The ‘wicked’ problem of alcohol

Newcastle upon TyneNorth TynesideNorthumberland

Lynda SeeryPublic Health Lead for

Drug and Alcohol

What we did in 2007?

• Nationally » information, data (NWPHO), evidence » MoCAM, » the Alcohol Needs Assessment Research Project

(ANARP)

• Locally » Strategies?» Needs Assessment ?» Service Reviews?

• Mapping of service provision

What we found?• Tier 1 - Prevention

» C&YP – Healthy Schools module» Adults – national campaigns only

• Tier 2 –Treatment» Community services

• Tier 3 – Treatment (specialist)» Specialist addictions service (detox available)» A&E» Admission to hospital

• Tier 4 – Residential rehab» Assessment against criteria (predominantly for

drugs)» Structured day care

How do we impact on the indicator?

• complex indicator• requested data extract 1/4/07 – 31/3/09• 3 particular hospital codes of interest identified

within the spell of care (not necessarily primary diagnosis)

– F10 mental & behavioural disorders due to alcohol– K70 alcoholic liver disease– T51 intoxication

• 1.00 - wholly attributable to alcohol (main focus)

Individual patient record

• postcode level & GP Practice• 1411 admissions (707) patients• Costs = £2.5m• 943/1411 re-admissions (66.8%)• 239/707 patients readmitted (33.8%)• 2 to 1 male to female split• 468/707 patients admitted once

(66.2%)• age breakdown

NewcastleProportion of population in each age group. Newcastle population as a whole and Newcastle admissions 1/4/07 - 31/3/09

<15

<15

15-24

15-24

25-34

25-34

35-44

35-44

45-5445-54

55-64

55-64

65-74

65-7475-84

75-8485+ 85+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Newcastle population Newcastle admissions

North TynesideProportion of population in each age group. North Tyneside population as a whole and North Tyneside admissions

<15

<15

15-24

15-24

25-34

25-34

35-44

35-44

45-5445-54

55-64

55-64

65-74

65-7475-84

75-8485+ 85+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

North Tyneside population North Tyneside admissions

NorthumberlandProportion of population in each age group. Northumberland population as a whole and Newcastle admission 1/4/07 - 31/3/09

<15

<15

15-24

15-24

25-34

25-34

35-44

35-44

45-54

45-54

55-6455-64

65-74

65-7475-84

75-8485+ 85+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Northumberland population Northumberland admissions

Segmentation - understanding the patient layers

The ‘patient layers’ fall into the following categories:

• Patients admitted to hospital for 1 day or less (no overnight stay)

• Patients admitted only once

• Patients admitted once for intoxication / patients re-admitted for intoxication

• Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)

• Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas

• Patients with severe ongoing/end stage illness

Patients admitted once only for 1 day or 8 hours or less

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Newcastle PCT North Tyneside PCT Northumberland CT

Admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(patient admitted once for 1 day or less)

Stomach or Duodenum Disorders

Ingestion Poisoning or Allergies

Epilepsy

Syncope or Collapse

Gastrointestinal Bleed

Sprains, Strains, or Minor Open Wounds

Chronic Pancreatic Disease

Chest Pain

General Abdominal Disorders

Poisoning, Toxic, Environmental

Example of intoxication record

Codes listed

T40 (primary diagnosis)

poisoning by drugs, medicaments and biological substances

X620 intentional self harm

T51 intoxication/toxic effects of substances non medicinal as to source

S099 injuries to head

W19 fall

F101 harmful use

‘Frequent users’ or re-admissions to hospital

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Newcastle PCT North Tyneside PCT Northumberland CT

Re-admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(239 frequent users accounting for 943 admissions )

Stomach or Duodenum Disorders

Gastrointestinal Bleed

Chronic Obstructive PulmonaryDisease or Bronchitis

General Abdominal - DiagnosticProcedures

Pancreatic Disorders

Drainage of Ascites

Poisoning, Toxic, Environmental

General Abdominal Disorders

Chronic Liver Disorders

Chronic Pancreatic Disease

Example of re-admission recordCodes listed

K703 (primary diagnosis)

Diseases of the liver

F102 Dependence syndrome

I10X Hypertensive diseases

J459 Chronic lower respiratory diseases

R18X Symptoms and signs involving the digestive system and abdomen

Z720 Persons encountering health services in other circumstances

Z867 Persons with potential health hazards related to family and personal history and certain conditions influencing health status

Phase 1 – focused work with identified individuals

• Target groups

– patients re-admitted for intoxication

- Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)

Significant 60

– Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas

Significant 12

  Male Female

Newcastle 44 49

North Tyneside 22 22

Northumberland 17 25

Community Alcohol team (virtual)

• Treatment Effectiveness & Governance Manager

• Community Matron for Social Exclusion (alcohol)

• Nurse Practitioner• x2 Alcohol Specialist Nurses (mental health)• X2 Alcohol Specialist Nurses (acute)• 4.5 wte Assertive Outreach Workers• x1 IBA Trainer (+2 sessional trainers)• x1 Health Link Worker (A&E)

What the team provides • Care Co-ordination – key worker responsibility

• Multi agency care plans – (individuals may have a single dominant condition i.e. alcohol but

may be known to different agencies)

• Community Matron post – key to working with GPs and into Practices

• Community Open clinics (walk in, self refer, referred into from any other service) – Professionals available at clinics, clinical & mental health staff,

social care, housing, benefits

• Assertive Outreach (voluntary sector)

• Wider use of IBAs & Brief Interventions (multi agency training – confidence & competence)

• Implementation of the Cardiff Model – A&E & CDRP

How hard can it be?

•Pace

•Purpose

•Passion

Questions?