The time is ripe for developing strategic steps to tackle the havoc wreaked by alcohol misuse, says Libby Ranzetta
These are exciting times for local alcohol leads. The Alcohol Harm Reduction Strategy for Englandwas a huge disappointment when it was published in 2004, but it is slowly bearing fruit in the form of useful guidance from the Department of Health and, through the Choosing Healthwhite paper, clear acknowledgement at last that action on alcohol screening and early intervention is required.
Thus we now have Alcohol Misuse Interventions: Guidance on Developing a Local Programme of Improvement for Tackling Hazardous and Harmful Drinkers(who constitute the vast majority of alcohol misusers).
For planning treatment for people with more serious alcohol problems we have Models of Care for Alcohol Misusersand Review of the Effectiveness of Treatment for Alcohol Problems. And directors of public health need not worry too much about organising expensive lifestyle surveys to determine the extent of excessive drinking in their populations: the DoH's Alcohol Needs Assessment Research Project gives a regional breakdown of prevalence and need for treatment.
Even the Licensing Act 2003, which appeared to be disastrous in public health terms (increasing the availability of alcohol and almost certainly increasing alcohol consumption as a consequence), may at least turn out to be helpful in promoting local alcohol harm reduction strategies.
How so? The act makes local authorities responsible for setting and implementing licensing policy. To do this effectively, licensing departments have had to forge stronger - sometimes new - relationships with partners such as primary care trusts and community safety units.
In Enfield, for example, the head of licensing led the development of a multi-agency alcohol harm reduction board in 2005, whose strategy is now bringing demonstrable reductions in alcohol-related problems - including those associated with licensed premises. This would not have happened before the Licensing Act.
Successful local strategies to reduce alcohol-related harm succeed or fail on the quality of partnership working. Alcohol misuse is not just about health, crime or family breakdown. It is about those things and more; reducing alcohol-related harm requires a range of co-ordinated responses.
Another relatively recent boost for the field is the rise of the local area agreement, the meta-strategy under which all the key local partners must meet and join up. LAAs have great potential for establishing local targets on alcohol harm reduction that drive down health inequalities, reduce violent crime, improve accident and emergency waiting times and a whole host of other objectives.
Blackpool's LAA is an excellent example of this principle in action, making alcohol a cross-cutting issue (it features in every 'block' of the agreement) and setting targets for alcohol treatment worth some£400,000 in reward grant funding. The lack of progress on alcohol misuse in recent years has much to do with the underlying lack of targets, local or otherwise; LAAs really ought to help.
If this does not yet sound exciting enough, consider the new recurring revenue PCTs will receive for alcohol interventions from April 2007;£15m is to be shared across England. The money is not ring-fenced, however, and many fear it will go the way of other Choosing Healthfunding, particularly in London (that is, into a black hole labelled 'budget deficit'). But it is an opportunity nonetheless.
It is easy enough to make an invest-to-save case for alcohol interventions: the UK Alcohol Treatment Trial (UKATT) has shown that every£1 invested in treatment brings a saving of£5 for the public sector, even over a short period; and A&E-based alcohol liaison nurses in hospitals such as St Mary's, Paddington, and the Royal Liverpool have reduced readmissions significantly. In primary care, we have not seen many local enhanced services for alcohol under the new general medical services contract, but a model developed in Lewisham PCT, for example, seems to be working well.
So now is a good time to be thinking about reducing alcohol-related harm. How to make a start? Here are some suggestions on establishing a good basis for the development of a local alcohol strategy (see also the Local Alcohol Strategy Toolkit, see below):
- Download your local indicators of alcohol-related harm from the North West Public Health Observatory alcohol resources site (see below).
- Consider using the NWPHO's Taking Measuresapproach to building a more detailed assessment of alcohol-related harm.
- Identify local stakeholders in alcohol harm reduction, and possible champions; get them together to discuss priorities and agree the way forward.
Experience from the growing network of local alcohol strategy co-ordinators suggests that successful strategies will be securely tied into other key corporate strategies - such as crime reduction, local delivery plans and the LAA - and that the strategy action plan needs a strong performance management framework to keep things moving.
The government's alcohol strategy does not require PCTs or local authorities to reduce alcohol-related harm. But really, there's no excuse not to.
Libby Ranzetta runs the alcohol harm reduction website and podcast www.alcoholpolicy.net.
- Department of Health guidance and publications www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/AlcoholMisuse.
- UKATT - see Alcohol Concern www.alcoholconcern.org.uk.
- Website and podcast for local alcohol leads www.alcoholpolicy.net.
- Local Alcohol Strategy Toolkit www.localalcoholstrategies.org.uk.
- North West Public Health Observatory alcohol resources www.nwpho.org.uk/alcohol.
- London Alcohol Coordinators' Group - contact firstname.lastname@example.org