COLLABORATIVE, SEAMLESS,
PATIENT-CENTRED,
ALCOHOL CARE IN BOLTON

ALCOHOL CARE MODEL
(1990-ONGOING)
 Pioneered, Sustained, Evolving
 Patient-Centred, Seamless, Holistic
 Collaborative Gastroenterology / Psychiatry / Community
 Teamworking
 Governance
 Audit, Research
 Training, Education
 Health Promotion
 Impact / Replicable

1990
 Established Multidisciplinary Team
 Weekly (1-2) Discuss Inpatients
 Nurses, Doctors, Dietician, Physio, OT,
Pharmacist, Chemical Pathologist, Speech
Therapist, Asian Link Worker, Social Worker
(Critical)
 Optimised, Unified Care
 Facilitated Discharge Planning
 Everyone Valued
 Teamworking Ethos

1993
 WENDY DARLING
- Consultant Psychiatrist
- Substance and Alcohol Misuse
 JOINT INPATIENT CARE
 SIMULTANEOUS ALCOHOL CLINIC
- Monthly

INITIAL PROBLEMS / PREJUDICES
OVERCOME
 NIGHTINGALE WARDS
- Risk Management, Privacy
- Ward Drinking, Drug Misuse
- Advocated / Planned GI Ward
- Opened 2007
- 8 Side Rooms
 SELF-INFLICTED DISEASE – Non Judgmental
 REMOVED STIGMA
- Asian Community Elders

1998 – DAVID PROCTOR –
PSYCHIATRIC LIAISON NURSE
 Hospital/Community
 MDT Member
 Brief Interventions
 A&E, Acute Admissions, Gastroenterology,
Psychiatry, Orthopaedics
 Firefighting
 HCP Training, Education, Screening Strategy
 Joined Simultaneous Alcohol Clinic
- 2 per Month
- Facilitated Communication
- Reduced DNA’s

DAVID PROCTOR (P.L.N) IMPACT
 PATIENTS’ RESOURCES
- Asian
 LIAISON
- GP’s
- Rapid Response Community Detoxifications
- C.A.T.
- Other Agencies
 METICULOUS AUDIT/RESEARCH DATA
- Alcohol Misuse In Older People (2006)
Collaboration Cabinet Office Strategy Unit
- Wernicke-Korsakoff Syndrome (2007)

2006
 Sandra Crompton Medical Liver Nurse Practitioner
 Partners Emma Dermody, Hospital / Community P.L.N.
 Gastroenterologist / Psychiatrist Supervision
 Monday - Friday, 8am. Jointly Triage All Admissions
- Brief Interventions
- Inpatient Detoxifications Reduced 50%
- Saves Trust 1000 Bed Days (£300,000) Annually
- Rapid OPD – Sandra, Emma, C.A.T
- Assess Inpatients Daily  Reduced Violent Incidents

JOINT GASTROENTEROLOGY/
PSYCHIATRY NURSING
 Weekly Clinic. Simultaneous with Doctors
 Open Access – Phone, Secretaries, Ward
 Regional Referrals
 Improved Abstinence
 Excellent Patient / Carer / Staff Satisfaction
 Feedback Adaptation
  Waiting Times, DNA Rates, Length of Stay
 Network 50+ Link HCP’s
 Education/Training/Support/Audit/Q.A
 Data for Health Commissioners
 District Health Promotion

2006 CLINICAL GOVERNANCE
MEETINGS
 Transparent, No-Blame Culture
 All Deaths, Inquests
 Clinical Incidents, Complaints
 End of Life Care
 Infections – MRSA, Cl. difficile
– Root Cause Analysis
– 50% Reduction
 Feedback – Trust Governance
– Adaptation
– Audit, Closing the Loop

SEAMLESS BOLTON DISTRICT
ALCOHOL CARE
2007
2007/08
2008
2008
UNIFIED PRIMARY, SECONDARY, C.A.T
DETOXIFICATION
- Lean Methodology, Saves Bed Days
INTEGRATED BOLTON MULTIAGENCY
ALCOHOL STRATEGY
3 HEALTHCARE AWARDS
- Access, Care, Overall Team Of The Year
Pivotal Role with Public Health Team,
Multiagency Partnership persuading
DH Team for Health Inequalities to make Bolton Early Implementer of National Alcohol Strategy

ALCOHOL-RELATED DISEASE
Meeting the challenge of improved quality of care and better use of resources
A Joint Position Paper on behalf of the
British Society of Gastroenterology,
Alcohol Health Alliance UK and the
British Association for Study of the Liver

RECOMMENDATIONS
DGH serving a population of 250,000

Key Recommendation (1)
DGH Requirement
A multidisciplinary “Alcohol Care Team,” led by a
Consultant, with dedicated sessions, who will also collaborate with Public Health, Primary Care Trusts, patient groups and key stakeholders to develop and implement a district alcohol strategy.

Key Recommendation (2)
DGH Requirement
Coordinated policies on detection and management of alcohol-use disorders in Accident and Emergency departments and Acute Medical Units, with access to
Brief Interventions and appropriate services within 24 hours of diagnosis.

Key Recommendation (3)
DGH Requirement
A 7-Day Alcohol Specialist Nurse Service and Alcohol
Link Workers’ Network, consisting of a lead healthcare professional in every clinical area.

Key Recommendation (4)
DGH Requirement
Liaison and Addiction Psychiatrists, specialising in alcohol, with specific responsibility for screening for depression and other psychiatric disorders, to provide an integrated acute hospital service, via membership of the “Alcohol Care Team.”

Key Recommendation (5)
DGH Requirement
Establishment of a hospital-led, multi-agency
Assertive Outreach Alcohol Service, including an emergency physician, acute physician, psychiatric crisis team member, alcohol specialist nurse, Drug and Alcohol Action Team member, hospital/community manager and Primary Care Trust Alcohol
Commissioner, with links to local authority, social services and third sector agencies and charities.

Key Recommendation (6)
DGH Requirement
Multidisciplinary, person-centred care, which is holistic, timely, non-judgmental and responsive to the needs and views of patients and their families.

Key Recommendation (7)
DGH Requirement
Integrated Alcohol Treatment Pathways between primary and secondary care, with progressive movement towards management in primary care.

Key Recommendation (8)
DGH Requirement
Adequate provision of Consultants in gastroenterology and hepatology to deliver specialist care to patients with alcohol-related liver disease.

Key Recommendation (9)
DGH Requirement
National Indicators and Quality metrics, including alcohol-related admissions, readmissions and deaths, against which hospitals should be audited.

Key Recommendation (10)
DGH Requirement
Integrated Modular Training in alcohol and addiction, available for alcohol specialist nurses and trainees in gastroenterology and hepatology, acute medicine, accident and emergency medicine and psychiatry.

Key Recommendation (11)
DGH Requirement
Targeted funding for research into detection, prevention and treatment strategies and outcomes for people with alcohol-use disorders.

CONCLUSION
Many of these recommendations can be implemented by intelligent re-organisation and co-ordination of existing alcohol services, while some require investment in people.

“We never give up on anybody, even when they have given up on themselves.”