Item: 13iii Enc: 5iii
REPORT TO THE TRUST BOARD
TO BE HELD ON: 29 JULY 2009
Enclosure: 5iii
Subject: Provision Of Alcohol Services in East Staffordshire
Lead Director: Sue Price
Lead Officer: Sarah Laing / Lalitha Webb
Recommendation: For Approval For Discussion For Information X
PURPOSE OF THE REPORT:
To inform the Trust Board of Developments in Alcohol Service Provision and
Partnership working in the East Locality
KEY POINTS:
An overview of provision of services and outcomes
CORPORATE OBJECTIVES:
In Line with Strategic Themes 1,3,4 and 6, Objectives cp5, cp7 , cp9 and cp11
RESPONSIBLE COMMITTEE:
NAME:
APPROVED at cmte: NO Date of Cmte: N/A
IMPLICATIONS:
Legal and/or Risk
Standards for Better
Health
Financial East Staffs - £50K (LSP) £63K BAC O Connor (Detox Beds)
£25K Liaison Worker £24K Nutrition/Dietary education (part of
rehab)
Training
PBC Fully supportive and engaged
Patient Engagement
& safety
RECOMMENDATIONS / ACTION REQUIRED:
The Board are requested to note the actions being taken.
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Item: 13iii Enc: 5iii
East Staffordshire PBC
1.0 It is estimated there are 21,344 dependant drinkers within South
Staffordshire, with a cost to the Health Economy of £7,812.028,000
( J Aldridge 2009 - Staffordshire Alcohol Strategy South Staffs PCT)
In East Staffordshire there are approximately 6,500 dependent drinkers and it
became apparent from local evidence, including service user assessments,
presentations in the acute sector and from within General Practice, that a
harm reduction approach was in many cases unsuccessful.
East Staffordshire PBC is truly committed to addressing the serious issues
surrounding excessive drinking and decided to take a multi faceted approach
to dealing with this extensive problem.
2.0 The PBC Have:
• Commissioned two Alcohol Detoxification Beds from the BAC O
Connor centre in Burton on Trent.
• Funded an Alcohol Liaison Worker in Accident and Emergency at
Burton Hospital Foundation Trust.
• Funded an Alcohol Arrest Referral Worker working in Partnership with
the BAC O Connor Centre, the Police and Social Services.
• Become an active partner in the Burton Local Strategic Partnership and
were involved in the creation of the Burton “Vampire Plus” project –
tackling alcohol related issues in Burton Town Centre. Plans are in
place to repeat this highly successful project and roll it out into the
wider community including Uttoxeter.
• Currently working alongside the PCT with Tim McGreggor and Public
Health, to establish a robust model of care that will form the basis of
our tiered approach to alcohol.
• Worked in partnership with Burton College with students to produce
15,000 plastic type “credit cards” carrying information on where to get
help if you are concerned about drinking or drugs. This also formed a
big part of the students degree programme.
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The alcohol detoxification service is commissioned through the BAC O
Connor centre by East Staffordshire Primary Care Trust on behalf of the
local Practice Based Commissioners.
2.1 The project began as a pilot in November 2008 for a six month period
to cover East Staffordshire dependant drinkers requiring detoxification
services and rehabilitation. The BAC O’Connor Centre currently operates
within tier 3/ 4, providing both day and residential rehabilitation services. The
detoxification service sit’s within the tiered structure in a manner that will
accept referrals from multiple points within the tiers and provides prompt and
flexible access to tier 4 detoxification, rehabilitation, resettlement to
independent living, with a two year aftercare and follow up programme.
The target was 30 admissions over a six month period, actual number was 32.
The majority of referrals have been via East Staffordshire General
Practitioners with a small number (four) from Social Care and six from BHFT.
By the end of the project BAC O Connor had received 39 referrals for East
Staffordshire residents of which 32 were admitted to the detoxification unit.
In January 2009 the successful outcomes were 88.8% and this has now risen
to 94% with this 94% entering rehabilitation.
Figure 1
• 6% Discharged = 2 Individuals
• 94%Successfully Completed Detox = 30 Individuals
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After successfully completing detoxification all of the 30 individuals entered
the intensive rehabilitation programme. Figure 2 below shows the outcomes
of the rehabilitation programme at May 09.
Figure 2
• 40% Graduated = 12 Individuals
• 47% Current = 14 Individuals
• 13% Discharged = 4 Individuals
NB: Since the analysis of this data 4 of the current clients have gone on to
complete the rehabilitation programme which increases the graduated clients
to 54% with a current client group of 33%. The potential long term outcomes
for this project are 87% which is an increase on the previous BAC O’Connor
Centre outcomes of 64%.
The Graduated clients are abstinent; as such we do not expect these clients
to undergo a further detox. They graduate as fully functioning members of our
community.
With the current pressures on NHS Services to reduce alcohol related hospital
admissions NI39 we have recently completed a study of 18 clients who have
accessed our services from detoxification to rehabilitation.
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Based on an admission to hospital for Degeneration of nervous system due to
alcohol the total cost for a 14 day period as an NHS in patient would cost
approximately £4,048. This equates to £289.14 per night. Based on the
findings of the recent study carried out at The BAC O’Connor Centre the
likely hood of this being an isolated incident is low as our data showed that
the average number of hospital admissions were 2.1 per person. These
finding clearly demonstrate the need for dependent drinkers to be referred for
Detoxification and Rehabilitation to ensure that the ‘revolving door’ is halted if
Local Authorities are to achieve NI 39 Reducing Hospital Admission.
Based on a figure of 21,000 dependant drinkers needing detoxification in
Staffordshire comparative costings of NHS Detoxification provision and BAC.
Average costing based on a 14 night stay
NHS @ £4,348.00 per episode 14 nights stay x 21,000 = £91,308,000
BAC O’Connor @ £1,000 per episode 14 nights stay x 21,000 = £21,000,000
Thus the 2 BAC O Connor Detox Beds will target 62 dependent drinkers at a
cost of £62,000 per year.
NHS costings for 62 patients equate to £269,576 per year.
THUS using BAC O Connor we save £207,576
3.0 The PBC have funded an Alcohol Liaison Worker within the A&E
department, employed by the BAC O Connor, working in partnership with all
available external agencies and who has clinical development and supervision
via BAC O Connor. The overall aim of the project was to provide relevant
alcohol misuse advice and intervention, in a hospital setting, thus reducing the
number of repeat admissions to A&E and hospital wards for alcohol related
conditions. Also to reduce the pressure on BHFT at peak times, which are
related to alcohol related trauma and violence.
• Between September 07 and June 09 the Alcohol Arrest Referral
Worker has received 410 referrals of these referrals 100% were offered
brief interventions with the Alcohol Liaison Worker (ALW). National
Figures show that about 33% of attendees at Emergency Department
(ED) who are offered interventions with a alcohol liaison worker,
accept/turn up for brief interventions. To date 85% of attendees at
BHFT, who have been referred to the ED Alcohol Liaison Worker, have
attended one or more brief interventions in East Staffordshire thus
exceeding National Figures by 52%.
• Out of the 410 people seen 314 were seen face to face, 25 consulted
via the telephone and 10 are pending appointments. Out of the 314
face to face 215 had been through previous detoxification, at an
estimated cost of over £600,000.
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• Over 300 have now been reffered on to other services including
ADSIS, BAC O Connor, Mental Health, social serviices etc
4.0 The remaining services/interventions have been produced in partnership
with East Staffordshire Borough Council and the Local Strategic Partnership.
On May 14 2008, South Staffs PCT and Staffordshire Police offered £50,000
and £20,000 respectively to the LSP to create a pooled funding. LSP partners
took the decision to form an LSP sub group and fund activities aimed at
reducing the negative impact of alcohol in Burton Town Centre. The project
was named “Vampire”.
4.1 The Vampire project consists of: increased Police presence, visits to
licensed premises from the Fire Service and Council Licensing, increased
access to medical treatment, patrolling of taxi ranks, provision of Alcohol
Arrest Referral Worker, and numerous social marketing campaigns. This
partnership activity has contributed to excellent crime statistics around Burton,
suggesting that LSP members may wish to consider revising internal
structures to permanently mainstream Vampire type events.
Target Outcomes were:
1. Reduction in serious violence by 48% in Burton and contributing
significantly towards a borough wide 4% reduction.
2. Increase in Pub Watch membership by 42%.
3. Alcohol retailers were given extra training regarding responsible
retailing. “Responsible alcohol retailing” was delivered to 71 persons
at 12 premises.
4. Arrest referral worker: 91% of people arrested for alcohol offences
were given the opportunity to have a referral to an Alcohol Arrest
Referral Worker. Between February and April 2009 38 people were
seen or offered? (35% from ethnic minorities- evidence would
suggest that further work needs to be done around migrant
communities and understanding the cultural and customs difference
in the UK.), one third involved an assault on a second party, 92%
being repeat offenders
An early case study provided through the Burton Addiction Centre
details how referral to the ARW has broken a cycle of repeat
offending connected to alcohol misuse for one individual. Resource
requirements for the post are £32000 per annum. Community
Safety Partnership funding has been secured for quarter four of
09/10.
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5. Alcohol related incidents in the town Centre reduced by 13.6% from
29.75 to 25.91 per month.
6. Place survey results indicate that fewer residents feel unsafe after
dark, a 1.4% reduction since August 2008. Furthermore an 11.6%
increase has occurred on residents being informed on what is being
done to tackle ASB.
7. A Minor injuries unit was set up in the town centre during the project,
the following figure demonstrates the use of this minor injuries unit
against use of A&E at the same time
8
7
6 Injuries Unit
5
Emergency Department
4
3
2
1
0
Vampire
Vampire
Vampire
Vampire
Vampire
(24/1/9)
(02/2/9)
(13/3/9)
(11/4/9)
(2/5/9)
8. Average arrests comparison between the Vampire period and
previous years without Vampire and rest of 08/09, prior to Vampire.
15
10
5 average arrests per
month
0
2007/8 2008/9 vampire average
9. Another successful element included the use of a projector to
promote key messages around safe drinking in Burton Town Centre.
Safer & Stronger funds were utilised to purchase the projector that
was placed around the Borough. However the projector is multi
functional and is also used to promote a variety of messages not just
those connected to alcohol related harm. Anecdotal findings from
projected images on Vampire events highlighted a Polish community
misconception over drink drive regulations.
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10. High visibility jackets and head cameras for door staff have been
employed at licensed premises since January. Sourced through a
local business at reduced rate, CCTV operators and Police have
noted how these simple changes have had significant positive
impact on their work, enabling them to distinguish between
offenders, genuine customers and door staff.
11. Taxi marshall’s have supported Vampire events and have eased the
problems around disputes over transport. Historically access to
Taxi’s has often caused flashpoints in the Town Centre. Further
work is taking place in reducing this problem with a taxi
representative invited to attend Pub Watch as a key stakeholder in
the night time economy.
12. ES News featured regular articles on the work of the alcohol sub
group, reaching all homes in East Staffordshire. Additionally the
Burton Mail and Touch radio have run articles and features on the
sub group programme.
13. 15,000 credit card sized information cards designed by Burton
College students have been produced so that the contact numbers
of treatment service providers are freely available to those persons
at risk of addiction. 10,000 of these have been distributed at
Vampire events and the premises of partner agencies. As a side: the
students used this activity as a fundamental part of their degree
course.
Sub group partners consider that each strand of the Vampire events cannot
stand alone and it is the cross partnership working and support that partners
provide to each other that adds to the success of this event.
Executive partners need to consider the level of resources that ought to be
made available to support the future running of Vampire events. Predicted
costs for each Vampire are £2000 per event.
In addition to this work we have a Substance Misuse team in Burton (part of
the foundation trust) they have a full time nurse and three project workers.
This team covers both drugs and alcohol. We also commission a service from
ADSIS -they run three sessions in Burton and an ad hoc session in Uttoxeter.
Work is in progress with Tim McGreggor and the PCT to unpick what else
should be going into our local alcohol services to ensure we address this
crucial need.
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List of all involvement in Alcohol partnerships in East Staffs:
Increased Pub Watch membership including Taxi’s
Responsible alcohol retail training
Monthly ES News
Credit Card sized information cards designed by Burton College
Press conference launch
Hi-visibility jackets for door staff
Improved CCTV coverage in the Town Centre
Medical services at Vampire
Public perception survey data
Mock road traffic accidents – Fire Brigade
Projected images in English & Polish relating to crime
Premises visits; Fire Service and Licensing
Review of Banning Policy
Bottle stoppers to prevent drink spiking
Recruitment of ARW
Burton Mail & Touch radio features
Taxi Marshalling
ADSIS
Community Substance Misuse
BAC O Connor
South Staffordshire and Shropshire NHS Foundation Trust
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5.0 Conclusion
The key to successful detoxification of clients lies in the programme of
abstinence and the extensive rehabilitation offered by the BAC O Connor
centre in Burton on Trent. Outcomes not only show significant financial
savings, but exceptional improvements in the quality of life for both patients
and their families.
Successful rehabilitation not only stops the revolving door but allows clients to
return to quality living, and those who are in current rehabilitation are certainly
not expected to undergo further detox. None of our clients have undergone a
second episode of detoxification…we have stopped that revolving door.
A recent email (received last week) from a client is attached to this report.
This outstanding partnership approach truly demonstrates that with relatively
little financial input, numerous positive outcomes have been achieved, and
have exceeded initial expectations.
The impact on our wider community is not easy to assess, however with
reduced feelings of fear at night across the community, markedly reduced
rates of crime, reductions in re-offending of those who saw the arrest referral
worker, safer taxi ranks, 32 dependent drinkers now abstinent, 10,000 help
line credit cards in circulation and increased awareness amongst landlords
and off licences, we can safely say it has been a success.
Whilst we can celebrate this successes in East Staffordshire, we are aware
that there are still many areas of concern with regard to Alcohol and we will
continue to develop our community services in line with evidenced need.
A final word from a service user:
“I really want to say ‘THANK YOU FOR EVERYTHING’ but that alone does not seem to me to
be any where near enough.
My time at The BAC has been without doubt the most valuable experience I have ever had. I
could not have envisaged the benefits and knowledge I have gained since walking into detox
on the 6th March 2009. I have met some wonderful people there and started some fantastic
friendship and relationships with people I know will remain lifelong companions.
I am truly grateful for all the help and guidance I received from everyone.
I think what you have created in Burton and Newcastle is fantastic. It is only being an
alcoholic and knowing what you do for people entering both places do I feel qualified to say
this!
I would like to help if I can? If there is any thing I can do to help you in any way please do not
hesitate to ask. If it’s helping with walks or around the house, talking to the newcomers in
detox – anything please ask, if I can help I will and I truly mean it.
Since leaving, I have maintained total sobriety and am attending many AA + NA meetings
along with Relapse Prevention and Aftercare at The BAC (thank you for that) and feeling
good and happy about things. I have you and your team to thank for this and I truly cannot
thank you enough!!!”
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South East Staffordshire PBC
Lichfield
SSPCT have provided additional monies to support:
• Christmas campaign targeting drinking, including providing breath test
devices for partners to use to indicate if people are over the limit; “I’ll
be Des” - designated driver initiative where soft drinks are funded;
bottle tops to stop drinks being spiked
• Alcohol Arrest Referral Worker – funded mainly by Tamworth
• Positive Futures Project - awareness raising around alcohol and
substance misuse.
• Funded Youth Service to produce a DVD around consequences of
alcohol etc (DITCH) peer education in schools.
• Burntwood Init / Where Is Your Child Tonight - work with the Youth
Service around education of young people and parents.
• Support Trading Standards Community Safety Officer around under
age sales etc.
• Road Safety – support for Pass Plus Extra
Tamworth
Tamworth Community Safety Partnership was successful in securing funding
to pilot a six month Alcohol Referral Worker working within the custody suite.
In recognition that a six month pilot will not provide sufficient data to monitor
and evaluate the effectiveness of the initiative, SSPCT has contributed
funding to extend the pilot to 12 months.
The pilot is being commissioned with ADSIS and the preliminary results
have demonstrated that the Alcohol Referral Worker has been very successful
in being able to assess, triage and either provide a structured intervention
programme for the individual, or to refer the client with consent onto more
appropriate services.
Although the pilot was directed at adults, clients under 16 were assessed and
if appropriate referred onto the Young Persons Substance Misuse services
(T3). This pilot is available to both Tamworth and Lichfield residents.
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