1. Assertive Outreach Service Health, Wellbeing and Social Care Scrutiny 27th October 2010

2. Overview Why What What if In 2008-09 alcohol related bed days equated to approximately 40,000 bed days OR 111 beds 63% emergency admissions

3. Repeat A & E Admissions (2005-2008) Courtesy of Mark Knight and Gordon Adams -Salford DAAT % of Total Attributable Factor of All 15,272 Individuals (2005-08) A&E Only 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0250050007500100001250015000 Number of Individuals % of Total Attributable Factors 10,000 people = 92.3% 100 people = 13.1%

4. Virtual ‘Outreach’ Team A&E Consultant Acute physician/ gastroenterologist Alcohol specialist nurse Community alcohol service manager Mental Health – Crisis response team GP Homeless Service Age Concern Salford DAAT

5. What does a virtual team mean? From mid June to December the team met fortnightly for 2-2.5 hours to assess the Top 20 patients and agree action plans Hours input- –Alcohol specialist nurses 82 hrs –Community Alcohol Team Manager 46 hrs –A&E consultant 30 hrs –Gastroenterologist 30 hrs –Crisis Response Team( Mental; Health) 10 hrs –GP Homeless Practice 8 hrs –Age Concern 6 hrs –Plus a 7 hours spent visit alcohol services across Salford followed by a debrief Total of 250 clinical hours approx

6. All age all cause mortality Top 100 2007-08 - 24 had died Age No. deaths % 20s14.2 30s14.2 40s312.5 50s1041.7 60s625 70s22.1 80s11

7. Top 20 cohort 2007-08

8. Top 20 – common presentation Multiple referral to ASN team- BI given Multiple referral to community alcohol service – no/ limited engagement Previous detoxes In and out of prison Difficult home situation/ abuse (multidirectional) Bereavement issues

9. Assertive case management Visit at home Linking with other services Smoothing pathways Management plan ready to go on next admission Prioritise/ fast track Bridge service gaps Support with additional services/ activities

11. ‘Top18’ patients…..snapshot Oct 2009 11% unfortunately died 15 of the 18 aged <51years Third <40 years 271 A&E visits 148 admissions 1.81 beds ( 100% occupancy) HRG tariff costs of £257,430 Expensive not only to health

12. Early results Number of A&E attendances and admissions pre and during pilot Outcome- all patients except non-alcohol and RAG = grey % Reduction A&E attendances 16.5 (n=125) % Reduction in admissions from A&E 14.3 (n=49)

13. Conclusions ( April 2010) Big problem with a financial & societal cost to match Current services have gaps AOT plugs gaps with some early suggestions of benefit Worthy of further investigation

14. AOT Phase 2 May 2010- completed Frequent Flyer proposal/ business case as part of Integrated Partnership Board Business case suggested alcohol, drug misuse and self harm presentations were strongly interlinked AOT business case extended to include drug misuse, self harm & alcohol

15. AOT Phase 3 June- August 2010- Completed further analysis which strengthened extended business case AOT Phase 4 Potential pilot in Salford initiated by Drinkwise Northwest – Intelligence led alcohol harm reduction working with ‘Better Life Chances’

16. AOT remit - if/when funded Top 30 patients admitted in relation to alcohol, drug misuse and self harm Up and comers( 2ARAs)- –8 from 72 now in top 30 –Top 30 ranked positions of 1,2,4,20,21&26 Strengthen relationships with other statutory services and third sector organisations (including Narrowgate Shelter/ Windsor Drop In)

17. Proposed Outreach Team Consultant emergency medicine Gastroenterologist/ liver disease Psychiatrist CPN ( alcohol background) Social worker AMP (Mental health practitioner) Clinical psychologist Tenancy support work Health trainer/ star worker Police / probation officer Alcohol specialist nurse Admin support

18. Recommendations Support commissioning of the AOT Need for all statutory services to work in more than partnership

19. Thank you !!!!