Reducing alcohol-related harm should form a key pillar of ICS action on health inequalities, writes Julie Bass, Chief Executive at Turning Point.
NHS England is currently consulting on a framework for NHS action on Inclusion Health, aimed at capturing best practice in this area.
The framework will support national and regional NHS leaders, and local systems, to identify specific priority actions to tackle health inequalities faced by vulnerable groups. Integrated care systems (ICSs) are central to this work due to their leadership role in efforts to identify and reduce health inequalities, as well as improving population health.
The framework’s view of vulnerable groups is broad – including those who experience homelessness, drug and alcohol dependence, vulnerable migrants, and other socially excluded groups. I would like to focus for a moment on those struggling with alcohol dependence, as tackling alcohol related harm through effective partnership working must be a priority within wider ICS action on reducing inequalities.
The Public Accounts Committee (PAC) recently published its report on alcohol treatment services, concluding that alcohol harm is not taken ‘sufficiently seriously’ emphasising the scale of harm caused by alcohol particularly within deprived communities.
Alcohol causes significant harm to individuals, families, communities, and public services. In 2012, the Department of Health estimated the annual cost of alcohol harm to the NHS at approximately £3.5 billion. Alcohol is linked to over 100 illnesses, can drive mental disorder, self-harm, and suicide, and is a major cause of preventable death. The ONS reported that alcohol was linked to 42% of all violent crime in 2019–20, and evidence suggests that harm is most prevalent within deprived communities – with five times as many liver deaths as their most affluent counterparts.
An estimated 10 million people in England regularly exceed low risk drinking guidelines, including 1.7 million who drink at higher risk and around 600,000 who are dependent on alcohol. Excessive alcohol consumption has huge consequences when it comes to population health and growing pressure on NHS and wider health and care services. Alcohol-related hospital admissions have risen steadily to 976,000, an increase of 16% over the four years to 2019–20. Serious attempts at addressing alcohol-harm need to be situated within broader efforts to improve population health, oriented towards early-intervention, with a particular focus on promoting healthy lifestyles.
Alcohol harm is more pronounced within our most deprived communities. ICSs have been tasked with leading efforts to identify and reduce health inequalities, alongside broad objectives to improve population health and contribute to social and economic development. Combatting alcohol harm will require ICSs to coordinate a range of local services and stakeholders, where provision is matched with a detailed mapping of local inequalities, alcohol harms, and health needs.
To achieve this, ICSs need to facilitate regular intelligence and data sharing amongst local stakeholders including the VCSE sector, local authorities, NHS services. ICSs are well placed to support a truly joined-up approach to service provision with hepatology departments, community treatment services, local authorities and mental health services working together to get more people who are drinking at higher or increasing risk support to cut down or stop altogether.
The extent to which ICSs have prioritised efforts to improve population health and reduce health inequalities varies hugely across the country and coordinated ICS led partnership working on alcohol-related harm remains patchy. Some ICSs, such as West Yorkshire, have delivered well on integration and outcomes. Within West Yorkshire ICS, alcohol harm has been central to wider efforts towards preventing ill-health. The ICS set itself the target of reducing the number of people admitted to hospital due to alcohol consumption by 500 every year and reducing the number of ambulance call-outs for related incidents. However, many ICSs have yet to publish priorities.
Where there are strong partnerships between local providers and ICSs, these tend to pre-date the development of ICSs. In many cases, ICSs have simply carried forward their engagement with local providers from their predecessors, rather than using the creation of new institutions as a chance to ‘reset’ and build better, more effective partnerships.
In Somerset, the local Combatting Drugs Partnership (CDP) reports into the ICS governance structures. Addiction is a key priority area for the ICS. The Somerset Director of Public Health chairs the CDP and sits on Somerset’s ICB. This structure has enabled clear pathways between place-based actors and the systems level and has led to key priorities being raised at ICS level, including continuity of care for people in hospital and community settings.
Alcohol causes significant harm to population heath and public services. If ICSs are going to tackle health inequalities, they need to prioritise reducing alcohol-related harm. The right response will require ICSs to support a joined-up approach between hospital and community services and to tackle the huge level of unmet need which currently exists when it comes to alcohol harm within this country. It is my hope that the upcoming inclusion health framework will direct ICSs in placing greater emphasis on preventing alcohol harm – delivering huge benefits for individuals, families and the health system.
This blog was originally published by Turning Point. You can read the original post here.
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