Better Health For All

On April 29th the Faculty of Public Health Special Interest Group on alcohol held its annual learning event. With support from Public Health England and from the Faculty, the event was able to attract national speakers who came to share their work around reducing alcohol related harm.

Chaired by Professor Woody Caan, the event began with a keynote presentation from Dr Amy O’Donnell from Newcastle University, who shared her work on implementation of alcohol Identification and Brief Advice. Although there is good evidence for the effectiveness of alcohol IBA, particularly in the primary care and Emergency Department settings, embedding this into routine practice has proved difficult. Barriers identified included lack of financial incentives to act as levers, GPs being unconvinced that the advice actually changed behaviour and clinicians seeing alcohol as a ‘sensitive subject’.

Amy went on to share her recent implementation science work in the primary care setting. Emerging findings suggest that both patients and GPs are supportive of the delivery of IBA in primary care, but that more work is needed around promoting the benefits of delivering IBA in this setting as well as around improving understanding of the long term health implications of heavy drinking.

We were also joined at the event by colleagues from Scotland. Debbie Sigerson from NHS Health Scotland shared research that has been done to understand the key strategies needed to embed alcohol brief advice, and also shared the count14 campaign that has been put in place to increase understanding of units and alcohol consumption. Debbie also shared progress of a review that is currently underway to determine variation in delivery of IBA across Scotland and to agree what suite of resources are required for public and professional use, ensuring these are fit for the future (e.g. digital first).

Barriers and enablers to delivery of alcohol IBA were also the theme of Dr Ben Rush’s work, with a specific focus on delivery in the ED setting. Ben, a Specialty Registrar in Public Health working with Nottingham City Council, described a project that had been completed with ED staff at a large acute trust. This had identified high levels of staff support for the delivery of IBA in this setting but that achieving this required ongoing staff training. Similarly to what was presented by Amy in relation to primary care, delivery of clear messages to staff about the benefits of delivering IBA in this setting was also raised as an important issue.

The meeting then received an update on the Lancet Liver commission from Professor Steve Ryder, Consultant Physician in Hepatology and Gastroenterology. The commission has been successful in giving liver disease a high profile and in bringing agencies together in a unified approach to reducing morbidity and mortality associated with liver disease. Steve shared recent research on the impact that use of ‘care-bundles’ has on patients admitted with decompensated cirrhosis and also shared progress made by Hepatology Networks around treatment for Hepatitis C.

The final two presentations of the day had a more local authority public health focus. The first was work presented by Dr Emily Walmsley, a Specialty Registrar in Public Health working with Portsmouth City Council. This focused on tackling issues associated with ‘pre-drinking’ through the use of breathalysers by door staff in the night time economy. The evaluation of this innovative

intervention was associated with small reductions in violent crime and ambulance call-outs and also raised the complexity and challenges that are associated with implementing and evaluating interventions of this kind. Professor Paul Roderick then shared another local authority based intervention that has been led by Rob Anderson-Weaver from Portsmouth City Council. This reported on the introduction of a voluntary initiative called ‘Reducing the Strength’ that put in place requirements of retailers that would limit sales of high strength beers and ciders. More than half of off-licences supported the initiative and it was concluded that it had reduced availability of high strength beer and cider. Issues were raised around evaluating wider health and social impacts and also the long term sustainability of this and similar voluntary schemes.

This learning event built on our 2018 event that was around alcohol licensing and we will be running a further event in 2020 on another key issue relating to reducing alcohol related harm. Anybody interested in joining the SIG can contact either Jane Bethea (jb518@le.ac.uk) or Catherine Chiang (catherine.chiang@ggc.scot.nhs.uk). Copies of slides from the event are also available through either Jane or Catherine.

Written by Dr. Jane Bethea FHEA FFPH, Associate Professor of Public Health, Leicester Medical School, co-Chair FPH Alcohol Special Interest Group