1. The ‘wicked’ problem of alcohol Newcastle upon Tyne North Tyneside Northumberland Lynda Seery Public Health Lead for Drug and Alcohol

2. What we did in 2007? Nationally »information, data (NWPHO), evidence »MoCAM, »the Alcohol Needs Assessment Research Project (ANARP) Locally »Strategies? »Needs Assessment ? »Service Reviews? Mapping of service provision

3. What we found? Tier 1 - Prevention »C&YP – Healthy Schools module »Adults – national campaigns only Tier 2 –Treatment »Community services Tier 3 – Treatment (specialist) »Specialist addictions service (detox available) »A&E »Admission to hospital Tier 4 – Residential rehab »Assessment against criteria (predominantly for drugs) »Structured day care

4. How do we impact on the indicator? complex indicator requested data extract 1/4/07 – 31/3/09 3 particular hospital codes of interest identified within the spell of care (not necessarily primary diagnosis) –F10 mental & behavioural disorders due to alcohol –K70 alcoholic liver disease –T51 intoxication 1.00 - wholly attributable to alcohol (main focus)

5. Individual patient record postcode level & GP Practice 1411 admissions (707) patients Costs = £2.5m 943/1411 re-admissions (66.8%) 239/707 patients readmitted (33.8%) 2 to 1 male to female split 468/707 patients admitted once (66.2%) age breakdown

6. Newcastle

7. North Tyneside

8. Northumberland

9. Segmentation - understanding the patient layers The ‘patient layers’ fall into the following categories: Patients admitted to hospital for 1 day or less (no overnight stay) Patients admitted only once Patients admitted once for intoxication / patients re- admitted for intoxication Patients with multiple re-admissions for alcohol- related harm (harmful and dependent drinkers) Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas Patients with severe ongoing/end stage illness

10. Patients admitted once only for 1 day or 8 hours or less

11. Example of intoxication record Codes listed T40 (primary diagnosis) poisoning by drugs, medicaments and biological substances X620intentional self harm T51intoxication/toxic effects of substances non medicinal as to source S099injuries to head W19fall F101harmful use

12. ‘Frequent users’ or re-admissions to hospital

13. Example of re-admission record Codes listed K703 (primary diagnosis)Diseases of the liver F102Dependence syndrome I10XHypertensive diseases J459Chronic lower respiratory diseases R18XSymptoms and signs involving the digestive system and abdomen Z720Persons encountering health services in other circumstances Z867Persons with potential health hazards related to family and personal history and certain conditions influencing health status

14. Phase 1 – focused work with identified individuals Target groups –patients re-admitted for intoxication - Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers) Significant 60 –Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas Significant 12 MaleFemale Newcastle4449 North Tyneside22 Northumberland1725

15. Community Alcohol team (virtual) Treatment Effectiveness & Governance Manager Community Matron for Social Exclusion (alcohol) Nurse Practitioner x2 Alcohol Specialist Nurses (mental health) X2 Alcohol Specialist Nurses (acute) 4.5 wte Assertive Outreach Workers x1 IBA Trainer (+2 sessional trainers) x1 Health Link Worker (A&E)

16. What the team provides Care Co-ordination – key worker responsibility Multi agency care plans –(individuals may have a single dominant condition i.e. alcohol but may be known to different agencies) Community Matron post – key to working with GPs and into Practices Community Open clinics (walk in, self refer, referred into from any other service) –Professionals available at clinics, clinical & mental health staff, social care, housing, benefits Assertive Outreach (voluntary sector) Wider use of IBAs & Brief Interventions (multi agency training – confidence & competence) Implementation of the Cardiff Model – A&E & CDRP

17. How hard can it be? Pace Purpose Passion

18. Questions?