1. Newcastle Alcohol Harm Reduction Strategy Safe, Sensible and Social in Newcastle upon Tyne Alcohol Harm Reduction Strategy High Impact Change 5 Appoint an alcohol health worker The Role of the Community Matron Margaret Orange Treatment Effectiveness and Governance Manager Newcastle PCT

2. Overview The Local context Newcastle admissions Data High Impact Changes Community Matron (Alcohol) What are the key challenges to developing the Community Matron role?

3. Newcastle.......... One of the most revitalised northern cities Vibrant nightlife and arts scene Visually impressive Passion for football Irresistible to hedonists, culture vultures and shoppers alike

4. Newcastle.......... One of the most revitalised northern cities Vibrant nightlife and arts scene Visually impressive Passion for football Irresistible to hedonists, culture vultures and shoppers alike And…….. Geordies know how to enjoy a good night out

5. Newcastle.......... has high rates of alcohol-related problems is one of the ‘wettest’ regions in the UK is in the top 5 LA s for worst health and social deprivation indicators has one of the highest binge-drinking rates in the country has rate higher than national average of dependent drinkers has one of the lowest levels nationally of access to treatment has one of the highest rates nationally of alcohol-related hospital admissions

6. Analysing the data Hospital Admissions Only – Requested data set Postcode/ GP / NHS number up to 7 identified codes accepted Wholly attributable to alcohol (main focus) K70 – Alcohol liver cirrhosis F10 – Mental and Behavioural disturbance due to alcohol T51 – Alcohol intoxication

7. Analysing the data 1411 admissions - (707) patients Costs = £2.5m 943/1411 readmissions (66.8%) 239/707 patients readmitted (33.8%) 153 males & 86 females 468/707 patients admitted once (66.2%) age breakdown

8. Newcastle

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. Example of an 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

11. Example of a 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

12. Phase 1 Initial target groups –Patients re-admitted for intoxication –Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers) 20% of patients using over 70% of the costs –Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas North of Tyne 12 MaleFemale Newcastle4449 North Tyneside22 Northumberland1725

13. Mapping the services and initiatives Tier system –MoCAM –Prevention/Early Intervention – implementing IBAs –Treatment – Community services & emerging alcohol workforce –Enforcement – management of environment & night time economy –Rehabilitation – very small numbers –Care Pathway

14. MOCAM tiers T4 T3 T2 T1 Residential Rehab In-patient managed withdrawal Comprehensive, complex, specialist services Open access, outreach services, community treatment, Shared care Targeted screening, information and brief advice, referral and signposting

15. The Community Matron “A Community Matron is a nurse who provides advanced clinical nursing care in addition to case management … to an identified group of very high intensity users through case finding.”

16. Long-term conditions “Long term conditions are chronic medical conditions that cannot be cured, but can be controlled and managed by medication and other interventions and therapies. Long term conditions include Heart Failure, Diabetes, Asthma, COPD (Chronic Obstructive Pulmonary Disease) and Arthritis.”

17. The Scale of the Problem

18. Binge Drinking; 28.93% Hazardous Drinking; 19.5% Harmful Drinking; 6.2% Newcastle.......... Drinking levels

19. The Community Matron model  Not mutually exclusive approaches.  A range of approaches will be required to suit the locality

20. The Community Matron model Level 1 - Self management of Long Term Conditions Level 2 - High risk single condition disease management. Level 3 - Highly complex conditions requiring case management.

21. Level 1 Self care support/management 70 to 80% of the Long Term Conditions population will receive self care support. Support includes educating patients on their condition, tools and devices, support networks etc. Wider use of IBAs

22. Level 2 Complex and multiple Long Term Conditions Case management can be provided by Community Matrons Community Matrons have advanced clinical nursing practice Care – coordination Multi agency care planning

23. Level 3 Disease-specific care management Specialist services using multi-disciplinary teams and disease-specific protocols and pathways. Clarity around pathways Community Open Clinics Assertive Outreach Case Management

24. Evidence Base Nurse-led care improves health outcomes Effectiveness of patient education and self care Care management well established Largest workforce Evidence shows the potential of nurse led services

25. The Community Matron Clinical role- no staff to manage Advanced clinical skills, medicines management combined with innovative case management Case loads of 50-80 With the authority to act ( this may include a budget)

26. Key competencies Work in an autonomous manner Able to assess, diagnose, prescribe, carry out treatments at home Initiating and interpreting diagnostic tests Extended prescribing to manage exacerbation of Long Term Condition Maximise quality of life Manage mental wellbeing and cognitive impairment alongside clinical care

27. How will the CM model support the reduction of alcohol related admissions? Prevent unnecessary emergency admissions to hospital Reduce Length of Stay in hospital Improve outcomes for patients Integrate all elements of care Improve quality of life

28. Improvement methodology Multi agency care plans –(individuals may have a single dominant condition i.e. alcohol but may be known to different agencies) 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 Wider use of IBAs (multi agency) Emerging workforce (i.e. new roles, liaison, co-ordination, systems approach to service delivery)

29. Newcastle ACTS Support the tier 3 specialist service Build capacity in tier 1 services Assessment, clinical interventions, care coordination Community/home detox where appropriate Alternatives to hospital admission Facilitate earlier discharge

30. Public Health Capacity Building Tier 1 staff enabled to; Identify hazardous and harmful drinkers – and those drinking over the recommended limits Provide advice around increasing health risks and impacts Provide information on decreasing risks and impacts Provide advice to reduce alcohol harm Signpost and refer to other services as appropriate

31. Newcastle ACTS Primary Care –Treatment Effectiveness Manager –Community Matron –Alcohol Nurse Specialist (Primary Care) Mental Health Trust –X2 Alcohol Nurse Specialist (Mental Health) Acute Hospitals Trust –X2 Alcohol Nurse Specialist (Acute Services) Tyneside Cyrenians –X4.5 Assertive Outreach Workers

32. Reducing hospital admissions A partnership approach to; Identify “frequent flyers” Multi agency care planning meetings Care coordination Provide alternatives to hospital admission Community Nurses Assertive Outreach Hospital Nurses Mental Health nurses Care Coordination

33. Community Open Clinics Development of open access “wrap- around” services across the city Assessment and monitoring of physical and mental health Alcohol support and relapse prevention Partner presence – social work, housing advice, benefits Targeted venues

34. So What are the Key Challenges? Data and Information for case finding, risk management Developing the workforce Systems Change Partnership working/Integration

35. Community Matrons Community Matrons promote and provide care at home with the aim of avoiding, where at all possible repeated hospital admissions. Community matrons work with patients who: Are experiencing long term illnesses Are over 18 May benefit from early hospital discharge Have had repeated hospital admissions Your GP may ask the Community Matron to contact you to offer you support if any of these issues apply to you. They can: Meet with you and find out how they can help you to be as well as possible. Make plans with you to achieve this. Involve your family or carer if you would like this. As part of the plan liaise with others involved with your care.

36. Practical Responses Community Open Clinics School Health Advisor (Alcohol) Day Clinics Pre-admission clinics Post discharge clinics

37. Questions? margaret.orange@newcastle-pct.nhs.uk