1. Providing a Cost Effective Alcohol Screening, Assessment and Referral Service within a Hospital Setting

2. 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.

3. 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

4. Severely dependent Moderately dependent Harmful drinkers Hazardous drinkers AUDIT 30+ AUDIT 24+ AUDIT 16+ Triage/ Coordination Team GP Practice IBA Consider referral to Specialist Prescribing service Direct referral to Specialist Prescribing service

5. 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

6. 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

7. 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

8. 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

9. 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

12. 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’

13. 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

14. High Impact – High Capacity Increased staff capacity Medical and Psychosocial approach Targeted times, including weekends Continuation of treatment from hospital into community More training to hospital staff PositionHrs.SalaryActual Alcohol Nurse37 31,856 Team Leader37 24,250 Substance Misuse Worker18.5 22,000 11,000 Substance Misuse Worker18.5 22,000 11,000 Substance Misuse Worker18.5 22,000 11,000 Substance Misuse Worker18.5 22,000 11,000 Substance Misuse Worker18.5 22,000 11,000 Admin Support37 13,500 Total Salaries 124,606 National Insurance12.0% 14,953 Pension3% 3,738 Total Staff costs 143,297 Running Costs7,900 setting up costs 3,000 Central management & admin 22,489 Total 176,686

15. 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

16. James Cook University Hospital Repeat Admissions 2007/082008/09 62 patients with 3+ Admissions including 59 Patients with 3+ Admissions including Admissions

17. 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

18. 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. High Impact - Repeat Admissions

19. Thank you.

20. Any Questions ?