WAKEFIELD DISTRCT ALCOHOL TEAM Its Work and how we might respond to change INTERGRATED CARE ORGAISATION PILOT Sandra McDade Service Manager

The ‘WAT’ Alcohol specific workforce integrated under the “WISMS umbrella” operating through integrated care pathways Alcohol specific workforce integrated under the “WISMS umbrella” operating through integrated care pathways Formed in 2006 following significant new investment from Local Authority Formed in 2006 following significant new investment from Local Authority Considered “ahead of its time” Considered “ahead of its time”

The team in 2006 Team manager Team manager Three whole time project workers (TP) Three whole time project workers (TP) One primary care worker (PCT) One primary care worker (PCT) Criminal justice worker (TP) Criminal justice worker (TP) Administrator (WMDC) Administrator (WMDC)

2006 No waiting list No waiting list Referrals around 46 per month Referrals around 46 per month Little need for home visits Little need for home visits Lower numbers needing in patient detoxification Lower numbers needing in patient detoxification

Team Structure 2009 Service Manager Service Manager Administrator/Data in putter Administrator/Data in putter Hospital liaison nurse (PCT) Hospital liaison nurse (PCT) Assertive outreach nurse (PCT) Assertive outreach nurse (PCT) Three primary care liaison nurses (PCT) Three primary care liaison nurses (PCT) Three whole time project workers (TP) Three whole time project workers (TP) Two whole time project workers (ATR) Two whole time project workers (ATR) Half time well being nurse (PCT) Half time well being nurse (PCT)

weeks wait for an assessment (10-12 in Doncaster and as much as six months in some area’s) 8-10 weeks wait for an assessment (10-12 in Doncaster and as much as six months in some area’s) referrals per month referrals per month Frequent requests for home visits Frequent requests for home visits Higher numbers accessing in patient detoxification Higher numbers accessing in patient detoxification

Accessibility Treatment is delivered across the district in various locations Treatment is delivered across the district in various locations In a variety of different agency premises In a variety of different agency premises Cover includes Pontefract, Castleford, South Elmsall, Ossett, & City centre Pontefract, Castleford, South Elmsall, Ossett, & City centre Within Wakefield integrated substance misuse services Within Wakefield integrated substance misuse services Consultancy and educational support to stakeholders Consultancy and educational support to stakeholders

Primary Care Grown from one staff member to three Grown from one staff member to three Covers 13 GP practices Covers 13 GP practices Offers advice and information Offers advice and information Structured therapy Structured therapy Community detoxification Community detoxification Support & aftercare Support & aftercare

Alcohol treatment requirement Two project workers Two project workers Cover Wakefield & Pontefract Cover Wakefield & Pontefract Huge success for Wakefield Huge success for Wakefield 230 referrals 230 referrals 170 assessments 170 assessments 105 ATR’s granted 105 ATR’s granted To date 51 completed To date 51 completed Plans to increase staff team Plans to increase staff team Media & radio coverage Media & radio coverage Included in Study for Addiction Included in Study for Addiction

Criminal justice In 2004 data suggested that 37% offenders had a problem with alcohol In 2004 data suggested that 37% offenders had a problem with alcohol 47% had misused alcohol in the past 47% had misused alcohol in the past 32% had a violent behaviour related to alcohol 32% had a violent behaviour related to alcohol 38% alcohol was considered to be a factor in re-offending rates 38% alcohol was considered to be a factor in re-offending rates (OASys assessments)

TRENDS Increase in referrals 70 – 85 per month (49 in April 06) Increase in referrals 70 – 85 per month (49 in April 06) More complex cases More complex cases Mental health Mental health Physical health Physical health Request for home visits Request for home visits Longer treatment episodes 121 days days 2009 Longer treatment episodes 121 days days 2009

Mental health Larger proportion with depression & anxiety Larger proportion with depression & anxiety More complex cases with long term mental health needs (MH versus Alcohol) More complex cases with long term mental health needs (MH versus Alcohol) Higher referrals from mental health services/crisis team/discharge liaison Higher referrals from mental health services/crisis team/discharge liaison

Physical needs Acute alcohol withdrawal Acute alcohol withdrawal Underlying physical health needs Underlying physical health needs Alcoholic liver cirrhosis (95% increase since 2000 & 36% in last two years) Alcoholic liver cirrhosis (95% increase since 2000 & 36% in last two years) Increase in deaths 18% from locally 8 deaths in treatment this year Increase in deaths 18% from locally 8 deaths in treatment this year More people die from alcohol related causes than from breast cancer, cervical cancer and MRSA combined More people die from alcohol related causes than from breast cancer, cervical cancer and MRSA combined

Passive effects Rape Rape Sexual assault Sexual assault Domestic violence Domestic violence Drink driving Drink driving Street disorder Street disorder Effects thousands more innocent victims than passive smoking (reference)

The Future QuIPP QuIPP Needs assessment Needs assessment Local strategic refresh and PCT priorities Local strategic refresh and PCT priorities NICE and brief interventions NICE and brief interventions –National alcohol programme/workforce development agenda

Quality NICE guidelines report 2010 NICE guidelines report 2010 –Align published evidence base with local policy and procedure Balanced scorecard Balanced scorecard Clinical Audit Clinical Audit Research Research

INNOVATION Introduction of nurse prescribing Introduction of nurse prescribing New detoxification pathway launched (April 2009) New detoxification pathway launched (April 2009) Strong emphasis of education and training Strong emphasis of education and training Integrated working at the heart of the team Integrated working at the heart of the team

Prevention Safer schools/extended schools Safer schools/extended schools Targeted neighbourhood initiatives Targeted neighbourhood initiatives Primary care education Primary care education Education to promote positive employment practice around alcohol Education to promote positive employment practice around alcohol Step up/down beds for short term intensive detox and rehabilitation Step up/down beds for short term intensive detox and rehabilitation

Productivity – how do we respond to change Target areas of greatest impact in relation to ‘lives lost’ Target areas of greatest impact in relation to ‘lives lost’ –Further develop links between WAT & in patient settings including A&E to respond to NI39 indicator –Focus on quality pathway for quality admission and effective discharge planning with seamless community interface Further develop third worker for ATR Further develop third worker for ATR Formalise arrest referral scheme Formalise arrest referral scheme Possible re-profile of assertive outreach nurse to hospital liaison role Possible re-profile of assertive outreach nurse to hospital liaison role

How will success be measured? National & local aim is to National & local aim is to Minimise the health harm, violence and anti-social behaviour associated with alcohol while ensuring that people enjoy alcohol safely and responsibly National Alcohol Monitoring System (NATMS) ? Fit for purpose to measure the impact of treatment across a variety of clinical settings (implementation plan 2009/10)

ICO challenges us to work smarter ICO challenges us to work smarter Light shone on imbalance between drugs and alcohol expenditure Light shone on imbalance between drugs and alcohol expenditure Team is at capacity and clinical iceberg is emerging Team is at capacity and clinical iceberg is emerging Bio psychosocial model has been shown to work Bio psychosocial model has been shown to work Team needs investment to unlock upstream working and innovation Team needs investment to unlock upstream working and innovation

Questions ? Questions ?