COLLABORATIVE, SEAMLESS, PATIENT-CENTRED, ALCOHOL CARE IN BOLTON

ALCOHOL CARE MODEL (1990-ONGOING)  Pioneered, Sustained, Evolving  Patient-Centred, Seamless, Holistic  Collaborative Gastroenterology / Psychiatry / Community  Teamworking  Governance  Audit, Research  Training, Education  Health Promotion  Impact / Replicable

1990  Established Multidisciplinary Team  Weekly (1-2) Discuss Inpatients  Nurses, Doctors, Dietician, Physio, OT, Pharmacist, Chemical Pathologist, Speech Therapist, Asian Link Worker, Social Worker (Critical)  Optimised, Unified Care  Facilitated Discharge Planning  Everyone Valued  Teamworking Ethos

1993  WENDY DARLING - Consultant Psychiatrist - Substance and Alcohol Misuse  JOINT INPATIENT CARE  SIMULTANEOUS ALCOHOL CLINIC - Monthly

INITIAL PROBLEMS / PREJUDICES OVERCOME  NIGHTINGALE WARDS - Risk Management, Privacy - Ward Drinking, Drug Misuse - Advocated / Planned GI Ward - Opened Side Rooms  SELF-INFLICTED DISEASE – Non Judgmental  REMOVED STIGMA - Asian Community Elders

1998 – DAVID PROCTOR – PSYCHIATRIC LIAISON NURSE  Hospital/Community  MDT Member  Brief Interventions  A&E, Acute Admissions, Gastroenterology, Psychiatry, Orthopaedics  Firefighting  HCP Training, Education, Screening Strategy  Joined Simultaneous Alcohol Clinic - 2 per Month - Facilitated Communication - Reduced DNA’s

DAVID PROCTOR (P.L.N) IMPACT  PATIENTS’ RESOURCES - Asian  LIAISON - GP’s - Rapid Response Community Detoxifications - C.A.T. - Other Agencies  METICULOUS AUDIT/RESEARCH DATA - Alcohol Misuse In Older People (2006) Collaboration Cabinet Office Strategy Unit - Wernicke-Korsakoff Syndrome (2007)

2006  Sandra Crompton Medical Liver Nurse Practitioner  Partners Emma Dermody, Hospital / Community P.L.N.  Gastroenterologist / Psychiatrist Supervision  Monday - Friday, 8am. Jointly Triage All Admissions - Brief Interventions - Inpatient Detoxifications Reduced 50% - Saves Trust 1000 Bed Days (£300,000) Annually - Rapid OPD – Sandra, Emma, C.A.T - Assess Inpatients Daily  Reduced Violent Incidents

JOINT GASTROENTEROLOGY/ PSYCHIATRY NURSING  Weekly Clinic. Simultaneous with Doctors  Open Access – Phone, Secretaries, Ward  Regional Referrals  Improved Abstinence  Excellent Patient / Carer / Staff Satisfaction  Feedback Adaptation  Waiting Times, DNA Rates, Length of Stay  Network 50+ Link HCP’s  Education/Training/Support/Audit/Q.A  Data for Health Commissioners  District Health Promotion

2006 CLINICAL GOVERNANCE MEETINGS  Transparent, No-Blame Culture  All Deaths, Inquests  Clinical Incidents, Complaints  End of Life Care  Infections – MRSA, Cl. difficile – Root Cause Analysis – 50% Reduction  Feedback – Trust Governance – Adaptation – Audit, Closing the Loop

SEAMLESS BOLTON DISTRICT ALCOHOL CARE 2007UNIFIED PRIMARY, SECONDARY, C.A.T DETOXIFICATION - Lean Methodology, Saves Bed Days 2007/08INTEGRATED BOLTON MULTIAGENCY ALCOHOL STRATEGY HEALTHCARE AWARDS - Access, Care, Overall Team Of The Year 2008Pivotal Role with Public Health Team, Multiagency Partnership persuading DH Team for Health Inequalities to make Bolton Early Implementer of National Alcohol Strategy

ALCOHOL-RELATED DISEASE Meeting the challenge of improved quality of care and better use of resources A Joint Position Paper on behalf of the British Society of Gastroenterology, Alcohol Health Alliance UK and the British Association for Study of the Liver

RECOMMENDATIONS DGH serving a population of 250,000

Key Recommendation (1) A multidisciplinary “Alcohol Care Team,” led by a Consultant, with dedicated sessions, who will also collaborate with Public Health, Primary Care Trusts, patient groups and key stakeholders to develop and implement a district alcohol strategy. DGH Requirement

Key Recommendation (2) Coordinated policies on detection and management of alcohol-use disorders in Accident and Emergency departments and Acute Medical Units, with access to Brief Interventions and appropriate services within 24 hours of diagnosis. DGH Requirement

Key Recommendation (3) A 7-Day Alcohol Specialist Nurse Service and Alcohol Link Workers’ Network, consisting of a lead healthcare professional in every clinical area. DGH Requirement

Key Recommendation (4) Liaison and Addiction Psychiatrists, specialising in alcohol, with specific responsibility for screening for depression and other psychiatric disorders, to provide an integrated acute hospital service, via membership of the “Alcohol Care Team.” DGH Requirement

Key Recommendation (5) Establishment of a hospital-led, multi-agency Assertive Outreach Alcohol Service, including an emergency physician, acute physician, psychiatric crisis team member, alcohol specialist nurse, Drug and Alcohol Action Team member, hospital/community manager and Primary Care Trust Alcohol Commissioner, with links to local authority, social services and third sector agencies and charities. DGH Requirement

Key Recommendation (6) Multidisciplinary, person-centred care, which is holistic, timely, non-judgmental and responsive to the needs and views of patients and their families. DGH Requirement

Key Recommendation (7) Integrated Alcohol Treatment Pathways between primary and secondary care, with progressive movement towards management in primary care. DGH Requirement

Key Recommendation (8) Adequate provision of Consultants in gastroenterology and hepatology to deliver specialist care to patients with alcohol-related liver disease. DGH Requirement

Key Recommendation (9) National Indicators and Quality metrics, including alcohol-related admissions, readmissions and deaths, against which hospitals should be audited. DGH Requirement

Key Recommendation (10) Integrated Modular Training in alcohol and addiction, available for alcohol specialist nurses and trainees in gastroenterology and hepatology, acute medicine, accident and emergency medicine and psychiatry. DGH Requirement

Key Recommendation (11) Targeted funding for research into detection, prevention and treatment strategies and outcomes for people with alcohol-use disorders. DGH Requirement

CONCLUSION Many of these recommendations can be implemented by intelligent re-organisation and co-ordination of existing alcohol services, while some require investment in people.

PHILOSOPHY “We never give up on anybody, even when they have given up on themselves.”