Purpose
Alcohol related admissions had risen by just almost 60% at West Middlesex University Hospital (WMUH) from 2010 - 2020.
Nationally, the NHS Long Term Plan highlighted the need for all areas to step up provision to reduce alcohol harms and Public Health England (PHE) modelled a saving to the broader health system of £3.85 for every £1 spend on Alcohol Care Teams (ACTs).
It was identified by partners that the hospital would greatly benefit from a seven day a week Alcohol Care Team. The ACT would provide alcohol screening and brief interventions; train staff would be trained in alcohol screening and care; provide excellent clinical care to alcohol patients; reduce bed days by moving patients out of hospitals with appropriate care plans and move people into community treatment services thus reducing future alcohol related admissions.
It was agreed that the Borough Based Partnership would fund a 5-person team, initially for a two-year period (starting in February 2022) with the expectation that the ACT would mitigate future growth in cost by reducing hospital admissions.
The following three targets were set for year 1 (February 2022-January 2023):
| Measure | Target | Performance |
|---|---|---|
| The number of alcohol-related hospital admissions | ≤ 2672 | 2029 |
| Number of those who were recorded as an ‘alcohol specific’ presentation, having an ‘alcohol specific’ readmission within 30 days | ≤ 732 | 300 |
| Number of Emergency Department Presentations | ≤ 4164 | 3385 |
Performance has surpassed targets, with the number of alcohol related admissions having significantly reduced from the baseline.
In addition to the performance indicators above, other measures were tracked including numbers screened, extended brief interventions, commencements into structured treatment as well as outcomes for those who remain in treatment for 3 months or more.
At the end of year 1, the following performance was captured:
| Performance Measures | Target | Actual |
|---|---|---|
| Number of Audit C (alcohol screening tool) Screenings | 1223 | 1739 |
| The number of people receiving extended brief interventions (with the aim of reducing alcohol intake) | NA | 260 |
| The number of patients commencing structured treatment with ARC (drug and alcohol treatment service) | 77 | 94 |
| The % of patients (who have commenced structured treatment with ARC) who are retained in ‘effective treatment’ (12 weeks or more) | 80% | 96% (this data is incomplete due to the 12 week time lag) |
The number of people who have received extended brief interventions and who have started structured treatment is seen as a really successful outcome of the joint work between the hospital and the community setting and the skill mix in the team.
- Staff training has been an ACT priority. Following a survey to understand the level of staff knowledge, bespoke training was designed. The ACT now deliver training to junior doctors as part of the rotational training organised by the learning and development team.
- The ACT and the Hospital Psychiatry Liaison Team (HPLT) have worked closely together throughout the first year of the project, with consultants from HLPS and the ACT in regular contact, as are staff working in the Emergency Department.
- Patients have benefited from regular joint assessments and reviews which has resulted in joint working with the MINT (Mental Health Integrated Network Team) and ARC (drug and alcohol service) for ongoing support. This is a significant development for patients who often suffer inequalities due to mental health conditions.
- The outpatient detoxification pathway proved challenging to implement, however this has now been agreed. Early reviews of the initial cases in quarter 4, would suggest that 10 bed days were saved. This pathway will continue to be developed.
- A key focus of the project has been connecting those seen in hospital into treatment with ARC (drug and alcohol service). A seven day a week booking system, flexible follow up and outreach and the utilisation of the 12-week Recovery Day Programme as a pathway following detoxification, has proved very successful.
- To secure ongoing funding past the end of the project period (February 2024)
- The ACT and Hospital Psychiatry Liaison Service to forge more formal joint processes and training
- To undertake a data review to understand levels of mental health conditions within this patient group
- To further develop the pathways for outpatient detoxification for patients
- To seek feedback from those who have experienced the service as well as from the professionals working alongside the Alcohol Care Team