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Providing a Cost Effective Alcohol Screening, Assessment and Referral Service within a Hospital Setting Mission Statement Enhancing 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 AUDIT 30+ AUDIT 24+ Moderately dependent Direct referral to Specialist Prescribing service Consider referral to Specialist Prescribing service Harmful drinkers Triage/ Coordination Team AUDIT 16+ Hazardous drinkers GP Practice IBA 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 North East North West 2500 Yorkshire and The Humber East Midlands West Midlands East of England London South East Admissions 2000 South East Coast SHA South Central SHA South West Total for England 1500 1000 500 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 Year Rate of alcohol admissions per 100,000 population by PCT 3000 Middlesbrough Redcar and Cleveland 2500 North Tees 2000 Average Total for 4 PCT's 1500 1000 500 9 20 08 /0 8 20 07 /0 7 20 06 /0 6 20 05 /0 5 20 04 /0 4 03 /0 20 02 /0 3 0 20 Admissions Hartlepool 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 Position Alcohol Nurse Team Leader Substance Misuse Worker Substance Misuse Worker Substance Misuse Worker Substance Misuse Worker Substance Misuse Worker Admin Support Total Salaries National Insurance Pension Total Staff costs Running Costs setting up costs Central management & admin Total • • • • • Hrs. Salary Actual 37 31,856 31,856 37 18.5 18.5 18.5 18.5 18.5 37 24,250 24,250 22,000 11,000 22,000 11,000 22,000 11,000 22,000 11,000 22,000 11,000 12.0% 3% 13,500 13,500 124,606 14,953 3,738 143,297 7,900 3,000 22,489 176,686 Increased staff capacity Medical and Psychosocial approach Targeted times, including weekends Continuation of treatment from hospital into community More training to hospital staff 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 Admissions STATISTICS • 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 High Impact - Repeat Admissions •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. Thank you. Any Questions ?