Implementation of the ‘Cardiff data sharing’ model in Derby

City:

2010 - 2013

• Derby Second worst in East Midlands for alcohol-related hospital admissions

• 22nd worst Local Authority in England

• Rate of increase in alcohol admissions between years of 23% - against a national average of 11%

• 66% greater rate of admission than East Midlands and England

• 6000 dependent drinkers; 33,000 binge drinkers; 9,000 harmful drinkers

• 2008/9 - 2,710 alcohol related crimes reported in the City

See: Quarterly rate of alcohol-related admissions per 100,000 population (EASR)

Derby: 2008

Derby: 2010

• New alcohol treatment system introduced at a cost of £1.6 million a year

• Derby’s model commended for excellence by the Department of Health

However….• £3.1 million still spent on alcohol related A&E interventions• £10.9 million spent on alcohol inpatient activity• £2.9 million wholly attributable to drinking • Failure to fully implement Cardiff approach in Derby City –

despite stakeholder engagement and detailed planning

Assaults – Knowledge/reporting

POLICEEMERGENCY

DEPARTMENT25%

Targeted policing

Identification of hot-spots earlyEnvironmental health

LicensingCCTV

The ‘Cardiff Model’

Original approach developed by Prof. John Sheppard – in Cardiff

Emergency Department reception staff collected a simple data set:

•Location of assault•Date / Time of assault•Weapon Used

Anonymous, monthly sharing of this data with CSP (then forwarded to Police for tasking)

Emergency Department Consultant was chair of local CDRP/CSP board

Derby’s Cardiff approach 2010

• Developed information sharing agreement between CSP, Police & Acute Trust - utilise former Cardiff model template

• Modified EDIS (Hospital data recording system) based on Royal College of Emergency Medicine best practice – to include four alcohol related admissions & situational questions

• Agreed to export data into the data warehouse on a fortnightly basis – with onward push to CSP

• CSP were to analyse and sanitise data, forward on to county and Police

Example of data collected - Addenbrookes

Day Post code Date Time Age Sex Location Disposal

Saturday CB2 7 31/01/2009 09:10 42 Male MILL ROAD DOP

Saturday SG1 4 31/01/2009 03:33 25 Male OUTSIDE H+M CITY C DNW

Saturday PE2 5 31/01/2009 03:39 32 Male FOUNTAIN CAMBRIDGE DGP

Sunday CB2 7 11/10/2009 01:30 18 Male OUTSIDE BALLARE DIS

Sunday PE2 7 11/10/2009 04:08 19 Male ROSE CRESCENT DIS

Sunday CB2 7 11/10/2009 05:34 44 Male LEISURE PARK DIS

Sunday CB4 8 11/10/2009 08:10 21 Male REFUSED TO SAY DIS

Sunday CB2 7 11/10/2009 11:21 20 Male OUTSIDE BALLARE M5

Sunday CB1 2 01/02/2009 00:54 18 Male BALLARE DOP

Derby: 2012/13

• Number of alcohol related admissions fallen from 2,125 to 1,375. A -14% decrease

• English national average showed an increase of 4%• Derby among England’s top 5 local authorities for minimal

alcohol harm• Between 2009 and 2011 there was an 184% increase in the

numbers receiving community alcohol treatment• Increase in percentage of successful treatment exits from

42% to 69%

Derby re-launch: 2012/13

• A re-launch of the Cardiff data collection model will take place over early 2013. Staff will be re-engaged by senior ED managers

• RDH to identify ‘nurse champions’ to work on embedding the concept of the Cardiff model with nursing and reception staff

• Visibility for the scheme will be increased at the hospital using posters displayed across the hospital outlining why the alcohol related questions are being asked

• A generic alcohol video to be played in the ED waiting room at appropriate times

• DAAT to sponsor an incentive scheme/competition for ED reception staff, whereby staff will be rewarded for the number of competed data sets recorded on a quarterly basis

• RDH to work through the practical difficulties previously encountered such as: sensitivity of receptionist to asking alcohol questions; the level of information ascertained at triage; the involvement of IT managers in the process; and the extent of the previous modifications to the EDIS system

• A dedicated police inspector will be identified to offer the necessary links between the Cardiff approach and on street policing results

• CNP will provide feedback information to ED staff (a bulletin) detailing how the information has been used by the police and the resulting police action

Police Expectations

• Less is more• Aim to collect a few items about

a lot of people

• Location / Date & Time of Assault / Weapon used

• There is no obligation for Emergency Departments to do this

• Ethnicity of perpetrator• Number of perpetrators • Where alcohol had been bought

prior to the assault?• Name of perpetrator?• Domestic assault?• Police aware of the incident?• GPS location of assault• Type of alcohol consumed• Amount of alcohol consumed

Dr Adrian Boyle MD FCEM - Consultant in Emergency Medicine, Addenbrooke's Hospital

Police Expectations

• Less is more• Aim to collect a few items about

a lot of people

• Location / Date & Time of Assault / Weapon used

• There is no obligation for Emergency Departments to do this

• Ethnicity of perpetrator• Number of perpetrators • Where alcohol had been bought

prior to the assault?• Name of perpetrator?• Domestic assault?• Police aware of the incident?• GPS location of assault• Type of alcohol consumed• Amount of alcohol consumed

Governance

Hospital IT governance•Onus is on the Police to use this data responsibly.•Crime prevention rather than crime detection.•Information Commissioner’s Office opinion

Barriers from Health•No ‘Command and Control’ structure.•Injury management versus injury prevention.•Data protection concerns.•No meaningful incentive.•Silo mentality

Dr Adrian Boyle MD FCEM - Consultant in Emergency Medicine, Addenbrooke's Hospital

Aiding Implementation

What Works

•Persistence and Relationships•Local Champions•Safety Awards•CQUINS•Commissioning•Violence Reduction Nurses

What doesn’t work

•Confrontation•Insisting•Negative Feedback•Scope-creep

Dr Adrian Boyle MD FCEM - Consultant in Emergency Medicine, Addenbrooke's Hospital

Derby: 2013 – story so far

• Irrespective, alcohol related crimes have reduced from 2,710 in 2008/9 to 765 in 2012/13

So far not particularly good….

• Some Cardiff data has come through from RDH to PH/CNP since early 2013

• Data quality is sketchy and numbers being recorded are very low

• 12 months of historical archived data was also forward for analysis – data quality made this difficult

• Examine the situation in 12 months time

Next steps

• Training of ED receptionist – what to ask and why?• Further awareness raising of scheme at RDH• Police and senior management visits to ED• Alcohol packs for ED to reinforce the HALT/RAID and

Cardiff data collection