1. WORKSHOP B ALCOHOL SERVICE KNOWSLEY Michele White Madeline Jones Elizabeth Gibbons

2. Alcohol is responsible for 6% of ALL hospital admissions. 459,836 admissions in 2005/06 811,433 admissions in 2006/07 Rising by around 80,000 admissions a year SOURCE: ALCOHOL LEARNING CENTRE

3. Alcohol misuse contribute to 48 conditions 13 conditions wholly attributable to alcohol consumption 35 conditions partially attributable to alcohol consumptions SOURCE: ALCOHOL LEARNING CENTRE

4. Areas of higher deprivation have:- 2-3 times higher loss of life 2-5 times more admissions to hospital SOURCE: ALCOHOL LEARNING CENTRE

6. Knowsley has had higher rates of hospital admissions for alcohol related harm than the North West and England since 2002/03.

7. The rate for alcohol related harm has increased by 55% since 2002/03 where it is now at its highest point of 2479 per 100,000 population in 2007/08.

8. ActualKnowsley Projected ActualEngland Projected

9. Across Merseyside, Knowsley has the second highest admission rate for alcohol related harm. PCTRATE PER 100,000 POPULATION LIVERPOOL2612 KNOWSLEY2479 WIRRAL2384 HALTON & ST HELENS2143 SEFTON1938

10. INCREASING RISK DRINKERS 24,988 HIGER RISK DRIKERS8,684 DEPENDENT4,776 BINGE27,997

11. Alcohol Service Knowsley is an alcohol service provided by alcohol specialists that can be accessed by Knowsley residents over the age of 18 Service is run by Merseycare addiction services, commissioned by Knowsley Primary Care Trust

12. Team Structure Specialist team manager: Michele White 2 Deputy managers 2 Hospital Alcohol Workers 2 Community alcohol nurses 3 Community practitioners 1 IAPT worker 1 Support worker 1 Admin worker

13. What does Alcohol Service Knowsley provide? Comprehensive alcohol assessment 1-6 Cognitive Behavioural Therapy based goal orientated treatment sessions Community detoxification or link in to in- patient detox at Windsor clinic for those not suitable Hospital Alcohol Service (Whiston &UHA) Link with probation service providing the treatment element of an Alcohol Treatment Requirement

14. What does the service provide cont…… Relapse prevention Harm reduction Complementary Therapies Family support Links to other agencies/services Training

15. Team Structure 3 staff across 2 acute trusts 2 band 6 nurses, 1 band 5 nurse Staff are all part of the ASK team

16. Objectives Identify A/E attendees with alcohol misuse Provide brief advice and education re alcohol Provide a detox management plan Bridge gap between hospital and community Provide training for hospital staff

17. Key Performance Indicator To be measured on: – Caseload per nurse – Number referred to BTC – Number hospital staff trained – Number of re attendees – Number hospital initiated detoxs

18. Training To build a service presence and awareness over 2 acute trusts Liaison with ward staff Increase alcohol awareness Collaborative working with existing services

19. Care pathway Agree clinical care pathways Evidence based Quality assured Responsive to needs of service users

20. Daily Visit A/E,Obs, MAU,GPAU Offer advice re detox Bridge services for clients Liaise with existing services Triage,screen,brief advice Engage clients prior to discharge Liaise with team colleagues Available daily Mon - Fri

21. The Story So Far…..

22. Identification / Screening AUDIT FAST or PAT? Same both sites? Fit in with existing services Future plans to work with A&E managers to screen all patient Brief

23. Detox Early discharge protocol agreed for 1 trust Plan to commence detox in acute trust and complete in community following discharge Patients are admitted because they are ill!!! Specialist detox care plan

24. Challenges 2 acute trusts to serve Other teams already on site - streamlining Acute staff expectations that all teams work to same remit Need for honorary contracts Data collection – tracking readmissions

25. No honorary contract? Permission to speak to patients Access to acute trust computer system How watertight is care plan if staff not recognised by hospital Legality to access case notes Vicarious liability work with for acute trust patients Discharge acute trust patients

26. What’s working Positively received by hospital staff & ASK team Capturing patients who tend not to access services (Brown 2006) Patients referred receive specialist in-patient care plan and/or Brief Advice “Teachable Moment” (Williams et al 2005) Better patient journey Patients leave hospital with care plan

27. What’s working cont Improved liaison with hospital staff Increased identification alcohol problems – training Team maintain contact with clients while in hospital HALs clinics – fast treatment access - improved engagement to treatment (Williams et al 2005)

28. Summary New project set up to meet particular local needs Comprehensive service specification on 2 year pilot period Performance indicators to demonstrate quality Some issues to deal with - the story goes on….

29. Questions Comments Suggestions

30. Which screening tool is the most practical for use in emergency departments?