wakefield distrct alcohol team its work and how we might respond to change intergrated care...
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WAKEFIELD DISTRCT WAKEFIELD DISTRCT ALCOHOL TEAMALCOHOL TEAM
Its Work and how we might respond to changeIts Work and how we might respond to change
INTERGRATED CARE ORGAISATION PILOTINTERGRATED CARE ORGAISATION PILOT
Sandra McDadeSandra McDadeService ManagerService Manager
The ‘WAT’The ‘WAT’
Alcohol specific workforce Alcohol specific workforce integrated under the “WISMS integrated under the “WISMS umbrella” operating through umbrella” operating through integrated care pathways integrated care pathways
Formed in 2006 following Formed in 2006 following significant new investment from significant new investment from Local AuthorityLocal Authority
Considered “ahead of its time”Considered “ahead of its time”
The team in 2006The team in 2006
Team managerTeam manager Three whole time project workers Three whole time project workers
(TP)(TP) One primary care worker (PCT)One primary care worker (PCT) Criminal justice worker (TP)Criminal justice worker (TP) Administrator (WMDC)Administrator (WMDC)
20062006
No waiting listNo waiting list Referrals around 46 per monthReferrals around 46 per month Little need for home visitsLittle need for home visits Lower numbers needing in patient Lower numbers needing in patient
detoxificationdetoxification
Team Structure 2009Team Structure 2009
Service ManagerService Manager Administrator/Data in putterAdministrator/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)
20092009
8-10 weeks wait for an assessment 8-10 weeks wait for an assessment (10-12 in Doncaster and as much (10-12 in Doncaster and as much as six months in some area’s)as six months in some area’s)
70-85 referrals per month70-85 referrals per month Frequent requests for home visitsFrequent requests for home visits Higher numbers accessing in Higher numbers accessing in
patient detoxificationpatient detoxification
AccessibilityAccessibility
Treatment is delivered across the Treatment is delivered across the district in various locationsdistrict in various locations
In a variety of different agency In a variety of different agency premisespremises
Cover includes Cover includes Pontefract, Castleford, South Elmsall, Pontefract, Castleford, South Elmsall,
Ossett, & City centreOssett, & City centre Within Wakefield integrated substance Within Wakefield integrated substance
misuse servicesmisuse services Consultancy and educational support to Consultancy and educational support to
stakeholders stakeholders
Primary CarePrimary Care
Grown from one staff member to Grown from one staff member to threethree
Covers 13 GP practicesCovers 13 GP practices Offers advice and informationOffers advice and information Structured therapyStructured therapy Community detoxificationCommunity detoxification Support & aftercareSupport & aftercare
Alcohol treatment Alcohol treatment requirementrequirement Two project workersTwo project workers Cover Wakefield & PontefractCover Wakefield & Pontefract Huge success for WakefieldHuge success for Wakefield 230 referrals230 referrals 170 assessments170 assessments 105 ATR’s granted105 ATR’s granted To date 51 completedTo date 51 completed Plans to increase staff teamPlans to increase staff team Media & radio coverageMedia & radio coverage Included in Study for AddictionIncluded in Study for Addiction
Criminal justiceCriminal justice
In 2004 data suggested that 37% In 2004 data suggested that 37% offenders had a problem with alcoholoffenders had a problem with alcohol
47% had misused alcohol in the past47% had misused alcohol in the past 32% had a violent behaviour related 32% had a violent behaviour related
to alcoholto alcohol 38% alcohol was considered to be a 38% alcohol was considered to be a
factor in re-offending ratesfactor in re-offending rates(OASys assessments)(OASys assessments)
TRENDSTRENDS
Increase in referrals 70 – 85 per Increase in referrals 70 – 85 per month (49 in April 06)month (49 in April 06)
More complex casesMore complex cases Mental health Mental health Physical healthPhysical health Request for home visitsRequest for home visits Longer treatment episodes 121 Longer treatment episodes 121
days 2008 155 days 2009days 2008 155 days 2009
Mental healthMental health
Larger proportion with depression Larger proportion with depression & anxiety& anxiety
More complex cases with long More complex cases with long term mental health needs (MH term mental health needs (MH versus Alcohol)versus Alcohol)
Higher referrals from mental Higher referrals from mental health services/crisis health services/crisis team/discharge liaisonteam/discharge liaison
Physical needsPhysical needs
Acute alcohol withdrawalAcute alcohol withdrawal Underlying physical health needsUnderlying physical health needs Alcoholic liver cirrhosis (95% increase Alcoholic liver cirrhosis (95% increase
since 2000 & 36% in last two years)since 2000 & 36% in last two years) Increase in deaths 18% from 2002-Increase in deaths 18% from 2002-
2005 locally 8 deaths in treatment this 2005 locally 8 deaths in treatment this yearyear
More people die from alcohol related More people die from alcohol related causes than from breast cancer, causes than from breast cancer, cervical cancer and MRSA combinedcervical cancer and MRSA combined
Passive effectsPassive effects
RapeRape Sexual assaultSexual assault Domestic violenceDomestic violence Drink drivingDrink driving Street disorderStreet disorder
Effects thousands more innocent victims Effects thousands more innocent victims than passive smoking (reference)than passive smoking (reference)
The Future The Future
QuIPP QuIPP Needs assessmentNeeds assessment Local strategic refresh and PCT Local strategic refresh and PCT
prioritiespriorities NICE and brief interventions NICE and brief interventions
– National alcohol National alcohol programme/workforce development programme/workforce development agendaagenda
QualityQuality
NICE guidelines report 2010NICE guidelines report 2010– Align published evidence base with Align published evidence base with
local policy and procedurelocal policy and procedure Balanced scorecard Balanced scorecard Clinical Audit Clinical Audit Research Research
INNOVATIONINNOVATION
Introduction of nurse prescribingIntroduction of nurse prescribing New detoxification pathway New detoxification pathway
launched (April 2009)launched (April 2009) Strong emphasis of education and Strong emphasis of education and
trainingtraining Integrated working at the heart of Integrated working at the heart of
the teamthe team
Prevention Prevention
Safer schools/extended schoolsSafer schools/extended schools Targeted neighbourhood initiativesTargeted neighbourhood initiatives Primary care education Primary care education Education to promote positive Education to promote positive
employment practice around employment practice around alcohol alcohol
Step up/down beds for short term Step up/down beds for short term intensive detox and rehabilitation intensive detox and rehabilitation
Productivity – how do Productivity – how do we respond to change we respond to change Target areas of greatest impact in relation to Target areas of greatest impact in relation to
‘lives lost’‘lives lost’– Further develop links between WAT & in patient Further develop links between WAT & in patient
settings including A&E to respond to NI39 indicatorsettings including A&E to respond to NI39 indicator– Focus on quality pathway for quality admission and Focus on quality pathway for quality admission and
effective discharge planning with seamless effective discharge planning with seamless community interface community interface
Further develop third worker for ATRFurther develop third worker for ATR Formalise arrest referral schemeFormalise arrest referral scheme Possible re-profile of assertive outreach nurse Possible re-profile of assertive outreach nurse
to hospital liaison roleto hospital liaison role
How will success be How will success be measured?measured? National & local aim is toNational & local aim is toMinimise the health harm, violence and anti-Minimise the health harm, violence and anti-
social behaviour associated with alcohol social behaviour associated with alcohol while ensuring that people enjoy alcohol while ensuring that people enjoy alcohol safely and responsiblysafely and responsibly
National Alcohol Monitoring System (NATMS) ? National Alcohol Monitoring System (NATMS) ? Fit for purpose to measure the impact of Fit for purpose to measure the impact of treatment across a variety of clinical settings treatment across a variety of clinical settings
(implementation plan 2009/10)(implementation plan 2009/10)
ICO challenges us to work smarter ICO challenges us to work smarter Light shone on imbalance between Light shone on imbalance between
drugs and alcohol expendituredrugs and alcohol expenditure Team is at capacity and clinical Team is at capacity and clinical
iceberg is emerging iceberg is emerging Bio psychosocial model has been Bio psychosocial model has been
shown to workshown to work Team needs investment to unlock Team needs investment to unlock
upstream working and innovation upstream working and innovation
