The ‘wicked’ problem of alcohol
Newcastle upon TyneNorth TynesideNorthumberland
Lynda SeeryPublic Health Lead for
Drug and Alcohol
What we did in 2007?
• Nationally » information, data (NWPHO), evidence » MoCAM, » the Alcohol Needs Assessment Research Project
(ANARP)
• Locally » Strategies?» Needs Assessment ?» Service Reviews?
• Mapping of service provision
What we found?• Tier 1 - Prevention
» C&YP – Healthy Schools module» Adults – national campaigns only
• Tier 2 –Treatment» Community services
• Tier 3 – Treatment (specialist)» Specialist addictions service (detox available)» A&E» Admission to hospital
• Tier 4 – Residential rehab» Assessment against criteria (predominantly for
drugs)» Structured day care
How do we impact on the indicator?
• complex indicator• requested data extract 1/4/07 – 31/3/09• 3 particular hospital codes of interest identified
within the spell of care (not necessarily primary diagnosis)
– F10 mental & behavioural disorders due to alcohol– K70 alcoholic liver disease– T51 intoxication
• 1.00 - wholly attributable to alcohol (main focus)
Individual patient record
• postcode level & GP Practice• 1411 admissions (707) patients• Costs = £2.5m• 943/1411 re-admissions (66.8%)• 239/707 patients readmitted (33.8%)• 2 to 1 male to female split• 468/707 patients admitted once
(66.2%)• age breakdown
NewcastleProportion of population in each age group. Newcastle population as a whole and Newcastle admissions 1/4/07 - 31/3/09
<15
<15
15-24
15-24
25-34
25-34
35-44
35-44
45-5445-54
55-64
55-64
65-74
65-7475-84
75-8485+ 85+
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Newcastle population Newcastle admissions
North TynesideProportion of population in each age group. North Tyneside population as a whole and North Tyneside admissions
<15
<15
15-24
15-24
25-34
25-34
35-44
35-44
45-5445-54
55-64
55-64
65-74
65-7475-84
75-8485+ 85+
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
North Tyneside population North Tyneside admissions
NorthumberlandProportion of population in each age group. Northumberland population as a whole and Newcastle admission 1/4/07 - 31/3/09
<15
<15
15-24
15-24
25-34
25-34
35-44
35-44
45-54
45-54
55-6455-64
65-74
65-7475-84
75-8485+ 85+
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Northumberland population Northumberland admissions
Segmentation - understanding the patient layers
The ‘patient layers’ fall into the following categories:
• Patients admitted to hospital for 1 day or less (no overnight stay)
• Patients admitted only once
• Patients admitted once for intoxication / patients re-admitted for intoxication
• Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)
• Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas
• Patients with severe ongoing/end stage illness
Patients admitted once only for 1 day or 8 hours or less
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Newcastle PCT North Tyneside PCT Northumberland CT
Admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(patient admitted once for 1 day or less)
Stomach or Duodenum Disorders
Ingestion Poisoning or Allergies
Epilepsy
Syncope or Collapse
Gastrointestinal Bleed
Sprains, Strains, or Minor Open Wounds
Chronic Pancreatic Disease
Chest Pain
General Abdominal Disorders
Poisoning, Toxic, Environmental
Example of intoxication record
Codes listed
T40 (primary diagnosis)
poisoning by drugs, medicaments and biological substances
X620 intentional self harm
T51 intoxication/toxic effects of substances non medicinal as to source
S099 injuries to head
W19 fall
F101 harmful use
‘Frequent users’ or re-admissions to hospital
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Newcastle PCT North Tyneside PCT Northumberland CT
Re-admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(239 frequent users accounting for 943 admissions )
Stomach or Duodenum Disorders
Gastrointestinal Bleed
Chronic Obstructive PulmonaryDisease or Bronchitis
General Abdominal - DiagnosticProcedures
Pancreatic Disorders
Drainage of Ascites
Poisoning, Toxic, Environmental
General Abdominal Disorders
Chronic Liver Disorders
Chronic Pancreatic Disease
Example of re-admission recordCodes listed
K703 (primary diagnosis)
Diseases of the liver
F102 Dependence syndrome
I10X Hypertensive diseases
J459 Chronic lower respiratory diseases
R18X Symptoms and signs involving the digestive system and abdomen
Z720 Persons encountering health services in other circumstances
Z867 Persons with potential health hazards related to family and personal history and certain conditions influencing health status
Phase 1 – focused work with identified individuals
• Target groups
– patients re-admitted for intoxication
- Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)
Significant 60
– Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas
Significant 12
Male Female
Newcastle 44 49
North Tyneside 22 22
Northumberland 17 25
Community Alcohol team (virtual)
• Treatment Effectiveness & Governance Manager
• Community Matron for Social Exclusion (alcohol)
• Nurse Practitioner• x2 Alcohol Specialist Nurses (mental health)• X2 Alcohol Specialist Nurses (acute)• 4.5 wte Assertive Outreach Workers• x1 IBA Trainer (+2 sessional trainers)• x1 Health Link Worker (A&E)
What the team provides • Care Co-ordination – key worker responsibility
• Multi agency care plans – (individuals may have a single dominant condition i.e. alcohol but
may be known to different agencies)
• Community Matron post – key to working with GPs and into Practices
• Community Open clinics (walk in, self refer, referred into from any other service) – Professionals available at clinics, clinical & mental health staff,
social care, housing, benefits
• Assertive Outreach (voluntary sector)
• Wider use of IBAs & Brief Interventions (multi agency training – confidence & competence)
• Implementation of the Cardiff Model – A&E & CDRP
How hard can it be?
•Pace
•Purpose
•Passion
Questions?