Alcohol Harm Reduction Strategy for Bristol

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					Alcohol Harm Reduction
  Strategy for Bristol

       March 2007
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                                             Page No.

The Bristol Partnership                         iii

Foreword                                        iv

1. Introduction                                 1

2. Background – National Policy                 1

3. Why is Alcohol Harm an Important Issue?      2

4. Alcohol Harm in Bristol                      3

5. Existing Local Action                        4

6. Proposals for Future Action                  6

Organisation chart                              7

Action Plan                                     8

References                                     19

Glossary                                       20


The Bristol Partnership is the city's Local Strategic Partnership (LSP). It brings
together leaders from the public, private, business, community and voluntary sectors
to establish priorities for joint action and develop a long-term strategic framework for
the city (the Community Strategy).

We work by building agreement on the shared priorities of the city and aligning our
work and resources to address joint concerns and deliver our shared aims. We aim
to improve the way services are planned and delivered and to provide strategic
direction for the targeting of investment.

The Bristol Partnership is chaired by Barbara Janke, Leader of Bristol City Council.
The members of the Bristol Partnership Board include representatives from
business, public agencies (including Bristol Primary Care Trust and Avon and
Somerset Constabulary) and Bristol City Council, as well as representatives
independent of business and public agencies.


As a regional capital and the gateway to the south west Bristol has become a much
sought after location in which to both live and work. Bristol is a city steeped in
history and is today proud of it’s diversity and cultural mix. It is an attractive city and
has become one of the country’s top tourist destinations.

There are, however, an estimated 40,000 men and 19,000 women with
hazardous/harmful alcohol use in Bristol, with about 7,500 men and 2,500 women
dependent on alcohol. There are over 18,000 young people in Bristol with
hazardous/harmful alcohol use and over 4,000 young people with alcohol
dependence. There are many costs – financial, social and emotional - associated
with this, to our city, our health services and workplaces and to families,
communities and individuals.

I am pleased to be able to introduce the first Alcohol Harm Reduction Strategy for
Bristol, produced by the Bristol Partnership. Work on reducing the harm caused by
alcohol is already taking place across Bristol in many different settings. A strategy
and action plan for co-ordinating work on alcohol harm reduction in Bristol brings
together all the different strands of this important work to give us a focus and a
structure with which to continue.

Barbara Janke
Leader, Bristol City Council

January 2007


1 Introduction

Work on reducing the harm caused by alcohol is already taking place across Bristol
in many different settings. An action plan for co-ordinating work on alcohol harm
reduction in Bristol will aim to bring together all strands of this work and place them
within the context of a number of recent important polices and guidelines.

2 Background – National Policy

In 2004 the Alcohol Harm Reduction Strategy for England (henceforth called the
‘national strategy’) outlined the Government’s strategy for ‘tackling the harms and
costs of alcohol misuse in England’ and put forward a framework in which this should
take place. Four key areas of harm were identified (health harms; crime and anti-
social behaviour harms; loss of productivity and profitability; and harms to family and
society) which the strategy addressed by actions focussing on the following themes:

•   Improved education and communication;
•   Better identification and treatment;
•   Alcohol related crime and disorder; and
•   Supply and industry responsibilities.

Nationally these are supported by a timetable of Government actions. The national
strategy was followed in 2005 by the National Treatment Agency’s (NTA) guidance
on alcohol misuse intervention. The intention is that this should be used by Primary
Care Trusts (PCTs) and partner organisations to support the development of local
programmes. In addition the National Treatment Agency is carrying out work on
Models of Care for Alcohol Misusers (MoCAM) in order to set out integrated care
pathways for alcohol treatment.

Choosing Health (2004) included encouraging sensible drinking as one of its six
priorities. It built on the recommendations in the National Strategy for reducing
alcohol-related harm and encouraging sensible drinking through:

•   A national information campaign to tackle the problems of binge drinking;
•   A social responsibility scheme;
•   Training for professionals;
•   Piloting screening and brief interventions in primary and secondary health
    settings, including accident and emergency;
•   Similar pilots in criminal justice settings; and
•   A programme of improvements for treatment services.

There are a number of other important documents and policies which form the
context within which any local action plan for reducing alcohol should be seen.

These include:

•   Crime and Disorder Act 1998 (amended by the Police Reform Act 2002)
•   Violent Crime: Tackling Violent Crime in the Night-Time Economy
•   Licensing Act 2003
•   The Respect Agenda
•   The Scottish Intercollegiate Guidelines Network clinical guideline, 2003
•   The Health Development Agency Evidence Briefing, 2005
•   The National Probation Service Alcohol strategy
•   The Prison Service Alcohol Strategy
•   Every Child Matters
•   Youth Matters: Next Steps

3 Why is Alcohol Harm an Important Issue?

The World Health Organisation (WHO) separates alcohol use disorders into three
useful categories:

•   Hazardous drinking: people drinking above ‘sensible’ levels but not yet
    experiencing harm.
•   Harmful drinking: people drinking above ‘sensible’ levels and experiencing harm.
•   Alcohol dependence: people drinking above ‘sensible’ levels and experiencing
    harm and symptoms of dependence.
                      (taken from the Alcohol Needs Assessment Research Project, 2004).

These categories can be used when assessing the level of need in a population as
well as when assessing the gap between need and the provision of appropriate
services. It is also important to consider the various ‘social harms’ that may be
consequences of any of the above categories of alcohol use (including violence,
domestic abuse, road accidents incurred from drink-driving and the consequences of
unprotected sex, including teenage pregnancy).

There are many reasons for prioritising work on reducing alcohol harm. Choosing
Health (2004) summarises these:

•   The financial burden of alcohol misuse is around £1.7 billion annually to the NHS
    and over £10 billion to society as a whole.
•   15,000-22,000 deaths and 150,000 hospital admissions each year are associated
    with alcohol misuse.
•   A quarter of children under 16 drink alcohol – on average around 10 units per
•   Over a million children are affected by parental alcohol problems in the UK.
•   Nearly half the victims of violent crime described their assailant as being under
    the influence of alcohol at the time.
•   Up to 17 million working days are lost annually due to alcohol-related absence.
•   About 2 in 10 male prisoners and 1 in 10 female prisoners reported that their
    drinking had caused injury to self or others in the year before coming into prison.

4 Alcohol Harm in Bristol

Further work needs to be done to relate national figures to our local population and
to more accurately assess the levels of need here. However, the following table and
charts give some idea of the scale of the problem.

If these percentages are applied to the population of Bristol using the 2001 Census
data we could expect to find the following numbers of men and women with alcohol
use disorders in our area (table 1). The proportions of males and females in our
population in this age group are very similar to the proportions in the national
population. More work would be needed to find out whether there are any significant
ways in which patterns of alcohol use disorders in our population differ from that in
England as a whole. The estimated figures given here could also be useful, for
example, in carrying out a needs assessment of local alcohol services. The
numbers of people receiving help with alcohol problems through various services
could be ascertained and this could be compared with the figures in this table to give
some estimate of unmet need.

Table 1: Estimated numbers of men and women with alcohol use disorders in
Bristol (2001 census data)

                                 Male                        Female
                                (Total males in population   (Total females in
                                aged 16-64 = 125,055)        population aged 16-64
                                                             = 126,083)
 Any alcohol use disorder       47,500 (38%)                 20,000 (16%)

 Hazardous/harmful              40,000 (32%)                 19,000 (15%)
 alcohol use
 Alcohol dependence             7,500 (6%)                   2,500 (2%)

                Source of graphs: DH Alcohol Needs Assessment Research Project (2004)

Again, if these percentages are applied to the population of Bristol (2001 Census) we
might expect, for example, that there are over 18,000 young people (aged 16-24)
with hazardous/harmful alcohol use and over 4,000 young people with alcohol

5 Existing Local Action

Strategic and Operational Groups

There are a number of strategic and operational groups working on various aspects
of reducing alcohol-related harm. The Bristol Partnership will be the overarching
body providing strategic leadership for the delivery of the Action Plan. Other groups
which contribute to delivery include:

Bristol Service and Health Improvement Network (SHIN) for Alcohol Misuse

The Bristol Service and Health Improvement Network is a multi-agency group which
includes local service providers from both statutory and non-statutory agencies and
primary care representation. It has been set up to develop a local response and to
oversee the local implementation of the health service aspects of the Alcohol Harm
Reduction Strategy. This is the group which is overseeing the implementation of the
local enhanced services.

Safer Bristol Partnership

The Safer Bristol Partnership is a delivery group of the Bristol Partnership and brings
together all those working to reduce crime and harm caused by drug misuse in the
city. Members include: Avon and Somerset Police, Bristol City Council, Bristol
Primary Care Trust, the Probation Service, Avon Fire Service, the voluntary sector

and drug treatment providers. The following delivery groups set up by Safer Bristol
Partnership will contribute to the delivery of the alcohol strategy:

Violent Crime Delivery Group

This group will be responsible for implementing the crime and disorder aspects of the
strategy. Members are from a range of statutory agencies in Bristol such as police,
health, Bristol City Council (BCC) planning, Bristol City Council licensing, Bristol
Domestic Abuse Forum, staff from Safer Bristol partnership and Government Office
South West (GOSW). The work of this group has resulted in the formation of a
number of licensees’ groups, in particular The Harbourside Forum, who work
together to promote and share good practice in pubs and clubs in the harbourside
area of the city.

Prevention and Early Intervention Work Stream Group

This strategic group is responsible for ensuring that the action plan from the Joint
Area Review of Children’s Services relating to prevention and early intervention are
implemented. Substance misuse is just one area of concern. Membership is from
statutory and voluntary agencies at a strategic level, concerned with delivering a
range of services to young people in Bristol.

Young People’s Substance Misuse Delivery Group

This is a multi-agency strategic planning and commissioning group, with a remit for
ensuring the delivery of substance misuse services (including alcohol) for young
people in Bristol. Services span prevention, education and treatment. Members
include senior officers from Children and Young People’s Services, Youth Offenders
Team, Connexions, Health, Housing and Police.

Young People’s Substance Misuse Prevention Group

This is a sub-group of the Young People’s Delivery Group. It is a multi-agency
planning group concerned with delivering a strategically linked model of best practice
across primary and targeted prevention programmes and education.

Bristol Drug Strategy Team (DST)

The Drugs Strategy Team is a Bristol City Council officer team responsible for
leading on the delivery of the national drugs strategy locally and leading the
commissioning of drug treatment services. Their remit does not currently
encompass alcohol, but as so many of the issues which face drug misusers are
similar to alcohol misusers there needs to be close alignment of their work around
the implementation of this strategy. In addition, many of the voluntary sector
agencies which contribute to the planning processes of the Drugs Strategy Team
through the Treatment Task Group offer services for drug and alcohol misuse.
These agencies also attend the Bristol Service and Health Improvement Network.

Please see the diagram on Page 7 outlining how the groups relate to one another.

6 Proposals for Future Action

This action plan is seen as one of the first steps in bringing together the various
strands of work currently being undertaken to tackle alcohol harm in Bristol. It is
suggested that further work should be underpinned by a systematic needs
assessment. This needs assessment should have a broad focus whilst also
ensuring that the needs of particular groups are also addressed (for example, young
people). This can be followed by the drawing up of a revised strategy and action
plan, focussing on addressing the identified gaps between unmet need and provision
of services.

Additional work currently underway:
•   A multi-agency alcohol strategy group has been convened to take forward work
    identified in the Action Plan. This group will report to the Bristol Partnership.
•   A Local Area Agreement stretch target has been agreed for the numbers of
    people retained in treatment for more than 3 months. Additionally a target around
    the young people’s Early Intervention Service is to be included early in 2007.
•   The action plan has incorporated all relevant recommendations from the Health
    Scrutiny Commission’s report ‘Moving from the margins to the centre?’ (July

Alcohol Structure Chart
                                                                     Bristol Partnership

                   Safer Bristol Partnership                    Alcohol Strategy Group                  Primary Care Trust

 Violent Crime         Young People’s          Prevention & Early                          Alcohol Service & Health Improvement Network
Delivery Group           Substance                Intervention                                      (Providers & Commissioners)
(Crime related         Misuse Delivery         Workstream Group
  actions re:               Group               Strategic group
    Alcohol)           (Drug & Alcohol             looking at                                         Providers of Services
                       commissioners)            Prevention &                         Bristol Integrated Drug & Alcohol Service, YPDTS,
                          for Young             Intervention for                          Alcohol Service, SWAN, CAAAD, WIARG,
                                                 Young People                           St James Priory, KWADS, HAWKS, BDP, AA,
Licensee Groups           Substance            across all services                      Serenity House, ARA, AMS, UBHT, NBT, EIS
e.g. Harbourside           Misuse
     Forum                Prevention

Better education and communication (relates to Chapter 4, national strategy and to the Choosing Health priority to encourage sensible drinking)
Focus on: public information and government messages; information provided by the industry; school education; the workplace; and advertising

Objective (From National           What’s happening nationally?     What’s happening locally? What needs to happen?         Who is responsible          Status   Timescale
Strategy)                          What guidance is available?      How will it happen? (actions)                           locally?

• Make the ‘sensible drinking’     • Relates to national strategy   • Leaflets, posters and bus adverts being produced      Senior Health Promotion       A      Ongoing
  message easier to                  actions 1 – 3                    (‘Drink less for more success’). Aimed at young       Specialist, PCT
  understand and apply.            • Supports Every Child Matters     people providing a positive image of sensible
                                                                      drinking through a variety of materials, including
• Target campaigns at those                                         • Work with specific groups of vulnerable young         Addiction Recovery            B      September
  most at risk, including binge-                                      people to produce educational materials tailored to   Agency/PCT                           2007
  and chronic drinkers.                                               their group.
                                                                    • Training of people who work with young people re      Young People’s Delivery       B      March 2008
                                                                      binge drinking.                                       Group
                                                                    • Alcoholic’s Anonymous presentations to schools        Alcoholics Anonymous          B      Ongoing
                                                                      (not complete coverage).                              School Shares Officer
                                                                                                                            Youth Offending Team
                                                                    • Health promotion campaign aimed at binge              Senior Health Promotion       B      Ongoing
                                                                      drinkers.                                             Specialist, PCT
                                                                    • Violent Crime Delivery Group Venue Awards             Violent Crime Delivery        B      Ongoing
                                                                      Scheme                                                Group
                                                                    • Addiction Recovery Agency Alcohol Misuse              Addiction Recovery            A      December
                                                                      Service have recently appointed young people’s        Agency Alcohol Misuse                2006
                                                                      worker.                                               Service

                                                                    • Offer inpatients with suspected alcohol misuse        UBHT                          B      March 2007
                                                                      issues referral to hospital based Alcoholics          Alcohol Specialist Nurse
                                                                      Anonymous sessions.
                                                                    • Roll out to NBT.                                      PCT/UBHT                      C      March 2008
                                                                    • Implement alcohol assessment tool for use with all    Alcohol Specialist Nurse,     B      March 2008
                                                                      inpatients who abuse alcohol.                         UBHT
                                                                    • Roll out to NBT.                                      PCT/UBHT                      C      March 2008
                                                                    • Re-instate Alcoholics Anonymous ‘advert’ in           Alcoholics Anonymous          C      March 2008
                                                                      accident and emergency                                Public Involvement/UBHT

• Provide better information for   • Relates to national strategy       • Checks of sales by retailers to young people          Trading Standards Office   B   Ongoing
  consumers, both on products        actions 4 - 7
  and at the point of sale.
• Provide alcohol education        • Relates to national strategy       • Early Intervention Service extended to community      Senior Health Promotion    B   March 2007
  and related skills in schools      actions 8 and 9 and local            settings.                                             Specialist, PCT
  and community settings that        objectives                         • ‘Know Limits’ pack for young people, parents and      Senior Health Promotion    B   Ongoing
  can change attitudes and         • Supports Every Child Matters         workers being piloted and evaluated in Bristol.       Specialist, PCT/ LEA
  behaviour, as well as raise      • Supports Youth Matters: Next       • Skill development within Bristol Children and         Bristol City Council       C   March 2008
  awareness of alcohol issues.       Steps                                Young People partnership                              Children and Young
                                   • Helps schools to obtain                                                                    People’s Services
                                     Healthy Schools status             • Needed - Partnership agreement on guidelines for      Young People’s Delivery    C   September
                                   • Supports Bristol Children and        best practice for alcohol misuse prevention and       Group                          2007
                                     Young People’s Plan 2006-            education.
                                     2009                               • Connexions Peer Education Health Show – The           Neighbourhood Renewal      A   Ongoing
                                                                          Tour, Lawrence Weston.
                                                                        • Bristol Police – 9 F/T schools officers/ Youth Team   Police                     C   March 2008
                                                                          who can assist with alcohol education
• Provide preventative             • Local objective                    • Alcohol Misuse Prevention Parenting Mentoring         Young People’s Delivery    A   Ongoing
  initiatives, particularly to     • Supports Every Child Matters         Project (Joint PCT/Neighbourhood Renewal pilot        Group
  promote protective factors       • International work on                scheme to involve families in preventative work)
  (Communities that Care             Strengthening Families (see        • Pilot programme with young people on peer             Young People’s Delivery    A   Ongoing
  2002)                              Foxcroft et al., Cochrane            influencing (Positive Futures – Youth Inclusion       Group
  1. Work with families to:          Reviews 2002, Issue 3).              Panels)
     a. improve family
     b. challenge role models in
         relation to the
         responsible use of
  2. Adopt a whole community       • Macfarlane (2005) British          • Action needed to support whole community              Young People’s Delivery    C   March 2008
  approach                           Medical Journal (5 March)            approaches to address protective factors.             Group
                                   • Health Development Agency          • Training and support for communities (including       Young People’s Delivery    B   March 2008
                                     (2005) prevention and                families and workers)                                 Group
                                     reduction of alcohol misuse:
                                     evidence briefing summary
                                   • Communities that care (2002)
                                     national survey of risk factors,
                                     protective factors and problem
                                     behaviour among young

• Provide more support and       • Relates to national strategy      • Review organisational policies around alcohol      Alcohol Strategy Group      B/C   March 2008
  advice for employers.            actions 10 and 11                   misuse
                                                                     • Provide support for staff in around these issues   Alcohol Strategy Group      B/C   March 2008
• Review the code of practice    • Relates to national strategy      • Develop local advertising protocols.               Bristol Trading Standards    C    March 2008
  for TV advertising to ensure     action 12.
  it does not target young
  drinkers of glamorise
  irresponsible behaviour
• Pursue concept of local        • Local objective (supported by
  restrictions on advertising      Bristol Health Scrutiny
  alcohol/local code of            Commission’s Alcohol and
  practice to control              Young People Review, Moving
  advertising messages.            from the Margins to the Centre)

Identification and treatment (relates to Chapter 5, national strategy and to the Choosing Health aims to increase training for professionals, to pilot screening and brief
interventions in primary and secondary care settings and to have a programme of improvements for treatment services).
Focus on: improving identification of alcohol problems and appropriate referral or treatment
Objective                        What’s happening nationally?         What’s happening locally? What needs to                   Who is responsible          Status   Timescale
                                 What guidance is available?          happen? How will it happen? (actions)                     locally?
• Make sure that those with      • Relates to national strategy       • Piloting of Local Enhanced Services for Alcohol         PCT                           A      Ongoing
  alcohol problems are             actions 13 – 17.                      Misuse in primary care
  identified and referred to     • Models of Care for Alcohol         • Identification of alcohol problems in                   PCT                           C      March 2008
  the appropriate services.        Misusers                              primary/secondary care
                                 • National Probation Service            i. targeted screening and brief interventions          PCT commissioned
                                   delivery strategy                        (motivational interviewing)
                                 • Prison Service Alcohol               ii. referral on to other statutory and non-statutory    PCT commissioned
                                   Strategy                                 services
                                                                       iii. work in accident and emergency (awaiting            UBHT
                                                                            further funding)
                                                                       iv. develop hospital strategies to deal with alcohol     UBHT
                                                                      • Employ Alcohol Nurse Specialist in UBHT                 UBHT                          A      Ongoing
                                                                      • Evaluate above and if appropriate seek                  UBHT                          B      September
                                                                         mainstream funding.                                                                         2007
                                                                      • Identification of alcohol problems through Offender     Probation                     C      September
                                                                         Assessment Reports. Ensure that Probation staff                                             2007
                                                                         include referral to appropriate services within the
                                                                         sentence plan
                                                                      • Develop an integrated care pathway to ensure that       PCT/Drugs Strategy            C      September
                                                                         all available local agencies are used appropriately,   Team/ Alcohol Service                2007
                                                                         including Alcoholics Anonymous, Addiction              and Health Improvement
                                                                         Recovery Agency Alcohol Misuse Service, Bristol        Network
                                                                         Drugs Project (all currently have some services for
                                                                         alcohol misuse).
                                                                      • Improve training of health professionals re alcohol     PCT/UBHT/ Alcohol             A      Ongoing
                                                                         issues.                                                Service and Health
                                                                                                                                Improvement Network

                                                                      • Ensure services are available for those who do not      PCT/DST                       A      Ongoing
                                                                        want to use 12 Step programmes

                                                                  • Investigate provision of long-term counselling       Avon & Wiltshire             C   March 2008
                                                                    (addressing issues behind harmful alcohol use).      Partnership currently lead
                                                                                                                         for undergraduate student
                                                                                                                         doctor training
                                                                                                                         (+midwives, nurses,
                                                                                                                         prison staff etc).
                                                                                                                         PCT commissioning
                                                                  • Ensure that the Young People’s Drug Treatment        Young People’s Delivery      A   March 2007
                                                                    Service provides treatment for alcohol misuse as     Group
                                                                    well as drug misuse.
                                                                  • Counselling for Young People, Lawrence Weston.       Neighbourhood Renewal        A   Ongoing
                                                                  • Gather data as evidence to enable development of     PCT                          B   March 2007
                                                                    a bid for an inpatient detox bed if appropriate.
                                                                  • Ensure appropriate use of Housing and Support        Bristol City Council         A   Ongoing
                                                                    Register - single point of access to match people    Homeless Options and
                                                                    with alcohol misuse issues to Supporting People      Advice service
                                                                    funding services.
• Make sure that appropriate     • Relates to national strategy   • Improvement of alcohol treatment services,           Drugs Strategy Team          B   April 2007
  treatment is available,          actions 18 – 20.                 including the proposed integration of health and
  through:                       • Models of Care for Alcohol       social services specialist substance misuse
   - better information on         Misusers (McCAM)                 providers.
     services to inform future   • Alcohol Needs Assessment       • Coherent commissioning overseen by the Drugs         PCT/Drugs Strategy           B   April 2007
     provision                     Research Project (ANARP)         Strategy Team                                        Team
   - clear standards             • National Treatment Agency      • Increase information available to primary care       PCT                          B   Ongoing
   - coherent commissioning        guidance on developing local     professionals about new services, policies etc.
                                   improvement programme          • Alcohol Specialist Nurse to provide brief            Alcohol Specialist           A   Ongoing
                                                                    interventions advice and follow up to problem        Nurse/UBHT
                                                                    drinkers and liaise with staff across the trust to
                                                                    improve knowledge
                                                                  • Develop care path ways for detoxification            Bristol Integrated Drug      B   September
                                                                                                                         and Alcohol Services /           2007
                                                                  • Increase awareness of needs of specific groups       Alcohol Strategy Group       C   September
                                                                    (e.g. black minority ethnic/lesbian, gay and                                          2007
                                                                    bisexual) to inform planning.

• Provide scope for working      • Local objective                  • Hidden Harm Drugs and Young Peoples Project             Drugs and Young          B   Ongoing
  with families and prevent      • Evidence includes:                 (Bristol City Council Children and Young People’s       Peoples Project
  further damage and               - Velleman, R, Templeton, L        Services)
  increase of risk factors for       (2006)                         • Hartcliffe & Withywood Kick Start (HAWKS) Family        Hartcliffe & Withywood   B   Ongoing
  children. This will then         Understanding and modifying        Project                                                 Kick Start
  contribute to preventing           the impact of parents          • Comprehensive services across the city for work         Young Peoples Drug       C   March 2008
  future alcohol misuse              substance misuse on children     with whole family                                       Treatment Service
  problems as children grow        - Hidden Harm                                                                              Alcohol Misuse Service
  up in to teenagers and           - Quarterly Review of Alcohol                                                              and local drug and
  adults.                            Research (Autumn 2006)                                                                   alcohol provision
                                     ‘Family experiences and
                                     adolescent drinking’           • Current Young Carers Project needs increased            Bristol Young Carers     B   Ongoing
                                                                      capacity to respond to demand. Need also
                                                                      identified by the joint area review (JAR) Inspection.
• Ensure that treatment for      • Relates to national strategy     • Referral to appropriate services by probation           Probation                B   Ongoing
  vulnerable groups covers all     action 21                          officers, especially the dedicated service being
  their related needs and        • Probation Alcohol Strategy         provided for offenders by Communities against
  problems and adequate          • Prison Alcohol Strategy            Alcohol & Drugs.
  aftercare is available.                                           • Prison alcohol work                                     Bristol Prison           B   Ongoing
                                                                    • Homeless Project shared care scheme                     PCT                      A   Ongoing
                                                                    • Local enhanced service developments                     PCT                      B   April 2007
                                                                    • Particular attention needs to be paid to the needs      Alcohol Strategy Group   C   March 2008
                                                                      of women (awareness of specific issues plus need
                                                                      for childcare etc) – Needs Assessment
                                                                    • Remodel existing provision of supported housing         Bristol City Council     B   Ongoing
                                                                      to include ‘wet’ as well as ‘dry’ houses.               Homeless Team

                                                                    • Psychiatric liaison team in UBHT provides services      UBHT                     A   Ongoing
                                                                      for patients with mental health and alcohol
                                                                    • Black Carers Project, Easton/Lawrence Hill              Neighbourhood Renewal    A   Ongoing
                                                                    • Support for Carers, Hartcliffe and Withywood (both      Neighbourhood Renewal    A   Ongoing
                                                                      the above not specifically alcohol but it could be

Alcohol-related crime and disorder (relates to Chapter 6, national strategy and the Choosing Health aims to introduce a social responsibility scheme and to pilot screening
and brief interventions in criminal justice settings)
Focus on visible areas of concern (alcohol-related disorder and anti-social behaviour in towns and cities at night) and less visible areas (crime, disorder and anti-social
behaviour; domestic violence; and drink-driving)
Objective                       What’s happening nationally?        What’s happening locally? What needs to                  Who is responsible         Status   Timescale
                                What guidance is available?         happen? How will it happen? (actions)                    locally?
• Reduce the problems           • Relates to national strategy      • Reviewing of licences for premises known to have       Police                       A      Ongoing
  caused by drinking in town      actions 22 – 29                     problems
  and city centres by clearly   • Licensing Act 2003                • Proactive approach to policing in City Centre          Police                       A      Ongoing
  defining the shared           • Choosing Health                      - officers on foot responding rapidly
  responsibilities of           • Violent Crime: Tackling Violent      - work around troubled premises, licensing issues
  individuals, the alcoholic      Crime in the Night-Time                and management of door policies
  drinks industry and the         Economy                           • Harbourside initiative including:                      Harbourside initiative       A      Ongoing
  Government.                                                          - formation of local area business forum for          Bristol Against Disorder
                                                                         collective action;                                  initiative
                                                                       - improved lighting in a potential late night crime
                                                                       - the addition of a second taxi rank (Canon’s Rd);
                                                                       - additional CCTV cameras on harbourside;
                                                                       - instalment of piped music to aid dispersal of
                                                                         early morning revellers.
                                                                    • Bristol Best Bar None Scheme (BBBN)                    Project Leader, Violent      A      Completed
                                                                                                                             Crime Delivery Group                for first year,
                                                                                                                                                                 funding for
                                                                    • Bristol Against Disorder Initiative (BADI)             Police                       A      Ongoing
                                                                    • Bus and taxi marshals – to ensure safe passage         Project Leader, Violent      A      Mainstreame
                                                                      home in the early hours of Sat and Sun morning         Crime Delivery Group                d and on-
                                                                    • Sharing of police and health data with licensed        Violent Crime Delivery       B      Difficult to
                                                                      premises – police data now shared with the             Group                               achieve but
                                                                      Harbourside Forum                                                                          on-going
                                                                    • Work with accident and emergency to develop            UBHT/PCT                     C      September
                                                                      strategies to deal with binge drinking and health                                          2006
                                                                      service usage.
                                                                    • Evaluation of City Council/Police initiatives in the   Violent Crime Delivery       C      March 2008
                                                                      City Centre                                            Group

• Develop a local licensing   • Local objective                   • Strategy to include:                                    Bristol City Council/Bristol   B   Ongoing
  strategy.                   • Relates to national strategy         - Building strong partnerships with the licensed       Partnership
                                actions 22-29                          trade;
                              • Licensing Act 2003                   - Raising standards in licensed premises;
                                                                     - Enforcing the Licensing Act 2003;
                                                                     - Licensed trade working with licensing authorities;
                                                                     - Licensed trade contributing to a review of
                                                                       licensing policy;
                                                                     - Licensed trade complying with licensing
• Tackle under age drinking   • Relates to national strategy      • Checks on retailers                                     Bristol Trading                A   Ongoing
  by greater enforcement of     actions 30 – 31                                                                             Standards, Bristol City
  existing laws, improving    • Licensing Act 2003                                                                          Council
  information available to    • Choosing Health                   • Venue awards                                            Police                         A   Ongoing
  young people and            • Violent Crime: Tackling Violent                                                             Harbourside initiative,
  encouraging provision of      Crime in the Night-Time                                                                     BADI,
  alternative activities.       Economy                                                                                     Safer Bristol Partnership
                                                                                                                            Violent Crime Delivery
                                                                  • ‘Drink less for more success’ campaign                  PCT                            A   Ongoing
• Tackle alcohol-related      • Relates to national strategy      • Probation staff to ensure early identification of       Probation/Drugs Strategy       B   All ongoing
  repeat offending.             actions 32 – 34                     offenders with alcohol problems using the Offender      Team
                              • Probation Alcohol Strategy          Assessment System (OASys)
                              • Choosing Health                   • To devise sentence plans that address alcohol                                          B
                              • Violent Crime: Tackling Violent     problems
                                Crime in the Night-Time           • To refer to suitable Probation Programmes such as                                      B
                                Economy                             Drink Impaired Drivers Scheme(DIDS),) Domestic
                                                                    Abuse Programme (DAP), and Substance misuse
                                                                  • To refer to Communities against Alcohol and                                            B
                                                                    Drugs for dedicated assessment and brief
                                                                    interventions scheme for offenders
• Better Identification and   • Relates to national strategy      • Identified through probation reports and referred to    Probation, Drugs Strategy      B   Ongoing
  referral of victims and       action 35                           Domestic Abuse Programme                                Team, Police
  perpetrators of domestic    • Probation Alcohol Strategy
  violence who have alcohol   • Choosing Health                   • UBHT accident and emergency liaise with Bristol         UBHT                           A   Ongoing
  problems.                                                         Domestic Abuse Forum (BDAF) around patients
                                                                    who are linked to alcohol and domestic violence.
                                                                  • Bristol City Council to investigate whether further     Bristol City Council           C   March 2008
                                                                    work can be done on the relationship between            (Social Developments
                                                                    domestic violence and alcohol.                          Commission)

• Monitor whether additional     • Relates to national strategy   • Police initiatives                                     Police                 B   Ongoing
  action is needed in relation     actions 36 and 37              • Bristol Police support of Avon and Somerset            Bristol City Council   B   Ongoing
  to drink-driving                                                  Constabulary initiatives (e.g. Christmas drink drive

Supply and industry responsibilities (related to Chapter 7, national strategy)
Focus on: recognition that solutions implemented with the industry are highly effective and reach large numbers of people
Objective                        What’s happening nationally?         What’s happening locally? What needs to               Who is responsible         Status   Timescale
                                 What guidance is available?          happen? How will it happen? (actions)                 locally?
• Introduce a new national       • Relates to national strategy       • Venue Awards Scheme (concluded for 2006 but         Violent Crime Delivery       A      Ongoing
  award scheme – voluntary         action 38                            awaiting funding for 2007).                         Group
  at first – to combine a code   • Violent Crime: Tackling Violent    • Comprehensive trader advice packs on under age      Licensing – Bristol City     A      Ongoing
  of good practice with a          Crime in the Night-Time              sales (written by Trading Standards).               Council
  financial contribution from      Economy                            • Bristol Health Scrutiny Commission’s Alcohol and    Bristol City Council         C      March 2008
  the industry to towards        • Awards in different areas but no     Young People Review (Moving from the Margins to
  efforts to tackle the harms      national award yet.                  the Centre) recommends action against sales of
  caused by alcohol misuse.                                             alcohol to young people through a Local Area


Objective                       What’s happening nationally?   What’s happening locally? What needs to                Who is responsible   Status   Timescale
                                What guidance is available?    happen? How will it happen? (actions)                  locally?
• Understand the scale of the   • Local objective              • Set up systems to record alcohol related inpatient   UBHT                  A/B     Ongoing
  problems across                                                statistics (look at clinical coding audit data)
  age/sex/geographical                                           including accident and emergency.
  spectrum                                                     • Carry out needs assessment across Bristol to         PCT                    C      September
                                                                 establish baseline/problem areas/gaps.                                             2007
                                                               • To utilise data from Probation offender              Probation              C      September
                                                                 assessments (OASYS) that indicates that 45% of                                     2007
                                                                 offender assessments in the Avon and Somerset
                                                                 Probation area highlight an alcohol problem.


1. Bristol City Council (July 2006). Moving from the margins to the centre? Bristol
   Health Commission’s alcohol and young people’s review.

2. Bristol City Council. Bristol Children and Young People’s Plan 2006-2009.

3. Cabinet Office, (2004). Alcohol Harm Reduction Strategy for England. The Prime
   Minister’s Strategy Unit.

4. Crime and Disorder Act 1998 (amended by the Police Reform Act 2002)

5. Department for Education and Skills (2003). Every child matters.

6. Department of Health (2004). Choosing Health: making healthy choices easier.

7. Department for Education and Skills (2005). Youth matters: next steps.

8. Department of Health (2005). Alcohol Needs Assessment Research Project

9. Foxcroft DR, Ireland D, Lowe G , Breen R. (2002). Primary prevention for alcohol
   misuse in young people (Cochrane Reviews 2002, Issue 3).

10. Health Development Agency (2005). Prevention and reduction of alcohol misuse:
    evidence briefing.

11. Home Office. Communications Directorate (2004). Violent Crime: Tackling Violent
    Crime in the Night-Time Economy

12. National Probation Service (2005). A delivery strategy for the national probation
    service: working with alcohol misusing offenders.

13. NHS National Treatment Agency for Substance Misuse (2005). Alcohol misuse
    interventions: guidance on developing a local programme of improvement.

14. NHS National Treatment Agency for Substance Misuse (2005). Models of care
    for alcohol misuse. Responses to the stage one consultation document.

15. Scottish Intercollegiate Guidelines Network (2003). The management of harmful
    drinking and alcohol dependence in primary care: a national clinical guideline.

16. Stationery Office (2003). The Licensing Act 2003

17. The Prison Service (2004). Addressing alcohol misuse: a prison service alcohol
    strategy for prisoners.


Accident and             Departments in hospitals which deal with people who need
Emergency                emergency treatment because of sudden illness or injury.
Alcoholics Anonymous A fellowship of men and women to help others to recover from
(AA)                 alcoholism.
Addiction Recovery       Addiction treatment and support service.
Agency (ARA)
Avon & Somerset          Local police force serving Avon and Somerset.
Bristol Against Disorder Coordinated by Avon & Somerset Police. This involves the Police
Initiative (BADI)        issuing photographs of those convicted of crime and disorder in
                         the area so that door staff can identify them and decline them
                         entry to the venue.
Bristol Best Bar None    Awards given to pubs, nightclubs and bars which meet a
scheme (BBBN)            standard of excellence and customer care and safety.
Bristol City Council     Bristol City Council – Local Council serving the population of
Bristol Domestic Abuse A multi-agency forum made up of representatives from both
Forum                  voluntary and statutory organisations as well as members of the
                       community who come together to promote a coordinated
                       approach to tackling domestic abuse in Bristol.
Bristol Partnership      The partnership (also known as the Local Strategic Partnership –
                         LSP) set up by Bristol City Council, comprising public, private,
                         business, community and voluntary sectors. The aim is to create
                         a shared vision and long term plans for agencies to work together
                         for the overall good of people in Bristol. It has a number of sub-
                         groups (Delivery Groups – including one on Health and
                         Wellbeing) tightly focused on delivering objectives.
Bristol Service and      Network to agree service improvement and monitor changes to
Health Improvement       the designated service.
Network (SHIN)
Census data              This is collected every 10 years and provides a comprehensive
                         population profile for small areas (wards and enumeration
                         districts). It is also used to allocate funding from central
Choosing Health          Government White Paper (published 2004) on promoting health
                         and wellbeing, protecting health and preventing ill health, rather
                         than treatment and care.
Community Strategy       Bristol City Council led joint strategy to improve services to the
                         local community.

Communities against       Community based drug and alcohol project with a harm
Alcohol and Drugs         minimisation approach based in Barton Hill.
Drink Impaired Drivers    Can form part of a Community Punishment Order, Community
Scheme (DIDS)             Rehabilitation Order, Community Punishment and Rehabilitation
                          Order or a post-release prison licence.
Drug Strategy Team        Team responsible for all aspects of tackling drug misuse in Bristol
Early Intervention        Service provided in schools to identify young people considered
Service                   to be “at risk” of substance misuse.
Government Office for Regional tier of the government for the South West.
the South West (GOSW)
Harbourside Initiative    The Harbourside Forum meets once a month to discuss ways of
                          making the area as attractive as possible to all visitors. Topics of
                          discussion range from keeping the area clean and tidy to
                          planning for forthcoming events, festivals or holidays. Since the
                          Forum’s conception, crime in the area has reduced, largely due to
                          a number of initiatives and information sharing between all of the
Hartcliffe & Withywood    HAWKS are based in Hartcliffe and Withywood. They offer
Kick Start (HAWKS)        support to anyone concerned about their own or someone else’s
                          substance use/misuse.
Health Development        The HDA is a special health authority that aims to improve the
Agency (HDA)              health of people in England - in particular, to reduce inequalities
                          in health between those who are well off and those on low
                          incomes or reliant on state benefits.
Health needs              A systematic assessment of the health needs of a specified
assessment                population at a given point of time.
Health Scrutiny           Scrutinises local health services under the powers of the Health
Commission                and Social Care Act 2001.
Joint Area Review (JAR) A single coordinated inspection of all publicly funded services for
                        all children and young people within a local area.
Local Area Agreement      Agreement between local statutory and non statutory agencies
                          with common targets around service improvements for local
Local/National            National enhanced services are set nationally by the Government
Enhanced Services         and local enhanced services are commissioned entirely by local
                          negotiation to meet local specific needs.
Local Strategic           Draws together organizations from the public, private, business,
Partnership (LSP)         community and voluntary sectors within the local authority, social
                          and environmental well being of the community.
Models of Care for        Guidance on ways of treating alcohol misuse.
Alcohol Misuse

North Bristol Trust      NHS Trust providing hospital services for Greater Bristol and very
(NBT)                    specialist services to a wider area. Manages both Southmead
                         and Frenchay hospitals.
National Treatment       National agency who provides a framework for the development
Agency                   of treatment services for drug misuse. It also performance
                         manages drug action teams.
Neighbourhood            Central government funded initiatives to improve services in
Renewal                  priority areas i.e. those considered to be most deprived.
Primary Care Trust       An NHS body whose main tasks are to assess local health
                         needs, develop and implement Local Delivery Plans, provide
                         primary care services and commission services from hospitals
                         run by NHS Trusts. PCTs are run by a Board whose members
                         include GPs, nurses, representatives from local authority social
                         services, and the lay public.
Probation Service        Service providing links with courts, prison and offenders.
Public Involvement       Process of working with members of the public so that they can have
                         a say in how health services are planned and run.
Safer Bristol            Overarching partnership between the Police, Bristol City Council,
Partnership              and PCT to reduce crime associated with drug misuse and
                         improve treatment
Treatment Task Group     A multi-agency group of commissioners and providers of drug misuse
United Bristol           NHS Trust providing hospital services for Greater Bristol and very
Healthcare NHS Trust     specialist services to a wider area.
Violent Crime Delivery   A multi agency sub group of Safer Bristol Partnership which
Group                    implements the crime and disorder aspect of the strategy.
World Health             The United Nations specialised agency for health.
Organisation (WHO)
Young People’s           A new group formed by the PCT in partnership with the Drugs
Substance Misuse         Strategy Team to agree and disseminate best practice guidelines
Prevention and Group     for preventative initiatives and education with young people.
Young People’s Drug      Provides treatment to young people aged 18 years and under
Treatment Service        who misuse drugs and have complex poly-drug misuse issues
                         associated with emotional and/or mental health issues.
Youth Matters            Government White Paper which sets out the vision for
                         empowering young people, giving them somewhere to go,
                         something to do and someone to talk to.


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