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Adult Alcohol Needs Assessment

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Adult Alcohol Needs Assessment NHS Swindon and Swindon Borough Council Adult Alcohol Needs Assessment Author Amy McCullough Last saved on 08 July 201002 July 2010July 2010 Version 0-5 Status Final CONTENTS PART 1: INTRODUCTION AND CONTEXT 1 1.1 The purpose of this document 1 1.2 Aim and objectives of the needs assessment 1 1.3 Methodology 1 1.4 Sources of information 2 1.5 Definitions and scope 3 1.6 Context: why a needs assessment is required 4 PART 2: ALCOHOL - THE NATIONAL CONTEXT 6 2.1 Drinking behaviours among adults 6 2.2 Knowledge and attitudes to alcohol 8 2.3 Trends in alcohol spending and sales 10 2.4 The impacts of drinking: Alcohol related harms 100 2.5 Vulnerable groups 15 2.6 Gap between need and service utilisation 16 PART 3: PROFILE OF SWINDON 17 3.1 Total population and population estimates 17 3.2 Ethnic Profile 19 3.3 Diversity 21 3.4 Socio-economic status 22 PART 4: ALCOHOL - THE LOCAL CONTEXT 25 4.1 Drinking behaviours among adults 25 4.2 Knowledge and attitudes to alcohol 26 4.3 The impacts of drinking: Alcohol related harms 28 4.4 Vulnerable groups with alcohol needs 36 PART 5: LOCAL SERVICE PROVISION 39 5.1 Models of Care for Alcohol Misusers (MoCAM) 39 5.2 Mapping current alcohol service provision in Swindon 39 5.3 Tier 1 alcohol services in Swindon: non-alcohol misuse 47 specific services which see alcohol misusers 5.4 Tier 2 alcohol services in Swindon: Open access alcohol 48 misuse services 5.5 Tier 3 alcohol services in Swindon: Structured community- 49 based alcohol misuse services 5.6 Tier 4 alcohol services in Swindon 50 5.7 Dual diagnosis services 51 5.8 Services in the criminal justice system 51 5.9 Activities focussing on primary prevention 53 5.10 Ongoing service development 54 PART 6: ANALYSIS OF LOCAL NEED – QUANTITATIVE 55 ANALYIS 6.1 Estimation of numbers of people that misuse alcohol 55 6.2 Gap analysis 57 6.3 What we can infer from this information 63 PART 7: LOCAL VIEWS ON ALCOHOL RELATED 65 NEEDS 7.1 View of professionals 65 7.2 View of those misusing alcohol 72 7.3 Views of carers and families 73 PART 8: WHAT WORKS IN REDUCING ALCOHOL- 75 RELATED HARMS 8.1 Alcohol initiatives in England 75 8.2 Education, information, and communication 75 8.3 Health and treatment services 76 8.4 Alcohol treatment pathways 82 8.5 Community safety and criminal justice 82 8.6 Supply and pricing 85 8.7 Future evidence base 86 PART 9: RECOMMENDATIONS 87 9.1 Recommendations of the 2007 Alcohol Needs Assessment 87 9.2 Recommendations of this needs assessment 87 APPENDICES 91 REFERENCES 94 ii PART 1: INTRODUCTION AND CONTEXT 1.1 The purpose of this document The purpose of this document is to identify, record and make recommendations on alcohol related needs in Swindon. The document is owned by the Alcohol Steering Group‟s Expert Group, whomwhich is responsible for ensuring that the recommendations are taken forward. This includes using the document to inform the development of Swindon‟s Alcohol Harm Reduction Strategy for Adults, 2010-12. 1.2 Aim and objectives of the needs assessment The overall aim of this needs assessment is to identify, through analysis and the involvement of key stakeholders, what Swindon‟s alcohol related health needs are and how well these are being met. This will in turn provide information to plan, negotiate and commission services that improve alcohol related health outcomes. The comprehensive analysis that is required to undertake a needs assessment will ensure that decision-making on how best to prevent and mitigate the impacts of alcohol use are based upon sound evidence. In line with this overall aim, the objectives of the needs assessment are to: Synthesise intelligence to identify alcohol-related (met and unmet) needs in Swindon. This will require the following activities: - Building a profile of the health, social and economic impact of alcohol misuse on Swindon using key indicators such as the incidence and prevalence of alcohol related harm; - Assessing the impact of alcohol on diverse and target communities; - Base-lining current alcohol service provision in Swindon; - Identifying the likely demand for prevention (including treatment) services; - Incorporating stakeholder views on need into the process, allowing a deeper understanding of needs to be gained. Indentify gaps between the need for and provision of alcohol services at the local level. This includes gaps in the coordination, commissioning and delivery of alcohol services in Swindon. Identify, using the evidence base, what works in promoting safe, sensible and social drinking. Identify which health needs are priorities for action in Swindon. Stimulate the involvement key stakeholders in the process, and their ownership of the outcomes. 1.3 Methodology The NICE (2005)1 definition of a health needs assessment will be used (also used by the National Treatment Agency) to inform the methodology for this needs assessment; “A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities”. 1 In this context “need” is defined as the ability to benefit from a policy or service intervention. There must also be capacity to meet needs within relevant alcohol prevention, treatment and recovery services. This needs assessment will therefore seek to make recommendations that could be implemented within the resources available. The needs assessment will take into account gender, ethnicity and other diverse needs in the local population and any unmet needs from this perspective. The assessment will also be undertaken in accordance with the requirements of the national guidance on undertaking an equality impact assessment. A range of health needs assessment methodologies have been suggested since the 1990s.These are: Epidemiology and Research: the collection, analysis and interpretation of data (both quantitative and qualitative) to generate hypotheses and answer them. Corporate: determining and balancing the views of a range of local and regional stakeholders, and building their commitment to the resulting action plans. Comparative: assessing existing provision against service standards, national targets and other comparable areas. Each has its place in the comprehensive approach required to identify need and reduce harms associated with alcohol use, and so a combination of the three approaches will be used in this needs assessment. Combined, they provide a robust and systematic process for the production of a needs assessment, and in turn evidence based decision-making. 1.4 Sources of information The information which has contributed to this needs assessment has been gathered from a number of sources: Review of key national and local documents. Review of the evidence base in what works to preventing and reducing alcohol use, focussing on harmful use. National and local data compiled by NHS Swindon, Swindon Borough Council (SBC) and Swindon‟s Community Safety Partnership (SCSP). Data on service demand and delivery compiled by Swindon and Wiltshire Alcohol and Drug‟s Service (SWADS). Feedback from adults engaged in alcohol treatment services (through focus groups). Feedback from professionals involved in the commissioning and/or delivery of alcohol related services (through one to one informal interviews and the “Big Debate” conference). Feedback from professionals involved in responding to the impacts if alcohol (through one to one informal interviews and the “Big Debate” conference). This includes professionals the Police, Probation, and licensing staff. 2 Feedback and direction from the Expert Group of the Alcohol Steering Committee‟s Group. 1.5 Definitions and scope Health needs This needs assessment has been commissioned as a Health Needs Assessment. Whist the focus will therefore be on identifying and meeting health needs, factors that are related to alcohol use and health will also be explored (i.e. crime and community safety, families, unemployment etc.). This is in line with the Dahlgren and Whitehead (1991) model2, which suggests that there are complex, multi-layered factors influencing behaviours such as drinking and which subsequently impact upon health. Adults This needs assessment has been commissioned to explore needs in adults only, which includes those people aged 19 years and above. A separate needs assessment has been conducted for children and young people (led by Swindon Borough Council). As it is important that children‟s and adults alcohol services are joined up, the needs of young people that move from using services for children and young people to services for adults will also be identified. Identifying these “transition period” needs has taken place with the steering group conducting the needs assessment for children and young people. Alcohol use In order to explore alcohol use in Swindon it is useful to define the different levels and types of drinking, as they can have varying impacts on the individuals concerned and those around them. All types of alcohol use will be explored in this needs assessment, though the focus is on preventing drinking that causes harm to oneself and others. In line with the definitions developed by the Alcohol Needs Assessment Research Project (2005)3 and used in Safe Sensible and Social: The Next Steps in the National Alcohol Strategy (2007)4, drinking can be defined as follows: Sensible drinking: drinking in a way that is unlikely to cause harm to one-self or others. Hazardous drinking: drinking above recognised „sensible‟ levels but not yet experiencing harm. Harmful drinking: drinking above „sensible‟ levels and experiencing harm to one-self and potentially harm to others. Binge drinking: drinking over twice the daily guidelines in one day (8 units + for men and 6 units + for women) on at least one occasion in the last week. In this report, this level of drinking is also referred to as heavy drinking.
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