Summary

The most recent data available indicates that higher-risk drinking is more widespread, and occurs more in deprived areas, suggesting that high levels of risky drinking are also occurring both at home and out of the home. In Merton, as highlighted in the LAPE published in August 2012, the estimated prevalence of binge drinking was 13.8% compared with 14.3% in London and 20.1% nationally. However, for small geographic areas within the borough, at middle super output area level, the range was 7% to 20%. The estimated levels of the adult population drinking at ‘increasing risk’ (21%) and ‘higher risk’ (7.2%) were above London or England levels.

In terms of alcohol harm overall and in 2012, Merton ranked 55 out of 326 local authorities but was in the higher percentiles for:

• Male mortality chronic liver disease (104/326)
• Female alcohol-specific hospital admissions (106/326)
• Male alcohol-specific hospital admissions (109/326)
• Male alcohol-attributable hospital admissions (151/326)
• Alcohol-related violent crimes (192/326)
• Alcohol-related sexual offences (208/326).

In terms of all alcohol-related crime and according to Local Area Profile Data for 2011-12, Merton with a rate of 7.3 recorded crimes per 1,000 populations was higher than the neighbouring boroughs Sutton (6.7) and Kingston (6.7) and the England average of 7 but lower than the London average of 11.1. The trend though in the five years since 2006-7 has generally been a downward one. Of people surveyed (‘My Place’ survey) in 2009, 49% thought that drunkenness and rowdy behaviour were a problem for the borough.

Key facts on reducing harm from alcohol

About 90% of adults in the UK consume alcohol to a greater or lesser extent and an increasing number of young people are binge drinking. The Public Health White Paper, ‘Healthy Lives, Healthy People’ (2010) identified reducing harm from alcohol misuse and encouraging sensible drinking as priorities, highlighting that regular heavy drinking is leading to a rapid rise in liver disease, which is now the fifth biggest cause of death in England.

Evidence on the harm that alcohol can cause is clear; it can cause cancers of the oral cavity and pharynx, larynx, oesophagus and liver, and misuse (i.e. drinking at levels that can cause harm) can be directly linked to ill health and death from liver cirrhosis and circulatory disease. The level at which alcohol can cause harm (i.e. the number of units per day or week) is less clear. Current guidance recommends not regularly drinking more than 3-4 units of alcohol a day for men (equivalent to a pint and a half of 4% beer) and not more than 2-3 units of alcohol a day for women (equivalent to a 175 ml glass of wine, depending on the strength). Evidence is still being established on these levels as there are a range of other factors that influence harm; such as age, weight and gender, how much you have eaten and how much sleep you have had. However, what is known is that the risk of harm is significantly increased if more than 30 units are consumed per week (less than half a bottle of wine of average strength per night).

The impact of alcohol misuse is not just on health; it is also associated with a wide range of criminal offences, including drink driving, being drunk and disorderly, criminal damage, assault and domestic violence, all of which can also indirectly impact on health. In younger people, risky drinking behaviour is associated with anti-social behaviour and teenage conceptions.

The picture of risky drinking behaviour is complex. Information from modelled estimates on binge drinking does not suggest a link with deprivation in Merton. However, this may reflect more on how the estimates have been modelled and does not reflect the pattern of health services use.  The most recent data available indicates that higher risk drinking is more widespread, and occurs more in deprived areas, suggesting that high levels of risky drinking is also occurring both at home and out of the home. In Merton, as highlighted in the Local Alcohol Profiles for England published in August 2012, the estimated prevalence of binge drinking was 13.8% compared with 14.3% in London and 20.1% nationally. However, for small geographic areas within the borough, at middle super output area level, the range was 7% to 20%. The estimated levels of the adult population drinking at ‘increasing risk’ (21%) and ‘higher risk’ (7.2%) were above London or England levels.

Prevalence of risky drinking behaviour by area – percentage of the adult population that binge drink by MSOA, Merton, 2007-08, (modelled estimate).

Source: Association of Public Health Observatories

Estimates of Adults' Health and Lifestyles, Percentage of the adult population that binge drink, 2007-08, by MSOA (modelled estimate)

©Crown copyright 2012. All rights reserved. ©1994-2012 ACTIVE Solutions Europe Ltd.

Alcohol-related mortality and morbidity were generally low suggesting levels of risky drinking behaviour have been lower than that in London or nationally. However, as the consequences of high levels of alcohol intake can take a number of years to become apparent, this may reflect a historical pattern of drinking. Alcohol-related hospital admission rates were lower compared with rates in London or across England, but are increasing, suggesting a change in drinking behaviour in Merton:  

• There are clear age and gender differences in the consequences of drinking behaviour.
• For older population – chronic conditions such as hypertension or alcohol-associated cardiac conditions.
• For the younger population – acute conditions (including the impact of alcohol related violence) and mental health conditions.

The two graphs below show that hospital admissions for alcohol-related harm in Merton in 2008-09 were higher for hypertensive, cardiac arrhythmia and mental health conditions.  While lower than London and England, these admissions have increased consistently over time.

Alcohol-related harm hospital admissions by cause and gender in Merton, 2008-9; and Admission episodes for alcohol-attributable conditions 2012.

Merton is ranked highest in South West London boroughs for the 2011-12 [directly standardised rate] (DSR), and ninth in all London boroughs.

Emergency admissions for alcohol-related liver disease.

A Health Status Assessment on alcohol misuse was commissioned by Public Health in 2010 as part of the priorities for more in-depth understanding of key issues affecting the health of the population and to gain a better understanding of the current scope and extent of alcohol- related harm in Merton and particularly around drinking behaviour.  Following its report and recommendations, an independent Alcohol Needs Assessment for the borough was commissioned by Safer Merton in 2012.

In 2012, in terms of alcohol harm overall, Merton ranked 55 out of 326 local authorities, but was in the higher percentiles for:

• Male mortality chronic liver disease (104/326)
• Female alcohol-specific hospital admissions (106/326)
• Male alcohol-specific hospital admissions (109/326)
• Male alcohol-attributable hospital admissions (151/326)
• Alcohol-related violent crimes (192/326)
• Alcohol-related sexual offences (208/326).

Alcohol-related crimes in Merton, 2007-08 to 2011-12.

Source: North West Public Health Observatory Merton Local Alcohol profile

Strategic Assessment Consultation 2012

Alcohol-related disorder was a concern expressed by participants in Safer Merton’s Strategic Assessment Consultation, which took place between October and November 2012. The table below outlines the top concerns for alcohol (respondents indicating an issue was a ‘very big’ or ‘fairly big’ problem).

Top concerns for alcohol, Safer Merton Strategic Assessment Consultation.

Source: Results of Merton’s Public consultation for a proposed borough-wide designated public places order (DPPO) also known as a controlled drinking zone.

Annual Residents Survey 2012 results.

The Department of Health Ready Reckoner estimates for Merton suggested populations of:

• Hazardous/Increasing Risk Drinkers at 29,285
• Harmful/High Risk Drinkers at 7,030
• Dependent Drinkers at 3,788.

Prevalence of risky drinking behaviour.

Messages on alcohol and support need to be consistent and well managed in a coordinated way by providers across a range of agencies. [Data] also highlight[s] a potential need to target support to both men and older people.

In terms of available statistics on alcohol treatment, nationally in 2011-12 there were some 108,906 people over the age of 18 in contact with structured treatment services and a further 33,689 clients citing problem alcohol use as secondary to a primary drug problem. For Merton, in March 2013, there were 344 adults receiving treatment for alcohol-related problems from commissioned substance misuse services, a very slight decline on the number reported as being in treatment in the previous April. Very high alcohol consumption is a feature of this population with on average about 20% of this group reporting having consumed in excess of a thousand units of alcohol in the 28 days before starting treatment.

In terms of morbidity and mortality, current trends suggest that there will be a considerable impact on local health and criminal justice systems as well as implications for the number of working days lost due to alcohol. The demand for healthcare resources due to alcohol- related admissions is likely to increase. Commissioners need to consider investment in prevention through early identification and advice for hazardous and harmful drinkers to reduce alcohol-related morbidity and mortality, and subsequently contribute to reducing the burden on healthcare resources. Evidence shows that alcohol harm reduction interventions can deliver short, medium and longer term cost benefits whilst also improving clinical outcomes and promoting health gain:

• For every pound invested in identification and advice for increasing and higher-risk drinkers, £4.30 is saved as a return on investment within 12 months.
• For every pound invested in treatment of dependent drinkers, £3.10 would be saved as a return on investment within 12 months.

In terms of all alcohol-related crime and according to Local Area Profile Data for 2011-12, Merton with a rate of 7.3 recorded crimes per 1,000 populations was higher than the neighbouring boroughs Sutton (6.7) and Kingston (6.7) and the England average of 7 but lower than the London average of 11.1. The trend though in the five years since 2006-07 has generally been a downward one.  From the people surveyed (‘My Place’ survey) in 2009, 41% thought that drunkenness and rowdy behaviour were a problem for the borough.

Alcohol-related harm costs the local health economy over £17 million. The total cost of alcohol-related harm represents 7% of healthcare costs. The high cost of tackling both alcohol-related crime and the health consequences indicate the need to work in a collaborative way to ensure that there is a coordinated approach across health services, local authority, the police and voluntary sector.  The well-established Safer Merton partnerships include work to tackle alcohol-related crime and anti-social behaviour.

A costings report by NICE on harmful drinking in 2010 cited the estimated annual costs of crime and anti-social behaviour linked to alcohol misuse in England, uplifting the 2004 estimated costs to 2009, totalled some £8,016,000,000.

Work on alcohol-related harm amongst older people, particularly, concluded that, whilst there are gaps in local data on the prevalence of alcohol problems in this age group, any development of alcohol services needs to consider and address the needs of older people. This should include the targeting of public education messages, brief intervention services and development of referral pathways between alcohol and older people’s services.

There is also some locally emerging and anecdotal evidence to suggest that levels of alcohol- related harm might also be rising in our eastern European population, though this is yet to be fully quantified.

Services, what works and best practice

See also Merton: Alcohol, drugs and substance misuse

Evidence about what works to prevent harmful drinking has been produced by NICE in 2010. The evidence recommends that a combination of population and individual approaches are needed, including:

• At a national level, policy control on price, availability and marketing, including introducing a minimum price per unit, revising licensing legislation and reducing exposure of children and young people to alcohol advertising, particularly web-based channels.
• At a local level, adopting a ‘cumulative impact policy’ if an area is considered saturated with licensed premises, preventing underage and proxy sales, and ensuring full legal sanctions are applied to businesses that break the law.
• Investing in resources for commissioning screening and brief interventions for individuals, and extended brief interventions and referral to specialist services.
• Supporting children and young people aged 10-15 years and commissioning screening and extended brief interventions for young people aged16-17 years.

In July 2013 and following analysis of the consultation’s responses, the Government announced that it would not be proceeding with minimum unit pricing. The policy would ‘remain under consideration’, but at present there was not enough ‘concrete evidence’ that it would be effective in reducing the harms associated with problem drinking ‘without penalising people who drink responsibly’. The Government would instead ban the sale of alcohol below the level of alcohol duty plus VAT. This would mean that it would no longer be legal to sell a can of ordinary-strength lager for less than 40p.

In Merton, we now have a borough-wide controlled drinking zone and two cumulative impact zones in place around the Wimbledon area.  

In 2013-14 and as part of the Alcohol Merton work programme, we are further investing in  alcohol screening, brief and extended brief interventions with targeted groups and in targeted locations such as A&E Departments, pharmacies and GP practices. We are also developing an enhanced support pathway for young people who present at A&E with substance-related conditions.

Key commissioning recommendations

For the treatment system as a whole:

• Continue to monitor local treatment services against an agreed Performance Assessment Framework and local indicators and outcomes for substance misuse as indicated in the Public Health Performance Dashboard.
• Safer Merton, Public Health and the Merton CCG to review current usage of commissioned substance misuse inpatient (Tier 4) bed nights and further develop community treatment capacity to manage down future demand for inpatient services.
• Safer Merton and Public Health to develop new substance misuse prevention frameworks and reinvestment proposals to complement these.
• Continue to develop assertive outreach capacity to support hard-to-engage populations.
• Further develop local capacity to respond to parents who misuse alcohol and other drugs, and to safeguard children.
• Maintain integrity, commitment and future resourcing for integrated substance misuse treatment services.

For alcohol:

• Develop an agreed local strategic framework for alcohol partnership work with an alcohol action work plan for 2013-14
• Stream relevant elements of the alcohol work programme through a new Merton Harm Prevention Forum.
• Target street drinking and anti-social behaviour and effect appropriate responses through the Local Multi-Agency Planning and Problem Solving Groups.
• Work with Trading Standards and the Metropolitan Police Licensing Team to target licensed premises and other alcohol outlets that continue to sell alcohol to children and/or are ‘hubs’ for anti-social behaviour in local communities.
• Have a Merton Alcohol Licensing and Planning Task Group.
• Through training, develop workforce capacity in identifying and responding appropriately to problem alcohol use.
• Have a specific alcohol arrest referral pathway to divert and support problem drinkers at an early point in the criminal justice system.

Further figures

Proportion of age-specific admissions for accidents and injury, alcohol, and violence, Sutton and Merton, 2008-9; and Percentage of alcohol-specific admissions related to mental and behavioural disorders for Merton, by age group.

Percentage of alcohol-specific conditions for chronic conditions by disease and age group, Merton, 2012.