I hope many of you had the opportunity to join in with events and celebrations to mark the new Chinese Lunar Year, that of the Pig.  I have read that the associated attributes of the Year of the Pig include a beautiful personality, good fortune and special associations with the late evening and night time.  I see this as an excellent augury for City Health 2019 which has several presentations concerning the problems linked to alcohol and the night time economy, alongside sessions looking at the links between the environment and health, a look at the role of art, reflections on what we have learnt and community initiatives.  The presentation on Public health – heroes and villains is one I particularly look forward to. Almost certainly the best £75 you will spend during the Year of the Pig. http://cityhealthinternational.org/2019/

My celebrations didn’t extend further than eating an excess of rather fine food.  However, the obligatory fortune cookie contained a particularly apt pearl of wisdom, “I am not a genius, but I am a terrific package of experience”.  A reality which I am sure many of us can relate to, although, if you are a genius please do keep reading.  Over the last two decades working in the drugs and alcohol field I have had the good fortune to have worked with some outstanding individuals.  I have also been involved in helping develop and expand national programmes (this back when such things were well resourced), witnessed the expansion and use of evidence-based approaches and seen significant, real gains for communities and individuals.  Much of this has been built on new partnerships and alliances, and a willingness to think and work differently.

Of course, I have also had less positive experiences.  The last decade has seen increased financial challenges and political interest has proven fickle.   Under such pressure there is a tendency for individuals and agencies to dig in, concentrate on what is seen as core business, and so there is a natural inclination to maintain existing approaches. Afterall we all know that our own specific specialism or work area is THE most important, don’t we?

 Now there are always some who can see the benefit of forging new approaches and alliances to deal with the challenges our communities face.  Sometimes you have to run a scheme or project to find out if it works.  Its not unusual to find unexpected outcomes for example work to help improve care for those experiencing dementia can significantly reduce demands on police resources. Sometimes we learn most from things that don’t work. To understand and evaluate complex problems, develop new ideas and determine whether they are worthwhile across a range of indicators is complex and requires a range of expertise and experience. 

Unfortunately, it is easier said than done. A major barrier is the fact we all like clinging to our professional comfort blankets.  It is easier to remain within the secure territory composed of our own experience, stick with our peers and view things from well established, comfortable, positions.  This can feel safe, it certainly provides plenty of opportunity for mutual reaffirmation, but it limits vision and impact.

I recently hosted an event looking at the range of interventions in place across England that seek to reduce the number of intoxicated people who end up in our Accident and Emergency Departments at peak times.  This is an important area of research. There are a huge range of projects of this kind, with different structures, remits and levels of resourcing.  Up until now there has been little meaningful evaluation.  Now this is no simple task, with many variables but clearly there must be some approaches which are better or more cost effective than others. Some will have better impacts in terms of demand on ambulance services, local emergency department, demands on police time, public perception and protection of the vulnerable.  There are important considerations about the safety of those who may be heavily intoxicated or injured, the degree of clinical oversight required and of course whether we are making best use of scarce finances and valuable human resources.  It is a challenge but this research is a valuable step in helping improve understanding of what these type of initiatives can deliver and some of the key issues in providing a safe and effective service (some insights on this developing area, and other approaches to trying to reduce alcohol harm, will be provided at City Health 2019 in Liverpool next month).  But one thing I did notice when speaking to those present after the event that nearly everyone was considering these projects from their own professional perspective.  There was great insight and huge expertise, but it was narrow.  It didn’t reflect the needs and experience of Council Leaders, Town Centre managers, venue owners or indeed the public.

I was given the opportunity to reflect on these thoughts a few hours later when I had to take a relative to hospital.  As a busy Friday night in Accident and Emergency wore on, I saw a succession of individuals, whose path to hospital clearly involved alcohol, be assessed and then await being patched up.  Now the NHS provides, by and large, an excellent service, for those who are seriously injured or ill (the care my relative received was excellent).  However, once you have been assessed as not being very ill or seriously injured the wait for having wounds stitched or be generally patched up can be lengthy.  So lengthy in fact that visits by the Police to take statements were a welcome punctuation relieving the tedium of waiting.    I saw people wait over seven hours to be sutured, watching their hangovers kick in and their bruising develop. 

Now how do you cost and evaluate the benefit of not having an Emergency Department full of alcohol infused walking wounding? Not having seriously ill and sick people “enjoying” the company of the inebriated?  Reducing the workload of doctors and nurses? The benefits in not having to take police officers away from town centres to wander hospital corridors and departments seeking those who may have been victims or perpetrators?  This of course must be balanced against the clinical expertise to be found within an A&E unit and the fact they are key assets requiring significant resourcing.  Clearly not an easy equation, but I am certain its one we can’t answer in isolation.   The perspective of any single agency or professional can not deliver what is needed, only by engaging with all those with skin in the game can we determine what works best in any particular locality.  This applies to a whole host of health issues, not just alcohol.  So, in the Year of the Pig I think we should make an extra effort to broaden our work networks, consider broader outcomes and increase our terrific package of experience. Being in Liverpool on 22 March would be a grand start.

D.Mackintosh photoDavid MacKintosh is the Head of Community Safety for the City of London, and has also been the Policy Adviser/Director to the London Drug and Alcohol Policy Forum (LDAPF) since 2001.  The LDAPF works to support policy delivery and promote good practice across the drugs, alcohol and community safety agendas.  He has been involved in a number of innovative campaigns around issues including drug driving, substance misuse in the workplace and improving awareness around drug safety in clubs and pubs. The LDAPF is funded by the City of London as part of its commitment to improving the life of all those who live and work in London.  For the last eight years he has also been seconded to the Greater London Authority to provide advice around substance use issues and health inequalities. 

Prior to this post David worked for the United Kingdom Anti-Drug Co-ordination Unit (part of the Cabinet Office) for two years, primarily on young people and treatment policy issues.  This followed on from some 8 years in the Department for Education and Skills where he worked in a number of areas including international relations and higher education policy. He spent ten years as chair of an East London based service provider and is currently a trustee of Adfam (families, drugs and alcohol) and the New Nicotine Alliance (which aims to improve public health by raising awareness of risk-reduced products).