Assertive OutreachService

Health, Wellbeing and Social Care Scrutiny

27th October 2010

Overview

• Why

• What

• What if

In 2008-09 alcohol related bed days equated to

approximately 40,000 bed days OR 111 beds

63% emergency admissions

Repeat A & E Admissions (2005-2008)Courtesy of Mark Knight and Gordon Adams -Salford DAAT

% of Total Attributable Factor of All 15,272 Individuals (2005-08) A&E Only

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 2500 5000 7500 10000 12500 15000

Number of Individuals

% o

f T

ota

l A

ttri

bu

tab

le F

ac

tors

10,000 people = 92.3%

100 people = 13.1%

Virtual ‘Outreach’ Team

• A&E Consultant

• Acute physician/ gastroenterologist

• Alcohol specialist nurse

• Community alcohol service manager

• Mental Health – Crisis response team

• GP Homeless Service

• Age Concern

• Salford DAAT

What does a virtual team mean?• From mid June to December the team met fortnightly for 2-2.5

hours to assess the Top 20 patients and agree action plans• Hours input-

– Alcohol specialist nurses 82 hrs– Community Alcohol Team Manager 46 hrs– A&E consultant 30 hrs– Gastroenterologist 30 hrs– Crisis Response Team( Mental; Health) 10 hrs– GP Homeless Practice 8 hrs– Age Concern 6 hrs

– Plus a 7 hours spent visit alcohol services across Salford followed by a debrief

Total of 250 clinical hours approx

All age all cause mortality

Top 100 2007-08 - 24 had died

Age No. deaths

%

20s 1 4.2

30s 1 4.2

40s 3 12.5

50s 10 41.7

60s 6 25

70s 2 2.1

80s 1 1

Top 20 cohort 2007-08 Patient

Medical

Alcohol team contact

Mental Health

Forensic interest

Social / Housing

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Key Problem Currently abstinent/ no longer able to drink/ not alcohol related

Top 20 – problem list identified thru’ MDT assessment review

Top 20 – common presentation

• Multiple referral to ASN team- BI given

• Multiple referral to community alcohol service – no/ limited engagement

• Previous detoxes

• In and out of prison

• Difficult home situation/ abuse (multidirectional)

• Bereavement issues

Assertive case management

• Visit at home

• Linking with other services

• Smoothing pathways

• Management plan ready to go on next admission

• Prioritise/ fast track

• Bridge service gaps

• Support with additional services/ activities

‘Top18’ patients…..snapshot Oct 2009

• 11% unfortunately died

• 15 of the 18 aged <51years

• Third <40 years

• 271 A&E visits

• 148 admissions

• 1.81 beds ( 100% occupancy)

• HRG tariff costs of £257,430

• Expensive not only to health

Early results

Number of A&E attendances and admissions pre and during pilot

Outcome- all patients except non-alcohol and RAG = grey

% Reduction A&E attendances16.5 (n=125)

% Reduction in admissions from A&E

14.3 (n=49)

Conclusions ( April 2010)

• Big problem with a financial & societal cost to match

• Current services have gaps

• AOT plugs gaps with some early suggestions of benefit

• Worthy of further investigation

AOT Phase 2

• May 2010- completed Frequent Flyer proposal/ business case as part of Integrated Partnership Board

• Business case suggested alcohol, drug misuse

and self harm presentations were strongly interlinked

• AOT business case extended to include drug misuse, self harm & alcohol

AOT Phase 3

• June- August 2010- Completed further analysis which strengthened extended business case

AOT Phase 4

•Potential pilot in Salford initiated by Drinkwise Northwest – Intelligence led alcohol harm reduction working with ‘Better Life Chances’

AOT remit - if/when funded

• Top 30 patients admitted in relation to alcohol, drug misuse and self harm

• Up and comers( 2ARAs)- – 8 from 72 now in top 30– Top 30 ranked positions of 1,2,4,20,21&26

• Strengthen relationships with other statutory services and third sector organisations (including Narrowgate Shelter/ Windsor Drop In)

Proposed Outreach Team

• Consultant emergency medicine• Gastroenterologist/ liver disease• Psychiatrist• CPN ( alcohol background)• Social worker AMP (Mental health practitioner)• Clinical psychologist • Tenancy support work• Health trainer/ star worker• Police / probation officer• Alcohol specialist nurse• Admin support

Recommendations

• Support commissioning of the AOT

• Need for all statutory services to work in more than partnership

Thank you !!!!