Main Author: Conrad Eydmann

Storyboard Entry Form 2014

Main author: Conrad Eydmann Email: [email protected] Telephone: 02920336221

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The word limit is 1100 words including references. Your storyboard will not be accepted if you exceed the word limit.

1. Storyboard title: a clear concise title which describes the work Cardiff Alcohol Treatment Centre –Working together to address alcohol related injury in Cardiff City Centre 2. Brief outline of context: where this improvement work was done; what sort of unit/department; what staff/client groups were involved The Cardiff Alcohol Treatment Centre provides additional capacity to assist the Emergency Department at UHW deal with intoxicated individuals at peak times. It reduces the burden on health, police and ambulance staff by diverting intoxicated individuals away from ED. The benefits are felt across police and health services, in the city centre for the community, and for those visiting the ED with waiting times reduced. In terms of health practitioners, it enables them to work with the correct client group, and eases pressure at times of need. 3. Brief outline of problem: statement of problem; how you set out to tackle it; how it affected patient/client care The ATC was set up in response to alcohol related crime and injury and its impact on statutory services in the city. Addressing this need is a priority for the Health Board, South Wales Police and Cardiff Council. Following the Proud Capital conference in 2011 a series of meetings were held bringing together all partners who have influence within the Cardiff Night Time Economy. Patient care is affected as waiting times at ED are reduced, as are ambulance hand over times. There is a Police Officer on site at the ATC, reducing the potential for violence and disorder. The ATC ensures that the right patients are diverted to the right care at the right time according to their needs. 4. Assessment of problem and analysis of its causes: quantified problem; staff involvement; assessment of the cause of problem; solutions/changes needed to make improvements The NHS in Wales spends approximately £70-85m each year on alcohol related health problems. Cardiff has a reputation as a busy night time economy, with visitors from across Wales coming to the city centre each weekend. The city hosts a number of high profile sporting events, again seeing increased visitors to Cardiff. Around 70% of EU admissions are alcohol related at peak times, increasing the potential for anti social behaviour and violence within emergency departments as waits are increased. This is frustrating for both staff of the ED, Ambulance staff, Police accompanying people to ED and patients waiting to be seen. The idea for the ATC was come to at a brainstorming session at the Proud Capital conference 2011, and was intended to build on work already carried out within Cardiff City Centre by highly skilled ENPs and Welsh Ambulance Service. It identified increasing alcohol consumption, especially amongst the student population of the city, as a key area of concern. It was felt that the best way of addressing this problem was through a partnership approach involving all agencies involved in and affected by alcohol related injury and crime. This moved the previous work by ENPs within the City Centre to a base, and provided more partnership input, enabling innovative work to grow further. 5. Strategy for change: how the proposed change was implemented; clear client or staff group described; explain how you disseminated the results of the analysis and plans for change to the groups involved with/affected by the planned change; include a timetable for change The change was implemented following the creation of a multi disciplinary group involving those working within the night time economy. A Standard Operational Procedure was drafted by the group defining who the clients were, hours of operation and partners involved. The group included Cardiff Local Authority Night Time Coordinators, South Wales Police, the Welsh Ambulance Service and ED practitioners and managers. There is further support and partnership working from those already involved within the NTE, including Street Pastors, St John’s Ambulance, licensees, taxi marshals and so on. The ATC pilot started in September 2012 and was initially funded for one year, a research project was commissioned to evaluate the impact of the centre on partner agencies. The evaluation was published and disseminated to all involved, including wider distribution across Substance Misuse networks and local authorities. Funding is now in place from the Regional Collaboration Board across Cardiff and the Vale. 6. Measurement of improvement: details of how the effects of the planned changes were measured An evaluation was commissioned by the Cardiff and Vale Area Planning Board and carried out by Cardiff University and published in May 2013. This measured ambulance hand over times, and waiting times in the ED at points when the ATC was open. The effects are constantly measured by a regular meeting involving partners to discuss the impact of the ATC. The impact on the City Centre is measured routinely by the Violence Prevention group chaired by Dr Jonathan Shepherd of Cardiff University. Quarterly reporting is fed into the APB Alcohol Group, and the Regional Collaboration Board in Cardiff. Regular reporting has found increased referral rates into the ATC. 7. Effects of changes: statement of the effects of the change; how far these changes resolve the problem that triggered the work; how this improved patient/client care; the problems encountered with the process of changes or with the changes Ambulance handover time was reduced by the ATC, improving client care as waiting times at the ED reduced. There are emerging trends that violence in the city is increasing in terms of Police reporting, but down in terms of ED reporting. This suggests that as police are working alongside the centre, they are off the street less transporting to ED and therefore able to intervene and prevent violent crime escalating. As a nurse led project, less than 25% of clients are referred onto ED for further care. Patient feedback highlights that the centre has impacted on their alcohol consumption, including messages of thanks from patients and parents for treatment received following their discharge. The centre measures where last drinks were served, which feeds into police and local authority licensing departments and can be used as evidence in license reviews. Street pastors working within the city centre are now able to take individuals to the ATC, freeing up time in the City for other vulnerable individuals. 8. Lessons learnt: statement of lessons learnt from the work; what would be done differently next time Initially it was anticipated that the busiest nights would be Thursday and Friday, this wasn’t the case; consequently opening times were changed to Friday and Saturday evenings. Future planning will involve looking at events calendars and evidence from all partners. Identifying premises was an issue, with the centre currently operating out of a temporary base. The centre is shortly due to move to new premises. 9. Message for others: statement of the main message you would like to convey to others, based on the experience described The ATC has impacted positively on the Health Service, the Ambulance Service, South Wales Police and the community. It has been a true example of partnership working, from the Probation Unpaid Work team renovating the centre until now. Dealing with intoxicated individuals enables staff to do work around Alcohol Brief Interventions, impacting on the patient in terms of future alcohol consumption. The centre has attracted benefits in terms of violence within the City, reduced police hand over times has resulted in an increased presence of Police on the street, and thus increased public reassurance. The ATC has ensured that the right patient is diverted to the right treatment at the right time according to their need, addressing a very real need identified by partners at the inception of the project.

The NHS Wales Awards are organised by the 1000 Lives Improvement Service in Public Health Wales. www.1000livesi.wales.nhs.uk