Public health influence

Nursing and midwifery staff can influence people’s attitude and consumption of alcohol not just at an individual level with particular patients or clients but also at a community and population level. 

Although for most nurses and midwives their impact and work will be with individuals, by understanding the cultural and social attitudes to alcohol within the local community or population they can be instrumental in changing attitudes and reducing overall consumption. 

In addition to this increasing demand on services and an increasing level of associated harms, there has also been an increase in the number of useful resources and tools that can help to understand and address such issues. 

Public Health England (PHE) has developed a range of materials to support local initiatives. This blog highlights some of the initiatives. The CLeaR tool launched in 2016 has been designed to help local authorities prevent or reduce the impact of alcohol harm. It is based on the successfultobacco CLeaR tool, providing a framework for local partnerships to review local structures and alcohol services.

Additional useful interventions that can be applied at a population level include:

• Health and Wellbeing Boards including alcohol in their Joint Strategic Needs Assessment (JSNA) and commissioning services to address the needs of the population
• adhering to commissioning standards available for alcohol services (see NICE quality standards)
• representing public health and other health concerns in local alcohol licensing process and decisions
• providers collecting data on patients that are experiencing alcohol problems
• sharing appropriate data between health, social care and community safety organisations to target prevention activity and co-ordinate care.

Nursing and midwifery staff need to be aware of these and understand how they can help address these issues both with their individual patients and clients but also within communities and at a strategic level.

Patient level 

At individual patient and client level, nursing and midwifery staff have significant impact but it is essential to understand the principles of supporting behaviour change:

• providing alcohol screening (using validated tools) and brief, structured advice to individuals drinking above lower-risk levels using training resources and e-learning courses
• ensuring that alcohol screening and brief advice is delivered effectively in line with national guidance 
• directing individuals drinking above lower-risk levels to appropriate support material on alcohol learning resources including One You Drinks Tracker and Identification and brief advice tool
• providing extended interventions to those who do not respond to brief intervention
• referring those with alcohol dependence to specialist alcohol treatment service and supporting individuals to attend appointments and engage in treatment
• checking patients with alcohol problems are registered with a GP and receive primary health care, vaccinations and screening programmes
• providing holistic health assessments for people undergoing alcohol treatment.

Community level

Community health professionals and providers of specialist services need to be aware of the cultural and social pressures within the area. They can have an impact by:

• developing targeted social marketing and public health campaigns to encourage lower-risk drinking in the population
• ensuring local ‘Making Every Contact Count’ initiatives include alcohol screening
• nsure local health trainers screen for alcohol misuse and support peers to reduce drinking to lower-risk levels
• getting to know the local alcohol support and treatment services and how to make referrals to them, using the national listing on NHS Choices
• running health clinics in alcohol treatment services
• commissioning hospital based alcohol services to provide co-ordinated hospital care, discharge planning and community care to promote treatment compliance and reduce the need for re-admission
• identifying regular and high users of NHS services for better co-ordinated care and assertive community treatment
• commissioning community-based, alcohol outreach workers, to work with regular attendees and vulnerable groups such as street-drinkers.