Alcohol in the East Midlands

August 2017

1 Alcohol in the East Midlands

About Public Health England

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Prepared by: Stephen Spreadborough, Public Health Analyst, Natalie Cantillon, Principal Public Health Intelligence Analyst, Tracy Carr, Health and Wellbeing Manager, PHE East Midlands

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Alcohol in the East Midlands

Foreword

Many of us enjoy alcohol, and there’s nothing wrong with that. However, alcohol is a powerful drug that kills someone nearly every hour in the UK, the vast majority of them men.

In the East Midlands, 1 in 4 adults drink over the recommended units of alcohol per week and 1 in 6 binge drink. We also have significantly higher rates of admission for alcohol related conditions when compared to England. There are higher rates of admission in the more deprived areas in the East Midlands. We know that, because of its effects on the wider determinants of health, tackling alcohol-related harm is an important route to reducing health inequalities in general.

Alcohol is a depressant which in low doses causes euphoria, reduced anxiety, and sociability and in higher doses causes intoxication (drunkenness), stupor and unconsciousness. Long-term use can lead to alcohol abuse, physical dependence, and alcoholism as well as:

 accidents and injuries requiring hospital treatment  violent behaviour and being a victim of violence  unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs)  loss of personal possessions, such as wallets, keys or mobile phones  alcohol poisoning – this may lead to vomiting, seizures (fits) and falling unconscious

What we need for the East Midlands is a broad range of alcohol policies and interventions, including treatment for harmful and dependent drinkers, as part of collective action to keep alcohol high on the public health agenda. Local authorities will need to continue, and strengthen, their work with the NHS, police, schools, businesses and local communities to understand local needs, agree local priorities and take determined action to tackle these problems.

This report reviews the level of harm related to alcohol use across the East Midlands. It explores inequalties in health outcomes linked to alcohol. The report includes a series of recommendations that will support the alcohol agenda for the East Midlands and lead to improved health outcomes.

Ann Crawford Deputy Director Health and Wellbeing Public Health England East Midlands

Alcohol in the East Midlands

Contents

Alcohol in the East Midlands 1 About Public Health England East Midlands 2

Foreword 3 Key findings 5 Place 5

Recommendations 6 Background 8 Overview of alcohol in the East Midlands 11

Local Alcohol Profiles 14 Reasons for admission 17 Inequalities 19

Treatment 27 Bibliography 28

Alcohol in the East Midlands

Key findings

 1 in 4 adults in the East Midlands drink over the recommended units of alcohol per week and 1 in 6 binge drink  The East Midlands has significantly higher rates of admission for alcohol-related conditions (narrow definition) when compared to England for both males and females  1,562 adults died from alcohol-specific conditions in the East Midlands in 2013 to 2015 and an additional 2,146 from alcohol-related conditions  In 2015/16 there were 686 hospital admissions per 100,000 population where an alcohol-related disease, injury or condition was the primary reason for admission or there was an alcohol-related external cause. This equates to 31,280 admissions and was significantly higher than England (647 per 100,000)  Alcohol-related mortality is twice as high in males than females (68.2 per 100,000 in males and 30.6 in females)  There are inequalities in terms of deprivation in the East Midlands with the higher rates of admission in the more deprived areas. For alcohol-specific conditions the rate of admission within the most deprived quintile in the East Midlands is almost 3.5 times greater than the least deprived quintile  There are specific areas of concern around Nottingham City, which is significantly worse than England for a number of health outcomes relating to alcohol. There are also poorer health outcomes in the city areas of Derby and Leicester

Place

There are specific areas of concern around Nottingham city, which is significantly higher than England for:

 Alcohol-specific mortality  Years of life lost due to alcohol-related conditions  Mortality from chronic liver disease  Admission episodes for alcohol-specific conditions and alcohol-related conditions  Admissions for alcohol-related unintentional injuries  Admissions for intentional self-poisoning by exposure to alcohol  Admissions for mental and behavioural disorders due to the use of alcohol  Admissions for alcohol-related cardiovascular disease conditions  Admissions for alcoholic liver disease  Claimants of benefits due to alcoholism

The city areas of Derby, Nottingham and Leicester show a high number of significantly worse outcomes linked to alcohol when compared to England, however when we compare to statistical neighbours, Derbyshire compares less favourably. 5

Alcohol in the East Midlands

Recommendations

It is recommended that:

PHE East Midlands supports the local system to raise awareness and support the use of tools that and evidence have been developed to improve health outcomes linked to alcohol by:

 continuing to promote and support the use of the Alcohol CleAR toolkit. The centre will focus initially on Lincoln, Nottingham and Northampton as pilot areas.  supporting and promote the use of the Recovery Diagnostic Tool (RDT). The centre will focus on Nottingham and Nottinghamshire as pilot areas.  working with local partners to disseminate and promote the use of the alcohol evidence review  working with local partners to support understanding and implementation of the interventions included in the Strategic Transformation Plan (STP) menu of preventative interventions. This includes initiatives such as “Identification and Brief Advice (IBA)” for alcohol.  supporting the local application of national marketing campaigns in the East Midlands. This includes promoting initiatives such as the OneYou campaign.  Will developing the SHAPE tool to incorporate local alcohol data and data on licenced premises to provide a more comprehensive view of local alcohol issues

PHE East Midlands will support the local system to share learning and disseminate good practice by:

 Sharing best practice across the East Midlands and with other centres and partners  Providing support for local authority public health teams to raise the profile of alcohol with elected members  Development of the East Midlands liver health network

PHE East Midlands will support the local system with a number of specific local projects relating to alcohol. The centre will:

 deliver Making Every Contact Count (MECC) and Identification and Brief Advice (IBA) presentations with the wider workforce, for example with dental health trainees.  support the local area action area in Nottinghamshire which has been designated as a phase 2 LAAA2 area

Alcohol in the East Midlands

 support local authorities in the development of service specifications for alcohol – for example the review of service specifications across Leicester, Leicestershire and Rutland  promote cross agency “blue light” projects and schemes and share learning across the schemes atht are in place in Lincoln, Nottingham and Northampton  Support the development a survey on alcohol consumption in Nottinghamshire and Lincoln

PHE East Midlands targets additional support at the areas of greatest risk with respect to alcohol by:

 Targeting activity with Nottingham to highlight the population needs in this area as this is the local authority with the greatest level of need  Working with system partners to support the prevention messages in the STP’s i.e. coordinate/fund MECC and IBA training.  Developing a programme of targeted work with other stakeholders, for example Police and Crime Commissioners (PCC) to raise awareness and protect investment in this agenda

Alcohol in the East Midlands

Background

The effects of harmful drinking on individuals, their families and communities are wide- ranging and require a response at a national and local level (1).

It is estimated that 10.8 million adults in England are drinking at levels that pose some risk to their health and 1.6 million adults may have some form of alcohol dependence. (1). The costs of alcohol to society are estimated at £21 billion – with £11 billion for alcohol-related crime, £7 billion for lost productivity through unemployment and sickness and £3.5 billion cost to the NHS (1).

In 2016, the Chief Medical Officer (CMO) published new alcohol guidelines that state drinking any level of alcohol regularly carries a health risk for everyone. Men and women should limit their intake to no more than 14 units a week to keep the risk of illness like cancer and liver disease low (2).

In 2012, the CMOs annual report dedicated a chapter to liver disease as the only major cause of mortality for which premature mortality was increasing in England while the average for the EU15 (the 15 European Union member states between 1 January 1995 and 30 April 2004) was decreasing. From 2001 to 2012, the majority of premature mortality from liver disease in England and Wales was due to alcoholic liver disease (67%), through non-alcoholic fibrosis and cirrhosis of the liver (20%) and non-alcoholic fatty liver disease (4%) also made substantial contributions (4).

Alcohol-related factors are found across all 4 domains of the Public Health Outcomes Framework (PHOF), table 1, for England and can contribute to the following outcomes (1):  Hospital-related admissions  Child poverty  Employment for those with a long term health condition  Social isolation  Falls and injuries in those over 65  Self-harm  Treatment completion for tuberculosis  Premature mortality from liver disease  Cardiovascular disease  Cancer

Alcohol in the East Midlands

Table 1: PHOF domains and alcohol related outcomes

Wider Health Health Healthcare determinants improvement protection and of health premature mortality Hospital-related admissions  Child poverty  Employment for those with a long term health condition  Social isolation  Falls and injuries in those over 65  Self-harm  Treatment completion for tuberculosis  Premature mortality from liver disease  Cardiovascular disease cancer 

Further to this, there is growing awareness of the considerable overlap of populations that experience severe and multiple disadvantages such as: alcohol and drug misuse, homelessness, poor mental health and offending behaviours. The average age of death of a homeless person is 47 years old and even lower for homeless women at just 43. This is compared to 77 for the general population. Alcohol and drug abuse are particularly common causes of death among the homeless population, accounting for just over a third of all deaths (1).

A recent study in England found that the quality of life reported by people with these experiences was much worse than that reported by many other people on low incomes and vulnerable people, especially regarding their mental health and sense of social isolation (1). Tackling alcohol-related harm is an important route to reducing health inequalities in general.

Nationally, there are approximately 10 million people drinking at levels which increase their risk of health harm. Among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill health, early mortality and disability and the fifth leading risk factor for ill health across all age groups.

Alcohol is now more affordable and people are drinking more than they did in the past. Between 1980 and 2008, there was a 42% increase in the sale of alcohol. Despite recent declines in sales, there is still a substantial burden of ill health associated with alcohol, with over 1 million hospital admissions relating to alcohol annually.

As well as harm to individuals, alcohol causes harm to others. Alcohol is cited as a significant factor in domestic violence and was a component in almost 18% of the assessments of children in need undertaken by children’s social care in England during

Alcohol in the East Midlands

2014 to 2015. In 2015, 47% of the victims of violent crime perceived their perpetrators to be under the influence of alcohol.

Alcohol-related harm falls disproportionately on the poorest in society. The most deprived fifth of the population suffer:

 2 to 3 times greater loss of life attributable to alcohol  3 to 5 times greater mortality due to alcohol-specific causes  2 to 5 times more admissions to hospital because of alcohol

The economic burden of health, social and economic alcohol-related harm is substantial, with estimates placing the annual cost to be between 1.3% and 2.7% of annual GDP (Gross Domestic Product). Alcohol-related deaths affect predominantly young and middle aged people; as a result alcohol is a leading cause of years of working life lost in England.

The purpose of this report is to review the available data around alcohol across the East Midlands for the Public Health England East Midlands Centre and constituent Local Authorities. Alcohol has been identified through a review of the indicators within the PHOF as an area where the health outcomes across the East Midlands have a number of challenges. This report has been tailored to focus on those identified challenges.

Alcohol in the East Midlands

Overview of alcohol in the East Midlands

In 2011 to 2014, 25% of adults in the East Midlands reported drinking over 14 units of alcohol per week and 16% of adults reported binge drinking on their heaviest drinking day in the past week (3). This equates to almost 1 million adults (905,878) in the East Midlands drinking over recommended levels and over half a million binge drinking (579,762). This varies by area within the East Midlands, figures 1 and 2.

1 in 4 adults in the East Midlands drink over the recommended safe weekly drinking level

1 in 6 adults in the East Midlands binge drink

Figure 1. Percentage of adults drinking Figure 2. Percentage of adults binge over 14 units of alcohol a week (2011-14) drinking on heaviest drinking day (2011-14)

Rutland Rutland Leicester Leicester Lincolnshire Lincolnshire Derby Derbyshire Nottingham Nottinghamshire East Midlands region East Midlands region England England Nottinghamshire Derby Derbyshire Northamptonshire Northamptonshire Nottingham Leicestershire Leicestershire

0% 10% 20% 30% 40% 0% 5% 10% 15% 20% 25%

Data source: Local Alcohol Profiles for England

11 Alcohol in the East Midlands

It is estimated that, in 2014, 1% of the adult population in the East Midlands were alcohol dependent, equating to 48,297 adults. This estimate varied across the areas in the East Midlands, figure 3.

In 2015 to 2016 there were 686 hospital admissions per 100,000 population where an alcohol- related disease, injury or condition was the primary reason for admission or there was an alcohol-related external cause. This equates to 31,280 admissions, which was significantly higher than England (647 per 100,000). The East Midlands also has significantly worse outcomes than England on a number of the alcohol-related PHOF indicators, figure 4.

1,440 adults died from alcohol-specific conditions in the East Midlands in 2013 to 2015 and 2,146 from alcohol-related conditions in 2015.

The peer benchmarking tool flags alcohol as an area for concern for the East Midlands with admission episodes for alcohol-related harm (narrow) and successful completion of alcohol treatment both significantly worse than England and getting worse. The PHE East Midlands business plan for 2017 to 2018 also emphasises its aims to:

 reduce the harmful impacts of alcohol  reduce alcohol-related hospital admissions  promote and share evidence, best practice, products and tools with a focus on priority partnerships  improve successful completions of treatment

This report will focus on areas of concern within the East Midlands which have been highlighted by the peer benchmarking tool, the PHOF and the Local Alcohol Profiles.

Figure 3. Estimated percentage of alcohol dependent adults, 2014

Data source: Estimates of Alcohol Dependence in England based on APMS, 2014 (5)

Alcohol in the East Midlands

Figure 4. Alcohol-related factors in Public Health Outcomes Framework compared to England

13 Alcohol in the East Midlands

Local Alcohol Profiles

The Local Alcohol Profiles for England (LAPE) have been developed by Public Health England to provide information for local government, health organisations, commissioners and other agencies to monitor the impact of alcohol on local communities and to monitor the services and initiatives that have been put in place to prevent and reduce the harmful impact of alcohol. (3)

LAPE shows us that the East Midlands is significantly worse when compared to England for:

 admission episodes for alcohol-related conditions (narrow) for males, females and persons  admission episodes for alcohol-related unintentional injuries (narrow) females and persons  admission episodes for mental and behavioural disorders due to alcohol (narrow) males and persons  hospital admission rate due to liver disease, males, females and persons (liver profiles)  alcohol-related road traffic accidents  successful completion of treatment for alcohol  volume of pure alcohol sold through the off-trade: beer  percentage of adults who abstain from drinking alcohol

Definitions

Alcohol -Attributable Fraction: Estimates of the number of alcohol-related hospital admissions have been calculated by applying alcohol-attributable fractions (AAFs) to Hospital Episode Statistics data. AAFs are the proportion of a health condition or external cause that is attributable to the exposure of alcohol in a given population. The total alcohol-related admission rates for an area is the sum of the AAFs from all patient episodes.

Alcohol -specific conditions: Alcohol-specific conditions include those conditions where alcohol is causally implicated in all cases of the condition; for example, alcohol-induced behavioural disorders and alcohol-related liver cirrhosis. The alcohol-attributable fraction is 1.0 because all cases (100%) are caused by alcohol.

Alcohol -related conditions: Alcohol-related conditions include all alcohol-specific conditions, plus partially attributable conditions where alcohol is causally implicated in some but not all cases of the outcome, for example hypertensive diseases, various cancers and falls. Partially attributable conditions include acute conditions, such as intentional and unintentional injuries, and chronic conditions, such as cardiovascular disease and malignant neoplasms. Alcohol- related conditions are further broken down into “Narrow” and “Broad” definitions:  Narrow : Indicators using the narrow definition include hospital admissions where an alcohol -related disease, injury or condition was the primary reason for a hospital admission or an alcohol-related external cause was recorded in a secondary diagnosis field.  Broad: Indicators using the broad definition include hospital admissions where an alcohol-related disease, injury or condition14 is recorded as a secondary diagnosis as well as including patients where it was the primary reasons for hospital admission.

Alcohol in the East Midlands

Figure 5 shows that when compared to England our city areas of Nottingham, Leicester and Derby have more ‘red’ indicators which are significantly worse than England, however when we compare each local authority against their CIPFA nearest neighbours Leicester and Derby improve and Derbyshire compares less favourably to its statistical peers.

Derbyshire has significantly higher rates of admission episodes for alcohol-related conditions (narrow) admission episodes for alcohol-specific conditions in the under 18s and alcohol-related mortality.

LAPE also shows that the city areas of the East Midlands are often significantly worse than England for many indictors and the counties and more rural areas are significantly better than England. This shows inequalities within the region but may also mask pockets of our population where there may be areas for concern (Figure 7).

Figure 5. Number of LAPE indicators that are better, worse or not significantly different than the average for each benchmark

Figure 6. Percentage of LAPE indicators that are better, worse or not significantly different than the average for each benchmark by indicator domain

Alcohol in the East Midlands

Figure 7. LAPE outcome indicators by area compared to England

16 Alcohol in the East Midlands

Reasons for admission

The East Midlands has a significantly higher rate of admission for alcohol-related conditions when compared to England under the narrow definition. The narrow definition can be further broken down into partially attributable conditions, including chronic and acute conditions, and alcohol-specific conditions such as alcoholic liver disease and intentional self-poisoning by exposure to alcohol.

Compared to England, the East Midlands has significantly higher rates of hospital admissions from wholly alcohol-attributable conditions and partially attributable chronic conditions, and comparable admission rates from partially attributable acute conditions.

Of alcohol-related conditions with a narrow definition, partially attributable chronic conditions are the leading causes of hospital admissions in the East Midlands, with a rate of 319 per 100,000, resulting in 14,464 admissions in 2015 to 2016.

Figure 8 shows how the East Midlands compares to England breaking down the conditions into alcohol-specific and partially attributable conditions. The East Midlands is significantly higher than England for cancer (within the partially attributable chronic conditions). Specifically, the East Midlands have significantly higher rates of hospital admissions from alcohol-related breast cancer, colorectal cancer, oesophagus cancer and lip, oral cavity and pharynx cancer than England.

There are some significant differences across the country in the coding of cancer patients in the Hospital Episode Statistics, with some areas incorrectly recording regular attenders of chemotherapy and radiotherapy as admissions. Analysis suggests that, although most Local Authorities comparison with the England average would remain the same, the ranking of Local Authorities would be altered (6).

Within the alcohol-specific conditions the East Midlands is significantly higher than England for admissions due to mental and behavioural disorders and alcoholic liver disease. Liver disease is one of the leading causes of death in England and people are dying from it at younger ages. Alcohol accounts for over a third of all cases of liver disease. Most liver disease is preventable. Liver disease has more than doubled since 1980 and is the only major killer disease on the increase during that period in the UK. The CMO has highlighted liver disease as a major issue (1).

Figure 9 shows the top 3 alcohol-specific conditions broken down by local authority in the East Midlands; it highlights the differences between the city areas and counties. Most areas have significantly higher rates of admission due to mental and behavioural disorders but Nottingham also has a significantly higher rate of admission due to alcoholic liver disease when compared to England and the East Midlands.

17 Alcohol in the East Midlands

Figure 8. Rates of Hospital Admissions from alcohol-related conditions (Narrow) 2015/16 England East Midlands

Malignant neoplasm

Cardiovascular disease

Respiratory infections

Partially attributable Chronic - Partially Mental and behavioural disorders

Intentional self-poisoning

Wholly attributable Wholly Alcoholic liver disease

0 50 100 150 200 Directly standardised rate per 100,000

Data source: Hospital Episode Statistics

Figure 9. Rates of Hospital Admissions from alcohol-specific conditions (Narrow) 2015/16 by area

Mental & behavioural disorders Intentional self-poisoning Alcoholic liver disease

Lincolnshire

Rutland

Northamptonshire

Leicestershire

Nottinghamshire

England

East Midlands

Derbyshire

Leicester

Nottingham

Derby

0 50 100 150 200 250 Directly standardised rates per 100,000

Data source: Hospital Episode Statistics

Alcohol in the East Midlands

Inequalities

Variation in alcohol outcomes by sex

In England, alcohol dependence is more common in men (6%) than in women (2%). This gender difference is found to be the case all over the world and is one of only a few key gender differences in social behaviour (1).

For the East Midlands:

 alcohol-related mortality per 100,000 is twice as high in males, 68.2, than females, 30.6  males have a significantly higher rate of years of life lost to alcohol-related conditions.  males have significantly higher rates for alcohol-specific conditions and alcohol- related conditions for both narrow and broad definitions  hospital admission rates are higher for males than females on all indicators other than admissions for under 18 year olds and admissions for intentional self- poisoning by exposure to alcohol, figure 10

The inequality between the genders also increases in city councils compared to the counties, with Nottingham showing the highest admission rates for alcohol-related conditions for males and females and also the largest gap between them, figure 11.

Alcohol in the East Midlands

Figure 10. LAPE outcome indicators by gender, East Midlands

20 Alcohol in the East Midlands

Figure 11. Rates of Hospital Admissions from alcohol-related conditions (Narrow) 2015/16 by gender

Data source: Hospital Episode Statistics

21 Alcohol in the East Midlands

Variation in alcohol outcomes by age

The LAPE indicates significantly higher admission rates for alcohol-related conditions in the East Midlands for under 40 year olds, 40 to 64 year olds and over 65 year olds compared to England. Rates of hospital admissions from alcohol-specific and alcohol- related conditions varies by age, with alcohol-related admissions increasing until 65 to 69 years old and remaining high, figure 12.

Figure 12. Rates of hospital admissions from alcohol-specific and related conditions by age, 2015 to 2016 6,000

5,000

4,000

3,000

2,000 Cruderate per 100,000

1,000

45-49 75-79 15-19 25-29 35-39 55-59 65-69 75-79 85-89 15-19 25-29 35-39 45-49 55-59 65-69 75-79 85-89 15-19 25-29 35-39 45-49 55-59 65-69 85-89 Alcohol Specific Conditions Alcohol-Related Conditions (Narrow Alcohol-Related Conditions (Broad definition) definition) Age and indicator England East Midlands Data source: Hospital Episode Statistics

For alcohol-specific admissions there is a peak in the middle ages, for alcohol-related conditions (narrow definition) there is an increase in the older age groups with the East Midlands having a higher rate than England for this indicator. For alcohol-related admissions (broad definition) there is a significant increase into the older age groups as conditions such as hypertension, cardiovascular disease and cancer become more common.

Variation in alcohol outcomes by socio-economic deprivation

The impact of harmful drinking and alcohol dependence is much greater for those in the lowest income bracket and those experiencing the highest levels of deprivation (1). The reasons for this are not fully understood. People on a low income do not tend to consume more alcohol than people from higher socio-economic groups. The increased risk is likely to relate to the effects of other issues affecting people in lower socio-

Alcohol in the East Midlands

economic groups. Alcohol-related deaths for the most deprived decile were 53% higher than the least deprived in 2013.

For the East Midlands hospital admissions for alcohol-related conditions using the narrow definition are 888.2 per 100,000 for the 20% most deprived areas in the East Midlands, 1.7 times higher than the 20% least deprived and 1.3 times higher than there overall admission rates. The largest health inequality is from alcohol-specific conditions, with the rates of the most deprived in the East Midlands, 328 per 100,000, almost 3 and a half times higher than the least deprived, figure 13.

Admissions for alcohol-specific conditions (narrow definition) are significantly higher in the most deprived quintile of the East Midlands compared to the least deprived, this is particularly stark in the middle ages groups from 35 to 60 years old (figure 14).

Figure 13. Rates of alcohol-related hospital admissions by deprivation quintile (Narrow) 2015 to 2016

Partially attributable conditions - Partially attributable Alcohol-Specific Acute conditions conditions - Chronic Conditions conditions

Least deprived quintile

Most deprived quintile 0 100 200 300 400 0 100 200 300 400 0 100 200 300 400

Directly standardised rates per 100,000

Data source: Hospital Episode Statistics

Alcohol in the East Midlands

Figure 14. Rates of Hospital Admissions from alcohol-specific conditions (Narrow) 2015/16 by deprivation and age

Data source: Hospital Episode Statistics

Variation in alcohol outcomes between counties and cities

Where the East Midlands is comparable to England on all of the 4 mortality indicators in the LAPE, the variability in mortality outcomes for the city councils in the East Midlands is a concern, figure 5. Nottingham, Derby and Leicester all have significantly higher rates of alcohol-specific mortality and mortality from chronic liver disease, with Nottingham having the 4th highest rate of alcohol-related mortality in the country. Compared to England, the city councils also have significantly higher rates of alcohol- related and specific hospital admissions whereas the more rural counties have lower rates. The rates of alcohol-related hospital admissions varies across the region, with increased numbers associated with built up areas, figure 15, and variations in trends over time, figure 16.

Alcohol in the East Midlands

Figure 15. Alcohol-related hospital admissions per 100,000 population (narrow definition) by Lower Super Output Area, 2015/16 Regional quintiles.

25 Alcohol in the East Midlands

Figure 16. Alcohol-related hospital admissions per 100,000 population (narrow definition) by area and time period

1,100

1,000

900

800

700

600

500

400 Directly Directly standardised rates per 100,000

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Data source: Hospital Episode Statistics

However, these 3 local authorities are comparable to the majority of their closest neighbours on mortality and hospital admission rates, suggesting national variation between city and county councils. This variation is likely to result from health inequalities, with these 3 local authorities having the highest levels of deprivation in the East Midlands. The gap in hospital admission rates between the most and least deprived also widens in these areas compared to England.

When comparing against closest neighbours, Derbyshire has significantly higher rates of hospital admissions for alcohol-specific and alcohol-related conditions compared to the majority of its closest neighbours, as well as significantly higher rates for alcohol- related conditions, narrow definition, than England (3).

There is variation between the cities in terms of availability and consumption. Nottingham has similar average sales of alcohol per outlet to England, but Derby has significantly higher average sales. Where Leicestershire has significantly lower hospital admissions than England, it is the only county to be significantly worse than England on all measures of consumption, with significantly higher percentage of adult’s binge drinking on their heaviest drinking day and drinking over 14 units of alcohol a week. In comparison, Derby, Leicester and Nottingham are comparable to England on these measures of consumption.

26 Alcohol in the East Midlands

Night time economy

Nottingham has the highest rates of alcohol-related hospital admissions; however, only around 3% of emergency admissions relating to alcohol are people living outside of the East Midlands. Whilst a large proportion of emergency admissions are from Nottinghamshire, Derby and Derbyshire, around 50%, these patients will be included in rates for their residential local authority, and will therefore not contribute to the increased admissions rates in Nottingham on these indicators.

The percentage of admissions from outside Nottingham does increase in 20 to 30 age groups over weekends (as does the overall rate of admissions from Nottingham residents) but the small proportion overall suggests that the larger issue for Nottingham City and it’s hospitals are the residents rather than the visitors.

Treatment

Individuals successfully completing treatment for alcohol demonstrate a significant improvement in health and well-being in terms of increased longevity, reduced alcohol- related illnesses and hospital admissions, improved parenting skills and improved psychological health. It will also reduce the harms to others caused by dependent drinking (3).

Alongside this, it aligns with the ambition of both public health and the Government's strategy of increasing the number of individuals recovering from addiction. It also aligns well with the reducing re-offending outcome, as some offending behaviour is closely linked to dependent alcohol use, and other alcohol-related factors found across all 4 of the domains in the PHOF (3).

Leicestershire has the highest proportion of alcohol users leaving treatment successfully in the East Midlands, 47.5% compared to 35.4% for the region as a whole. However there is a great deal of variation with only 28.5% of users successfully completing treatment in Derby city, figure 17.

Alcohol in the East Midlands

Figure 17. Percentage of alcohol users leaving drug treatment successfully, by area 2015

Data source: Local Alcohol Profiles for England

Bibliography ibliography 1. Public Health England. Public Health England. Health matters: harmful drinking and alcohol dependence. [Online] 21 January 2016. [Cited: 2 August 2017.] https://www.gov.uk/government/publications/health-matters-harmful-drinking-and-alcohol- dependence/health-matters-harmful-drinking-and-alcohol-dependence. 2. Department of Health. UK Chief Medical Officers’ Low Risk Drinking Guidelines. 2016. 3. Public Health England. Fingertips. Local Alcohol Profiles for England. [Online] August 2017. [Cited: 4 August 2017.] https://fingertips.phe.org.uk/profile/local-alcohol-profiles. 4. Department of Health. Annual Report of the Chief Medical Officer. [Online] 2012. [Cited 2 August 2017.] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/298297/cmo- report-2012.pdf 5. The University of Sheffield. Estimates of Alcohol Dependence in England based on APMS 2014, including Estimates in Children living in a Household with an Adult with Alcohol Dependence. http://www.nta.nhs.uk/uploads/estimates-of-alchohol-dependency-in- england%5b0%5d.pdf [Cited: 17 August 2017] 6. Public Health England. Local Alcohol Profiles for England 2017 user guide. [Online] March 2017. [Cited: 10 August 2017] https://fingertips.phe.org.uk/documents/LAPE%202017%20User%20Guide_01.03.17.pdf

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Available tools

Public Health Outcomes http://www.phoutcomes.info/ Framework

Local Alcohol Profiles for https://fingertips.phe.org.uk/profile/local-alcohol-profiles England (LAPE)

Liver Profiles https://fingertips.phe.org.uk/profile/liver-disease

Longer Lives https://healthierlives.phe.org.uk/topic/mortality

ROI tool https://www.nice.org.uk/about/what-we-do/into- practice/return-on-investment-tools/alcohol-return-on- investment-tool

Alcohol licensing and public https://www.gov.uk/government/collections/alcohol- health licensing-and-public-health

Atlas of Variation Healthcare http://fingertips.phe.org.uk/profile/atlas-of-variation for people with Liver Disease

Alcohol in the East Midlands

Appendix

30 Alcohol in the East Midlands

Alcohol in the East Midlands