WAKEFIELD DISTRCT ALCOHOL TEAM

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

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

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

4. 2006 • No waiting list • Referrals around 46 per month • Little need for home visits • Lower numbers needing in patient detoxification

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

6. 2009 • 8-10 weeks wait for an assessment (10-12 in Doncaster and as much as six months in some area’s) • 70-85 referrals per month • Frequent requests for home visits • Higher numbers accessing in patient detoxification

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

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

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

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

11. TRENDS • Increase in referrals 70 – 85 per month (49 in April 06) • More complex cases • Mental health • Physical health • Request for home visits • Longer treatment episodes 121 days 2008 155 days 2009

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

13. Physical needs • Acute alcohol withdrawal • Underlying physical health needs • Alcoholic liver cirrhosis (95% increase since 2000 & 36% in last two years) • Increase in deaths 18% from 2002-2005 locally 8 deaths in treatment this year • More people die from alcohol related causes than from breast cancer, cervical cancer and MRSA combined

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

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

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

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

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

19. Productivity – how do we respond to change • 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 • Formalise arrest referral scheme • Possible re-profile of assertive outreach nurse to hospital liaison role

20. How will success be measured? • 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)

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

22. Questions ? • smcdade@wdpct.nhs.uk