Introduction

This quality standard covers a range of approaches at a population level to prevent harmful alcohol use in the community by children, young people and adults. These statements are particularly relevant to trading standards, other local authority teams, the police, and schools and colleges. This quality standard does not cover screening and brief interventions, which are covered by NICE's quality standard on alcohol dependence and harmful alcohol use. For more information see the topic overview.

NICE quality standards focus on aspects of health and social care that are commissioned at a local level. Areas of national policy, such as minimum unit price, legislative changes and marketing of alcohol, are therefore not covered by this quality standard.

Why this quality standard is needed

In the UK the annual amount of alcohol sold per person (aged 16 years and over) rose from 9.53 litres of pure alcohol in 1986/87 to a peak of 11.73 litres in 2004/05, before dropping to 9.65 litres in 2012/13 (Tax and Duty Bulletins: alcohol factsheet HM Revenue and Customs 2013). For 2012/13, this is approximately 18 units per week for each person. In England, the NHS guidelines on alcohol recommend that men should not regularly drink more than 3 to 4 units of alcohol per day and women should not regularly drink more than 2 to 3 units per day ('regularly' means most days or every day). Although most people who drink alcohol stay within these limits, 'binge drinking' accounts for half of all alcohol consumed in the UK (The government's alcohol strategy Home Office 2012). Statistics on alcohol: England (Health and Social Care Information Centre 2014) estimate that in 2012 24% of men and 18% of women aged 16 and over drank more than the recommended levels of alcohol each week.

Drinking more than the limit suggested by the NHS guidelines may damage a person's health. Alcohol is one of the biggest behavioural risk factors for increased disease and death (along with smoking, obesity and lack of physical activity). Alcohol consumption is associated with many chronic health problems, including psychiatric, liver, neurological, gastrointestinal and cardiovascular conditions and several types of cancer. Drinking during pregnancy can also have an adverse effect on the developing fetus (Alcohol-use disorders – preventing harmful drinking NICE guideline PH24).

In 2012/13, there were estimated to be over 1 million hospital admissions in England for which an alcohol‑related disease, injury or condition was the primary reason for admission or a secondary diagnosis[1]. Over 15,000 children and young people (under 18) were admitted to hospital in 2010/11 to 2012/13 as a result of conditions caused by drinking alcohol (Local alcohol profiles for England Public Health England 2014). In 2010–12 there were 15,785 deaths specifically resulting from alcohol (Public Health England 2014).

Not only is alcohol a burden on individuals and families, it also has negative economic and social consequences, and is linked to accidents, injuries, crime and violence. Every year alcohol‑related harm costs the UK in excess of £21 billion (£3.5 billion in NHS costs in England, £11 billion for alcohol‑related crime in England and Wales and £7.3 billion of lost productivity because of alcohol in the UK) (Next steps following the consultation on delivering the government's alcohol strategy Home Office 2013). In 2012/13 there were 305,048 recorded crimes in England related to alcohol (Public Health England 2014) and 881,000 violent incidents in England and Wales in which the victim believed that the offender was under the influence of alcohol (table 3.11, Crime Survey for England and Wales Office for National Statistics 2013).

The quality standard is expected to contribute to improvements in the following outcomes:

  • quality of life

  • admissions to hospital – alcohol-related, and admissions for violence or accidents resulting from alcohol

  • alcohol-related deaths

  • antisocial behaviour and violent crime related to alcohol

  • prevalence of harmful and hazardous drinking

  • rates of under-age drinking.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2015–16

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measure

1A Social care‑related quality of life*

Outcome measures

People are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation

1F Proportion of adults in contact with secondary mental health services in paid employment** (Public Health Outcomes Framework 1.8, NHS Outcomes Framework 2.5)

Aligning across the health and care system

* Indicator complementary

** Indicator shared

Table 2 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost from causes considered amenable to healthcare

i Adults

ii Children and young people

Improvement areas

Reducing premature mortality from the major causes of death

1.1 Under 75 mortality rate from cardiovascular disease (PHOF 4.4*)

1.3 Under 75 mortality rate from liver disease (PHOF 4.6*)

1.4 Under 75 mortality rate from cancer (PHOF 4.5*)

Reducing premature mortality in people with mental illness

1.5 Excess under 75 mortality rate in adults with serious mental illness* (PHOF 4.9)

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Improving functional ability in people with long‑term conditions

2.2 Employment of people with long‑term conditions (ASCOF 1E**, PHOF 1.8*)

Enhancing quality of life for people with mental illness

2.5 Employment of people with mental illness (ASCOF 1F**, PHOF 1.8**)

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Table 3 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improving the wider determinants of health

Indicators

1.3 Pupil absence

1.4 First time entrants to the youth justice system

1.5 16–18 year olds not in education, employment or training

1.8 Employment for those with long‑term health conditions including adults with a learning disability or who are in contact with secondary mental health services

1.9 Sickness absence rate

1.10 Killed and seriously injured casualties on England's roads

1.11 Domestic abuse

1.12 Violent crime (including sexual violence)

1.13 Re-offending levels

1.19 Older people's perception of community safety

2 Health improvement

Objective

People are helped to live healthy lifestyles, make health choices and reduce health inequalities

Indicators

2.1 Low birth weight of term babies

2.4 Under 18 conceptions

2.7 Hospital admissions caused by unintentional and deliberate injuries in children and young people aged 0–14 and 15–24 years

2.8 Emotional well-being of looked after children

2.10 Self-harm

2.12 Excess weight in adults

2.18 Alcohol-related admissions to hospital

2.23 Self-reported well-being

2.24 Injuries due to falls in people aged 65 and over

4 Healthcare, public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities.

Indicators

4.1 Infant mortality

4.3 Mortality rate from causes considered preventable

4.4 Under 75 mortality rate from cardiovascular diseases (including heart disease and stroke)

4.6 Under 75 mortality rate from liver disease

Coordinated services

The quality standard for preventing harmful alcohol use in the community specifies that services should be commissioned from and coordinated across all relevant agencies. An integrated approach that promotes multi agency working is fundamental to preventing harmful alcohol use in the community.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing high‑quality interventions for preventing harmful alcohol use in the community are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All people who are involved in preventing harmful alcohol use in the community should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in helping to prevent harmful alcohol use in the community. If appropriate, organisations should ensure that family members and carers are involved in the decision‑making process about initiatives to reduce alcohol use and availability, and in schools' and colleges' approaches to alcohol.



[1] Full details of the methodology used for calculating hospital admissions related to alcohol can be found in Statistics on alcohol: England (Health and Social Care Information Centre 2014).