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Alcohol continues to be detrimental to the health of people in Milton Keynes. More than 25% of our population aged 16 and over drink above the recommended guidelines. It is estimated that 37,000 people drink at a level of increased risk, 9,000 at a level of high risk and 40,000 binge drink (see table 1 for definitions). There are significant health and social harms caused by drinking alcohol excessively. The effects of alcohol are different for each person, and for men and women. The level, the frequency and the length of time an individual has been drinking alcohol all make a difference to their level of risk for individual diseases such as liver disease, cancer, stroke, mental ill- health, heart disease and sexually transmitted diseases. 11 Alcohol Key Points • Drinking alcohol above the recommended guidelines directly impacts on health; people are at increased risk of liver disease, cancer, stroke and heart disease. In addition, alcohol is involved in a wide range of other social and health issues; risky behaviours such as sexually transmitted infections; domestic violence; suicide and deliberate self-harm; child abuse and child neglect; mental health problems; unwanted pregnancies and homelessness. • The general perception of alcohol problems are that they are associated with alcohol dependency and binge drinking. The biggest challenge for the NHS continues to be effective communication about the serious health impacts of regularly drinking above the recommended guidelines, a level of drinking which is usually socially acceptable. • The reported rate of alcohol-related hospital admissions has risen from 1,375 to 1,837 per 100,000 population. This is similar to national trends and continues to represent a significant challenge to public health. Risk Men Women Lower Risk (within recommended limits) No more than 3 to 4 units per day on a regular basis No more than 2 to 3 units per day on a regular basis Increasing Risk Four or more units per day on a regular basis Three or more units per day on a regular basis Higher Risk More than 50 units per week More than 35 units per week Binge drinking Eight units or more in one episode Six units or more in one episode Generally understood to be drinking to get drunk Table 1 Risk ratings related to units of alcohol 78

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Alcohol continues to be detrimental to the health of people in Milton Keynes. More than 25% of our population aged 16 and over drink above the recommended guidelines. It is estimated that 37,000 people drink at a level of increased risk, 9,000 at a level of high risk and 40,000 binge drink (see table 1 for definitions). There are significant health and social harms caused by drinking alcohol excessively. The effects of alcohol are different for each person, and for men and women. The level, the frequency and the length of time an individual has been drinking alcohol all make a difference to their level of risk for individual diseases such as liver disease, cancer, stroke, mental ill-health, heart disease and sexually transmitted diseases.

11 AlcoholKey Points

• Drinking alcohol above the recommended guidelines directly impacts on health; people are at increased risk of liver disease, cancer, stroke and heart disease. In addition, alcohol is involved in a wide range of other social and health issues; risky behaviours such as sexually transmitted infections; domestic violence; suicide and deliberate self-harm; child abuse and child neglect; mental health problems; unwanted pregnancies and homelessness.

• The general perception of alcohol problems are that they are associated with alcohol dependency and binge drinking. The biggest challenge for the NHS continues to be effective communication about the serious health impacts of regularly drinking above the recommended guidelines, a level of drinking which is usually socially acceptable.

• The reported rate of alcohol-related hospital admissions has risen from 1,375 to 1,837 per 100,000 population. This is similar to national trends and continues to represent a significant challenge to public health.

Risk Men Women

Lower Risk (within recommended limits)

No more than 3 to 4 units per day on a regular basis

No more than 2 to 3 unitsper day on a regular basis

Increasing Risk Four or more units per day on a regular basis

Three or more units per day on a regular basis

Higher Risk More than 50 units per week

More than 35 units per week

Binge drinking Eight units or more in one episode

Six units or more in one episode

Generally understood to be drinking to get drunk

Table 1 Risk ratings related to units of alcohol

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Milton Keynes has one of the highest rates of alcohol-related hospital admissions in the South East region (figure 1) at 1,837 for every 100,000 people.

11

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ol“There are

significant health and

social harms caused by

drinking alcohol excessively”

Rate of hospital admissions for alcohol-related conditions, South East region, 2009-10 Hospital admissions rate for alcohol-related

conditions per 100,000 persons, 2009-10

1,623.0 to 1,993.4 (worst quintile) 1,371.5 to 1,622.9 1,253.1 to 1,371.4 1,135.3 to 1,253.0 849.5 to 1,135.2 (best quintile)

England rate: 1,742.8South East England rate: 1,335.1Worst rate in South East: Portsmouth (1,993.4)Best rate in South East: Isle of Wight (849.5)

Figure 1

London

East of England

Milton Keynes

Aylesbury ValeCherwell

West Oxfordshire

Vale of White Horse

Oxford

South Oxfordshire Wycombe

Chiltern

West Berkshire

Bassingstoke & Deane

Test Valley

New Forest

Isle of Wight

Winchester

East Hampshire

HartRushmoor

Eastleigh

Southampton

FarehamPortsmouth

Gosport

Havant

Chichester

Waverley

Guildford

Surrey Heath

Woking

Runnymede

Spetthorne

Elmbridge

Mole Valley

Epson & Ewell

Reigate & Banstead

Crawley

Horsham

Tandridge

Mid Sussex

Sevenoaks

ArunWorthing

Adur Brighton & Hove

Lewes

Wealden

Eastbourne

Dartford

Tonbridge & Malling

Gravesham

Medway

Swale

Maidstone

Tunbridge Wells

Rother

Hastings

Ashford

Caterbury

Thanet

Dover

Shepway

Reading

Wokingham

Bracknell Forest

Windsor & Maidenhead

South Bucks

Slough

East MidlandsWest Midlands

South West

Source: NWPHO. Local Alcohol Profiles for England. (www.nwph.net/alcohol/lape)

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l Additionally, figure 2 shows that there is a significant increasing trend in alcohol-related hospital admissions in Milton Keynes which is in line with national projections for England.

Alcohol-related harm

Alcohol increases people’s risk of ill-health, it also impacts on a wide range of social issues such as domestic violence, family breakdown, child neglect, mental health problems, unwanted pregnancies and homelessness.

The North West Public Health Observatory produces profiles of each Primary Care Trust (PCT) and provides comparisons

Alcohol Related Admissions with projected trend 2002/3-2010/11Figure 22000

1500

1000

500

0

DA

SR p

er 1

00,0

00

2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9 2009-10 2010-11

Year

England Actual Milton Keynes Actual England Projected Linear (England)

N.B. A local problem with data submission is the cause of the low Milton Keynes value in 2006/7Source: https://www.hub.info4local.gov.uk/DIHWEB/Logon/default.aspx

Profile of Alcohol-related harm in Milton KeynesFigure 3Compared to England average:

Significantly better Not significant

Significantly worse Not calculated

Months of life lost - males

Months of life lost - females

Alcohol -specific mortality - male

Alcohol -specific mortality - female

Mortality from chronic liver disease - males

Mortality from chronic liver disease - females

Alcohol-attributable mortality - males

Alcohol-attributable mortality - females

Alcohol-specific hospital admission - under 18s

Alcohol-specific hospital admission - males

Alcohol-specific hospital admission - females

Alcohol-attributable hospital admission - males

Alcohol-attributable hospital admission - females

Hospitals admissions for alcohol-related harm (NI 39)

Alcohol-related recorded crimes

Alcohol-related violent crimes

Alcohol-related sexual offences

Claimants of incapacity benefits - working age

Mortality from land transport accidents

Increasing risk drinking (synthetic estimate)

Higher risk drinking (synthetic estimate)

Binge drinking (synthetic estimate)

Employees in bars - % of all employees

Alcohol Treatment-Prevalence per 1,000 population

England Average

75th Percentile25th Percentile

England Best

Regional Average

England Worst

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between the PCT, the region and England using the latest available information and some estimates (described as synthetic estimates in the profile). Our region includes Buckinghamshire, Berkshire East, Berkshire West, Hampshire, Isle of Wight, Oxfordshire, Portsmouth and Southampton. Figure 3 shows Milton Keynes’ measure for each indicator identified.

Multi-agency response

Multiple agencies, including Milton Keynes Council, NHS Milton Keynes, HMP Woodhill, Thames Valley Probation, Thames Valley Police, the Community Safety Partnership (Safer MK), the Fire and Rescue Service, the National Treatment Agency and the Government Office for the South East are part of the Drug and Alcohol Strategic Group (DASG) and involved in reducing alcohol harm. As part of the work of this group throughout 2010, a new Drug and Alcohol strategy was developed.

Many people think that the alcohol problems we experience in our country and borough relate to binge drinking and alcohol dependency. A major challenge is to successfully communicate the health impacts of drinking above the recommended guidelines, which are often socially acceptable.

The following actions are currently in progress and recommendations from the 2008 drug and alcohol needs assessment continues to be implemented:

• Research is currently being undertaken with local residents to establish what mechanisms we can use to deliver the messages about socially acceptable drinking behaviours and their potential to impact on health and social wellbeing.

• In addition to offering general medical services, GP practices can also provide enhanced services. We are commissioning services called Identification and Brief Advice (IBA) for the identification of all patients registering with the GP surgery who are drinking above the recommended guidelines. They can either be offered support through the GP practice to reduce their alcohol consumption or referred to specialist alcohol services.

• During 2010, a multi-agency group and treatment service users were involved in the process of selecting new drug and alcohol service providers. The next challenge for the alcohol

“The reported rate of alcohol-related hospital admissions has risen from 1,375 to 1,837 per 100,000 population”

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l services is to ensure that IBA interventions in primary care and other settings are developed further to work in synergy with these services.

• We have piloted an IBA programme within Brook Sexual Health Services. A total of 1,318 clients were screened to assess their level of alcohol intake. Of these, 987 were identified as low risk drinkers, 265 as increasing risk drinkers, 29 as higher risk drinkers and 23 as potentially dependent drinkers requiring referral into the alcohol services. Of the 265 clients identified as at increasing risk, 60 (23%) reduced their drinking levels to low risk. Of the 29 higher risk drinkers, 10 (34%) have reduced their drinking levels to low risk drinking. This has been a very successful pilot and we will be developing these IBA services through Brook into the future.

How will we know we are making progress?

The measures of success will be determined in the following way: the number of patients receiving brief advice through GP practices; Brook Sexual Health Services; the number of patients whose drinking levels have dropped to below the recommended guidelines following extended brief advice; a reduced trend or decrease in alcohol related hospital admissions (National Indicator); and finally the reduction in violent crime in Milton Keynes.

The increase in alcohol-related hospital admissions described above is reflected nationally and clearly shows the result of many years of harmful alcohol consumption. This is a complex public health problem and we will continue to work towards reversing this trend.

“It is estimated that 37,000 people drink at a level of increased risk,

9,000 at a level of high risk and 40,000 binge drink”

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Recommendations• Monitor the new drug and alcohol service to ensure that alcohol continues to be a priority within these joint services.• Use the findings of the social marketing research to inform our communications about the health impacts of drinking above

recommended guidelines.• Continue to develop innovative approaches to IBA (identification and brief advice) services.

References

1. Substancemisuse(drugandalcohol)andservicesinMiltonKeynes:NeedsAssessment,Finalreport.August20082. DrugandAlcoholStrategy–http://www.miltonkeynes.nhs.uk/assets/_managed/editor/file/Publications_NHS_Milton_Keynes/

Drugs_and_Alcohol_Strategy.pdf

“The biggest challenge for the NHS continues to be effective communication about the serious health impacts of regularly drinking above the recommended limits”

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