short-term and long-term effects are highlighted in the following table:

Short-Term Effects Long-Term Effects

Loss of inhibitions Hepatitis and cirrhosis of the liver

Loss of physical co-ordination Gastritis (inflammation of the stomach lining)

Blurred vision Pancreatitis (inflammation of the pancreas)

Slurred speech High blood pressure, which can lead to stroke

Loss of Balance Certain cancers (including mouth and throat)

Unconsciousness Damage to the brain

Coma Heart failure

6

Death by suffocation through vomiting whilst unconscious

Neurological problems such as epilepsy

Become more aggressive Certain types of vitamin deficiency

A more comprehensive guide to the effects of alcohol on the body and mind, dependent on how much alcohol you drink – refer to Appendix B. People who drink excessive amount of alcohol are causing a strain on many services being provided to the public, including the National Health Service, the Police, Trading Standards, licensing and so on. With this in mind, Members of the Alcohol Abuse Working Group set out to determine what was happening nationally and locally. Members were very pro-active in gathering the relevant research, for example, inviting guest speakers to meetings, interviewing expert witnesses who are on the pulse of local events relating to alcohol abuse and services provided to support such people. Members also examined organisations and linked with key people to determine how we as a borough are dealing with alcohol-related problems and more importantly, areas where we could potentially improve our community as a whole. Prior to presenting the research findings, the next section outlines the methodology used in conducting the research by the Alcohol Abuse Working Group.

7

Methodology In July 2007, the Scrutiny and Review Committee – Health and Social Care resolved that a Working Group would be established to investigate alcohol abuse (Minute No. 22) and the following Councillors were nominated to this Alcohol Abuse Working Group: Working Group Membership Councillor P. Hardy Councillor Hill Councillor Griffiths Councillor Preston Councillor Webster The following Alcohol Abuse Working Group Meetings took place: Tuesday 7th August 2007 Tuesday 11th September 2007 Friday 2nd November 2007 Friday 4th January 2008 Tuesday 19th February 2008

The initial meeting on 7th August discussed the following:

• Councillor Preston elected as Lead Member of the Alcohol Abuse Working Group;

• the structure of the review / scoping document (Appendix C);

• the focus of the Working Group; and

• Officer involvement. The Scoping Exercise produced the following Terms of Reference and Objectives for the Alcohol Abuse Working Group: Working Group Terms of Reference and Objectives 1. To monitor progress, and input to, the revision of the Sefton Alcohol Harm

Reduction Strategy covering the specific areas of… 2. Identification and Treatment - Interventions 3. Integrated Care Pathways – reduce mortality rates, reduction of alcohol

related hospital admissions. 4. Integrated Alcohol / Mental Health Treatment Services. 5. Working undertaken in partnership with industry to improve interventions and

to develop appropriate strategies and delivery mechanisms. (Sefton Council, Scoping Exercise – Alcohol Abuse Working Group, August 2007) During the process of this review, Members of the Working Group gathered a substantial amount of information from various sources, which is noted in the ‘Reference’ section. The findings from this research are reported in the next section.

8


9

Findings This section highlights some key national and local findings, which will help the reader gain a picture of the extent of alcohol abuse and its effects. We will then go on to explain what we are doing locally to alleviate some of the problems encountered within our community.

Key National Findings on the rates and effects of alcohol abuse:

• Alcohol is one of the ten leading causes of disease and injury;

• 13 children a day are hospitalised as a result of alcohol misuse;

• Alcoholic liver cirrhosis has increased by 95% since 2000 and still increasing;

• Alcohol related deaths have increased by 18% from 2002-2005;

• More people die from alcohol related causes than from breast cancer, cervical cancer and MRSA combined;

• The catastrophic ‘passive effects’ of alcohol misuse include rape, sexual assault, domestic and other violence, drunk driving and street disorder – alcohol affects thousands more innocent victims than passive smoking;

• Negative consequences of alcohol consumption cost £20 billion each year through issues such as absence from work, crime, health treatment and premature mortality;

• One in five drivers admit to regularly drink driving;

• 11,500 children were killed or injured on Britain’s roads in 2006 as pedestrians, cyclists or car passengers;

• Young people (18-24 year olds) perceive binge drinking as a cultural norm, with reasons given for binge drinking included having fun, escaping everyday reality, increasing self-confidence and conforming to peer group norms;

• Some young people saw getting ill, losing their memory or behaving out of character as a result of binge drinking as ‘part of the fun’;

• Young people reported engaging in a range of risk-taking behaviours while drunk, including getting into cars or going home with strangers, using unlicensed minicabs, having unprotected sex and taking part in ‘pranks’ that put them in physical danger;

10

• Annually, there are1.2 million violent incidents related to alcohol abuse, which is approximately half of all violent crimes;

• Death can occur from respiratory or circulatory failure or if binge drinkers inhale their own vomit;

• 66% of alcohol is consumed on Fridays and Saturdays; (Information cited from: Royal College of Physicians, November 2007; Autoglass, Datamonitor, October 2007; www.thinkroadsafe.gov.uk; John Moore University et al, August 2007; British Medical Association, 2005).

Key Local Findings on the rates and effects of alcohol abuse:

• 87% of people drink alcohol at least occasionally;

• 79% consumed alcohol in the previous week;

• 76% of those who had consumed alcohol in the last week had binged at least once in the same period, of which 76% were binge drinking sessions;

• On average, 11 units were consumed on their heaviest drinking occasion in the last week (recommended allowance is 2-3 women and 3-4 men);

• Two thirds of drinkers had experienced at least one alcohol-related harm in the last six months;

• Problem drinkers, binge drinkers and those who drink before going out were more likely to have experienced alcohol-related harm in the last six months, in particular arguments, blackouts and fights;

• Knowledge of recommended levels of alcohol consumption were relatively low - a third of males and two-fifths of females knew their correct daily limits;

• Nearly two thirds of participants reported seeing health information relating to alcohol in the last six months, and of these, they were more likely to recall the source of the health information rather than the actual message;

• Cost of alcohol is relatively low compared to children’s income;

• Children experiencing sensible drinking in parentally supervised settings have reduced alcohol-related risk behaviours in teenagers;

• A range of identity schemes are available to facilitate alcohol vendors in identifying underage individuals;

11

• The North West has the highest level of hazardous/harmful drinking in England (29%), with Sefton having the 6th highest level of binge drinking (23%), and areas of higher deprivation experiencing higher levels of alcohol consumption and related harm;

• 54% of 14-17 year olds in Sefton admit to drinking alcohol once a week or more, with 51% buying their own alcohol

(Information cited from: John Moore University et al, August 2007; North West Regional Alcohol Harm Reduction Strategic Group et al, September 2006) A local study carried out in the Linacre and Derby Wards of Sefton (John Moore University et al, August 2007), from a sample of 536 participants, ages 18-55, gathered the following results:

52% of participants abused alcohol to some degree (binge and problem drinkers):

Alcohol Consumption Between

Drinking Categories

Other Drinkers

35% (185)Binge Drinkers

40% (213)

Non Drinkers

13% (70)

Problem

Drinkers

12% (63)

On the heaviest drinking day of the week, participants consumed the following number of alcohol units:

Units of Alcohol Male Female

Up to 10 units 29% 62.5%

10.1 – 20 units 37% 30%

20.1 – 30 units 22% 5%

30.1 – 40 units 7% 2%

More than 40 units 5% 0.5%

100% 100%

Considering the recommended alcohol consumption per day is 3-4 for men and 2-3 for women, that an average of 21-28 and 14-21 for men and women respectively, the above chart suggests many drank their weekly limit n just on session.

Sample response

= 531

Other Drinkers =

consume less

alcohol than binge

drinkers

12

Furthermore, of those participants who consumed alcohol in the last week, 65% of them had a binge drinking session, with alcohol consumption being more prevalent on Fridays and Saturdays. The chart below show the results when participants were asked how many days in the previous week had they had an alcoholic drink:

Overall, only 37% of participants knew the recommended daily alcohol limits, with females having a slightly better knowledge than males:

The 63% who did not know the recommended alcohol limits, either got the answer incorrect or did not know.

Number of days on which alcohol was consumed

38.9%

28.8%

13.0%7.3%

2.4% 2.2%7.3%

0%

10%

20%

30%

40%

50%

1 2 3 4 5 6 7

Number of Days

% of People

Knowledge of Recommended Daily Alcohol Limits

Correct

37%

Female

30%

Male

33%

Incorrect

63%

13

Alcohol Related Admission to A&E, Southport and Ormskirk Hospitals: Additionally, the Alcohol Abuse Working Group analysed raw data that showed anonymised alcohol related A&E admissions from Southport and Ormskirk Hospital NHS Trust over a three-year period. A note of warning when comparing data over the three years – Southport and Ormskirk Hospital NHS Trust introduced a new computer system in 2007, which enabled them to record whether or not A&E admissions were alcohol related. As a result, this has enabled them to record alcohol attendances more accurately, which substantiates the increase of attendance in 2007 from previous years. Additionally, the gender of patients’ was not obtainable in these statistics.

This graph shows the total number of alcohol related A&E admissions in each year:

Using the above overall figures, the average number of alcohol related incidents admitted to A&E were calculated:

Total for Year

Average No. Admitted to A&E per Month

Average No. Admitted to A&E per Week

Average No. Admitted to A&E per Day

2005 694 58 13 2

2006 967 81 18 3

2007 2,719 227 52 7

Therefore, in 2007, an average of 7 people per day were admitted into A&E that were alcohol related.

Alcohol Related A&E Admissions 2005-2007

Total Per Year

694967

2719

0

1000

2000

3000

2005 2006 2007

Time of Day

No. People Admitted

Per Year

14

These figures were broken down further to provide more specific local data: The following graph shows how many of the alcohol related A&E admissions occurred at the weekend and during the week, over a one-year period for 2005, 2006 and 2007. Weekdays consist of Mondays to Thursdays; and weekends are Fridays to Sundays.

This indicates that in 2007, more that half (55%) of alcohol related A&E admissions took place at the weekend. The following graph shows how many of the alcohol related A&E admissions occurred during the day and night, over a one year period for 2005, 2006 and 2007. Days are 8am to 7.59pm, and nights are 8pm to 7.59am.

This indicates that more than half (58%) of alcohol related A&E admissions occur between 8pm and 8am.


Time of Day

285 409366601

1130

1589

0

500

1000

1500

2000

Day (8am-7.59pm) Night (8pm-7.59am)

Time of Day

No. People Admitted

Per Year 2005

2006

2007


Time of Week

315 379590

377

12031516

0

500

1000

1500

2000

Weekday (Mon-Thurs) Weekend (Fri-Sat)

Weekday or Weekend Admissions

No. People Admitted

Per Year 2005

2006

2007

15

Each patient’s age was also recorded, and ranged from 11 to 95 years of age. Due to the range being so wide, categories were created.

Using the 2007 figures, the above graph shows that there is a prevalence of alcohol related A&E admissions in 26-45 year olds, having approximately a third on all admissions, as highlighted in more detail below:


Age of People Admitted

125 119

216170

37 27

184 158

334

229

44 18

217

729

944

626

170

18

0

100

200

300

400

500

600

700

800

900

1000

<18 18-25 26-45 46-65 >65 Age not

allocated

Age of People Admitted

No. People Admitted Per Year

2005

2006

2007

Age

2007 Alcohol Related A&E Admissions

26-45

35%

46-65

23%

Over 65

6%

Not allocated

1%

Under 18

8%

18-25

27%

16

Concentrating on the latest, more reliable figures for 2007, the data was analysed to determine when alcohol related A&E admissions took place, i.e. day of the week and so on:

More than half of admissions took place at the weekend (Friday – Sunday) and during the evening (8pm-8am), as shown in the graphs above and below.

Hopefully, the information provided in the section has given a clear picture of what is happening both nationally and locally. So, what are we doing about some of the problems encountered to ease the pressure of alcohol related incidents in the borough?

Time of Day


Night

58% (1,589)

Day

42% (1,130)

Day of Week


Weekday

44% (1,203)

Weekend

56% (1,516)

17

What we are doing There is much work being done locally to combat the problem of alcohol abuse, and some of these are highlighted below:

• Survey to gather information and effectively plan campaigns to prevent alcohol abuse amongst youngsters: A survey commissioned by Trading Standards North West, with the primary aim to identify how and where youngsters obtain alcohol in order to effectively plan intelligence led campaigns.

The report concluded that the results demonstrated the success of the underage enforcement programme operated by Trading Standards and Merseyside Police (both the underage test purchase exercises and the ‘Knock Back’ Scheme); that the results however highlighted the worrying increase in ‘proxy purchasing’ by over 18s and parents/adults; and that the Trading Standards Section, along with its partners on the Sefton Public Health Partnership Alcohol Related Crime Sub-Group, would have to revise enforcement strategies if it was to maintain the positive downward trend in underage sales and tackle the developing problem of proxy purchasing.

• New Powers for Police and Trading Standards The Licensing Act 2003 not only introduced longer opening hours, it also provided Police and Trading Standards with more powers and made available new sanctions when dealing with underage alcohol sales, including: - Fixed penalty notices - Prosecution - Premise licence review - Closure of premises

These sanctions have already been used by Police and Trading Standards throughout Merseyside. Fixed penalty notices have proved particularly useful, meaning that an underage sales offence can be dealt with quickly without the expense to the taxpayer of pursuing a prosecution. The changes have also led to a closer working relationship with Police and Trading Standards resulting in more efficiency enforcement.

• ‘Knock Back’ Campaign An initiative produced by Trading Standards Services across Merseyside, designed to assist those who work in the licensed trade in preventing underage alcohol sales, reducing underage drinking and anti-social behaviour. Whereby, if a member of staff thinks a customer looks under 21, they are instructed not to serve alcohol unless the customer can prove they are over 18. The only acceptable proof of age is: - Photo Driving Licence - Valid UK Passport - PASS Accredited Proof of Age Card

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• Parental Responsibility Where an individual repeatedly commits underage drinking offences, there are now powers to obtain ASBOs and injunctions for parents.

• Litmus Strips Concealing alcohol in soft drink bottles is a practice known to be adopted by some underage drinkers. Local Police Officers now carry Litmus strips that quickly and easily indicate if there is alcohol in a drinks container. Use of the strips has resulted in the immediate confiscation of hundreds of drink containers carrying alcohol inside them.

• ‘Proxy Purchase’ – Buying alcohol for anyone who is under 18 The recent survey indicated that a large proportion of underage drinkers obtain alcohol by asking adults to buy it for them. Those in the licensed trade have also reported that this is on the increase due to more youths being knocked back. This forces youngsters to ask adults to but it for them. Any adults found buying alcohol for underage drinkers can now get an £80 fixed penalty or be prosecuted and receive a fine up to £5,000. Posters have been given to all ‘Knock Back’ premises to get this message across. Ongoing operations between the Police and Trading Standards to deal with this problem, has resulted in action being taken against adults purchasing for under 18s, as well as those under 18 asking for alcohol to be bought for them.

• Sefton Council ‘Guidelines for Handling Alcohol Abuse in the Workplace Sefton Council recognises that alcohol abuse is a health problem and has had a policy in place to deal with reports of drugs and alcohol abuse in place since 1990, which is updated as appropriate. The Council suggests that those who suffer from it need to recognise their problem and accept treatment and assistance. The Council states that it treats such employees sympathetically and will arrange counselling and will encourage them to actively seek appropriate help whilst protecting, as far as it can reasonably can, their jobs and career prospects. The staff is briefed on this policy, which is the role of the Trade Union. The policy includes a process to enable Managers to identify staff with alcohol problems. The policy (Appendix D) is going to have an Equalities Impact Assessment performed on it, which examines a proposed or existing policy, plan, strategy or project to identify what effect its implementation may have on different groups of people. It can anticipate and recommend ways to avoid any discriminatory or negative consequences for a particular group, on the grounds of race, gender, disability, faith, sexuality or age. Although there is no separate policy for employees who drive or operate machinery or equipment, it is likely at some point in the future for random testing to be carried out. This has been supported by the Health Unit, the Trade Unions and Managers, but recognise implementation of this is not easy, and needs to be thought through and take into consideration Human Rights and equity.

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• Sefton MBC working in Partnership with Public Health This partnership working has created pro-active work including Health Promotion Days and healthy Workforce Initiatives. Alcohol initiatives are managed by Public Health Partnership Steering Group, one on the six being alcohol with the Assistant Director, Environmental Protection being their co-Chair along with the Consultant in Public Health from Sefton PCT. Each of the Steering Groups has a budget for Health Promotion.

• Drink Drive Campaign (national) This new approach launched in July 2007, aims to convince all drivers, with a particular focus on 17-29 year olds that a drink drive conviction has the potential to ruin their life by highlighting a mixture of the legal and personal consequences: - being caught and breathalysed by the Police; - 12 month driving ban; - criminal record - hefty fine; - lifestyle changes i.e. potential loss of job, relationships or car)

• Stepping Stones Project Stepping Stones is a project run by Sefton Adult and Community Learning Service, and has been set up in the south of the borough to help the hardest to reach groups, including recovering drug and alcohol misusers. They provide support, information, advice and guidance to groups or individuals who would like to access learning services but have barriers that prevent them from doing so.

• Sefton MBC ‘Alcohol Misuse’ Sefton MBC have information on their website that directs people to ‘Sefton Alcohol Services for help, advice and support for anyone experiencing alcohol problems or their family members.

• Sefton MBC ‘Drink Drive’ Sefton MBC have information on their website that informs people of the effects of drinking, drinking limits and warns of the consequences for drink driving. There are also links to national campaigns and precautions to take when going out drinking.

• Sefton Alcohol Harm Reduction Strategy (SAHRS) SAHRS was established to develop and deliver a strategy for reducing the harm arising from alcohol consumption in Sefton. The multi-sector group, whose membership includes: - Sefton CVS - Sefton PCT (SHISS) - Sefton PCT - Children’s Services - Sefton Council - Merseyside Police - Sefton Alcohol Services

20

Was also aided by three expert sub-groups (crime and disorder, health economy, and communication/young people). There was a wide consultation period in 2006, which resulted in an action plan for 2007/08 with the aim to: - Improve the education available to individuals and to start the process of

changing the culture of ‘drinking to get drunk’ by promotion of informed positive choice;

- To better identify and treat alcohol misuse; - To prevent and tackle alcohol-related crime and disorder and deliver

improved services to victims and witnesses; and - To work with the industry in tackling the harms caused by alcohol.

• ‘Best Bar None’ Scheme Unbreakable polycarbonate glasses were distributed to clubs and bars where glass attacks are most common, and have been a great success so far with very positive feedback

• Public Health work with GP Practices Sefton Public Health provides help to GPs so they can assess, support and refer people on as appropriate. Presently at Stage One of this scheme, which involves twelve GP Practices being piloted. Stage two aims to involve all GP Practices;

• ‘Brief Interventions in Primary Care - a GP intervention scheme A GP intervention scheme was introduced in South Sefton with 9 GP Practices. This Pilot provided a wide range of primary health staff with the skills to identify patients who had health issues that either directly or indirectly linked to alcohol abuse. It also equipped staff with the confidence to raise the issue of alcohol with these patients.

• 3 Specialist Services in Sefton These services provide interventions adopted from a Model of Care for Alcohol Misusers that advocates a 4 Tier model of care. The 3 specialist services in Sefton use ‘Tier 2’, ‘Tier 3’ and ‘Tier 4’, which equate the following types of interventions: - Tier 2 –brief intervention, conducted in various settings such as A&E,

primary care and the criminal justice system and requires a number of sessions of motivational interviewing;

- Tier 3 – structured programmes of care, including psychotherapeutic interventions and structured counselling e.g. cognitive behavioural therapy, day care alcohol-free programmes, aftercare programmes. Client agree to a comprehensive assessment and a care plan.

- Tier 4 - residential services aimed at individuals with a high level of presenting need. Services include inpatient detoxification or stabilisation services; and residential rehabilitation units.

The 3 Specialist Services in Sefton include the following:

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Sefton Alcohol Services, Southport This service provides ‘Tier 2’ and ‘Tier 3’ support to people referred from a wide range of settings, including hospital, primary care, probation services, social services, housing and drug services. Provides advice and information after assessing their needs and acts as a gateway to other services.

‘Lifestyles’, Litherland Town Hall This service provides ‘Tier 2’ and ‘Tier 3’ support for South Sefton patients. Also provides support for medical problems that could be a result of lifestyle issues and liaise with local hospitals by offering detailed follow-ups. This service has attracted more funding via savings from the PCT. People need to be referred to this service by their GP, Sefton Alcohol Services or similar organisations. Patients cannot refer themselves directly. Windsor Clinic, Aintree This service provides ‘Tier 4’ support, managed by Merseycare NHS Trust and situated in Aintree Hospital. Provides detoxification and short-term inpatient rehabilitation. People need to be referred to this service by their GP, Sefton Alcohol Services or similar organisations. Patients cannot refer themselves directly.

• Sefton PCT support in the community Sefton PCT provides support in completing drink diaries, which helps people make changes to their behaviour and gives relevant advice based on their circumstances.

• ‘Know Your Limits’ Leaflets in GP Practices

• The Police Course The Police provide a four-day course for people involved in alcohol related

incidents.

• SMASH (Substance Misuse Advice Support and Help) Service This is a coordinated substance misuse service that links into Children’s

Services, launched last year;

• Anti-Social Behaviour Unit The Unit links with the Police and research on street drinking, which is available from John Moore’s University;

(Sources of information: Sefton Safer Stronger Communities Partnership ‘Booze Losers’ leaflet; Sefton MBC, April 2001; www.thinkroadsafety.gov.uk; www.sefton.gov.uk; Meeting notes, November 2007; Sefton Alcohol Harm Reduction Strategy, Feb 2007).

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Conclusions It is evident from the findings within this report, both nationally and locally, the abuse of alcohol is a problem, a problem that does not appear to be going away. Alcohol abuse affects not just certain types of people or specific age groups, but is an issue that flows through all classes, genders, neighbourhoods and age groups. Certainly, there is evidence that the more deprived areas are at more risk from the misuse of alcohol, but it is not unique to these people. The media has given much priority to public drinking, which has in effect, detracted attention from a much broader spectrum of the population’s routine domestic drinking practices. Many people consume high levels of alcohol in very different social circumstances, feeling unwarrantedly insulated from concern. In a recent study funded by the Rowntree Foundation (Valentine et al, 2007), they found many people consumed alcohol that far exceeded government-recommended weekly limits, and continued to regard their own drinking practices as unremarkable. People may genuinely be unaware that they are drinking excessively (refer to Appendix E – Are you poisoning yourself?). There has been much excellent work accomplished locally to prevent the abuse of alcohol and support people affected by this, whether its schemes that make it difficult for young people to purchase alcohol, or initiatives that reduce the damaging effects of alcohol-related violence in pubs and clubs or health promotion days to make people drink aware. Nevertheless, alcohol abuse is still a national issue. Binge drinking has come to symbolise high levels of street drinking by young people, however, looking at evidence from the local Southport and Ormskirk hospitals, the number of people presenting themselves at A&E through the affects of alcohol related incidents, varies considerably between the ages of 11 to the oldest being 95 years of age. This doesn’t mean to say that elderly people necessarily go out binge drinking at weekends or such like, it could simply mean that some people are not aware of their limits. Ask yourself the question: Do you know your limits? You may have a vague idea, but addressing issues such as this could be made more available by advertising more effectively, for example in trains - where all age groups and all types of people go, and probably with different drinking patterns. By doing this, we would be operating in a more proactive rather than reactive environment, by actively informing and educating the general public to know their limits and recognise if they are actually abusing alcohol. Whether people binge drink or just stay at home to have a few home measures of spirits, or decide to open their second or even third bottle of wine, these people may not realise they are actually drinking excessively, because they feel fine. However, these drinking patterns are, in a way, an arbitrary concern to the damaging effects it can have on peoples health and well being.

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It can often take extreme binge drinking incidents or long-term alcohol misuse to reveal the effects of excessive alcohol on your health, and often, this can be too late. Touquet et al recognised this factor (BMJ 2006) and suggested that large amounts of money and resources would be saved if all frontline NHS staff had basic knowledge about the social and physical effects of alcohol misuse and advise people on how to cut down their alcohol intake (refer to Appendix F – Tips for cutting down). South Sefton did undergo such an initiative, a GP intervention scheme that involved nine GP Practices - called the ‘Brief Interventions in Primary Care’. This pilot provided a wide range of primary health staff with the skills to identify patients who had health issues that either directly or indirectly linked to alcohol abuse. It also equipped staff with the confidence to raise the issue of alcohol with these patients. Rolling out a similar programme in the North of Sefton would hugely benefit, not just the local population, but also skill up staff in the health care sector and enabling them to share good practice with their colleagues. However, this would involve more money being used by the Primary Care Trust to fund skill training and time out for medical staff when learning such skills. Sefton does offer some quality services that support people with alcohol problems, however, from the research found, it appears to be more concentrated in South Sefton, with initiatives such as ‘Lifestyles in Litherland and the Windsor Clinic at Aintree. It would be good to see such similar practices being more obvious and easily accessible in North Sefton. It needs to be recognised that many Sefton organisations, such as the NHS, Trading Standards, the Police Force and so on, are doing a tremendous job at combating the abuse of alcohol in Sefton, by working in collaboration with each other, sharing information and learning from experience. This is reflected in the information shown in the Findings section of this report, and there may well be more first-rate work that is beng done in the community. The Alcohol Abuse Working Group had a huge task on their hands: wading through mounds of information, researching leads they were presented with and going into more depth to bring all this information together. From using the information in the report, plus other key data that was relevant to alcohol abuse, Members of the Alcohol Abuse Working Group persented some key recommendations, which are outlined in the following section.

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Recommendations

R1 The good practice used in South Sefton, for example Litherland, to prevent people abusing alcohol, should be reflected in North Sefton.

R2 More advertising is needed to promote the services that provide help to

people who abuse alcohol, for example advertisements such as ‘Know Your Limits’, could be placed in trains, hospitals and day care centres, which would also help toward older people knowing their limits.

R3 More finance needs to be injected into North Sefton by Sefton PCT on

alcohol related services

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References Autoglass, Datamonitor, October 2007. British Medical Association (BMA) Guide Notes, Binge Drinking, arch 2005. Cabinet Office – The Strategy Unit, National Alcohol Harm Reduction Strategy-Interim Analysis Executive Summary, September 2003. Daily Mail, Binge-drinking epidemic increases as alcohol related A&E admissions soar, 15 October 2007 Department of Health, Sensible Drinking: The Report of an Inter-Departmental Working Group, 1995 (www.dh.gov.uk) Department of Health (DoH), National Alcohol Harm Reduction Strategy – The Consultation, October 2002. John Moore University/Sefton Primary Care Trust, Investigating drinking behaviours and alcohol knowledge amongst people resident in the Linacre and Derby wards of Sefton: interim report, August 2007. Nursing and Midwifery Council, Modernising nursing careers – adapting to change, November 2007. Royal College of Physicians, New coalition calls for tougher measures on alcohol, 13 November 2007.

Sefton Alcohol Harm Reduction Strategy Group, Sefton Alcohol Harm Reduction Strategy, February 2007 Sefton Metropolitan Borough Council, Guidelines for Handling Alcohol Abuse in the Workplace, April 2001. Sefton Metropolitan Borough Council, Alcohol Abuse Meeting Notes, November 2007. Sefton Safer Stronger Communities Partnership, ’Booze Losers’ Leaflet. Southport and Ormskirk Hospital NHS Trust, Alcohol Related Episodes – Complete Data, January 2008. Scrutiny and Review Committee (Health and Social Care) – Sefton Metropolitan Borough Council, Minutes of meeting held at Town Hall, Southport on 3 July 2007 (Item No. 22), July 2007

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North West Regional Alcohol Harm Reduction Strategic Group/John Moore University-Centre for Public Health/Trading Standards North West/Department of Health/Government Office for the North West, Patterns of risky alcohol consumption in North West teenagers and their implications for preventing alcohol-related harm September 2006. Telegraph, Hospitals admit 500 binge drinkers each day, 31 December 2007. Touquet R and Paton A, Tackling Alcohol Misuse at the Frontline, British Medical Journal ; 333:510-511, 9 September 2006. Valentine G and Holloway S, Drinking Places: Where People Drink, Joseph Rowntree Foundation, November 2007. www.thinkroadsafe.gov.uk (15/11/07) www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Alcoholmisuse/Alcoholmisusegeneralinformation/DH_4062199 (November 2007)

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