Providing a Cost Effective Alcohol Screening, Assessment

and Referral Service within a Hospital Setting

Mission StatementEnhancing the quality of life for people

in the Tees Valley by promoting sensible drinking patterns, raising the awareness

of alcohol and drugs and their effects, and by offering help to those suffering

from the effects of alcohol and drug misuse.

Introduction

• Established in1980

• Registered Charity no. 1103901

• Company Limited by Guarantee no. 5069305

• A Treatment, Counselling, Support, Advice, Information and Training service

for people affected by alcohol & drug misuse

Severely dependent

Moderatelydependent

Harmful drinkers

Hazardous drinkers

AUDIT 30+

AUDIT 24+

AUDIT 16+Triage/CoordinationTeam

GP PracticeIBA

Consider referral to Specialist Prescribing service

Direct referral to Specialist Prescribing service

The Problem

“For the NHS alone, the estimated financial burden of alcohol misuse is around £2.7 billion in hospital admissions, attendance at A&E, primary care, etc.

‘Signs for Improvement – Commissioning Interventions to reduce Alcohol related Harm’ Department Of Health

History of Primary Alcohol & Drugs Service

• PADS – University of North Tees Hospital 2001

• Counselling- 2 FTE Counsellors

• Maximum Case Load 36 patients

• Majority of referrals from the wards

• Invited back into hospital for counselling

• 8 to 12 counselling sessions offered

• Funded via the DAT and PCT

History of Primary Alcohol & Drugs Service

• PADS – James Cook University Hospital

• Established June 2006

• Two FTE Staff members plus admin support

• Not based on Counselling model

• Patients usually seen once for assessment/ IBA

• Train hospital staff on alcohol awareness, screening

tools and Identification & Brief Advice

Benefits of Voluntary Sector• Trained in counselling skills, motivational interviewing, IBA,

• Psychosocial approach

• Comprehensive holistic assessment of patients needs

• Quality time spent with patient (Not drawn into other duties)

• Involve Carers and relatives

• Advocate on behalf of patient

• Familiar with community services

• Cost effective

Achieved so far

• 1178 referrals (April 08 – March 09)

• 801 seen and assessed

• 114 already accessing services

• 301 new referrals to community services

• 95 hospital staff trained

• Supported by Hospital Managers, Consultants and Ward

sisters

• Psychiatry Liaison Team referral pathways agreed

Rate of alcohol admissions per 100,000 population and Projected Trend by SHA

500

1000

1500

2000

2500

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Year

Ad

mis

sio

ns

North East

North West

Yorkshire and The Humber

East Midlands

West Midlands

East of England

London

South East

South East Coast SHA

South Central SHA

South West

Total for England

Rate of alcohol admissions per 100,000 population by PCT

0

500

1000

1500

2000

2500

3000

Year

Adm

issi

ons

Middlesbrough

Redcar and Cleveland

North Tees

Hartlepool

Average Total for 4 PCT's

What is the Government trying to achieve?

‘A reduction in chronic and acute ill-health caused by

alcohol, resulting in fewer alcohol related accidents and

hospital admissions than otherwise projected from 2008/09

baseline’

High Impact Changes within the Hospital

Department of Health recommends:

• High capacity, effective team

• Alcohol Liaison Nurse

• Targeting repeat admissions

• Identification & Brief Advice

• Importance of partnership working

                                                                                          

High Impact – High Capacity

• Increased staff capacity• Medical and Psychosocial approach• Targeted times, including weekends• Continuation of treatment from hospital into community• More training to hospital staff

                                                                                          

Position Hrs. Salary ActualAlcohol Nurse 37 31,856 31,856 Team Leader 37 24,250 24,250 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Substance Misuse Worker 18.5 22,000 11,000 Admin Support 37 13,500 13,500 Total Salaries 124,606

National Insurance 12.0% 14,953

Pension 3% 3,738 Total Staff costs 143,297

Running Costs 7,900setting up costs 3,000

Central management & admin 22,489

Total 176,686

High Impact – Alcohol Liaison Nurse

•Grade 7 Prescribing Nurse

•Specifically treating alcohol dependant patients

•Liaise with community treatment service

•Develop prescribing regimes with community treatment service and

hospital

•Shorten length of stay in hospital for patients

•Joint visit with outreach service for those patients that do not engage

with community services

James Cook University Hospital Repeat Admissions

2007/08 2008/09

62 patients with 3+ Admissions including

59 Patients with 3+ Admissions including

Admissions Admissions

James Cook University Hospital Repeat AdmissionsSTATISTICS

• Specific alcohol diagnostic codes = 1391 (April- October 2009)

• 915 (65%) ward admission of less than 24 hours (644 individuals)

• And of this group 49 individuals resulted in 244 admissions of more than 3 admissions.

ACTIONS

• JCUH to create a CaMIS risk alert to identify when patient is admitted.

• Agree information sharing protocol with hospital

• Identify any other services engaged with these individuals

• Obtain alcohol treatment history

• Introduce a Case Conference/ Care Coordination group to specifically review care packages

• Invite all agencies who are involved or could have a support role

• Chairperson with the experience, authority and motivation to  make plans happen

•Fresh look at what has been done and what can be done

•Proactive approach

•Look at underlying causes: housing, finance, mental health, lifestyle

•Consider : Detox, Residential Rehabilitation, Assertive Outreach,

Counselling, Support groups, Buddying Services, Care centres,

Supported Housing.

We need to get away from the “we have already tried that” mind set.

High Impact - Repeat Admissions

Thank you.

Any Questions ?