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6.5 A whole-system approach – a focus on alcohol

Alcohol harm is a good example of an issue that requires a whole-system approach.

The South Gloucestershire Alcohol Harm Reduction Strategy (2014-17)[1] was produced by the local Alcohol Stakeholder Group in 2014. The first priority identified for the healthcare system is to apply a whole-system approach to commissioning and planning, in which commissioners address all stages from prevention through to specialist care.

A number of indicators help measure the level of harm caused by alcohol within South Gloucestershire. Indicators such as those shown in Table 2 reflect the burden of illness and hospital care demand that could be avoided if a whole-system approach to alcohol harm reduction is taken.

Table 2. Main healthcare indicators for alcohol

Area Emergency admissions for alcohol-related liver disease (2013/14 provisional) * Under 75 mortality from liver disease (2013) ­**
South Gloucestershire 18.3 12.2
England 24.1 15.5

Source: HSCIC

*Age and sex directly standardised rate for >18s per 100,000 registered population
** Age and sex directly standardised mortality rate per 100,000 registered population

Actions taken in 2014/15 have involved engagement of health and wellbeing board members and key health and local authority commissioners. As a result three pilot posts offering services across organisational boundaries are now operational.

For example, an alcohol interface nurse is now in post to ensure patients do not attend hospital unnecessarily and that appropriate services are identified for them in the community. Other examples of whole-system work include identifying clients through NHS Healthchecks and the continuation of GP alcohol liaison nurse posts in the community.

Public health and wellbeing’s next steps for developing a whole-system approach to alcohol include:

  • evaluate local pilots. Monitoring is underway to support robust evaluations and enable joint commissioning
  • review service provision against NICE guidance and examples of best practice (see Figure 7)
  • generate innovative service design ideas, with a focus on vulnerable and at risk groups such as children and young people and priority neighbourhood populations
NICE guidelines – effective services to reduce the harm caused by alcohol

Figure 7. NICE guidelines – effective services to reduce the harm caused by alcohol

For more information or to get involved please contact Sara Blackmore, Public Health Consultant