Alcohol Local Area Update

Paper for Joint Commissioning Group – Adult

Subject: Alcohol

RESTRICTED - COMMERCIALLY SENSITIVE AND IN CONFIDENCE

Introduction

The paper provides the Joint Commissioning Group with an update on current alcohol projects in Sunderland.

Alcohol Evaluation

The Director of Public Health has asked for an evaluation of all commissioned alcohol services with a focus on:-

 Outcomes  Value for money  Efficacy of pathways  Equitable delivery  Areas of improvement

As services have been in place for sometime, the evaluation has allowed us to see what is working and if resources need to prioritised differently and also formulate a forward plan for 2011/12.

This is now drawing to a close though due to lack of availability of key staff, HHAS Drug and Alcohol Team and Counted4 CIC have not yet been accessed.

Interim Findings

Oaktrees  Two Sunderland participants (total of 12 places available annually – based in Gateshead).  High degree of satisfaction with programme (in common with anecdotal evidence from service providers and commissioners). Oversubscribed with a number undertaking pre-programme work. Programme is structured for 12 weeks and uses evidence-based approach – feeds into developed aftercare system. Daily plan in place at weekend for support.  No pathways issues identified – good relationships with HHAS Drug and Alcohol Team and Huntercombe Centre.

Oaktress – Interim Recommendations

 Would recommend purchase of additional places if feasible.  Explore potential for provision of similar services within Sunderland

Hospital Project

 Extra-ordinarily busy project operating way past capacity.  Observed eight assessments in one day by specialist nurse who also has other commitments and offers phone contact to service users. Many who are seen have severe physical problems connected to alcohol use – extent evidenced by routine timely liver function tests.  Follow on passed to Turning Point staff. Medical intervention based on CIWA process – currently being evaluated for effectiveness.  Consultant provides strong and supportive leadership.  Specialist nurse appears to have potentially unmanageable caseload.  System flags up substantial medical need, social aspects dealt with by Turning Point or in one case Self Harm team.

Turning Point

Hospital Project

 Hospital staff mainly pick up referrals from nursing staff including specialist nurse, patients are assessed using standard partnership assessment form and then referred to other agencies or offered Brief Intervention.  Staff have undertaken training to help assess motivation.  Records are kept electronically on TP database and staff have access to hospital database.  Staff not currently included in case discussions with Alcohol Nurses from hospital and Counted4 CIC, which should be addressed.  Staff report delays in people being picked up following referral. Gap for service users once returned home.

Engagement and Motivating Team  Engagement and motivation staff undertake assessments following referral into treatment with an attendance rate above the national average.  They are motivated and committed workers, who perhaps would provide a more effective service assertively following no-shows (they currently offer three appointments).

Arrest Referral

 Arrest referral staff offer service to alcohol as well as drug users but were fairly quiet on date of visit.  Staff have referred to continual problem of statutory workers re-assessing referrals and not necessarily paying heed to what was written.

Turning Point – Interim Recommendations

 Be involved more offering follow up presently offered by specialist nurse  Be explicit about follow up of cases and where they would be offered services – possibly feeding in to some central co-ordination function  Staff could possibly build in some elements of strength-based assessment into process.

Huntercombe

 Examples of seamless work evidenced – spoke to service users who had gone direct from hospital to complete detox using CIWA framework and one who went straight from Huntercombe to Oaktrees. Detox facilities are well managed and well resourced.  Facilities are of a good standard.  Leadership is strong and supportive.  The rehab programme would benefit from adopting a modernised, asset building approach.  Aftercare is successful and offered twice weekly as a voluntary drop-in.  Service user feedback was positive.

Huntercombe – Interim Recommendations

 There is a clear tension between medical and social models which needs to be resolved, there are clearly significant numbers who would benefit from use of the project who cannot access due to perceived lack of motivation or a coherent aftercare plan. However, the expertise amongst the medical staff and the design of the building means this facility could be used for more complex cases.

Nicola Grainger Joint Commissioning Officer - Sunderland May 2011