Liverpool Community Alcohol Service (LCAS)

Part 1: Why?

Alcohol Related Admissions for Liverpool PCT (residents) 2002/03 to 2008/09 by Condition Group.

0

500

1000

1500

2000

2500

3000

3500

2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009

Rat

e pe

r 10

0,00

0

Chronic Conditions Rate

Wholly Attributable Rate

Acute Consequences Rate

Trevor McCarthy: September 2010

The treatment paradox

• Most alcohol harms are associated with people whose drinking is hazardous & harmful

• Dependent drinkers linked with greater degrees of harm

• But there is so much drinking that the hazardous & harmful drinkers harm outweighs that of dependent drinkers

• So where to go with Treatment?• In other words tier 4 v rest

ALCOHOL-RELATED DISEASE• Joint BSG, Alcohol health alliance, BASL• Each DGH should have;-

• Alcohol Care Team• AED, AMU policies detox, BI, EBI• 7 day ANS, ALWN service• Liason and Addiction Psych • Assertive Outreach Alcohol Service• Multidisc, patient-centred care• Integrated Alcohol Treatment pathways• Adequate GI Hepatology Consultants• NI and Quality metrics• Integrated Modular Training alcohol and addiction• Targeted funding for Research detection, prevention, treatment

Trevor McCarthy: September 2010

Practice Recommendations (9-12)

• 9 Screening adults• 10 Brief advice for

adults• 11 Extended brief

interventions for adults• 12 Referral

Liverpool Community Alcohol Service (LCAS)

Part 2: The story so far

Modelling solutions

24/04/2023

Assertive Outreach

30+30High Fraction /

Frequent Admissions

Hospital Alcohol Nursing Service6 Wte

7 day Service

Leadership

£270k

£390k

400 admissions

133 NI39s

= -1%

475 admissions

475 NI39s

= - 4%

InvestmentBenefits Realisation

Investment and payback

. • If each region implements the Case for Change £35 million.

• Crucially, to make the savings it requires a shared approach between PCTs and Acute Trusts

24/04/2023

Service Cost £ Bed Liberation Tariff

Liberation £Hospital

Alcohol Nurse Team

£270k 2 beds £698k

Assertive Outreach £390k 8 beds £895k

£660k £275k £1,593k

Community?

• PCT and Public Health• Councillors• Politicians• GPs• Local Leaders• Advocates• Champions• Volunteers, Champions• Mums, Dads, Brothers, Sisters

Number in Treatment APRIL 2010

% of all those in treatment1

Windsor Clinic 369 53.8

Liverpool CIC Addiction Service 309 45.0

Spider Project 126 18.4

Young Addaction Liverpool 101 14.7

Park View Project 93 13.6

Liverpool YOT 55 8.0

Sharp Liverpool 48 7.0

OK UK 40 5.8

Alternatives LHT 26 3.8

Summer Grove 22 3.2

Transit 19 2.8

Other (Services with just 1 client) 11 1.6

Liverpool Croxteth Addaction 7 1.0

MERC DRR 5 0.7

Liverpool Criminal Justice Addaction 4 0.6

Phoenix Futures Wirral Adult Services 4 0.6

StreetScene Bournemouth 4 0.6

Chatterton Hey 3 0.4

St Helens Community Integrated Care 3 0.4

St Helens YP 3 0.4

Indepedence Initiative 2 0.3

Lampton Court 2 0.3

Sefton Park 2 0.3

Turning Point Residential Rochdale 2 0.3

Numbers in Primary Alcohol Treatment by Treatment Provider, APRIL 2010

NB. We did not interview the vast majority of treatment providers during the visit. Our recommendations should be considered in this context

Service?Alcohol Harm ReductionNational Support Team

Liverpool Visit June 2010

• Themes• Overall strengths• Good innovative practice• Scale of Challenge• Priority actions

Alco

hol H

arm

Red

uctio

n N

ation

al S

uppo

rt Te

am

Data

• Alcohol service data lacking• Performance monitoring• Sub regional network CHaMPS• Lifestyles Tier 3 need to input data

Priority Actions• Clear Communication• Project Plan• Avoid confusion, duplication• Investment available ££s• Trial projects now• Pool data use all available• Clear roles at all tiers 1-4• Strategy re-write• Partnership across teams• NST follow up support 6-8 weeks

Liverpool Community Alcohol Service

ProcurementFull Competitive Tender

Development of Treatment ModelService SpecificationProcurement Process

An Experienced Team

• Established ACT 2002• Regional Liver Centre MDT• Expert management of

alcoholism• Complex patients • Proven admissions avoidance• Lead a network of providers and

experts in Public Health • Proactive advocate

• Windsor Clinic from 1978• Expert addiction psychiatry• Provides MoCAM tiers 2 to 4

services across C&M• Expertise to support

community treatment interventions & early discharge

• Reduce secondary care length of stay

A Robust Working PartnershipCommon goals and aspirations for this community-based clinical service

Aintree Foundation Trust Mersey Care Trust

PRIMARY CARE GPs Practice NursesLCAS neighbourhood Alcohol Nurse serving each GP

cluster or neighbourhood

LIVERPOOL COMMUNITY ALCOHOL SERVICE

Alcohol Nurse Specialist Team7/7

RLBUHMDT

Joint Alcohol TeamMeeting

Assertive OutreachFrequent Flyers

Alcohol Nurse Specialist Team7/7

Aintree Hospitals NHS TrustMDT

Long termResidential

NGOs

WindsorMerseycare

HepatologyPsychiatryAlcohol Nurse SpecialistOT, NutritionPhysiotherapySocial WorkerClinical Support

TIER 1

TIER 2

TIER 3

TIER 4

- Whole System Partners Across Liverpool -Delivering the Difference

For Commissioners

Value for MoneyLow tech, measurable intervention

Liver specialist + Addiction Psych Tier 4 Back up

Proven expertise, highly experienced.To prevent complex, expensive admissions

DoH ALOS for ALD 18/7

Successes so far

• Early implementation, Community centres• Satisfied service users• Dedicated, caring skilled nurses• LCAS service user group developed• Annual report produced• Engagement with community• Pharmacological management in community• Integration with Acute/Mental Health/Community• Data to ATMS – Public health for future service delivery

- Whole System Partners Across Liverpool -

Delivering the Difference

As Providers - Where are we now?The proposed service model will deliver the required service specification in full

IN ADDITION1.Clients are partners in the treatment programme – ownership and choices2.The partnership will allow us to safeguard and deliver a seamless wrap around service user journey– right care , right time3.Immediate start; premises and experience4.Proactive assertive out reach approach to hard to reach groups5.Web based interventions6.GP advisors and active outreach and engagement with primary care 7.Links with clinical champions in other organisations 8.Single assessment process, documentation and information system

• Q10

• Overall are you satisfied with the care that you have received?• • • Result• • • • • Percentage• • • • • • Of the 31 respondents 31 (100) stated that they were satisfied with the care that they had received.• • • There were 6 comments made in relation to this question• • Comment 1 – A respondent who answered ‘Yes’ to the question wrote:• ‘Without the time given to me I really don’t know where I would be right now’• • Comment 2 – A respondent who answered ‘Yes’ to the question wrote:• ‘I was very satisfied with all the care I have received’• • Comment 3 – A respondent who answered ‘Yes’ to the question wrote:• ‘A very excellent service. Full marks.’• • Comment 4 – A respondent who answered ‘Yes’ to the question wrote:• ‘The counsellor I have seen recently was very good. She was sincere, had information sheets, details of complimentary services. Intuitive Recovery course for

me was very positive’• • Comment 5 – A respondent who answered ‘Yes’ to the question wrote:• ‘I was very satisfied with the overall quality of care. Other than a free holiday in the Bahamas I don’t think there’s anything you can add to your service’• • Comment 6 – A respondent who answered ‘Yes’ to the question wrote:• ‘Could not have asked for better. The service and support has been excellent. I was listened too and felt safe. I work in the NHS so was worried about seeing

people I may know however couldn’t have been more safe, and confident about the trust I felt with Keiley. She has been a real star. Thank you’•

LIVERPOOL COMMUNITY ALCOHOL SERVICE

Service User Satisfaction SurveyQuarter 3 – 2012

• Actions • More accompanying info, partner services• Receptionist discretion• Bigger survey next time, rating scale• Friends and Family test • Patient progress and ‘outcomes’

• Jan – Dec 2012 there were 878 patient assessments within secondary care

• 322 were discharged from AED avoiding a hospital admission.

• 1288 bed days. • Of the 878 patient assessments undertaken 78

patients were assessed as appropriate for implementation of the Early Discharge Policy (EDP).

• 156 bed days saved.

• Savings to the Health Economy from the Liverpool Community Alcohol Service (LCAS) Intervention

• Scenario 1• Assumes:• That patients within the LCAS service who have been started in prescribing treatment would have benefited

from either discharge from AED or early discharge. • 34% of 4015 contacts = 1365 patients.• That, as observed within the Aintree service, 80% patients (1092) are discharged from AED and 20% patients

are discharged early from a ward based environment.(273)• If we apply a reduced bed day saving of 2 days to these figures; the total savings, to the Commissioner, from

admission avoidance is £626,808 and the total savings, to the Provider, from early discharge is £156,702. This gives a total saving of £783,510 to the Liverpool health economy as a result of LCAS intervention.

• Scenario 2• Assumes:• That, as observed in the Aintree service, 45% of LCAS contacts would have resulted in either admission

avoidance or early supported discharge (1807 patients)• That, as observed in the Aintree service, 80% of these patients (1445) are discharged from AED and 20%

patients (361) are discharged early from a ward environment.• If we apply a reduced bed day saving of 2 days to these figures; the total savings, to the Commissioner, from

admission avoidance is £829,430 and the total savings, to the Provider, from early discharge is £207,214. This gives a total saving of £1,036,644 to the Liverpool health economy as a result of LCAS intervention.

•

• Scenario 3: Uses the data available from DFI on alcohol related admissions and average length of stay•DFI data indicates that between January 2012 and December 2012 there were 213 fewer alcohol related spells than previously observed. If we apply a the observed average length of stay bed day saving of 7.1 days to this figure this gives a saving, to the Commissioner, from admission avoidance of £434,030.•DFI data indicates that between January 2012 and December 2012 the total observed bed days totalled 31,656 against the total expected bed days of 24,792. If we apply the bed day saving to these figures this gives a saving, to the Trust, of £900,032.This gives a total saving of £1,334,062 to the Liverpool health economy as a result of LCAS intervention.

Date Observed Spells Expected Spells Observed LOS Observed Bed Days Expected LOS Expected Bed Days01/01/2012 430 430 6 2580 7 301001/02/2012 377 430 7.9 2978 6.8 256401/03/2012 429 430 6.8 2917 6.6 283101/04/2012 411 430 5.4 2219 6.6 271301/05/2012 466 430 8.1 3775 7 326201/06/2012 451 430 6.2 2796 6.8 306701/07/2012 401 430 6 2406 7 280701/08/2012 431 430 6.1 2629 6.7 288801/09/2012 411 430 9.6 3946 7.1 291801/10/2012 361 430 8.3 2996 7.8 281601/11/2012 383 430 6.3 2413 7.9 302601/12/2012 396 430 9.5 3762 7.3 2891TOTAL 4947 5160 31656 34792

Admissions saved 213 Bed days saved 3136

Liverpool Community Alcohol Service (LCAS)

Part 3: Next steps.....

Priorities – Work streams

• Communication Strategy (inclusive of community engagement work stream)

• IT Strategy and Focus group• Data analysis – (data check)• Data definition review• KPI review – to ensure reporting is measured

and meaningful

Real Challenges• Increase numbers, use capacity, improve data collection• One stop shop model• Target low referring practices• Occupational Health• IT focus group

NWAC, now in its fourth year• Alcohol and Primary Care • NHS CIP• Economy• MUP• Women’s health• Licensing• Advertising

More actions• Communication group – which will include community engagement• IT input to be via Merseycare informatics group• Feedback questionnaire to be revised• Manual data collection to commence in April• Summary of data collection processes at both sites• Once data collection completed for April meeting to be arranges prior to

contract meeting (MAY) to discuss figures in contract

• Report outline to be proposed • Away day June • Update on current service• Future plans• SMART objectives to be agreed by the team

In summary

• Liverpool no longer top of the league!• Hospital admissions bucked the National trend• 5th successive year Alcohol death rate has

reduced• An effective service• TEAM EFFORT