Item 5 Appendix 1 - NHS report
West Dunbartonshire Council · 9 May 2023
Back to Licensing Board — 9 May 2023 and its agenda
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Overprovision Evidence to the West Dunbartonshire Licensing Board from NHS Greater Glasgow and Clyde and West Dunbartonshire Health and Social Care Partnership March 2023 For further information please contact: Health Improvement Team West Dunbartonshire Health and Social Care Partnership WDHSCP@ggc.scot.nhs.uk www.wdhscp.org.uk Document Title: Overprovision Evidence to the West Dunbartonshire Licensing Board from NHS Greater Glasgow and Clyde, March 2023 Owner: Health Improvement Team Version No. 3 Superseded Version: 0 Date Effective: 30th March 2023 Review Date: None
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2 Contents Figures .............................................................................................................................................. 3 Summary ........................................................................................................................................... 5 1 Introduction .............................................................................................................................. 7 1.1 Background ...................................................................................................................... 7 1.2 Strategic Context ............................................................................................................. 7 1.3 Purpose ............................................................................................................................ 9 2 Method of Data Collection ......................................................................................................... 9 3 West Dunbartonshire Population Profile .................................................................................. 10 3.1 Age .................................................................................................................................. 10 3.2 Gender ............................................................................................................................. 10 3.3 Ethnicity ........................................................................................................................... 11 3.4 Life Expectancy ................................................................................................................ 11 3.5 Employment..................................................................................................................... 11 3.6 Deprivation ...................................................................................................................... 12 4 Current Trends in Alcohol Consumption ................................................................................... 14 4.1 Adults .............................................................................................................................. 14 4.1.1 Alcohol Sales ............................................................................................................ 18 4.1.2 Minimum Unit Price ................................................................................................. 19 4.2 Young People ................................................................................................................... 20 4.2.1 Planet Youth in Scotland ........................................................................................... 20 4.2.2 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) ................ 21 5 Alcohol Related Hospital Admissions........................................................................................ 23 6 Alcohol Specific Deaths ............................................................................................................ 28 7 Alcohol Related Mental Health ................................................................................................ 35 8 Scottish Ambulance Service – Alcohol Calls .............................................................................. 36 9 Impact on Children and Families .............................................................................................. 37 9.1 Children & Families Affected by Parental Drinking (Non-Dependent) ...................... 37 9.2 Alcohol in Childhood ..................................................................................................... 38 9.3 Child Protection ............................................................................................................. 39 10 Economic Impact ................................................................................................................. 41 11 Alcohol and Drug Partnership – Service Data ........................................................................ 42 12 Alcohol Related Harm Data by Intermediate Zone ................................................................ 43
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3 13 References ........................................................................................................................... 52 14 Glossary and Technical Notes ............................................................................................... 55 14.1 Glossary ......................................................................................................................... 55 14.2 Data Limitations ............................................................................................................. 58 14.3 Clinical codes for alcohol-related conditions ............................................................... 59 Figures Figure 1: Population by age and sex (National Records for Scotland, 2021) ......................... 10 Figure 2: Life Expectancy (West Dunbartonshire v Scotland) .................................................. 11 Figure 3: Percentage of Deprivation by Council Area ............................................................... 13 Figure 4: Weekly Alcohol Consumption by SIMD quintile ......................................................... 15 Figure 5: Alcohol consumption (mean weekly units) by sex, Scotland .................................... 16 Figure 6: Alcohol consumption (mean weekly units) by age, Scotland .................................... 16 Figure 7: Alcohol consumption (hazardous/harmful), Scotland ................................................ 17 Figure 8: Alcohol consumption (hazardous/harmful) by SIMD, Scotland ................................ 17 Figure 9: Off-trade/On-Trade Sales – litres per adult, Scotland v England & Wales .............. 18 Figure 10: WD Pupils - Ever drank alcohol ................................................................................ 21 Figure 11: WD Pupils - Ever Drunk ............................................................................................. 21 Figure 12: WD Pupils - Drunk 10 Times + .................................................................................. 22 Figure 13: WD Pupils - Purchased Alcohol ................................................................................ 22 Figure 14: Alcohol Related Hospital Admissions – West Dunbartonshire v Scotland ............ 23 Figure 15: Alcohol Related Hospital Admissions, young people (11-25 years) ...................... 24 Figure 16: Alcohol Related Hospital Admissions crude rate by age – West Dunbartonshire, NHSGGC and Scotland ............................................................................................................... 25 Figure 17: Alcohol Related Hospital Admissions in West Dunbartonshire by SIMD quintile 2021/22 .......................................................................................................................................... 26 Figure 18: Excess Alcohol Related Hospital Admissions due to Inequality ............................. 27 Figure 19: Number of Alcohol Specific Deaths in West Dunbartonshire ................................. 28 Figure 20: Alcohol Specific Deaths, West Dunbartonshire v Scotland .................................... 29 Figure 21: Alcohol Specific Deaths, Females – West Dunbartonshire v Scotland ................. 29 Figure 22: Alcohol Specific Deaths, Males – West Dunbartonshire v Scotland ...................... 30 Figure 23: Alcohol Specific Death Rates by Age – Changes over time (Scotland) ................ 31 Figure 24: Alcohol Specific Deaths in Council Areas 2017-21 ................................................. 32 Figure 25: Alcohol Specific Deaths in West Dunbartonshire by SIMD 2017-21 ..................... 33 Figure 26: Profile of an Alcohol Related Death .......................................................................... 34 Figure 27: West Dunbartonshire, NHSGGC & Scotland Alcohol Related Mental Health Admissions .................................................................................................................................... 35 Figure 28: Ambulance Calls by Gender and Age 2020 & 2021 to West Dunbartonshire postcodes ...................................................................................................................................... 36 Figure 29: Concerns identified at the case conferences of children who were on the child protection register, 2020-21 (Scotland) ...................................................................................... 39
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4 Figure 30: Child Protection with Parental Alcohol Misuse – West Dunbartonshire v Scotland ........................................................................................................................................................ 40 Figure 31: Domestic Abuse by Council Area 2021/22 ............................................................... 40 Figure 32: Number of Referrals and Client Engagement 2015-2021 - DACA ......................... 42 Figure 33: 2011 Intermediate Zones - Datazones by SIMD Quintile ....................................... 46 Figure 34: Alcohol Related Health Indicators by Intermediate Zone ........................................ 47 Figure 35: Alcohol Related Harm Indicators – Data changes over duration of current policy 48 Figure 36: Alcohol Related Hospital Admissions by Intermediate Zone .................................. 49 Figure 37: Alcohol Specific Deaths by Intermediate Zone ........................................................ 50 Figure 38: Alcohol Related Mental Health Admissions by Intermediate Zone ........................ 51
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5 Summary West Dunbartonshire Population Profile • West Dunbartonshire has an aging population. Life expectancy is lower than the Scottish average. The proportion of working age population on out of work benefits is higher than the Scottish average. • West Dunbartonshire has the fourth highest (in Scotland) local share of the most deprived SIMD (Scottish Index of Multiple Deprivation) datazones. • People living in more deprived areas experience greater levels of alcohol related harm. Current Trends in Alcohol Consumption • Accurate alcohol consumption data is difficult to obtain. Self-reported survey data usually obtains lower estimates than sales data. The best indicator for alcohol consumption in West Dunbartonshire is from the Scottish Health Survey 2021. • Harmful drinking (defined as consuming more than 14 units per week) in West Dunbartonshire (20%) is lower than NHSGG&C (23%) and Scotland (24%). • The mean number of units per week among drinkers in West Dunbartonshire is 11.2 with male drinker’s consumption considerably higher at 14.1 units compared to 8.6 units for females. • 85% of alcohol is sold in supermarkets and off-sales. Alcohol Related Impact in West Dunbartonshire • The rate of alcohol-related hospital admissions in West Dunbartonshire is higher than the Scottish average. • In 2021, 40 alcohol specific deaths were recorded in West Dunbartonshire. This is the highest number of alcohol specific deaths in the time period from 2010. Alcohol specific death rates for West Dunbartonshire remain higher than for Scotland as a whole and are rising for both males and females. • Rates of alcohol related mental health hospital admissions are higher than the Scottish average and have consistently been higher for the available time period (2013-2022)
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6 • The highest rates of alcohol ambulance calls are for males in the age groups 35- 44 and 55-64. • The impact on children and families of non-dependent parental drinking has been highlighted by research. Locally, concerns about parental alcohol use continue to be identified at a number of case conferences for children on the child protection register. • Up to date estimations of the economic impact of alcohol are not available at a local level. Alcohol Related Impact in West Dunbartonshire by Intermediate Zone • The 2011 Intermediate Zones have not changed in size significantly in the last 2 years. The population sizes range from an estimated 3,464 for IZ05 to 7,162 for IZ12. • All Intermediate Zones have residents living in SIMD 1 and 2 areas. • An analysis of the three main alcohol related health indicators has been undertaken by Intermediate Zone. Fifteen Intermediate Zones have two or more indicators worse than the Scottish average (IZ01, IZ02, IZ03, IZ04, IZ06, IZ08, IZ10, IZ11, IZ12 IZ13, IZ14, IZ15, IZ16, IZ17 and IZ18). • Three Intermediate Zones have less than two indicators worse than the Scottish average (IZ05, IZ07 and IZ09).
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7 1 Introduction 1.1 Background With the increase of alcohol related harm in Scotland during the mid 2000s the Scottish Government co-ordinated a strategic approach to reduce overall alcohol consumption and harm. Changing Scotland’s Relationship with Alcohol: A Framework for Action was published in 2009 and three Parliamentary Acts were passed. The approach was evidence based and contained the main strategic elements advocated by the World Health Organisation’s Global Strategy to Reduce the Harmful use of Alcohol. The Licensing (Scotland) Act 2005 was implemented in September 2009 and introduced five licensing objectives which should underlie both Licensing Policy Statements and the decision made on Premises Licence Applications. These objectives are: • Preventing crime and disorder • Securing public safety • Preventing public nuisance • Protecting Children from hard • Protecting and improving public health Licensing boards must publish a statement of their licensing policy which must seek to promote the five licensing objectives. The Licensing Act, therefore, places a direct obligation on local licensing boards to consider the protection and improvement of public health when granting or reviewing licenses. The policy statement must also include a statement on overprovision of licensed premises within its area and the licensing board must subsequently pay regard to the content of the policy statement when making licensing decisions. 1.2 Strategic Context The Licensing Board Policy and Overprovision Statement are connected with and make an important contribution to a number of national and local policies and strategies. At a national level, a number of policies and strategies were introduced in 2018 that will co-exist with the updated Licensing Policy Statement. The Scottish Government published Scotland’s top six Public Health Priorities, which highlighted that substance use, including alcohol, is a major cause of preventable harm nationally. To address this, Minimum Unit Pricing was introduced in May 2018, followed by the Alcohol Framework 2018 and Rights, Respect and Recovery later in the year. Also,
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8 since 2018, it has been a Ministerial Priority to reduce the attractiveness, access and availability of alcohol. In addition, the Community Empowerment (Scotland) Act 2015 details a range of ways in which local communities can get more involved in the design and delivery of services in their local areas and the Fairer Scotland Duty places a legal requirement on public bodies to actively consider and reduce inequalities. At a local level, the Licensing Board Policy will impact on locality plans developed to support implementation of the West Dunbartonshire Plan for Place 2017 – 2027 (Local Outcome Improvement Plan) as required by the legislation. The plan places an emphasis on tackling health inequalities, placing specific duties on Community Planning Partners to act with a view to reducing inequality of outcomes. The West Dunbartonshire Council Strategic Plan 2022-2027 also highlights health inequalities as a key concern and focusses on the following 4 strategic priorities: strategic priorities: • Resilient and thriving communities who support each other and take responsibility for their local area • A need to protect and enhance our environment in response to climate change • A strong, flourishing and sustainable local economy which reflects the demands of a changing population • Inclusive and adaptable local government working efficiently and effectively to improve outcomes for communities The West Dunbartonshire Health and Social Care Partnership Strategic Plan 2019-2022 vision is to improve the lives of people in West Dunbartonshire by delivering actions under the following strategic priorities: • Early Interventions • Access • Resilience • Assets • Inequalities The West Dunbartonshire Substance Use Prevention Strategy 2018-2027 aims to prevent, delay or reduce use of substances and reduce related harm. This will be achieved directly or indirectly using a variety of approaches (policies, programmes and/or activities). The strategy has specific actions to reduce alcohol availability by supporting alcohol licensing policy development, including overprovision and its implementation whilst responding to applications as required. The West Dunbartonshire Community Planning Partnership Integrated Children’s Services Plan 2021 – 2023 strategic priorities to improving outcomes for West Dunbartonshire’s children and young people include:
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9 • Ensuring the wellbeing and safe care of all children and young people • Improved attainment and achievement for all children and young people • Ensure all children and young people have a safe and stable home environment • Respecting the voices of all children and young people in their life choices 1.3 Purpose This report collates and presents the current data available in relation to alcohol and public health. It has been gathered by and on behalf of NHS Greater Glasgow and Clyde fulfilling its duty as a statutory consultee to the West Dunbartonshire Licensing Board. It provides an overview of the main indicators available presenting a picture of alcohol related harm in West Dunbartonshire and aims to support the development an evidence-informed policy. 2 Method of Data Collection Data and other information on alcohol consumption and impact over the past five years was identified and collated from a range of local and national sources. On occasion data older than five years has been referenced where the content still provides valuable evidence. Where data has been affected by the coronavirus pandemic, this will be highlighted throughout the document. As different information sources have different publishing schedules the most up to date information available at time of writing is provided. Where available, data is presented for West Dunbartonshire and where this has not been possible, data for NHSGG&C or Scotland is provided as a proxy indicator. In addition, where relevant, latest research evidence has been included. A glossary of terms and explanation of data limitations is provided.
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10 3 West Dunbartonshire Population Profile Key Finding: • By 2043, the population of West Dunbartonshire is projected to decrease by 7.4% to 82,537 (from 89,130 in 2018). • The average age of the population of West Dunbartonshire is projected to increase as more people are expected to live longer. 3.1 Age West Dunbartonshire's population 88,340 (June 2020), which accounts for 1.6% of the Scottish population. In contrast to Scotland as a whole, the population of West Dunbartonshire has been declining steadily (6% since 2000). This is due to fewer babies being born each year and more people moving out of the area than moving in. Figure 1: Population by age and sex (National Records for Scotland, 2021) West Dunbartonshire has an ageing population. In terms of overall size, the 45-64 age group was the largest in 2020, with a population of 25,646 (29%). 3.2 Gender In keeping with the Scottish picture, there are more females (52.2%) than males (47.8%) living in West Dunbartonshire. The gender split begins to widen with increasing age from the 25-44 age group onwards.
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11 3.3 Ethnicity There is a very small minority ethnic population in West Dunbartonshire. In the 2011 Census, the majority of residents (93%) of West Dunbartonshire identified as being white Scottish, and 1.5% identified as being Asian, Asian Scottish or Asian British, or ‘other ethnicity’. This is lower than Scotland which is 4%. In terms of nationality, an estimated 3.4% of the local population are non-British, compared to 8% in Scotland. 3.4 Life Expectancy Life expectancy in West Dunbartonshire is lower than the Scottish average (Female 80.8 years: Male 76.5 years). Female life expectancy at birth is the second lowest in Scotland at 78.4 years. Similarly, male life expectancy is also the second lowest at 73.4 years (National Records of Scotland, 2022). For both males and females’ life expectancy is falling. Figure 2: Life Expectancy (West Dunbartonshire v Scotland) Source: National Records of Scotland, 2022a 3.5 Employment West Dunbartonshire has a slightly lower percentage of the population who are economically active (74.2%) compared to the Scottish average of (76.1%). 77.4% of males were economically active during this time period compared to 71.3% of females. The Scottish equivalent figures were 79.3% for males and 73.1% for females (Nomis)
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12 3.6 Deprivation Key Findings: • West Dunbartonshire has the fourth highest (in Scotland) local share of the most deprived SIMD (Scottish Index of Multiple Deprivation) datazones. • People living in more deprived areas experience greater levels of alcohol related harm SIMD 2020 provides an analysis of deprivation across Scotland based on 6,976 data zone areas across Scotland. West Dunbartonshire has 48 data zones in the most deprived 20%. Compared to other local authorities in Scotland, West Dunbartonshire contains the fourth highest local share of the most deprived datazones (below Inverclyde, Glasgow City and North Ayrshire – see chart on next page) and contains the highest share of the 40% most deprived datazones (see pink and white area combined). The association between alcohol and deprivation is complex. Several studies have shown that the more deprived an area, the lower the levels of alcohol consumption (Pollack et al, 2005). However, a Glasgow University study found that low socioeconomic status was associated with a greater risk of alcohol-attributable harms such as mortality or illness due to alcohol consumption (Vittal et al 2017). Local data shows there are over four times as many hospital admissions and more than double the rate of alcohol specific deaths, when comparing those living in the most deprived areas of Scotland to those living in the least deprived areas (ScotPHO, 2022).
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13 Figure 3: Percentage of Deprivation by Council Area Source: Scottish Government (2020) West Dunbartonshire has the fourth greatest local share of the most deprived datazones in Scotland. Additionally, West Dunbartonshire has the highest percentage of individuals residing in the 40% most deprived datazones.
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14 4 Current Trends in Alcohol Consumption Key Findings: • Accurate alcohol consumption data is difficult to obtain. Self-reported survey data usually obtains lower estimates than sales data. The best indicator for alcohol consumption in West Dunbartonshire is from the Scottish Health Survey 2021. • Harmful drinking (defined as consuming more than 14 units per week) in West Dunbartonshire (20%) is lower than NHSGG&C (23%) and Scotland (24%). • The mean number of units per week among drinkers in West Dunbartonshire is 11.2 with male drinker’s consumption considerably higher at 14.1 units compared to 8.6 units for females. • 85% of alcohol is sold in supermarkets and off-sales. 4.1 Adults The consumption of alcohol is recognised as a major issue in Scotland, carrying a risk of physical and mental health problems, as well as potential negative social consequences. People who consume large quantities of alcohol have increased risks of high blood pressure, chronic liver disease and cirrhosis, pancreatitis, some cancers, mental ill-health and accidents. The current Chief Medical Officers’ guidelines to keep health risks from drinking alcohol to a low level are 14 units per week for both men and women. They recommend spreading the units over three or more days and having drink free days, as heavy drinking sessions can increase your risk of death and long term illnesses and accidents and injuries (Department of Health, 2016). Self-reported alcohol consumption data is problematic. Surveys usually obtain lower consumption estimates than those implied by alcohol sales data (Health Scotland, 2011). This can largely be explained by participants' under-reporting of consumption, due in part to not accounting for atypical / special occasion drinking. There is also some evidence that survey non-responders are more likely than responders to engage in risky health behaviours, including hazardous alcohol use (Cheung et al, 2017). In spite of this surveys do provide an indication about the social patterning of individuals' alcohol consumption. Furthermore, accurate consumption data for West Dunbartonshire is difficult to obtain. A number of sources have been reviewed. It is difficult to make comparisons
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15 due the differences in questions used. It is also difficult to assess drinking levels in relation to the national guidelines as the questions and analysis do not always reflect the 2016 changes (from 21 units for men prior to 2016, to 14 units for both men and women from 2016 onwards). Scottish Health Survey The best indicator for alcohol consumption in West Dunbartonshire is from the Scottish Health Survey 2021 (combined 2017 - 2021). Harmful drinking (defined as consuming more than 14 units per week) in West Dunbartonshire (20%) is lower than NHSGG&C (23%) and Scotland (24%). The mean number of units per week among drinkers in West Dunbartonshire is 11.2 with male drinker’s consumption considerably higher at 14.1 units compared to 8.6 units for females. Figure 4: Weekly Alcohol Consumption by SIMD quintile Source: Scottish Health Survey, Scottish Government In Scotland, levels of harmful/hazardous drinking (defined as 14 units and over per week) increase with higher household income. There is a slight decrease in SIMD 2 areas however this rises again in the most deprived areas (SIMD 1) (Fig 4).
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16 Figure 5: Alcohol consumption (mean weekly units) by sex, Scotland Source: Scottish Health Survey, Scottish Government The graph above shows nationally, since 2008 until 2021 males have consistently consumed more mean weekly units than females. Female consumption has been relatively static throughout the time period whilst male consumption has fallen overall (from a mean of 20 units in 2008, to 14.8 units in 2021). Figure 6: Alcohol consumption (mean weekly units) by age, Scotland Source: Scottish Health Survey, Scottish Government In Scotland, 45 to 74 year olds consume the most mean weekly units.
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17 Figure 7: Alcohol consumption (hazardous/harmful), Scotland Source: Scottish Health Survey, Scottish Government Similar to alcohol consumption by mean weekly units, the graph above shows that nationally, males are more likely than females to consume alcohol at hazardous/harmful levels. Figure 8: Alcohol consumption (hazardous/harmful) by SIMD, Scotland Source: Scottish Health Survey, Scottish Government Nationally there are higher levels of reported hazardous/harmful drinking among those living in the least deprived quintiles, this is consistent over the available time period (2008-2021). However, Katikireddi et al (2017) highlighted disadvantaged social groups have greater alcohol-attributable harms compared with individuals from advantaged areas even with equal levels of alcohol consumption and after
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18 accounting for different drinking patterns, obesity, and smoking status at the individual level. This observation is also known as the Alcohol Harm Paradox (Bloomfield, K 2020). 4.1.1 Alcohol Sales Figure 9: Off-trade/On-Trade Sales – litres per adult, Scotland v England & Wales Source: Monitoring and Evaluating Scotland's Alcohol Strategy (MESAS), Public Health Scotland(2022) Scotland has consistently had greater pure alcohol volume sold in the off-trade than England & Wales. In the on-trade, the pure alcohol volume sold is the same in Scotland as it is for England & Wales, and it has consistently been the same since 2005. Alcohol Sales and Harm in Scotland During the Coronavirus Pandemic • Alcohol sales indicate that population-level consumption was above recommended levels. Between the start of COVID-19 restrictions in March 2020 and May 2021, 17 units (171 ml) of pure alcohol have been sold per adult each week on average, 16 (162 ml) of which have been from off-trade premises. This represents enough alcohol to put every adult in Scotland over the Chief Medical Officer’s low-risk weekly drinking guideline • Alcohol-related hospital stays were 7.3% (95% CI: 5.9% to 8.6%) lower in 2020 than the 2017–19 average. • Rates of alcohol-related hospital stays decreased most for males, those aged over 45 years, and those living in deprivation quintiles 1 (most deprived), 2 and 4. In general, these groups had the highest rates of alcohol-related stays in 2017– 19. -1 1 3 5 7 9 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 L per adult Volume of pure alcohol (litres) sold per adult (16+) Scotland and England & Wales, by trade sector, 1994-2021 Scotland - off-trade England & Wales - off-trade Scotland - on-trade England & Wales - on-trade
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19 • Alcohol-specific deaths increased following the start of the pandemic. This was driven primarily by an increase in alcohol-specific death rates among males and those aged 45 to 64 years. • Increased rates of alcohol specific death for some groups may support existing evidence that drinking at hazardous and harmful levels may have increased for some groups, despite consumption reducing at the population level. • Of concern is the potential that groups with high levels of alcohol consumption before the pandemic may have increased their alcohol consumption, had reduced access to hospital treatment for alcohol related conditions, and potentially experienced higher rates of mortality as a consequence. 4.1.2 Minimum Unit Price Minimum unit pricing for alcohol (MUP) was implemented in May 2018 at a rate of 50p per unit. The policy is subject to a sunset clause, which means it will lapse unless renewed by the Scottish Parliament by end of April 2024. A recent Public Health Scotland Evaluation (2023) of MUP shows: • 13% significant reduction in deaths (averted ~156 deaths per year) • 4% reduction in hospitalisations (averted ~411 hospitalisations per year), although this finding was not statistically significant • Greatest reductions in deaths and hospitalisations were for males and those residing in 40% most deprived areas This evidence indicates minimum pricing remains an essential component of Scotland’s alcohol strategy to reduce our high levels of alcohol consumption and harm. However, as highlighted in section 12 of this paper, alcohol harm continues to be higher in West Dunbartonshire than Scotland as a whole and has increased in some intermediate zones since the introduction of MUP.
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20 4.2 Young People 4.2.1 Planet Youth in Scotland West Dunbartonshire is one of five pilot sites across Scotland as part of ‘Planet Youth in Scotland’ (Icelandic Prevention Model). In West Dunbartonshire the pilot is led by WDC Education Services in collaboration with the Health Improvement Team and sits within the Substance Use Prevention Strategy Delivery Plan: Action Area 2 Healthier and Safer Environments. The Planet Youth survey was completed during class time under exam conditions in October 2021 by S3 pupils in a West Dunbartonshire Secondary School A summary of results that may be of interest to the Licensing Board is given below: Alcohol Use – S3 • 61% have drank alcohol in their lifetime • 25% have drank alcohol in the last 30 days • 31% have been drunk in their lifetime • 10% have been drunk in the last 30 days • Average age of trying alcohol for the first time is 12.3 years Location of Alcohol Consumption – S3 • 18% drink alcohol in their own home • 17% drink alcohol at a party or other organised event • 13% drink alcohol in the home of others • 12% drink alcohol outdoors Accessing Alcohol – S3 • 15% get alcohol from a family member • 13% get alcohol from another adult • 3% buy alcohol in a shop • 1% take alcohol from a store without paying • 1% get alcohol delivered
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21 4.2.2 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) SALSUS is a series of publications which provided data on a range of health indicators for S2 (13 year olds) and S4 (15 year olds) pupils across Scotland. Data was gathered by self-completion survey which was completed under exam conditions in class time. The most recent and final publication in the series, for West Dunbartonshire is from 2018. Figure 10: WD Pupils - Ever drank alcohol SALSUS 2018 shows there was an increase in underage drinking (15-year-olds; red ring) in West Dunbartonshire since the last data point in 2013. However, there was a decrease overall since the first data published in 2006. Figure 11: WD Pupils - Ever Drunk More 13- and 15-year-olds reported having ever been drunk in 2018 than in the 2013 survey.
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22 Figure 12: WD Pupils - Drunk 10 Times + The above shows there was an increase in pupils reporting having been drunk more than ten times since the last data point in 2013. However, this has decreased overall since the question was first asked in 2010. Figure 13: WD Pupils - Purchased Alcohol SALSUS 2018 West Dunbartonshire reports that the majority of pupils, 13 and 15 years of age (90% and 87%, respectively) have never tried to purchase alcohol from a shop, supermarket or off licence. However, as seen above (red ring) 10% of 15- year-olds successfully managed to purchase alcohol.
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23 5 Alcohol Related Hospital Admissions Key Finding: • The rate of alcohol-related hospital admissions in West Dunbartonshire is consistently higher than the Scottish average. Figure 14: Alcohol Related Hospital Admissions – West Dunbartonshire v Scotland Source: Scottish Public Health Observatory Profile Tool Since 2002/3 the rate of alcohol related hospital admissions (ARHA) in West Dunbartonshire has consistently remained higher than the national rate. Data points over the past ten years show that the gap between local and national rates is increasing. Whilst the Scottish rate is in slow decline, the West Dunbartonshire rate is rising overall. The latest data points for WD does show a fall in ARHA but this is likely due to the covid 19 pandemic.
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24 Figure 15: Alcohol Related Hospital Admissions, young people (11-25 years) Source: Scottish Public Health Observatory Profile Tool National and local alcohol related hospital admissions for young people have fallen overall since 2007-10. In West Dunbartonshire the rate began to rise again from 2013-16. The latest data points show a fall in admissions, which could be attributable to the coronavirus pandemic where public messaging asked people to avoid hospitals, if possible.
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Figure 16: Alcohol Related Hospital Admissions crude rate by age – West Dunbartonshire, NHSGGC and Scotland Source: LIST Analyst data, provided upon request In West Dunbartonshire, 45-64 year olds have the highest ARHA crude rate followed by 25-44 and 65-74 year olds. The crude rate for these age groups is higher than is observed in NHSGGC and Scotland
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26 Figure 17: Alcohol Related Hospital Admissions in West Dunbartonshire by SIMD quintile 2021/22 Source: Scottish Public Health Observatory Profile Tool Residents in the most deprived quintile (1500.4 per 100,000 population) and second most deprived quintile (1371.5 per 100,000 population) account for a significant proportion of admissions. The Alcohol Harm Paradox tells us that people living in more deprived areas experience greater alcohol related harm than those in more affluent areas even if the consumption patterns are the same.
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27 Figure 18: Excess Alcohol Related Hospital Admissions due to Inequality Source: Scottish Public Health Observatory Profile Tool In 2021/22, 66% of alcohol related hospital admissions could have potentially been avoided if inequalities were more effectively addressed and the level of alcohol related harm experienced by the least deprived was shared across the population.
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28 6 Alcohol Specific Deaths Key Findings: • In 2021, 40 alcohol related deaths were recorded in West Dunbartonshire. • From 2010, numbers of deaths relating to alcohol slowly decreased, with the latest data point in 2021 showing the highest number of deaths in the time period. • The West Dunbartonshire rate has consistently been higher than Scotland as a whole. Despite an overall fall from 2002-2006 data, the latest data shows the local death rate is rising overall, for both males and females. Figure 19: Number of Alcohol Specific Deaths in West Dunbartonshire Source: Alcohol Specific Deaths, National Records of Scotland In West Dunbartonshire from 2017-21, there have been 140 alcohol specific deaths. Since 2010 the number of deaths relating to alcohol slowly decreased to a low of 18 in 2019 but has risen sharply with the most recent data point (n=40 in 2021).
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29 Figure 20: Alcohol Specific Deaths, West Dunbartonshire v Scotland Source: Scottish Public Health Observatory Profile Tool Although there has been a fall in the number of alcohol specific deaths overall, rates for West Dunbartonshire remain higher than for Scotland as a whole with the latest data point showing the date rate is rising. Figure 21: Alcohol Specific Deaths, Females – West Dunbartonshire v Scotland
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30 Source: Scottish Public Health Observatory Profile Tool The female alcohol specific death rate in West Dunbartonshire has been consistently higher than the national rate. Despite a narrowing of the gap between local and national rates in 2011-2015, locally the rate is rising whilst the national rate has remained relatively static. Figure 22: Alcohol Specific Deaths, Males – West Dunbartonshire v Scotland Source: Scottish Public Health Observatory Profile Tool Similar to females, the male alcohol specific death rate in West Dunbartonshire has been consistently higher than the national rate. The male rate steadily declined to the lowest rate in the time period shown in the above graph (2016-2020). However, the latest data point shows the male death rate is rising again.
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31 Figure 23: Alcohol Specific Death Rates by Age – Changes over time (Scotland) Source: National Records of Scotland (2022b) Nationally age band rates for alcohol specific deaths naturally fluctuate within each age bracket. However, age 45-64 and 65-74 have consistently been the most common ages for an alcohol specific death. In more recent years (2012 onwards) there has been a noticeable rise in the over 75s dying of alcohol specific causes. 0 10 20 30 40 50 60 70 1994 1997 2000 2003 2006 2009 2012 2015 2018 2021 Deaths per 100,000 people Year Age 10-24 Age 25-44 Age 45-64 Age 65-74 Age 75 or more
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32 Figure 24: Alcohol Specific Deaths in Council Areas 2017-21 Source: National Records of Scotland (2022b) The above graph shows a comparison of alcohol specific deaths across all Scottish Council Areas for the period 2017-21. West Dunbartonshire is the third worst local authority area.
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33 Figure 25: Alcohol Specific Deaths in West Dunbartonshire by SIMD 2017-21 Source: Scottish Public Health Observatory Profile Tool Alcohol specific deaths in West Dunbartonshire could be 50% lower if the rates of the least deprived areas were experienced across the population.
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34 Figure 26: Profile of an Alcohol Related Death Profile of an Alcohol Related Death An individual who will die of an alcohol related death will most likely be: • a white Scottish male between the ages of 45 – 54 years. • single or divorced • living in his own home (council rented accommodation), alone, in one of the most deprived areas. • may have adult children but it is unlikely that he will be in contact with them. • unemployed at the time of death and in the years leading to it, but he will have previously worked within a skilled industry and may have lost his job as a result of his alcohol use. It is likely that: • he will have had his first drink at around 13/14 years of age • developed a problem with drinking alcohol before he reaches the age of 25 years. • will be a dependent drinker, drinking alcohol daily consuming on average 233 units of alcohol weekly. This equates to 9 bottles of vodka per week. He will have experienced acute withdrawal symptoms and attended emergency services as a result. His GP will most likely be aware that he has had a long standing alcohol problem and he will carry the physical biomarkers of this, such as abnormal liver function tests, low platelet levels and elevated mean cell volume. He will most likely have been prescribed thiamine and omeprazole by his GP. He will have Alcoholic Liver Disease and will have been referred for acute outpatient appointments with Gastroenterology. He will have had on average 8 acute inpatient episodes, a result of emergency admissions, probably within a general medical ward. He will have received treatment for his alcoholic liver disease and acute withdrawal symptoms and he may have been in contact with the acute addiction liaison service during one of these admissions. He will have had contact, at some point in his drinking career, with an alcohol treatment service (including pre Community Addiction Team services). He will have been in contact with a psychiatric service, most likely a non addiction specific psychiatric service and will have received medication to reduce or stop alcohol withdrawal without any formal support. He may have attended a community addiction team and he will have also attended a community/voluntary alcohol service. It is more than likely that he has defaulted from these services. He will be socially isolated with a lack of a social network and will most probably have a close relation with an alcohol problem. He will also be experiencing some financial problems and housing issues as a result of his alcohol use and although likely to have been in contact with police, he is unlikely to have been charged or taken into custody. He will most likely die in hospital of an alcohol related liver condition. Dargan et al (2013)
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35 7 Alcohol Related Mental Health Key Finding: • West Dunbartonshire rates of alcohol related mental health hospital admissions are higher than the Scottish average and have consistently been higher for the available time period. Figure 27: West Dunbartonshire, NHSGGC & Scotland Alcohol Related Mental Health Admissions Source: LIST Analyst Data, provided upon request The above chart presents rates of alcohol related mental health admissions within West Dunbartonshire, NHSGG&C and Scotland. Since 2013/14 West Dunbartonshire has had higher rates than Scotland. Scotland’s alcohol mental health admissions have been decreasing overall while West Dunbartonshire’s have been rising since 2016. The decline in admissions in West Dunbartonshire for the last data point, is likely due to covid restrictions and public messaging to avoid hospitals, if possible.
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36 8 Scottish Ambulance Service – Alcohol Calls Key Finding: • The highest rates of alcohol ambulance calls are for males in the age groups 35-44 and 55-64. When an ambulance is called out to an emergency the paramedic will record the reason. This method of data collect has limitations as it is reliant on the responder logging the call as alcohol related. In 2016 the way the data was recorded was changed, which led to only 25% of calls being recorded and as a result this data can be taken as an indication only and not reflective of alcohol related ambulance calls overall. Data is collected by the postcode the call came from so may not be reflective of the whole population of West Dunbartonshire i.e., calls made by a person living in West Dunbartonshire from a Glasgow postcode will not be counted. Males have the highest rate of alcohol ambulance calls in the age groups 35-44 and 55-64. Figure 28: Ambulance Calls by Gender and Age 2020 & 2021 to West Dunbartonshire postcodes Source: LIST Analyst data, provided upon request
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37 9 Impact on Children and Families Key Findings: • The negative impacts on children and families of non-dependent parental drinking are evidenced by research. Locally, concerns about parental alcohol use continue to be identified at a number of case conferences for children on the child protection register. 9.1 Children & Families Affected by Parental Drinking (Non- Dependent) Research ‘Like Sugar for Adults’ (Foster et al., 2017) has highlighted a direct link between non-dependent parental drinking habits and the attitudes, behaviours and impacts reported by their children. The mixed methods study found that factors which affect children in regards to alcohol are: • Peer influence, the media, alcohol marketing, price of alcohol all lower parental influence on a child’s attitudes towards alcohol • Majority of parents conscious their drinking sets an example to their children • Parents discussing their own negative experiences of alcohol may normalise excessive drinking behaviours for their children • Children do not differentiate between seeing their parents tipsy or drunk • Impacts on children can begin from relatively low levels of alcohol consumption • There is a clear gradient between negative impacts on children and increasing parental alcohol consumption More recent research (Bryant et al, 2019) has shown a significant association between parental alcohol consumption and children reporting negative outcomes. The age of the child also had an association where younger children were more likely to report negative impacts. Significantly associated negative impacts reported by children are: • Put to bed earlier than usual • Spend less time doing homework • Put to bed later than usual • Given less attention than usual
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38 9.2 Alcohol in Childhood Children’s Parliament In 2019 the Children’s Parliament published a report on an Alcohol-Free Childhood where the views of children aged 9-11 were expressed in relation to alcohol. The report highlighted that children feel alcohol ‘is all around you, all the time’ and that ‘most children don’t like being around alcohol’. The majority of the concerns were in relation to the visibility of alcohol and child safety when adults consume alcohol. Below is a summary of quotes within the report that relate to the wider availability of alcohol of which licensing has a role. • “Where do we see alcohol? Everywhere!” • “…there are four rows of alcohol in Asda” • “People want to get as much as possible, so they go to the shop to get it before it closes” • “…when you go to the till, you pass the big alcohol bit” • “…children might feel unsafe if they see people drunk” • “It sometimes makes people feel left out at parties when everyone is drinking. Children can feel sad, ignored and not listened to” • “I was at a wedding and by the time it was 3pm, everyone was so drunk. Me and my brother were bored” • “...pubs are open when I walk to school” The children were asked ‘What do we need to do for children to have an alcohol-free childhood?.’ Suggestions that are related to licensing include: 1. Stop people drinking in public places 2. Make alcohol less visible in shops
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39 9.3 Child Protection Parental substance use can involve alcohol and/or drug use which creates risks to and impacts on children. It can also result in sustained abuse, neglect, maltreatment, behavioural problems, disruption in primary care-giving, social isolation and stigma of children (Scottish Government, 2021). Categories of concerns are recorded at case conferences which can then lead to inclusion on the child protection register. Multiple concerns can be recorded at each case conference. Figure 29: Concerns identified at the case conferences of children who were on the child protection register, 2020-21 (Scotland) Source: Scottish Government 2022 Nationally in 2020-21, parental substance use was the fourth most frequent concern identified at case conferences of children on the child protection register.
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40 Figure 30: Child Protection with Parental Alcohol Misuse – West Dunbartonshire v Scotland *NB data from 2014/15 has been suppressed for confidentiality reasons. Source: Scottish Public Health Observatory Profile Tool Since 2016 West Dunbartonshire has had a higher rate of Child Protection cases where parental alcohol use has been cited. The fall in 2020 and 2021 could be attributable to the pandemic. Figure 31: Domestic Abuse by Council Area 2021/22 Source: Scottish Public Health Observatory Profile Tool West Dunbartonshire has the second worst domestic abuse rate of all local authorities in Scotland. Domestic abuse and alcohol frequently co-exist. Locally there has been 223 domestic related common assaults since April 2022 (year to date), 53% of these (n=118) were committed when the offender and/or the victim were under the influence of alcohol (Police Scotland, 2023). These figures have been consistent over the previous five-year period.
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41 10 Economic Impact Key Finding: • Up to date estimations of the economic impact of alcohol are not available at a local level or national level. • The most recent estimate from 2011, estimates £40.65 million is the total cost of alcohol related harm in West Dunbartonshire. It is anticipated this cost is now far greater in 2023. An updated estimate of the economic impact of alcohol nationally or in West Dunbartonshire is not currently available. As reported in the 2013 overprovision evidence submission, in 2010 the Scottish government produced The Societal Cost of Alcohol Misuse in Scotland for 2007 which estimated a central cost of £3.6 billon. This was applied to local data to provide estimates of the cost of alcohol-related harm at a local authority area level (Alcohol Focus Scotland, 2011). In West Dunbartonshire it is estimated that the total cost of alcohol related harm is £40.65 million as follows: • Crime £15.53 million • Productive Capacity £13.10 million • Health £6.60 million • Social Care £5.42 million A more recent analysis (Bhattacharya, 2017) highlights the continued impact of alcohol on the UK economy as a result of presenteeism, absenteeism, unemployment and premature death. In addition, the report recognises that the alcohol industry plays a small but not insignificant part of the UK economy through production and retail. It goes on to note that on trade jobs are typically part-time and poorly paid whereas producers provide relatively few jobs that these are better paid. West Dunbartonshire is cited as being one of only seven local authorities in the UK where alcohol producers account for more than 1% of jobs. It should be noted that evidence has shown there is no systemic relationship between an area’s prosperity and its dependence on alcohol industry employment.
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42 11 Alcohol and Drug Partnership – Service Data Dumbarton Area Council on Alcohol (DACA) DACA is a community alcohol service within West Dunbartonshire that supports anyone affected by alcohol, whether it is their own drinking or a loved one’s drinking. The service is free and confidential and includes one to one counselling, group support, diversionary activities and health and wellness advice. The table below shows the number of referrals and clients engaging with the service from 2015/16. The most recent data in 2020/21 has likely been affected by the coronavirus pandemic. Figure 32: Number of Referrals and Client Engagement 2015-2021 - DACA Source: Dumbarton Area Council on Alcohol, 2023
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43 12 Alcohol Related Harm Data by Intermediate Zone Key Findings: • The 2011 Intermediate Zones have not changed in size significantly in the last 2 years. The population sizes range from an estimated 3,464 for IZ05 to 7,162 for IZ12. • All Intermediate Zones have residents living in SIMD 1 and 2 areas. • An analysis of the three main alcohol related health indicators has been undertaken by Intermediate Zone. Fifteen Intermediate Zones have two or more indicators worse than the Scottish average (IZ01, IZ02, IZ03, IZ04, IZ06, IZ08, IZ10, IZ11, IZ12 IZ13, IZ14, IZ15, IZ16, IZ17 and IZ18). • Three Intermediate Zones have less than two indicators worse than the Scottish average (IZ05, IZ07 and IZ09). The Alcohol Framework 2018 acknowledges that Scotland as a whole has a problem with alcohol use and our communities, including families, pay too high a price in regards to alcohol harms and the preventable deaths it causes. For this reason, it is recommended to use the Scottish average as the threshold for each alcohol related harm indicator. The Alcohol Framework also highlights that more needs to be done to protect children and young people and to address health inequalities. With this in mind, the local alcohol harm related indicators that will be presented as evidence to inform the new licensing overprovision policy and used thereafter when reviewing licensing applications, will be: • Alcohol Related Hospital Admissions: higher than the Scottish average • Alcohol Specific Deaths: higher than the Scottish average • Alcohol Related Mental Health Admissions: higher than the Scottish average • Scottish Index of Multiple Deprivation (SIMD): a higher proportion of the population live in SIMD quintile 1 (most deprived) and 2 (second most deprived) data zone areas than is the case in Scotland as a whole. Previously, Alcohol Related Brain Damage (ARBD) would have been available. Whilst we know in some areas significant harms occur as a result of ARBD, due to issues with local reporting it is no longer possible to present this data. The following analysis shows the alcohol harms data by intermediate zone. Intermediate zones are a statistical geography that sit between data zones and Dunbartonshire (listed on table 34). The population within each intermediate zone ranges from 3,464 (IZ05) to 7,162 (IZ12). Alcohol-related hospital admissions data from ScotPHO show that only three intermediate zones of the eighteen within West Dunbartonshire are lower than the
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44 national average rate of 61.1 per 10,000 population in 2021/22. These are: IZ05 (60.5), IZ10 (59.0) and IZ11 (38.9). Furthermore, when comparing this indicator to data available at the start of the current policy, the following intermediate zones have increased over time: IZ01, IZ03, IZ07, IZ09, IZ10, IZ12, IZ16 and IZ17. Similarly, local data (from Public Health Scotland’s Local Intelligence Support Team - LIST) on the rate of alcohol specific deaths in 2019-20211 shows that seven intermediate zones are lower than the Scottish average of 5.8 deaths per 10,000 population. These are: IZ04 (4.5), IZ05 (5.7), IZ07 (0), IZ09 (4.2), IZ15 (1.7), IZ17 (3.4) and IZ18 (2.3). Furthermore, when comparing this indicator to data available at the start of the current policy, the following intermediate zones have increased over time: IZ01, IZ02, IZ04, IZ05, IZ06, IZ08, IZ11, IZ12, IZ14 and IZ16. The third alcohol related harm indicator analysed by intermediate zone is the rate of alcohol-related mental health admissions. LIST data for 2019-2021 show that six West Dunbartonshire intermediate zones have a lower rate than Scotland (12.8 per 10,000 population). These are: IZ03 (5.5), IZ05 (5.7), IZ06 (9.8), IZ07 (4.6), IZ09 (6.2) and IZ12 (10.0). Furthermore, when comparing this indicator to data available at the start of the current policy, the following intermediate zones have increased over time: IZ01, IZ02, IZ04, IZ10, IZ11, IZ12, IZ13, IZ14, IZ15 and IZ16. In addition to the alcohol harm indicators, Scottish Index of Multiple Deprivation (SIMD) data has also been presented. Figure 33 identifies the number of individual data zones within each intermediate zone by SIMD quintile. The data shows all intermediate zones within West Dunbartonshire have residents living in the 40% most deprived SIMD quintiles (SIMD 1 and 2), and all but four of the intermediate zones have a higher proportion of their population living in the 40% most deprived quintiles than does Scotland as a whole. The table below (fig 34) provides a summary of the three alcohol harm indicators and SIMD for each intermediate zone. All indicators that are above the Scottish average have been highlighted in yellow for each alcohol harm. Additionally, each intermediate zone where the percentage of residents living in the 40% most deprived SIMD quintiles is higher than it is for Scotland as a whole have been highlighted in blue. The table shows that the intermediate zones that have two or more indicators worse than the Scottish average are IZ01, IZ02, IZ03, IZ04, IZ06, IZ08, IZ10, IZ11, IZ12 IZ13, IZ14, IZ15, IZ16, IZ17 and IZ18. 1 Whereas it is possible to present data on alcohol-related admissions for a single year, for alcohol-specific deaths this is not possible since the number of deaths is smaller and so the data are aggregated into three-year periods. Furthermore, it takes longer to collate data on cause of death, and so the most recent data available on alcohol-specific deaths is up to 2021.
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45 Council Areas. Intermediate zones are often used for the dissemination of statistics that are not suitable for release at the data zone level because of the sensitive nature of the statistic, or for reasons of reliability. There are eighteen intermediate zones in West Dunbartonshire. All but two of the areas with two or more indicators above the Scottish average (IZ10 and IZ12) have a higher proportion of their population living in data zones in quintiles 1 and 2 (the 40% most deprived data zones) than does Scotland as a whole. Conversely, only one of the three areas with less than two indicators above the Scottish average (IZ07) has a higher proportion of its population living in quintile 1 and 2 data zones than does Scotland as a whole.
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46 Figure 33: 2011 Intermediate Zones - Datazones by SIMD Quintile
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47 Figure 34: Alcohol Related Health Indicators by Intermediate Zone ^Yellow and blue highlight indicates higher than Scottish average.
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48 Figure 35: Alcohol Related Harm Indicators – Data changes over duration of current policy ^Red highlight indicates an increase over time
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49 Figure 36: Alcohol Related Hospital Admissions by Intermediate Zone 0 50 100 150 200 250 Age Standarised Rate per 10,000 Intermediate Zone Alcohol Related Hospital Admission By Intermediate Zone 2019/20 2020/21 2021/22
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50 Figure 37: Alcohol Specific Deaths by Intermediate Zone 0 5 10 15 20 25 30 Age Standardised Rate per 10,000 Intermediate Zone Alcohol Specific Death Rate by Intermediate Zone 2017-2019 2018-2020 2019-2021
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51 Figure 38: Alcohol Related Mental Health Admissions by Intermediate Zone 0 10 20 30 40 50 60 70 Age Standardised Rate per 10,000 Intermediate Zone Alcohol Related Mental Health Admissions by Intermediate Zone 2017-2019 2018-2020 2019-2021
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52 13 References Alcohol Focus Scotland (2011) The Cost of Alcohol in West Dunbartonshire 2010/2011 http://www.alcohol-focus-scotland.org.uk/media/61660/The-Cost-of- Alcohol-West-Dunbartonshire.pdf Bloomfield, K. (2020). Understanding the Alcohol Harm Paradox: What Next? The Lancet Public Health. https://doi.org/10.1016/S2468-2667(20)30119-5 Bhattacharya A (2017) Splitting the Bill: Alcohol’s Impact on the Economy Institute of Alcohol Studies http://www.ias.org.uk/uploads/pdf/IAS%20reports/rp23022017.pdf Bryant L, MacKintosh A. M & Bauld L. (2019) An Exploration of the Impact of Non-Dependent Parental Drinking on Children. https://doi.org/10.1093/alcalc/agz086 Cheung, K. L., Klooster, P. M, Smit, C., Vries, H. & Pieterse, M. E. (2017) The impact of non-response bias due to sampling in public health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health. BMC Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363011/ Children’s Parliament (2019) Alcohol Free Childhood. https://www.childrensparliament.org.uk/our-work/alcohol-free-childhood-consultation/ Community Planning Partnership West Dunbartonshire (2018) Substance Use Prevention Strategy 2018-2027. http://www.wdhscp.org.uk/health- improvement/west-dunbartonshire-substance-use-prevention-strategy/ Dargan S et al (2013) Alcohol Related Deaths in Glasgow City: A cohort study http://www.staffnet.ggc.scot.nhs.uk/Partnerships/Addictions/Documents/ARD%202013.pdf Department of Health (2016) UK Chief Medical Officers’ Low Risk Drinking Guidelines 2016. http://www.gov.scot/Topics/Health/Services/Alcohol/safer- drinking Foster J, Bryant L and Brown K (2017) Like Sugar for Adults: The effects of non-dependent parental drinking on children and families. Institute Of Alcohol Studies, Alcohol and Families Alliance, And Alcohol Focus Scotland http://www.ias.org.uk/uploads/pdf/IAS%20reports/rp28102017.pdf Giles L, Robinson M. Monitoring and Evaluating Scotland’s Alcohol Strategy: Monitoring Report 2017. Edinburgh: NHS Health Scotland; 2017 Health Scotland (2011). Monitoring and Evaluating Scotland’s Alcohol Strategy. Setting the Scene: Theory of Change and baseline picture. https://www.healthscotland.com/uploads/documents/15580-MESASsettingTheSceneReport.pdf Hexagon Research and Consulting (2015) Libraries and Cultural Services, Housing and Health and Social Care Partnership Survey Report 2015. http://www.west-dunbarton.gov.uk/media/4312100/2015_libraries_and_cultural_services_etc_survey_final.pdf ISD (2017) Alcohol-Related Hospital Statistics Scotland 2016/17 http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/ National Office of Statistics (2016) Labour Market Profile: West Dunbartonshire. https://www.nomisweb.co.uk/reports/lmp/la/1946157435/report.aspx?town=west%20dunbartonshire#tabempunemp
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53 National Records of Scotland (2013) Scotland’s Census 2011: Table No. KS201SC – Ethnic Group. http://www.scotlandscensus.gov.uk/documents/censusresults/release2a/councilarea/KS201SC_CA.pdf National Records of Scotland (2022) West Dunbartonshire Council Area Profile. https://www.nrscotland.gov.uk/files/statistics/council-area-data-sheets/west- dunbartonshire-council-profile.html National Records of Scotland (2022a) Life Expectancy. West Dunbartonshire Council Area Profile (nrscotland.gov.uk) National Records of Scotland (2022b) Alcohol Specific Deaths. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital- events/deaths/alcohol-deaths Pollack C, Cubbin C, Ahn D, Winkleby M (2005). Neighborhood Deprivation and Alcohol Consumption: Does the Availability of Alcohol Play a Role? International Journal of Epidemiology. 34(4):772 Public Health Scotland (2023) Evaluating the impact of alcohol minimum unit pricing (MUP) on alcohol-attributable deaths and hospital admissions in Scotland: Briefing Paper Evaluating the impact of alcohol minimum unit pricing (MUP) on alcohol-attributable deaths and hospital admissions in Scotland: Briefing paper (publichealthscotland.scot) Scottish Government (2013) Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) 2013: Summary Finding for West Dunbartonshire. http://www.isdscotland.org/Health-Topics/Public-Health/Publications/2014-11-25/SALSUS_2013_West_Dunbartonshire.pdf Scottish Government (2014) National Guidance for Child Protection in Scotland. http://www.gov.scot/Publications/2014/05/3052 Scottish Government (2015) Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) 2015: National Overview. http://www.gov.scot/Resource/0050/00508306.pdf Scottish Government (2016a) Introducing the Scottish Index of Multiply Deprivation 2016. http://www.gov.scot/Resource/0050/00504809.pdf Scottish Government (2017a)The Scottish Health Survey http://www.gov.scot/Publications/2017/10/2970/downloads#res526018 Scottish Government (2017c) Children’s Social Work Statistics. http://www.gov.scot/Topics/Statistics/Browse/Children/PubChildrenSocialWork Scottish Government (2020) Introducing the Scottish Index of Multiple Deprivation 2020. https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2020/01/scottish-index-multiple-deprivation-2020/documents/scottish- index-multiple-deprivation-2020/scottish-index-multiple-deprivation-2020/govscot%3Adocument/scottish-index-multiple-deprivation-2020.pdf Scottish Government (2021) National Guidance for Child Protection in Scotland. National Guidance for Child Protection in Scotland 2021: Consultation Report (www.gov.scot) Scottish Public Health Observatory (2023) Online Profile Tool. https://www.scotpho.org.uk/comparative-health/profiles/online-profiles-tool Vittal et al (2017) Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data. Lancet 2(6): 267-276 West Dunbartonshire Council (2022) Strategic Plan 2022-2027. https://www.west-dunbarton.gov.uk/media/4322598/strategic-plan-2022-27.pdf World Health Organisation (2014) Global Status Report on Alcohol and Health. http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf
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54 Wrecked and Wasted (2014) Alcohol Survey 2013-2014. http://www.cldplanning.com/site/assets/files/11037/alcohol_young_people_report_summary_2014_email.pdf
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55 14 Glossary and Technical Notes 14.1 Glossary SMR01/ SMR04/ Combined These statistics are derived from data collected on alcohol-related inpatient and day case activity taking place within general acute hospitals and psychiatric hospitals in Scotland, submitted to ISD as part of the Scottish Morbidity Record 01 (SMR01) and Scottish Morbidity Record 04 (SMR04) data sets. SMR01 – General acute hospital discharges SMR04 – Psychiatric hospital discharge Combined – SMR01 and SMR04 EASR This publication includes rates of activity presented as European Age-sex Standardised Rates (EASR). Comparisons of rates that have not been standardised can be misleading when the age structures of populations differ between geographical areas or where they have changed over time. For example alcohol-related hospital admissions are more common in males and older people. Adjustment for age and sex using the EASR prevents misleading comparisons between areas that may have populations with different age or gender structures. Stays For this report, a hospital stay (also described as a continuous inpatient stay or CIS), is defined as an unbroken period of time that a patient spends as an inpatient or day-case. During a stay a patient may have numerous episodes as they change consultant, significant facility, speciality and/or hospital. Stays are counted at the point of discharge, when all diagnostic information regarding the full stay is available. Therefore a ‘stay’ and a ‘discharge’ are equivalent in this report. However, the demographic information (age, gender, SIMD decile, NHS Board or local authority of residence) is taken from the first episode of the stay, thus most closely corresponding to the circumstances of the patient at the point of entering the hospital. Patients Where numbers of patients are reported, this refers to the number of unique individuals treated within the financial year. Patients are counted only once in the financial year in which they have an alcohol-related stay, even though the same patient may be admitted to hospital several times in a year. New patients New patients are defined as patients who have not been previously admitted to hospital with an alcohol diagnosis within the last 10 years. If a patient has several alcohol-related stays over a number of years, this patient will be counted only in the year of the first alcohol-related hospital stay within a 10 year period.
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56 Alcohol-related diagnoses and clinical codes (ICD9/ICD10) Alcohol misuse is recorded using the International Classification of Diseases. In 1996, ISD moved from using the 9th revision to the 10th revision of the ICD. The change introduced a number of new alcohol-related ICD codes. However, mapping of codes from ICD9 to ICD10 is not exact and therefore the longer trends (back to 1981/82) are only used for reporting on ‘all’ alcohol codes combined, and time trends for individual alcohol-related conditions start in 1997/98. Up to six diagnoses can be recorded within each episode within a stay. Analysis is based on all diagnoses in any position from any episode within the patient’s stay. Note that where alcohol misuse is suspected but unconfirmed it may not be recorded by the hospital and hence recording may vary between hospitals; therefore caution is necessary when interpreting these figures. Codes can be seen below. Age Age is taken at the date of admission for hospital discharge data. Totals Patients may reside in more than one NHS Board or local authority within the same year. Therefore the totals for smaller areas may not add up to the total for Scotland. Disclosure * Indicates values that have been suppressed due to the potential risk of disclosure and to help maintain patient confidentiality. Scottish Index of Multiple Deprivation (SIMD) The Scottish Index of Multiple Deprivation (SIMD) ranking can be used to divide the Scottish population into ten groups (deciles). Each decile represents the same number of people, those living in areas in decile 1 live in the most deprived areas of Scotland and those in decile 10 live in the least deprived areas in Scotland. There have been SIMD releases in 2004, 2006, 2009, 2012 and 2016. The Scottish Index of Multiple Deprivation 2016 combines 38 indicators across 7 domains, namely: income, employment, health, education, skills and training, housing, geographic access and crime. The overall index is a weighted sum of the seven domain scores. The weighting for each domain is based on the relative importance of the domain in measuring multiple deprivation, the robustness of the data and the time lag between data collection and the production of the SIMD. Prior to weighting, the domains are standardised by ranking the scores. The ranks then undergo a statistical transformation to avoid high ranks in one domain 'cancelling out' low ranks in another. The domain weightings used in SIMD 2016, expressed as a % of the overall weight are: current income (28%), employment (28%), health (14%), education (14%), geographic access (9%), crime (5%) and housing (2%). SIMD can then be mapped to show the geographical variation and spread of deprived (and non-deprived) communities across Scotland. See www.SIMD.scot 5 year moving average A moving average is a technique to get an overall idea of the trends in a data set; it is an average of any subset of numbers. The moving average is extremely useful for forecasting long-term trends. You can calculate it for any period of time. An average represents the “middling” value of a set of numbers. The average is calculated several times for several subsets of data
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57 Age Standardised A technique used to allow populations to be compared when the age profiles of the populations are quite different. Confidence interval (CI) A confidence interval provides an estimated range of possible outcomes of the measurement, which gives us some idea of how uncertain we are about the measurement. A 95% confidence interval implies that if we were to repeat the same measurement many times, 95% of values would fall within the defined range. It follows that there is a 5% chance that the true value will fall outside the defined range. Data zones The data zone is the key small-area statistical geography in Scotland. The data zone geography covers the whole of Scotland and nests within local authority boundaries. Data zones are groups of Census output areas and have populations of between 500 and 1,000 household residents. Where possible, they have been made to respect physical boundaries and natural communities. They have a regular shape and, as far as possible, contain households with similar social characteristics. Following the 2011 census, Data Zones were redrawn and are known as Data Zone 2011. Intermediate data zones The intermediate zones are aggregations of data zones within local authorities and contain between 2,500 and 6,000 people Not all statistics are suitable for release at the data zone level because of the sensitive nature of the statistics, or for reasons of reliability, and it was apparent that a statistical geography between data zone and local authority was required. For the purpose of this report intermediate data zone is used as the larger population permits a relatively precise but more stable base for monitoring trends The Licensing Board Statement of Licensing Policy November 2013 used Intermediate Zone 2001 boundaries to determine 18 sub-localities within West Dunbartonshire. Following the 2011 census, Intermediate Data Zones were redrawn and are known as Intermediate Zone 2011. There remain 18 sub-localities within West Dunbartonshire but the names and numbers are not equivalent. For the purpose of the 2017 overprovision evidence paper Intermediate Zone 2011 boundaries are used. Thus the Intermediate Zones are not directly comparable to the previous overprovision evidence. Nielsen/CGA Nielsen, a global information & measurement company, provides market research, insights & data about what people watch, listen to & buy CGA is a market measurement, data and research consultancy.
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58 14.2 Data Limitations Source of data Strengths Limitations National Records of Scotland (NRS): Non-ministerial department of the Scottish Government and its purpose is to collect, preserve and produce information on Scotland’s population. • Council Area Profile (Factsheet) • Published yearly • Scotland’s census • Large sample size • Official estimate of every person and household • Published every 10 years • Alcohol specific deaths • Published yearly • 3 and 5 year rolling averages given for trends • Yearly death rates fluctuate – need to use rolling averages for trends and comparisons Office for National Statistics (NOMIS) • Access to up to date labour market stats • Updated yearly • Datasets include: employment, unemployment, qualifications, earning, and benefit claimants Scottish Health Survey • References new Low Risk Drinking Guidelines • Small sample size – data only available for NHSGG&C and not West Dunbartonshire • Those living in institutions were outwith the scope of the survey. • Self administered, face to face questionnaire SALSUS • Large sample size • National data every 2 years • Only publish local authority data every 4 years • Covers age 13 and 15 only – not a full representation of young people Planet Youth • Recent post covid data • 80% response rate • Small sample size • Data gathered from only 1 school, 1 year group Public Health Scotland • Alcohol Related Hospital Statistics • Alcohol Related Mental Health Admissions • Part of NHS Scotland – provides health information, health intelligence and statistical services • Data published yearly • Good trends Recorded Crime in Scotland • Published yearly • National statistics on crimes and offences recorded by Police Scotland • Some data only published at national level
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59 14.3 Clinical codes for alcohol-related conditions Condition Sub-Condition ICD-10 Code Description ICD-10 Code Description F10 Mental and behavioural disorders due to the use of alcohol F10.0 Acute Intoxication F10.1 Harmful use F10.2 Dependence syndrome F10.3 Withdrawal state F10.4 Withdrawal state with delirium F10.5, F10.6, F10.7 Psychotic & amnesic conditions F10.8, F10.9 Unspecified & other conditions K70 Alcoholic Liver Disease K70.0 Alcoholic fatty liver K70.1 Alcoholic Hepatitis K70.2, K70.3 Alcoholic liver disease: cirrhosis K70.4 Alcoholic hepatic failure K70.9 Alcoholic Liver Disease, unspecified T51.0, T51.1, T51.9 Toxic effect of alcohol I42.6 Alcoholic Cardiomyopathy K29.2 Alcoholic gastritis K85.2, K86.0 Alcohol-induced pancreatitis E24.4 Alcohol-induced pseudo-Cushing syndrome E51.2 Wernicke encephalopathy G31.2 Degeneration of nervous system due to alcohol G62.1 Alcoholic polyneuropathy G72.1 Alcoholic myopathy O35.4 Maternal care for (suspected) damage to fetus from alcohol P04.3 Fetus and newborn affected by maternal use of alcohol Q86.0 Fetal alcohol syndrome (dysmorphic) R78.0 Finding of alcohol in blood
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60 X45 Accidental poisoning by and exposure to alcohol X65 Intentional self-poisoning by and exposure to alcohol Y15 Poisoning by and exposure to alcohol, undetermined intent Y57.3 Alcohol deterrents Y90 Evidence of alcohol involvement determined by blood alcohol level Y91 Evidence of alcohol involvement determined by level of intoxication Z50.2 Alcohol rehabilitation Z71.4 Alcohol abuse counselling and surveillance Z72.1 Alcohol use Condition Sub-Condition ICD-9 Code Description ICD-9 Code Description 291 Alcohol psychoses 2910 Delirium tremens (DTs) 2911 Korsakov's psychosis, alcoholic 2912 Other alcoholic dementia 2913 Other alcoholic hallucinosis 2915 Alcoholic jealousy 2918 Other (Alcohol withdrawal syndrome) 2919 Unspecified 571 Chronic liver disease and cirrhosis 5710 Alcoholic fatty liver 5711 Acute alcoholic hepatitis 5712 Alcoholic cirrhosis of liver 5713 Alcoholic liver damage, unspecified 980 Toxic effect of alcohol 9800 Ethyl alcohol 9801 Methyl alcohol 9809 Unspecified
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61 E860 Accidental poisoning by alcohol, not elsewhere classified E8600 Alcoholic beverages E8601 Other and unspecified ethyl alcohol and its products E8602 Methyl alcohol E8609 Unspecified 2651 Other and unspecified manifestations of thiamine deficiency 3039 Alcohol dependence syndrome 3050 Non-dependent abuse of drugs - Alcohol 3575 Alcoholic polyneuropathy 4255 Alcoholic cardiomyopathy 5353 Alcoholic gastritis 7598 Other and unspecified congenital anomalies - Other specified anomalies 7607 Noxious influences transmitted via placenta or breast milk 7903 Excessive blood level of alcohol E9473 Other and unspecified drugs and medicaments - Alcohol deterrents D3039 + A3317 Alcohol dependence syndrome + Cerebral degeneration in other diseases classified elsewhere D3039 + A3344 Alcohol dependence syndrome + Cerebral ataxia in diseases classified elsewhere