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Key points for Alcohol –related Crime and Disorder in the New

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					             Strategy for Alcohol Misuse in Stockport 2008-11
1. Stockport’s Alcohol Strategy

    1.1.      The aim of this strategy is to reduce the harms that alcohol misuse causes
           to people in Stockport.

    1.2.       Alcohol misuse in Stockport represents a major challenge to the well-being
           of individuals, communities and the local economy. Public Services, the
           business community and voluntary organisations, as well as individuals, all
           have important parts to play preventing and reducing the harms caused by
           alcohol. It is clear that there are real opportunities to build on what has already
           been achieved, and by combining our efforts in partnership, we can change
           many different aspects of life for the better.

    1.3.      The Safer Stockport Partnership has the lead statutory responsibility for the
           development and implementation of this strategy. However, the impact of
           alcohol is such that the objectives are shared with other elements of the
           Stockport Partnership, especially the Health and Well-being Partnership and
           the Children and Young People’s Strategic Partnership.

    1.4.      Investing in improved prevention and treatment of alcohol misuse makes
           economic sense, as the financial benefits of tackling alcohol misuse have been
           shown to outweigh the costs.i Taking no action is likely to cost more than
           taking preventive action. Therefore, all partners are urged to identify additional
           resources to invest in the strategic priorities set out in this document.

    1.5.      Stockport’s first comprehensive partnership alcohol strategy (2005-8) was
           launched in November 2005. There have been many developments at
           national, local and regional levels since then, and this strategy sets out a
           framework for taking forward our work to address alcohol misuse and its
           consequences in the new context.

    1.6.       This paper briefly outlines the context for the new strategy, and sets out
           proposals for the key objectives and themes of the new strategy. A review of
           the achievements of the 2005-8 Stockport Alcohol Strategy and further details
           of the evidence base and context are included in the context paper attached at
           appendix 2.

2. The Current Level and Impact of Alcohol Misuse in Stockport

    2.1.      The charts below are based on the Northwest Public Health Observatory
           Local Alcohol Profiles for England (LAPE) which enables comparison of local
           regional and national indictors. The North-west suffers the highest rates of
           alcohol-related deaths, illness and incapacity and among the highest rates of
           alcohol-related crime in England. On health-related indicators, Stockport is
           better than the north-west average, but worse than the England average, while


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           alcohol-related crime and disorder are similar to, or better than, the England
           average. This is in contrast to Stockport’s general social and economic profile
           which is very much in line with the England average.


                                              Alcohol-related Mortality 2005
                                                        (NWPHO)

                                       70.0
                                              55.9          58.1
                                       60.0
                                       50.0                              47.2
                         DSR/100,000




                                       40.0                                           Male
                                                               29.3
                                       30.0       26.1                         23.8   Female

                                       20.0
                                       10.0
                                        0.0
                                              Stockport    North West    England


                                          Hospital Admissions Attributable to
                                                     Alcohol 2005

                                       1400
                                                            1215
                                       1200    1090
                                       1000                              909
                         DS/100,000




                                        800          648           674                Male
                                        600                                     510   Female

                                        400

                                        200
                                          0
                                               Stockport   North West    England



    2.2.      Local data shows that the number of A&E attendances due to alcohol
           poisoning or intoxication has more than doubled in the last five years, while
           hospital admissions due to alcohol-related conditions nearly doubled.

    2.3.       Alcohol is a major factor in maintaining the inequalities in life expectancy
           between different parts of the borough, which amounts to a 12 year gap
           between wealthiest and most deprived wards, for men in Stockport. People
           living in the most deprived ward are far more likely to suffer harm to health as a
           result of alcohol, with alcohol-related deaths among residents of Brinnington
           and Central Ward being three times the Stockport average.

    2.4.      The Stockport Lifestyle Survey (2005-6) indicated that levels of very heavy
           binge drinking (four times the recommended daily limit) were common among
           young people in all areas, but in deprived areas the pattern tends to persist in
           to middle age, whereas in most of the borough prevalence of this pattern falls
           with age.




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    2.5.       While alcohol misuse tends to be less prevalent among older people, it is
           not uncommon, and the Stockport Lifestyle Survey indicates that around 19%
           of males and 5% of females aged over 65 had drunk over twice the daily
           guidelines at least once in the previous week – figures much higher than the
           national statistics suggest. We know that alcohol misuse in older people is
           likely to be under-reported and it often goes unrecognised as a factor in health
           and social problems affecting them. It also presents particular issues for those
           supporting them.

3. Government Priorities

    3.1.     National Alcohol Strategy
        The Government published a new National Alcohol Strategy in June 2007.
        Titled, ‘Safe. Sensible. Social.’, the strategy sets out three broad aims:
        3.1.1. Tackling irresponsibly managed premises, through wide and effective
              use of new and existing laws and licensing powers, to protect young
              people and prevent crime and disorder.
        3.1.2. Sharpening the focus on the minority of drinkers who cause or
              experience the most harm to themselves, their communities and their
              families:
               18-24 year old binge drinkers, a minority of whom are responsible for
                  the majority of alcohol-related crime and disorder;
               Young people under 18 who drink alcohol;
               Harmful, adult drinkers who do not necessarily realise their drinking
                  patterns are damaging their physical and mental health and may be
                  causing substantial harm to others.
        3.1.3. Partnership working to create an environment that actively promotes
              sensible drinking.

    3.2.      The strategy estimates the cost of alcohol misuse to the national health
           economy at £1.7 billion per year. It estimates that investing £28M in
           identification and advice for hazardous and harmful drinkers could save £46M,
           and investing £66M in treatment of dependent drinkers could save £109M.

    3.3.       The new national alcohol strategy introduces a requirement for Crime and
           Disorder Reduction Partnerships to develop and implement local alcohol
           misuse strategies, as part of the rolling three-year strategies to address crime,
           disorder and substance misuse. The Safer Stockport Partnership’s annual
           Strategic Assessment, which provides the evidence and rationale for action,
           already includes alcohol-related crime and disorder, and this will be extended
           to include broader alcohol misuse issues, such as prevention and treatment.

    3.4.       Public Service Agreements
           In the spending review published in October 2007, the Government set out its
           spending plans for 2008-11, underpinned by a set of Public Service
           Agreements (PSAs), describing specific objectives and how success will be
           measured. Three of the national PSAs specifically include specific alcohol-
           related measures (see also appendix 2 p15):

         3.4.1. PSA 25: Reduce the Harm Caused by Alcohol and Drugs
              This PSA will support the new national alcohol strategy as well as the new
              drugs strategy. It aims to reduce the harms caused by drug and alcohol
              misuse to:




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                         the community as a result of associated crime, disorder and anti-
                          social behaviour
                         the health and well-being of those who use drugs or drink
                          harmfully
                         the development and well-being of young people and families

         3.4.2. PSA 14 to Increase the number of children and young people on
              the path to success.
              This PSA includes a measure of:
                     Young people frequently using drugs, alcohol or volatile
                      substances

         3.4.3. PSA 23 Make Communities Safer
              Linked to the national crime strategy, this PSA identifies s alcohol as a key
              factor in violent crime, anti-social behaviour and re-offending.

    3.5.     New Performance Framework for Local Authorities and Local
          Partnerships
         3.5.1. The Department for Communities and Local Government has published
              a list of 198 local performance indicators, which are aligned with the
              Government’s own PSA targets. Three of these specifically include
              alcohol:
               NI 39: Alcohol-harm related hospital admission rates (PSA 25).
               NI 41: Perceptions of drunk or rowdy behaviour as a problem (PSA 25)
               NI 115: Substance Misuse by Young People (PSA 14)
              Local Strategic Partnerships will negotiate local targets for upto 35 of
              these indicators, and may also agree additional targets for local priorities.

         3.5.2. In addition to these, it is clear that alcohol plays a part in many other
              issues, and a further 31 alcohol-related indicators are identified in the
              appended background document (pp 15-16).

         3.5.3. It is clear that alcohol misuse is a cross-cutting issue, and given the
              above-average levels in Stockport, one which has significant impact on
              many aspects of life in the borough. Therefore, investment in addressing
              alcohol misuse will bring benefits in terms of improved outcomes for a
              significant portion of the new National Indicators. The Stockport
              Partnership is considering potential alcohol indicators to be included in the
              new Local Area Agreement for 2008-11.

         3.5.4. Local partnerships will be expected to demonstrate how they are
              working to support the Government’s PSA objectives. The range of
              performance monitoring frameworks, such as the new national
              performance assessment framework for crime and community safety
              (APACS), the NOMS Performance Management Framework and the YJB
              Performance Framework, will all take account of these priorities in their
              assessments.

4. Proposal for a new strategy aligned with the national PSA targets

    4.1.      It is proposed that we should structure the Stockport Alcohol Misuse
           Strategy around the new National Indicators, with three themes linked to the
           key PSA indicators. These are:
              Protecting Communities



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              Health and Well-being
              Young People and Families
         The need to address health inequalities is relevant to all three themes, and will
         be a key priority for Health and Well-being and Young People and Families
         work. Each theme will be supported by a coordinated programme of
         communication and training, and the objectives within these themes are set out
         in the following paragraphs.

    4.2.      The Alcohol Reference Group (ARG) will continue to provide the strategic
           direction and coordination and drive delivery of the strategy, while more
           detailed action plans will be developed and monitored by its two sub-groups
           and by the Young People’s Substance Misuse Strategic Managers Group,
           which includes a broader remit around substance misuse. Membership of the
           group will be reviewed in the light of the new strategy, to ensure all key
           agencies are represented.

    4.3.    Protecting Communities: The ACID group
        The Alcohol-related Crime, Incidents and Disorder (ACID) Group, currently
        including Police, Licensing, Fire Service, Trading Standards, Community
        Safety, Regeneration and Public Health, will address
            PSA 25 / National Indicator 41: The percentage of the public who perceive
              drug use or dealing/ drunk and rowdy behaviour to be a problem in their
              area, and
            PSA 23 / National Indicator 14: Reduce the most serious violence,
              including tackling serious sexual offences and domestic violence
            Existing 2005-2009 Local Area Agreement Reward Targets for alcohol-
              related Crime:
                    o Number of incidents of criminal damage recorded by Police
                    o Major and minor woundings recorded by Police (excluding
                       Domestic Violence)

         4.3.1. The ACID Group already leads on work with the night-time economy
              and tackling disorder through use of enforcement powers, such as
              dispersal orders and street drinking powers, and is therefore best placed
              to lead on these aspects of the work. The group’s activities will include:
                    o Improving data collection and analysis to better identify the role
                        of alcohol in crime and disorder
                    o Policing operations to manage the night-time economy
                    o Licensing policy, partnership and enforcement, including under-
                        age sales prevention and promotion of best practice, such as
                        pub-watch schemes and training for the licensed trade
                    o Anti-social behaviour interventions, such as confiscation of
                        alcohol on the streets
                    o Drink-driving prevention and enforcement
                    o Targeted communications work, designed to change behaviour,
                        drawing on the principles of Social Marketing, and to raise
                        awareness of the successes of the Partnership.

         4.3.2. Some aspects of the work to reduce serious violence will require
              improved effectiveness in working with individuals who are perpetrators or
              victims of violence, especially in respect of domestic violence, and it is
              suggested that the Alcohol Treatment Services group is the appropriate
              forum for driving this work (see below).




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    4.4.      Health and well-being
           The Stockport Alcohol Treatment Services (SATS) Group, currently
           includes Pennine Care Substance Misuse Services, MOSAIC, PCT
           Commissioner, Adult Social Care, a GP representative, voluntary sector and
           service user representatives, Probation Service and Public Health. It will
           address:
                  PSA25 / National Indicator 39: The number of alcohol-related hospital
                    admissions
                  PSA 23/ National Indicator 14 & 32: Reduce the most serious
                    violence, including tackling serious sexual offences and domestic
                    violence

         4.4.1. This Group will drive the development of a comprehensive and effective
              tiered alcohol treatment system, compliant with the guidance and
              standards set out in Models of Care for Alcohol Misusers. This work will
              seek to address health inequalities, by focussing in particular on engaging
              the groups at highest risk of suffering health harms as a result of alcohol,
              and will include:
                    o Targeted communications work, designed to change behaviour,
                         drawing on the principles of Social Marketing and promoting
                         take-up of services.
                    o Promotion of best practice in the workplace, in relation to policies
                         on alcohol misuse and interventions to support individuals
                         affected.
                    o Introduction of alcohol screening and improving data collection in
                         hospital, primary care and criminal justice settings
                    o Delivery of brief interventions for adult hazardous drinkers as
                         part of a healthy lifestyles service
                    o Implementation of other recommendations of the review of
                         alcohol treatment services, including:
                              Improving monitoring of service demand and take up
                              Diversity monitoring, analysis and consultation, to ensure
                                 services are accessible and sensitive to the needs of all
                                 groups in the community, taking account of ethnicity, age,
                                 gender, sexual orientation, social class and physical,
                                 sensory or learning disabilities
                              Responding to findings of service user and stakeholder
                                 consultation
                              Maintaining and improving access to tier 3 and 4
                                 services, in line with needs
                              Establishing clear treatment and referral pathways
                                 between all services involved in alcohol-related work
                              Identifying options for addressing other gaps in the
                                 treatment system.
                    o Improving availability of housing and resettlement support for
                         recovering dependent drinkers
                    o Improving coordination and integration of services for individuals
                         affected by both alcohol misuse and mental health problems
                    o Improving access to alcohol treatment and support for alcohol
                         misusing offenders, and victims of domestic violence, in the
                         context of the Resettlement Strategy, Domestic Abuse Strategy
                         and Models of Care for Alcohol Misusers.
                    o Development and coordination of training for a broad range of
                         services, to support these objectives.



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    4.5.     Young people and families.
           The newly established Young People’s Substance Misuse Strategic
           Managers Group, including the MOSAIC service, Drug Action Team, Children
           and Young People’s Services, Youth Offending Team, PCT and Police, will
           address:
              PSA 14 Indicator / National Indicator 115: Reduce the proportion of
                young people frequently using illicit drugs, alcohol or volatile substances

         4.5.1. This group will be accountable to the proposed Children’s Trust Board
              via its Health Board. Its objectives will include:
                     o Using the findings of the 2007-8 Young People’s Lifestyle Survey
                        to further develop interventions to address young people’s
                        drinking and associated anti-social and/or risky behaviour.
                     o Responding to the 2007-8 Young People’s Substance Misuse
                        Needs Assessment and implementation of the Young People’s
                        Substance Misuse Treatment Plan, including:
                              Robust preventative services
                              Appropriate funding and support for Making it Back
                                (schools-based service)
                              Links to National Healthy Schools targets
                              Appropriate referrals from a wide range of services
                                including the YOT and other services working with young
                                people
                              Appropriate screening and assessment
                              Sufficient capacity within MOSAIC
                              Work with Children of Substance Misusing Parents
                     o Targeted communications work, based on social marketing
                        principles, to engage with those young people at greatest risk of
                        alcohol related harm, as well as their parents and carers.
                     o Development and coordination of training to support these
                        objectives.

5. Measuring Impact and Effectiveness of the Strategy

    5.1.      It is important that ARG is able to measure the impact of the strategy and
           other changes, beyond its direct influence, which may affect the level of harm
           caused by alcohol misuse in the borough. Therefore, the ARG and its sub-
           groups will receive regular reports on a range of indicators, in order to assess
           the impact and effectiveness of the strategy, and identify need for further
           action.

    5.2.      The ARG will use a set of key indicator measures and targets, including the
           three alcohol-specific National Indicators, as set out in appendix 1, to monitor
           and analyse effectiveness of the strategy. These include a health inequalities
           analysis. This analysis will be complemented by the use of the Local Alcohol
           Profiles for England, published by the North-West Public Health Observatory,
           which will provide benchmarking comparison with other areas.

    5.3.      While NI39 will provide a good measure of impact of the strategy, a large
           proportion of the hospital admissions are due to the long-term effects of alcohol
           misuse and it will take some years to impact on these. Therefore, in order to
           better measure the impact of the strategy on short-term alcohol misuse



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           impacts, such as hazardous drinking patterns, we will also monitor a sub-set of
           the admissions which excludes the longer-term effects.

    5.4.     More detailed data monitoring and analysis, including outputs, customer and
           public feedback, and services’ performance will be undertaken on a regular
           basis at meetings of the ARG subgroups.

6. Links with other strategies
   6.1.     The impact of the Stockport Alcohol Misuse Strategy will also be measured
        in other related strategies, which in turn may support the objectives of this
        strategy. These include (but are not limited to) the following:
            Crime, Drugs and Disorder Reduction
            Health Inequalities Strategy
            Cancer Reform Strategy
            Well-being Strategy
            Dual Diagnosis Strategy
            Suicide Prevention Strategy
            Healthy Schools programme
            Town Centre Evening Economy Strategy
            Children and Young People’s Strategic Plan
            All Our Tomorrows (Older People’s Strategy)
            Road Safety strategy
            Homelessness Strategy


7. Development and review of the Strategy
   7.1.     The Groups with responsibility for implementing the strategy will develop
        detailed action plans for each of the work areas as outlined above, and targets
        will be finalised in the context of the Local Area Agreement negotiations.

    7.2.      Progress and performance will be monitored at quarterly meetings of the
           ARG, its sub-groups and the Young People’s Substance Misuse Strategic
           Managers Group, and reported annually to the Safer Stockport Partnership and
           other responsible partnerships. The objectives may be altered or added to by
           the ARG, in the light of any new evidence or other developments emerging
           during the term of the strategy.

8. Contact for information or comments
   Simon Armour: Stockport PCT Public Health Directorate: 0161 426 5095
   simon.armour@stockport-pct.nhs.uk




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                                                                                                                                                Appendix 1

    Stockport Alcohol Strategy Performance                                                           Health Inequalities analysis
    Indicators
Indicator                                          Baseline       Target                               % from                 % of above
                                                   (2006-7)       (2010-11)                            priority 1             from 40%
                                                                                                       areas of               most
                                                                              Number                   deprivation            deprived
                                                                              relating to              (5.3% of               (30.3% of
                                                                              under 25s     Target     population)   Target   population)   Target
NI 39: Alcohol-harm related hospital                  5,319                       316                      8.6%                 41.1%
admissions (PSA 25)
Externally caused alcohol-related                       626
hospital admissions (subset of
NI39)
Alcohol-related hospital admissions
of under-18s (subset of NI39)
Number of alcohol-specific hospital                   1,458
admissions (NWPHO definition)
Deaths directly due to alcohol per                     19.1
100,000: (3 year rolling average
SMR)
Referrals to Community Alcohol                         716          1,000
Team
Alcohol referrals to MOSAIC                             53           100
Service
Referrals to Alcohol Brief                               0          6,000
Interventions service
Number of incidents of                               13,786
rowdy/inconsiderate behaviour
recorded by Police




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Indicator                                                         Baseline     Target
                                                                  (2006-7)     (2010-11)
NI 32 Repeat incidents of Domestic Violence
(PSA23)
All Alcohol-related Penalty Notices for Disorder
issued (inc. drunk & disorderly, under-age sales
and sales to drunks)
NI 41: Perceptions of drunk or rowdy behaviour         Not yet
as a problem (PSA 25)                                 available
NI 115: Proportion of young people frequently          Not yet
using illicit drugs, alcohol or volatile substances   available
(PSA 14)
Existing Local Area Agreement Reward Targets (2005-6 to 2008-9)
Indicator                                           Current     Target
                                                    (2006-7)    (2008-9)
Number of incidents of criminal damage                 6,689       5050
recorded by Police
Major and minor woundings recorded by Police           1,655       1,807
(excluding Domestic Violence)


i
    Safe. Sensible. Social. The next Steps in the National Alcohol Strategy. HM Government 2007 pp50-51




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