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Liverpool Community Alcohol Service (LCAS)

Liverpool Community Alcohol Service (LCAS). Part 1: Why?. The treatment paradox. Most alcohol harms are associated with people whose drinking is hazardous & harmful Dependent drinkers linked with greater degrees of harm

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Liverpool Community Alcohol Service (LCAS)

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  1. Liverpool Community Alcohol Service (LCAS) Part 1: Why?

  2. The treatment paradox • Most alcohol harms are associated with people whose drinking is hazardous & harmful • Dependent drinkers linked with greater degrees of harm • But there is so much drinking that the hazardous & harmful drinkers harm outweighs that of dependent drinkers • So where to go with Treatment? • In other words tier 4 v rest Trevor McCarthy: September 2010

  3. ALCOHOL-RELATED DISEASE • Joint BSG, Alcohol health alliance, BASL • Each DGH should have;- • Alcohol Care Team • AED, AMU policies detox, BI, EBI • 7 day ANS, ALWN service • Liason and Addiction Psych • Assertive Outreach Alcohol Service • Multidisc, patient-centred care • Integrated Alcohol Treatment pathways • Adequate GI Hepatology Consultants • NI and Quality metrics • Integrated Modular Training alcohol and addiction • Targeted funding for Research detection, prevention, treatment

  4. Practice Recommendations (9-12) • 9 Screening adults • 10 Brief advice for adults • 11 Extended brief interventions for adults • 12 Referral Trevor McCarthy: September 2010

  5. Liverpool Community Alcohol Service (LCAS) Part 2: The story so far

  6. Modelling solutions Benefits Realisation Hospital Alcohol Nursing Service 6 Wte 7 day Service Investment 400 admissions £270k 133 NI39s = -1% Assertive Outreach 30+30 High Fraction / Frequent Admissions Leadership 475 admissions £390k 475 NI39s = - 4% 18/03/2013

  7. Investment and payback. If each region implements the Case for Change £35 million. Crucially, to make the savings it requires a shared approach between PCTs and Acute Trusts 18/03/2013

  8. Community? • PCT and Public Health • Councillors • Politicians • GPs • Local Leaders • Advocates • Champions • Volunteers, Champions • Mums, Dads, Brothers, Sisters

  9. Numbers in Primary Alcohol Treatment by Treatment Provider, APRIL 2010 NB. We did not interview the vast majority of treatment providers during the visit. Our recommendations should be considered in this context

  10. Alcohol Harm Reduction National Support Team Liverpool Visit June 2010 Themes Overall strengths Good innovative practice Scale of Challenge Priority actions Service? Alcohol Harm Reduction National Support Team

  11. Data • Alcohol service data lacking • Performance monitoring • Sub regional network CHaMPS • Lifestyles Tier 3 need to input data

  12. Priority Actions • Clear Communication • Project Plan • Avoid confusion, duplication • Investment available ££s • Trial projects now • Pool data use all available • Clear roles at all tiers 1-4 • Strategy re-write • Partnership across teams • NST follow up support 6-8 weeks

  13. Liverpool Community Alcohol Service Procurement Full Competitive Tender Development of Treatment Model Service Specification Procurement Process

  14. An Experienced Team Aintree Foundation Trust Mersey Care Trust • Established ACT 2002 • Regional Liver Centre MDT • Expert management of alcoholism • Complex patients • Proven admissions avoidance • Lead a network of providers and experts in Public Health • Proactive advocate • Windsor Clinic from 1978 • Expert addiction psychiatry • Provides MoCAM tiers 2 to 4 services across C&M • Expertise to support community treatment interventions & early discharge • Reduce secondary care length of stay A Robust Working Partnership Common goals and aspirations for this community-based clinical service

  15. PRIMARY CARE GPs Practice Nurses LCAS neighbourhood Alcohol Nurse serving each GP cluster or neighbourhood TIER 1 LIVERPOOL COMMUNITY ALCOHOL SERVICE TIER 2 Alcohol Nurse Specialist Team 7/7 Alcohol Nurse Specialist Team 7/7 Joint Alcohol Team Meeting Assertive Outreach Frequent Flyers Aintree Hospitals NHS Trust MDT RLBUH MDT TIER 3 Hepatology Psychiatry Alcohol Nurse Specialist OT, Nutrition Physiotherapy Social Worker Clinical Support TIER 4 Long term Residential NGOs Windsor Merseycare

  16. - Whole System Partners Across Liverpool - Delivering the Difference For Commissioners Value for Money Low tech, measurable intervention Liver specialist + Addiction Psych Tier 4 Back up Proven expertise, highly experienced. To prevent complex, expensive admissions DoH ALOS for ALD 18/7

  17. Successes so far • Early implementation, Community centres • Satisfied service users • Dedicated, caring skilled nurses • LCAS service user group developed • Annual report produced • Engagement with community • Pharmacological management in community • Integration with Acute/Mental Health/Community • Data to ATMS – Public health for future service delivery

  18. - Whole System Partners Across Liverpool - Delivering the Difference As Providers - Where are we now? The proposed service model will deliver the required service specification in fullIN ADDITION Clients are partners in the treatment programme – ownership and choices The partnership will allow us to safeguard and deliver a seamless wrap around service user journey– right care , right time Immediate start; premises and experience Proactive assertive out reach approach to hard to reach groups Web based interventions GP advisors and active outreach and engagement with primary care Links with clinical champions in other organisations Single assessment process, documentation and information system

  19. Q10 • Overall are you satisfied with the care that you have received? • Result • Percentage • Of the 31 respondents 31 (100) stated that they were satisfied with the care that they had received. • There were 6 comments made in relation to this question • Comment 1 – A respondent who answered ‘Yes’ to the question wrote: • ‘Without the time given to me I really don’t know where I would be right now’ • Comment 2 – A respondent who answered ‘Yes’ to the question wrote: • ‘I was very satisfied with all the care I have received’ • Comment 3 – A respondent who answered ‘Yes’ to the question wrote: • ‘A very excellent service. Full marks.’ • Comment 4 – A respondent who answered ‘Yes’ to the question wrote: • ‘The counsellor I have seen recently was very good. She was sincere, had information sheets, details of complimentary services. Intuitive Recovery course for me was very positive’ • Comment 5 – A respondent who answered ‘Yes’ to the question wrote: • ‘I was very satisfied with the overall quality of care. Other than a free holiday in the Bahamas I don’t think there’s anything you can add to your service’ • Comment 6 – A respondent who answered ‘Yes’ to the question wrote: • ‘Could not have asked for better. The service and support has been excellent. I was listened too and felt safe. I work in the NHS so was worried about seeing people I may know however couldn’t have been more safe, and confident about the trust I felt with Keiley. She has been a real star. Thank you’

  20. LIVERPOOL COMMUNITY ALCOHOL SERVICEService User Satisfaction SurveyQuarter 3 – 2012 • Actions • More accompanying info, partner services • Receptionist discretion • Bigger survey next time, rating scale • Friends and Family test • Patient progress and ‘outcomes’

  21. Jan – Dec 2012 there were 878 patient assessments within secondary care • 322 were discharged from AED avoiding a hospital admission. • 1288 bed days. • Of the 878 patient assessments undertaken 78 patients were assessed as appropriate for implementation of the Early Discharge Policy (EDP). • 156 bed days saved.

  22. Savings to the Health Economy from the Liverpool Community Alcohol Service (LCAS) Intervention • Scenario 1 • Assumes: • That patients within the LCAS service who have been started in prescribing treatment would have benefited from either discharge from AED or early discharge. • 34% of 4015 contacts = 1365 patients. • That, as observed within the Aintree service, 80% patients (1092) are discharged from AED and 20% patients are discharged early from a ward based environment.(273) • If we apply a reduced bed day saving of 2 days to these figures; the total savings, to the Commissioner, from admission avoidance is £626,808 and the total savings, to the Provider, from early discharge is £156,702. This gives a total saving of £783,510 to the Liverpool health economy as a result of LCAS intervention. • Scenario 2 • Assumes: • That, as observed in the Aintree service, 45% of LCAS contacts would have resulted in either admission avoidance or early supported discharge (1807 patients) • That, as observed in the Aintree service, 80% of these patients (1445) are discharged from AED and 20% patients (361) are discharged early from a ward environment. • If we apply a reduced bed day saving of 2 days to these figures; the total savings, to the Commissioner, from admission avoidance is £829,430 and the total savings, to the Provider, from early discharge is £207,214. This gives a total saving of £1,036,644 to the Liverpool health economy as a result of LCAS intervention.

  23. Scenario 3: Uses the data available from DFI on alcohol related admissions and average length of stay • DFI data indicates that between January 2012 and December 2012 there were 213 fewer alcohol related spells than previously observed. If we apply a the observed average length of stay bed day saving of 7.1 days to this figure this gives a saving, to the Commissioner, from admission avoidance of £434,030. • DFI data indicates that between January 2012 and December 2012 the total observed bed days totalled 31,656 against the total expected bed days of 24,792. If we apply the bed day saving to these figures this gives a saving, to the Trust, of £900,032. This gives a total saving of £1,334,062 to the Liverpool health economy as a result of LCAS intervention.

  24. Liverpool Community Alcohol Service (LCAS) Part 3: Next steps.....

  25. Priorities – Work streams • Communication Strategy (inclusive of community engagement work stream) • IT Strategy and Focus group • Data analysis – (data check) • Data definition review • KPI review – to ensure reporting is measured and meaningful

  26. Real Challenges • Increase numbers, use capacity, improve data collection • One stop shop model • Target low referring practices • Occupational Health • IT focus group NWAC, now in its fourth year • Alcohol and Primary Care • NHS CIP • Economy • MUP • Women’s health • Licensing • Advertising

  27. More actions • Communication group – which will include community engagement • IT input to be via Merseycare informatics group • Feedback questionnaire to be revised • Manual data collection to commence in April • Summary of data collection processes at both sites • Once data collection completed for April meeting to be arranges prior to contract meeting (MAY) to discuss figures in contract • Report outline to be proposed  • Away day June • Update on current service • Future plans • SMART objectives to be agreed by the team

  28. In summary • Liverpool no longer top of the league! • Hospital admissions bucked the National trend • 5th successive year Alcohol death rate has reduced • An effective service • TEAM EFFORT

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