High Impact Complex Drinker’s Service

Version control

Version number	Date	Author	Comments
001	15/01/2025	George Bell

Overview

Name of product under development or review	Surrey’s High Impact Complex Drinker’s Service (HICD)
Description of the product	Alcohol-related risk places a significant challenge on a range of public services. Additionally, there is also a group of more complex drinkers, whose alcohol use and associated lifestyle contributes to a pattern of more frequent contact with a range of frontline services. They are often characterised by the complexity of their needs and exclusion from society. This is a highly diverse group whose social circumstances range from being housed, being homeless or having temporary accommodation, involved in the criminal justice system, commonly experiencing mental health problems, facing financial difficulties, and lacking a support network. They may often fail to engage in core services, both substance misuse and wider health and social care services (HICD Service Specification).  High Impact Complex Drinkers are a key contributor to a range of issues from emergency hospital admissions, anti-social behaviour, and re-offending. Alcohol Change UK states that in an average Local Authority area there are estimated to be at least 450 high risk treatment resistant drinkers, which may cost public services a minimum £12.5 million per annum. Surrey’s HICD programme is based on extensive evidence-based research by Alcohol Change UK whilst developing their Blue Light principles, to assertively engage and sustain medium to long term change with those who are change or treatment resistant. Assertive outreach underpins the model, and there is also great emphasis placed on the role of partnership working between agencies that an individual may come into contact with. Rather than the individual touching on a range of different services all responding in isolation, the model looks to engage services to joint case manage the service user with no fixed-time limit to intervention and/or thresholds that impact on future engagement. Surrey’s HICD service has been running since 2014 and has evolved over time.   The Office of the Police and Crime Commissioner supports the funding of the HICD programme, in partnership with Surrey County Council.
EIA start date	15/01/25
EIA author and role	George Bell – Criminal Justice Policy & Commissioning Officer, Office of the Police and Crime Commissioner for Surrey
EIA owner and role	Craig Jones – Policy & Commissioning Lead for Criminal Justice, Officer of the Police and Crime Commissioner for Surrey
Date of last review
Date of next review	15/01/26

Key product development dates

To evidence PSED compliance, equality and inclusion must be considered throughout the life cycle of a product. You can do this by integrating EIA reviews into key product development stages. List your product’s key stages and the dates you will review your EIA here.

Key stage	Date
Publication	15/01/25
12 month review	15/01/26

Research and evidence

To undertake effective equality assessment that meets PSED compliance standards, you must work from an evidence base. Use this section to list the research you will use to understand the product’s potential or actual equality impacts (for example, surveys, customer feedback, protected characteristic data, academic research).

1. Surrey Substance Misuse Joint Strategic Needs Assessment chapter
2. HICD Quarterly Contract Monitoring Reports
3. Via Working with Service Users Policy (May 2024)
4. Via Diversity, Equity and Inclusion Policy
5. Surrey Combatting Drugs Partnership meetings & reports
6. Alcohol Concern’s Blue Light Project Manual – Working with change resistant drinkers
7. Alcohol Dependence Prevalence in England reports
8. Surrey County 2021 Census Area profile
9. APCC Guide to Taking a Public Health Approach to Policing for PCCs
10. Alcohol Treatment Services National Audit Office Briefing 2023
11. Surrey Health and Wellbeing Strategy (Updated 2022)
12. High Impact Complex Drinkers Service Specification – Surrey County Council
13.  Alcohol Change UK Rapid Evidence Review: Drinking problems and interventions in black and minority ethnic communities (2019)

Consultation record

Stakeholder consultation will give you a better understanding of your product’s impacts and is crucial to satisfying the PSED requirements. Use this section to record the engagement you have undertaken, summarise the feedback received and note subsequent actions. This section can also be used to record nil returns.

Name of group or organisation	Date of contact	Date reply received	Feedback	Action taken or reason why no action was taken
Competitive Tender Process			A competitive process was put in place by Surrey County Council and completed, with the service awarded to VIA.	Process was concluded.
Surrey County Council / Surrey OPCC – HICD service is continually assessed with engagement from Key Stakeholders in contract monitoring meetings	Ongoing on a quarterly basis		Programme data reported on in monitoring meetings, along with service user feedback.	Ongoing monitoring.
Surrey Police			Surrey Police representative have supported the approval the commissioning of this service.	Support taken in to consideration in the approval process of this service.
Alcohol Change UK			Discussions have previously taken place with senior consultants at Alcohol Change UK who have advised and given feedback on delivery of the model used in HICD.	Alcohol Change UK principles adopted in this service.

General considerations

Use this section to note any general diversity, equality and inclusion activities or considerations that are relevant to the product. Please only document general considerations here. Protected characteristic analysis can be completed in the section below.

As set out in the Surrey Health and Wellbeing Strategy, the focus in Surrey is on a commitment to working in partnerships with communities to reduce health inequalities. People who experience the poorest health outcomes include people with drug and alcohol problems (Surrey Health & Wellbeing Strategy).

Misuse of alcohol is a major public health concern nationally. It has wide-ranging effects on individuals, their families, and wider society.  Alcohol use costs the taxpayer millions of pounds every year in dealing with the associated health problems, children and adult social care costs, and related crime and disorder. Problematic alcohol use can lead to family breakdown, crime, debt, homelessness, and child neglect.

Supporting campaigns to reduce alcohol consumption among adults and young people, increasing the use of alcohol recovery requirements and programmes within the criminal justice system, and work to increase successful completions for alcohol treatment among adults are all recommendations outlined in the Surrey Substance Misuse Joint Strategic Needs Assessment. The service being supported in this document falls within these aims.

The Office of the Police and Crime Commissioner for Surrey look to take a public health approach in the commissioning of services to reduce reoffending. This approach, in this case, looks to address the causes and impact of alcohol use by working to a multi-agency and whole system response. Reducing harm by promoting recovery and increasing resilience.

The targeted blue light group, in relation to this service, is defined by three aspects – the alcohol problem, the pattern of not engaging with or benefiting from alcohol treatment, and the burden placed on public services – either themselves or the impact on their family (Alcohol Concern’s Blue Light Project Manual).

Impact assessment and actions

Apply learning from research, consultation and project knowledge to consider equality considerations relevant to your project. This should include any potential or actual impacts (positive or negative), as well as how the project will uphold the three PSED aims for each of the protected characteristics.

1. Eliminate discrimination, harassment and victimization.
2. Advance equal opportunity.
3. Foster good relations between people of different characteristics.

If you have identified a negative impact, note what mitigating action will be taken to reduce or eliminate that impact. If no mitigating action can be taken, please explain why. The issues or impacts identified may change, or new factors may emerge, as your project develops. Use the EIA to document these and how your project has evolved to accommodate equality considerations.

Don’t forget to consider intersectionality. This refers to when characteristics overlap to shape experiences of inequality and discrimination. For further information, please refer to the ‘Addressing Intersectionality within Policing’ report.

Duplicate the boxes below if required. If you need further information about a protected characteristic, open the webpage linked to each subtitle.

All characteristics

Details of positive and/or adverse impact or other issue

Via do not fully capture and monitor all the protected characteristics information of beneficiaries of this service, at assessment stage. Via have reviewed their assessment and there are a number of key protected characteristics they do not specifically collect information on. The assessment for HICD is purposely focussed on the immediate needs of the individual in terms of risk, such as their alcohol use, physical health, mental health care needs etc. Via are aware of the those protected characteristics that are relevant when working with a service user in their home, but these may not be documented at assessment in a way that is easily collated.   Of all adults in treatment in Surrey, the most common reported substances were opiates, alcohol, and cannabis. This is slightly different from adults starting treatment in Surrey, where the most commonly reported substances were alcohol, cannabis and cocaine. Nearly a quarter of adults in Surrey reported drinking at increased or higher risk levels (over 14 units of alcohol a week), than England. In Surrey, levels of alcohol dependence are lower than England, but there has been a gradual increase in numbers in treatment and an increase in hospital related alcohol admissions, mainly for alcohol related liver disease. It is estimated that there are high levels of unmet need for alcohol treatment, at 74%, although this is similar to the South East and England (Surrey Substance Misuse JSNA 2024). The rate of alcohol related hospital admissions has been increasing over the past ten years in England and Surrey. Overall, the rate of admissions is lower in Surrey than England, however there was a 43% increase in alcohol-related hospital admissions in Surrey between 2008/9 and 2018/19 and some boroughs have higher rates than England (Surrey Substance Misuse JSBA 2024).

Mitigating action for any adverse impact or rationale for no further action

Via are committed to meeting the needs of diverse service users, providing inclusive services that promote equity through delivering equality of opportunity, services that are free from stigma and discrimination and are delivered in a culturally competent way. Via is committed to their responsibilities under the Equality Act 2010 and beyond to ensure best practice for all who access our services.   Via are currently exploring how protected characteristics information can be captured, which would be beneficial, without substantially changing the assessment process. They are mindful of other changes being undertaken for their teams and these needs considering when making decisions about further adaptations. The service’s users policy listed in publications includes each stage of the process for service users across Via’s services. This is currently under review. Additionally, Via are in the process of finalising an improved process for equality impact assessments.  This will be applied to all policies and large projects etc. Currently a Diversity, Equity and Inclusion Forum is held on a quarterly basis. This is split in into two sub-groups – Services (focussing on the services and the people who use the services) and People (focussed on our workforce, both paid and volunteer).    Similarly, Surrey County Council, the lead commissioner of this service, is committed to ensuring that equality and fairness are embedded in everything it does as a commissioner. The service will respond positively to the needs of all groups who have a protected characteristic within the Equality Act 2010. The service is expected to engage with these groups through all necessary means to ensure inclusion is in a positive and meaningful way. The service must demonstrate awareness and be responsive to the accessibility and needs of groups described above either in services or attempting to access services (HICD Service Specification).

Age

Details of positive and/or adverse impact or other issue

Service is accessible for 18+, there is no upper age limit. The service is not accessible for under 18’s. For young people, nationally and in Surrey there has been a reduction in people in contact with substance use services. A higher proportion of young people commencing treatment for substances in Surrey reported that they had problems with alcohol compared to England. Surrey has a slightly higher proportion of state funded school suspensions and a higher proportion of permanent exclusions due to drugs and alcohol compared to England (Surrey Substance Misuse JSNA 2024).

Mitigating action for any adverse impact or rationale for no further action

The service is largely delivered from individuals homes making this accessible for those that may have difficulty accessing a service in the community. Alternative services for under 18’s are available in Surrey. Catch 22 is an example of one of these services, who are commissioned in Surrey and work in partnership with Surrey County Council and criminal justice agencies. Their services provide targeted, age-appropriate substance misuse services for young people, that put the young person at the centre of treatment (Catch 22).

Disability or neurodiversity

Details of positive and/or adverse impact or other issue

Via staff work closely with Adult Social Care services and will support referrals where it is identified that someone has care and support needs, including those as a result of disability or neurodiversity, to access Adult Social Care. The Oliver McGowen training is mandatory for all Via staff, including staff who work on the High Impact Complex Drinker’s Service. This training is named after Oliver McGowan. Oliver was a young man whose death shone a light on the need for health and social care staff to have better skills, knowledge and understanding of the needs for autistic people and people with a learning disability. The Oliver McGowan Mandatory Training on Learning Disability and Autism is the government’s preferred and recommended training for health and social care staff (NHS England).

Mitigating action for any adverse impact or rationale for no further action

Service user cases are discussed weekly, at a minimum, with the wider team and management, where additional needs are identified and there are difficulties adapting/adjusting this will be discussed as a team to identify ways in which they can support. The service is largely delivered from individuals homes making this accessible for those that may have difficulty accessing a service in the community. Via have worked with service users who they strongly believed were Neurodiverse although undiagnosed. Via adapt the way they work, allowing for shorter visits, keeping to regular appointments and using visual aids.  Working with service users at a slower pace and for an extended period of time allows them to better understand what works best for them, if they are not already able to say.   This is a general theme in Via’s approach across the board, many of their service users are suffering from poor health, often resulting in disabilities, cognitive issues and often undiagnosed mental health, or learning difficulties. In addition, they have noted that with their older service users, given most neurodiverse traits were not recognised in their earlier years, due to the limited understanding and awareness more widely and due to lack of engagement with healthcare and significant waiting times (5 years in Surrey currently), they continue to remain undiagnosed.

Gender reassignment

Details of positive and/or adverse impact or other issue

The service does not currently ask gender reassignment status on assessment.    For context, across Surrey, there were responses from 921,833 residents (94.79% of the population aged 16 years and over). 94.42% of residents answered “Yes”, indicating that their gender identity was the same as their sex registered at birth. 0.37% of residents answered “No”, indicating that their gender identity was different from their sex registered at birth. Within this group: 0.14% answered “No” but did not provide a write-in response, 0.08% identified as a trans man, 0.08% identified as a trans woman, 0.05% identified as non-binary, 0.03% wrote in a different gender identity. 5.21% did not answer the question on gender identity and therefore data for this group is unknown (Census 2021 Surrey data).

Mitigating action for any adverse impact or rationale for no further action

This will be reviewed by Via in line with supporting individual’s needs. The service is largely delivered from individuals homes making this accessible for those that may have difficulty accessing a service in the community.  This also includes those that may experience difficulties accessing services due to stigma. • SCC stigma training is available to HICD staff • Via are developing an LGBT self-assessment for services which will enable them to improve practice and service provision by measuring against an evidence-based set of baselines. • The above self-assessment includes the use of the Out of Your Mind audit for service providers developed by London Friend. This report was first published in 2014 and continues to be a useful tool for services. This will be built into the HICD service workplan to be completed by end of 24/25. ‘Out of your mind’ is a report examining how drug and alcohol treatment services can be improved for lesbian, gay, bisexual & trans (LGBT) people. The report aims to encourage commissioners and providers of drug and alcohol treatment services to be more mindful of the support needs of LGBT people when planning and delivering services (London Friend). The report also includes a number of audits for; service providers, commissioners and practitioners to use to measure their delivery and to direct where improvements could/should make.

Marriage and civil partnership

Details of positive and/or adverse impact or other issue

The service does not currently ask marital status on assessment.  The Census 2021 classified a family as a group of people who were either: a married, civil partnered or cohabiting couple with or without children (the children do not need to belong to both members of the couple); a lone parent with children; a married, civil partnered or cohabiting couple with grandchildren but where the parents of those grandchildren were not present; or a single or couple grandparent with grandchildren but where the parents of those grandchildren were not present. Therefore, a multiple family household could include a household with more than one family living together (e.g., grandparents, parents, and dependent children) or a household where unrelated adults lived together. The most common type of single-family household were those with a married or civil partnership couple and dependent children (19.8% of all households). The second and third most common family type in Surrey were one person households, with 14% of Surrey households only containing one person aged 65 or under, and 13% containing only one person over the age of 65 (Census 2021 Surrey data).

Mitigating action for any adverse impact or rationale for no further action

This will be reviewed by Via in line with supporting individual’s needs. While engaging with an individual within their own home this information will often be shared with the staff member.

Pregnancy and maternity

Details of positive and/or adverse impact or other issue

Contact with or having children is included within the assessment for HICD, pregnancy is not specifically documented as a question however on disclosure individuals are supported alongside risk management. Pregnancy is not an exclusion criterion for HICD however individuals meeting the other criteria for HICD and pregnant would present significant safeguarding concerns.

Mitigating action for any adverse impact or rationale for no further action

The service works closely with other organisations and often pregnancy would be highlighted on the referral and in Community Harm and Risk Management Meetings. The Via HICD assessment will be updated to include specific reference to pregnancy.

Ethnicity

Details of positive and/or adverse impact or other issue

The service does not currently ask for ethnicity on assessment.    It is worth noting that although research literature has previously reported high levels of abstention from alcohol across minority communities, alcohol services describe a different picture with the prevalence of problematic alcohol use being under-estimated. It has been found that there is no ‘size fits all’ approach to providing interventions relating to alcohol use to minority communities. This differs between and within communities. Experiences of exclusion, whether at a younger age, or older age due to social perceptions of masculinity in some communities, as well as the hidden nature of women’s drinking across different communities, are all factors which could increase the risk of problematic alcohol use (Alcohol Change UK 2019).   For context, approximately 77% of Surrey residents reported that they identified as White British in 2021, alongside 9% who reported that they were ‘White Other’. 14.5% of Surrey residents reported that they identified as non-White, with residents who identified as Asian made up the largest percentage of non-White population in Surrey (Census 2021 Surrey area).

Mitigating action for any adverse impact or rationale for no further action

This will be reviewed by Via in line with supporting individuals cultural and spiritual needs.   Enabling access to support is key. This could include providing materials in community language, using specific broadcasters (e.g. radio), including community members in developing services, emphasising the strict confidentiality of services, raising awareness of services available, peer led support, and being flexible as a service, being able to respond to changing community needs (Alcohol Change UK 2019).

Religion or belief

Details of positive and/or adverse impact or other issue

The service does not currently ask for religion/belief on assessment.    Key barriers to accessing support identified in previous research included: lack of understanding of the harms of alcohol use; lack of knowledge of services available; language problems; shame and stigma within communities in admitting to problems with alcohol; and cultural attitudes towards help-seeking that can view this as a weakness of character (Alcohol Change UK 2019).   In Surrey, 50.2% of residents are Christian, making it the largest religious group. 36.3% of Surrey residents were of no religion. Non-Christian religions were reported by 7.0% Surrey residents, where Muslims represented 3.2% of Surrey residents (Census 2021 Surrey data).

Mitigating action for any adverse impact or rationale for no further action

This will be reviewed by Via in line with supporting individuals cultural and spiritual needs.   Enabling access to support is key. This could include providing materials in community language, using specific broadcasters (e.g. radio), including community members in developing services, emphasising the strict confidentiality of services, raising awareness of services available, peer led support, and being flexible as a service, being able to respond to changing community needs (Alcohol Change UK 2019).

Sex

Details of positive and/or adverse impact or other issue

The service does not currently ask gender on assessment.    For context in Surrey (latest data 2021), 51.3% of the population is female, with 48.7% being male.

Mitigating action for any adverse impact or rationale for no further action

This will be reviewed by Via in line with supporting individual’s needs. Via are developing an LGBT self-assessment for services which will enable them to improve practice and service provision by measuring against an evidence-based set of baselines. The above self-assessment includes the use of the Out of Your Mind audit for service providers developed by London Friend.  This will be built into the HICD service workplan to be completed by end of 24/25.

Sexual orientation

Details of positive and/or adverse impact or other issue

Sexual orientation is an umbrella term covering sexual identity, attraction, and behaviour. For an individual respondent, these may not be the same. The statistics should be interpreted purely as showing how people responded to the question, rather than being about whom they are attracted to or their actual relationships. In total, 93.1% of Surrey residents answered the question. 90.66% of the Surrey population (aged 16 years and over) identified as straight or heterosexual. 1.17% described themselves as gay or lesbian, with 1.05% describing themselves as bisexual. 0.26% selected ‘Other sexual orientation’. The overall number of residents of Surrey who identified with an LGB+ orientation was therefore 2.48% (Surrey Census 2021 Surrey data).

Mitigating action for any adverse impact or rationale for no further action

This will be reviewed by Via in line with supporting individual’s needs. Via are developing an LGBT self-assessment for services which will enable them to improve practice and service provision by measuring against an evidence-based set of baselines. The above self-assessment includes the use of the Out of Your Mind audit for service providers developed by London Friend.  This will be built into the HICD service workplan to be completed by end of 24/25. ‘Out of your mind’ is a report examining how drug and alcohol treatment services can be improved for lesbian, gay, bisexual & trans (LGBT) people. The report aims to encourage commissioners and providers of drug and alcohol treatment services to be more mindful of the support needs of LGBT people when planning and delivering services (London Friend). The report also includes a number of audits for; service providers, commissioners and practitioners to use to measure their delivery and to direct where improvements could/should be made.

Socio-economic background

Our socio-economic background is a combination of different factors, such as our income, occupation and social background. A person’s socio-economic background can expose them to inequalities, so it’s important to understand how your project could affect different socio-economic groups. Further information about socio-economic status can be found in the Cabinet Office Measuring socio-economic background in your workforce guidance.

Details of positive and/or adverse impact or other issue

In the Census 2021, Households were also classified by dimensions of deprivation and were considered deprived if they met one or more of the four dimensions of deprivation: –         employment: where any member of a household, who is not a full-time student, is either unemployed or long-term sick. –         education: no person in the household has at least five or more GCSE passes (grade A* to C or grade 4 and above) or equivalent qualifications, and no person aged 16 to 18 years is a full-time student. –         health and disability: any person in the household has general health that is “bad” or “very bad” or has a long-term health problem. –         housing: the household’s accommodation is either overcrowded, with an occupancy rating of negative 1 or less (implying that it has one fewer room or bedroom required for the number of occupants), or is in a shared dwelling, or has no central heating.   Surrey, on average, had less households which were deprived than other parts of the South East and England with 57.1% of households which did not meet any of the dimensions of deprivation. Overall, 42.9% of Surrey households (representing 206,798 households) were deprived in at least one of the dimensions, which was lower than the national (51.6%) and regional (48.0%) averages (Census 2021 Surrey data).

Mitigating action for any adverse impact or rationale for no further action

Via are committed to meeting the needs of diverse service users. They will continue to explore how socio-economic background can act as a barrier to access their services, and any action that can be taken to mitigate this.

Other characteristics

Use this section to consider the PSED aims and any impacts your product may have on characteristics that are not protected under the Equality Act 2010 but are still significant to equality and inclusion. For example, your product may have a particular effect on people with caring responsibilities or on people with English as an added language, or you may need to consider the Welsh Language (Wales) Measure 2011 in delivery. Think creatively and invite input from stakeholders.

Details of impact or other issue

Multiple Disadvantage and other risk factors. A range of risk factors can make people more susceptible to alcohol related harm. These include individual factors, such as mental health, health/disability, trauma, experience of adverse childhood experiences (ACEs), employment /educational /housing /economic status and genetics.  Interpersonal factors, such as prosocial relationships, peer influences and norms, family structure and functioning.  Community factors, such as economic and housing opportunity, marginalisation, and social isolation /cohesion. Institutional factors such as accessibility of alcohol use services and generic helping services, exclusion, and discrimination. People who experience severe and multiple disadvantage are in particular at increased risk alcohol related harm.

Mitigating action or rationale for no further action

Via are committed to meeting the needs of diverse service users, providing inclusive services that promote equity through delivering equality of opportunity, services that are free from stigma and discrimination and are delivered in a culturally competent way.

Action log

Record EIA actions and monitor action progress in the optional action log.

1. To consider further consultation on this document with service users, partner agencies and stakeholders.
   1. To work with Via on capturing and monitoring of protected characteristics information of beneficiaries of this service, at assessment stage.
      1. Via are in the process of finalising an improved process for equality impact assessments. This will be applied to all policies and large projects etc. This document will need to consider this improved process.