By Ravi Menghani, Programme Manager – Prevention, Champs Public Health Collaborative Support Team
Alcohol has been identified as a causal factor in more than 60 medical conditions, making it the third leading risk factor for death and disability after smoking and obesity.
Alcohol-related liver disease accounts for 60% of all liver disease and since 1970, deaths due to these conditions have increased by 400%, with this now being the biggest cause of death in those aged between 35-49 years old, according to data from the British Liver Trust.
COVID-19 has exacerbated the situation, with community referrals rising dramatically, and the Office for National Statistics reporting the highest year-on-year increase in deaths from alcohol-specific causes on record.
The Collaborative’s ‘Reduction of Harm from Alcohol’ programme, jointly led by public health and the NHS, aims to reverse this trend through ‘upstream’ projects covering alcohol sales through to specialist hospital care.
Seven of our alcohol-related initiatives, aimed at improving lives across Cheshire and Merseyside are described below:
1. Working with Alcohol Care Teams
In the Competencies Framework PROgram for Alcohol Care Teams (PROACT) workstream, our aim has been to help Alcohol Care Team (ACT) nurses to develop the targeted skills and knowledge that would lead to improved detection of alcohol problems and alcohol-related diseases (physical and psychological); improvement in patient care standards; and less variation in standards of care.
Over the past year we have achieved this through the delivery of education, support, and mentorship to alcohol specialist nurses.
2. Alcohol Harm Dashboard
Identifying and addressing unwarranted variation and promoting Continual Quality Improvement (CQI) are integral to the programme. The need for an effective measurement system to manage this has led to the development of an Alcohol Harm Dashboard which tracks key metrics in terms of alcohol related Emergency Department (ED) attendances, hospital admissions, bed days, and specific alcohol related harms such as alcohol related liver disease.
The data will be used by the programme team as part of CQI cycles to assess the effect of the competency framework and other projects, aiding future intelligent based commissioning.
Local teams across Cheshire and Merseyside having access to real time data will engender a better understanding of their populations needs and identify areas of unwarranted variation to improve services and ultimately health outcomes for their patients.
3. Identification and Brief Advice (IBA)
Alcohol IBA aims to identify and influence patients who are increasing or higher risk drinkers. National and local evidence indicated that we needed to improve uptake of IBA across Cheshire and Merseyside, however traditional means to deliver alcohol IBA had been curtailed due to COVID-19.
As such we sought to bolster our Alcohol IBA capacity, in a way that would be resistant to the impact of any further lockdowns, and at the same time provide a convenient tool that people could access, at any time.
We undertook a market and value for money analysis and opted for the ‘Lower My Drinking’ app which has proven to be a success following the launch in July 2021 with more than 1,200 mobile app downloads and a further 329 assessments via the triage website to date.
4. Community Engagement in Licensing
Levels of harm in communities are clearly associated with availability of alcohol, including density of licensed premises.
We have developed an online resource to support community engagement in licensing. This has been tested with local authority, licensing, and public health teams, as well as members of the public.
It is anticipated the guidance document and website will be useful tools to empower residents, by explaining, and guiding them in submitting representations through the licensing process. This in turn will enhance the ability of the licensing team to regulate on and off licensed premises in the pilot Local Authorities (Liverpool and Cheshire West & Chester).
5. Early detection of alcohol-related liver disease
To support early detection of alcohol-related liver disease, the Collaborative successfully bid for capital funding from the Office for Health Improvement and Disparities (OHID) to purchase five Fibroscan machines for use across Cheshire and Merseyside.
These scanners are now being used in local pilots to detect evidence of liver disease and to begin new conversations with people about their alcohol use. Fibroscan can be used to provide feedback in this process by giving patients a score they can work towards by reducing their alcohol use.
More than 50 frontline staff have received training in the use of the scanner and around 600 scans have already been performed.
6. Early identification of co-occurring Alcohol and Mental Health disorders
We are delighted to have been awarded funds from NHS England and Improvement (NHSEI) to undertake a pilot for a scalable initiative, intended to reduce the risk of patients with comorbid alcohol use disorder and mental health diagnoses ‘falling between’ services.
The pilot focuses on services linked to Liverpool University Hospitals NHS Foundation Trust (LUFT), including the liaison mental health and wider services provided by Mersey Care, and aims to reduce admissions, unscheduled attendances, ambulance call-out, and increase the referral rates from admission into hospital through improving integration between the services.
Our progress to date has been very well received and in December 2021 was selected for presentation to the NHSEI Prevention Board. As such we are in the process of developing our proposal for Year 2 subject to securing funding. In addition, we are seeking funds to expand the pilot to cover a new site across Cheshire and Merseyside.
7. Targeted physical activity support for Alcohol patients (Liverpool and Warrington)
Working with the sports partnerships in Cheshire and Merseyside, Local Authorities in pilot areas, third sector delivery organisations and other partners, we are piloting physical activity interventions into the clinical pathways for Alcohol Care Teams and community services.
Through the projects our aim is to ascertain whether this approach can have longer-term beneficial outcomes for both patients, by improving physical and mental health and the wider NHS system by reducing re-admittance and primary care interventions together with gaining learning from implementing physical activity within a clinical pathway with a view to expanding out into other pathways and areas.
Find out more
For further information about any of these initiatives or the Collaborative’s ‘Reduction of Harm from Alcohol’ programme, contact firstname.lastname@example.org