Getting to Grips with Alcohol 2016

Service Innovation – HSJ FinalistSetting up the Poole

Alcohol Care & Treatment Service

27th January 2016 Getting to Grips with Alcohol 2016 1

Building of an alcohol care team• August 1996

Gastroenterologist appointed, Alcohol and drug service overseen by psychiatrist on a nominal half day a week ‘retainer’ - avenues for combined working failed to progress …….

• August 2012 Recruitment of x1 PCT funded (initially) specialist addiction nurse

• June 2013 3rd sector addiction care coordinator seconded from Poole

community treatment system to PHFT & IBA service provided by 3rd sector• December 2013

Funding secured to recruit an additional specialist addiction nurse plus a team administrator

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• January 2014Trust wide alcohol screening initiative implemented 20,000 patients per year

• July 2014Funding secured via CCG for x2 assertive outreach alcohol

workers to cover Poole localities only• August 2014

Funding received from Health Education Wessex for an addiction nurse training position (Band 5)• August 2014

Funding secured via LA for a clerical assistant (Band 2)• January 2015

Funding received for a specialist social worker (LA employed seconded into PHFT)

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• January 2015Interim results of assertive outreach alcohol service producedIn response to positive results additional funds released to

appoint an addition x2 workers covering Purbeck & East Dorset localities.• 2015 Focus

Evidencing the benefit and need for a 7 day specialist addiction

nurse service.Measuring the units – NCEPOD 2013Alcohol care in England’s hospitals - An opportunity not to be wasted - PHE

2014

• September 2015 Funding secured for an addition x2 specialist addiction nurses (PHT)• January 2016

7 day specialist addiction service goes live27th January 2016 Getting to Grips with Alcohol 2016 4

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What we looked like then…

This was Bill

Bill was a lone(ly) alcohol liaison nurse

Bill wanted colleagues

Bill asked everyone for funding

Bill is happy now

Be like Bill

What we look like now…

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ACTS

Assertive outreach team

(CCG localities)

Addiction social worker (LA funded)

Specialist Addiction nurses

Addiction care coordinator

(LA funded)

IBA Worker(PH Dorset, private provider )

Admin & service management

Clinical lead

Activity

• Data – admissions/readmission– 1157 wholly attributable alcohol related admissions (ICD-

10 codes) last FY– 303 readmissions (26%) within 12 month period

• Impact of specialist nurse team– Quicker access to treatment for patients with unmet needs

and not known to community based treatment services (teachable moments)

– Provide out-patient based detoxification (earlier safe discharge)

– Providing option for patients who are resistant to attending traditional addiction services

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• Assertive Outreach Alcohol Team– Targeting frequent attenders in both primary and

secondary care– Improving patients social functioning, relationships,

health and wellbeing– Providing treatment for patients who are resistant to

attending traditional addiction services

• Routine trust-wide alcohol AUDIT screening– 15,000+ screenings – financial year 2014-2015

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Positive Financial Impact• Assertive outreach CCG data (Poole locality 2014 - 15)

– Independent CCG impact data taken from the assertive outreach team caseloads (30 patients) over the first 6 months of operation (2 workers)

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6 month pre AO 6 month post AO Impact

Ambulance Conveyance91 70 -23%

- 21 conveyances

Emergency Department attendance 153 91 -41% - £ 5,000.00

Emergency admissions97 39 -60% - £52,000.00

Primary care contacts(all conditions) 225 93 -59% -£5166.00Primary care contacts(alcohol-related problems) 96 47 -51% -£1917

• ACTS clinically managed 87 emergency alcohol withdrawal programs 2014-2015 continuing them as an outpatient where appropriate. Early discharge saving approximately 435 bed days at a total cost of £116,580

• Financial year to date, the 75 individual patients from the above cohort ED attendance total is currently -103 and emergency admission total is -111

• Hospital based Addiction Care coordinator has made 47 new direct referrals into the Poole community addiction treatment system

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Positive Partnership Working

ACTS is now a multi agency, multi disciplinary 7 day service:

We comprise: secondary care specialist nursing and medical

stafflocal authority social care servicesCCG commissioned assertive outreach alcohol workersthird sector charities and social enterprisesprivate health care organisations

Partners: Dorset CCG & Public Health commissioners and Health and Wellbeing Board members have been essential in realising our vision

‘invest to save’27th January 2016 Getting to Grips with Alcohol 2016 11

Thank You

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