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Innovation

Multi-agency care for people with alcohol-related long-term conditions

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In Nottinghamshire, a dedicated team cares for people with alcohol-related chronic ill health. This initiative won the award for Managing Long-term Conditions in the 2016 Nursing Times Awards

Citation: Holmes M (2017) Multi-agency care for people with alcohol-related long-term conditions. Nursing Times [online]; 113, 8, 46.

Author: Mark Holmes is mental health workstream lead at Principia Nottingham.

Introduction

The Nottinghamshire alcohol-related long-term condition team (LTC) was set up in 2013 to work with people who frequently use hospital services for alcohol-related chronic ill health. The aim of the service is to promote better coordination of care leading to appropriate and less costly use of services.

The team case manages people with a combination of alcohol dependence, alcohol-related long-term physical health conditions and a high risk of readmission to hospital.

A vital part of the work is the trust’s relationship with the Blue Light project, a national initiative developed by Alcohol Concern and Public Health England to develop alternative approaches for the treatment of resistant drinkers (those resistant to changing their lifestyle). It provides:

  • Tools for understanding why clients may not engage with treatment;
  • Risk assessment tools and harm reduction techniques;
  • Advice on nutritional approaches that can reduce alcohol-related harm;
  • Help non-clinicians identify potential serious health problems;
  • Management frameworks;
  • Guidance on legal frameworks.

The Blue Light project offers a positive message that while it may not always be possible to ‘treat’ resistant drinkers, services can help reduce harm and manage the risk posed to themselves and others.

Our team was a key partner in its development and the team leader is the co-author of the project manual (Ward and Holmes, 2014).

Working with resistant drinkers

The aim of the service is to make access as simple as possible to increase the likelihood of engagement. Crucial to this phase are a range of simple referral methods and a weekly clinic on the liver ward at the acute trust.

The team receives a referral and contacts the person to make an assessment. Once the team starts working with the client, staff aim to build a relationship with them, stabilise them, reduce harm, develop interventions and engage in recovery where possible.

The service works in a multi-agency framework and central to this are twice-monthly Blue Light meetings to discuss high-risk clients with alcohol problems. These are chaired by the LTC team and attended by the East Midlands Ambulance Service, the emergency department’s high-volume service user lead, hospital liaison, fire service and police.

Evaluations of the service

Three carers commented on their experience of the team:

“It’s great that Mum has people working with her who really care about her wellbeing and have been able to drive some change so that she can have support in living safely at home.”

“Previously I have felt alone in managing the care of my father in relation to getting him to see doctors at the hospital, GPs, obtaining blood tests and Fortisips. Since the LTC service has come along I no longer feel alone in coping with all these things and a lot of the pressure has been taken off me.”

“Without the support from LTC she would not be where she is now and that is abstinent from alcohol.”

The annual cost of the service, in terms of staffing and immediate overheads, is just under £180,000. The return on investment to the NHS was evaluated by Public Health England. The annual gross savings provided by the service are £393,792 based on an average of 168 admissions avoided each year.

The team has also reduced cost burdens on other public services such as the police, fire service and housing providers, however, this has not been accurately costed.

Implications for practice

  • People with a combination of alcohol dependence and related long-term physical health conditions are at high risk of readmission to hospital
  • Alcohol Concern and Public Health England have developed alternative approaches for the treatment of resistant drinkers
  • Access to services need to be as simple as possible to increase engagement with this patient group
  • Using a multi-agency approach can improve client wellbeing and reduce demands on services
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