Newcastle Alcohol Harm Reduction Strategy

Safe, Sensible and Social in Newcastle upon Tyne

Alcohol Harm Reduction Strategy

High Impact Change 5 Appoint an alcohol health worker

The Role of the Community Matron

Margaret Orange Treatment Effectiveness and Governance Manager Newcastle PCT

Overview

• The Local context• Newcastle admissions Data• High Impact Changes• Community Matron (Alcohol)• What are the key challenges to developing the

Community Matron role?

Newcastle ..........

•One of the most revitalised northern cities

•Vibrant nightlife and arts scene

•Visually impressive

•Passion for football

•Irresistible to hedonists, culture vultures and shoppers alike

Newcastle ..........

•One of the most revitalised northern cities

•Vibrant nightlife and arts scene

•Visually impressive

•Passion for football

•Irresistible to hedonists, culture vultures and shoppers alike

And……..

•Geordies know how to enjoy a good night out

Newcastle ..........

• has high rates of alcohol-related problems

• is one of the ‘wettest’ regions in the UK

• is in the top 5 LA s for worst health and social deprivation indicators

• has one of the highest binge-drinking rates in the country

• has rate higher than national average of dependent drinkers

• has one of the lowest levels nationally of access to treatment

• has one of the highest rates nationally of alcohol-related hospital admissions

Analysing the data

• Hospital Admissions Only – Requested data set

• Postcode/ GP / NHS number

• up to 7 identified codes accepted

• Wholly attributable to alcohol (main focus)

K70 – Alcohol liver cirrhosisF10 – Mental and Behavioural disturbance due to alcoholT51 – Alcohol intoxication

Analysing the data

• 1411 admissions - (707) patients

• Costs = £2.5m

• 943/1411 readmissions (66.8%)

• 239/707 patients readmitted (33.8%)

• 153 males & 86 females

• 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

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

Example of an 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

Example of a re-admission record

Codes 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

• Initial target groups

– Patients re-admitted for intoxication

– Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)

20% of patients using over 70% of the costs

– Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas

North of Tyne 12

  Male Female

Newcastle 44 49

North Tyneside 22 22

Northumberland 17 25

Mapping the services and initiatives

Tier system– MoCAM– Prevention/Early Intervention – implementing IBAs– Treatment – Community services & emerging

alcohol workforce– Enforcement – management of environment &

night time economy – Rehabilitation – very small numbers– Care Pathway

MOCAM tiers

Residential RehabIn-patient managed withdrawal

Comprehensive, complex, specialist services

Open access, outreach services, community treatment,Shared care

Targeted screening, information and brief advice, referral and signposting

The Community Matron

“A Community Matron is a nurse who provides advanced clinical nursing care in addition to case management … to an identified group of very high intensity users through case finding.”

Long-term conditions

“Long term conditions are chronic medical conditions that cannot be cured, but can be controlled and managed by medication and other interventions and therapies. Long term conditions include Heart Failure, Diabetes, Asthma, COPD (Chronic Obstructive Pulmonary Disease) and Arthritis.”

The Scale of the Problem

6600%% ooff aadduullttss iinn EEnnggllaanndd rreeppoorrtt aa cchhrroonniicc

hheeaalltthh pprroobblleemm

Binge Drinking;

28.93%

Hazardous Drinking;

19.5%

Harmful Drinking;

6.2%

Newcastle .......... Drinking levels

The Community Matron model

Not mutually exclusive approaches.

A range of approaches will be required to suit the locality

The Community Matron model

• Level 1 - Self management of Long

Term Conditions

• Level 2 - High risk single condition

disease management.

• Level 3 - Highly complex conditions

requiring case management.

Level 1

• Self care support/management • 70 to 80% of the Long Term Conditions population will

receive self care support. • Support includes educating patients on their condition,

tools and devices, support networks etc. • Wider use of IBAs

Level 2

• Complex and multiple Long Term Conditions • Case management can be provided by Community

Matrons • Community Matrons have advanced clinical

nursing practice • Care – coordination• Multi agency care planning

Level 3

• Disease-specific care management

• Specialist services using multi-disciplinary teams and disease-specific protocols and pathways.

• Clarity around pathways

• Community Open Clinics

• Assertive Outreach

• Case Management

Evidence Base

• Nurse-led care improves health outcomes

• Effectiveness of patient education and self care

• Care management well established

• Largest workforce

• Evidence shows the potential of nurse led services

The Community Matron

• Clinical role- no staff to manage

• Advanced clinical skills, medicines management combined with innovative case management

• Case loads of 50-80

• With the authority to act ( this may include a budget)

Key competencies

• Work in an autonomous manner • Able to assess, diagnose, prescribe, carry out treatments at home • Initiating and interpreting diagnostic tests • Extended prescribing to manage exacerbation of Long Term

Condition • Maximise quality of life • Manage mental wellbeing and cognitive impairment alongside

clinical care

How will the CM model support the reduction of alcohol related admissions?

• Prevent unnecessary emergency admissions to hospital • Reduce Length of Stay in hospital • Improve outcomes for patients • Integrate all elements of care • Improve quality of life

Improvement methodology

• Multi agency care plans – (individuals may have a single dominant condition i.e. alcohol but may

be known to different agencies)

• 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 • Wider use of IBAs (multi agency)• Emerging workforce (i.e. new roles, liaison, co-ordination,

systems approach to service delivery)

Newcastle ACTS

• Support the tier 3 specialist service• Build capacity in tier 1 services• Assessment, clinical interventions, care coordination• Community/home detox where appropriate• Alternatives to hospital admission• Facilitate earlier discharge

Public Health Capacity Building

Tier 1 staff enabled to;

• Identify hazardous and harmful drinkers – and those drinking over the recommended limits

• Provide advice around increasing health risks and impacts• Provide information on decreasing risks and impacts• Provide advice to reduce alcohol harm• Signpost and refer to other services as appropriate

Newcastle ACTS

• Primary Care – Treatment Effectiveness Manager– Community Matron– Alcohol Nurse Specialist (Primary Care)

• Mental Health Trust – X2 Alcohol Nurse Specialist (Mental Health)

• Acute Hospitals Trust– X2 Alcohol Nurse Specialist (Acute Services)

• Tyneside Cyrenians– X4.5 Assertive Outreach Workers

Reducing hospital admissions

A partnership approach to;

• Identify “frequent flyers”

• Multi agency care planning meetings

• Care coordination

• Provide alternatives to hospital admission

Community Nurses

Assertive Outreach

Hospital Nurses

Mental Health nurses

CareCoordination

Community Open Clinics

• Development of open access “wrap- around” services across the city

• Assessment and monitoring of physical and mental health

• Alcohol support and relapse prevention

• Partner presence – social work, housing advice, benefits

• Targeted venues

So What are the Key So What are the Key Challenges?Challenges?

• Data and Information for case finding, risk management

• Developing the workforce

• Systems Change

• Partnership working/Integration

Community MatronsCommunity Matrons promote and provide care at home with the aim of avoiding, where at all possible repeated hospital admissions.

Community matrons work with patients who:

•Are experiencing long term illnesses

•Are over 18

•May benefit from early hospital discharge

•Have had repeated hospital admissions

Your GP may ask the Community Matron to contact you to offer you support if any of these issues apply to you.

They can:

•Meet with you and find out how they can help you to be as well as possible.

•Make plans with you to achieve this. Involve your family or carer if you would like this.

•As part of the plan liaise with others involved with your care.

Practical ResponsesPractical Responses

• Community Open Clinics

• School Health Advisor (Alcohol)

• Day Clinics

• Pre-admission clinics

• Post discharge clinics

Questions?Questions?

margaret.orange@newcastle-pct.nhs.uk