The second review of this case study has been undertaken. Additional information about implementation of the initiative has been added for the lead site, The Royal Bolton Hospital. In addition, alcohol specialist nurse services have now been introduced at Queen Alexandra Hospital in Portsmouth and NHS Hampshire. The original case study was published to the Quality and Productivity (formally QIPP) collection in February 2011 and reviewed in September 2012.
The principal component of this initiative is for a multidisciplinary Alcohol care team in each district hospital, led by a consultant with designated sessions, who will collaborate across hospitals and primary care, to develop a coordinated alcohol treatment and prevention programme. This team would organise systematic interventions and alcohol specialist nurses.
It is estimated that the annual cost of alcohol-related harm to the NHS in England is £3.5 billion (Public Health England 2013). Of this cost, 78% was for hospital-based care, and 45% was for inpatient care (NHS Confederation and Royal College of Physicians 2010).
A significant proportion of this spending is avoidable. Alcohol services could be more effective, cheaper and person-centred if each area had a plan to deliver evidence-based care in an appropriate setting, integrated between primary and secondary care.
Until recently, very few hospitals had dedicated alcohol services, and a 2009 survey showed that only 42% of acute hospitals had any alcohol specialist nurse support (Ward et al. 2009).
Alcohol care teams coordinate policies of care across acute departments, including accident and emergency (A&E). They provide access to brief interventions and appropriate services within 24 hours of the detection of alcohol-related problems. Structured advice lasts for 20–40 minutes and involves personalised feedback to people about their level of health risk because of alcohol consumption, practical advice about reducing alcohol consumption, with a range of options for change, and written information to support the advice.
Hospitals have coordinated policies of care for patients with alcohol-related problems in A&E and acute medicine departments, including a 7-day alcohol specialist nurse service, a mental health crisis team and alcohol link workers’ network.
Each health area can establish a hospital-led, multi-agency alcohol assertive outreach service to move the most frequent attendees and biggest consumers of hospital resources into a more appropriate, supported, community environment. These initiatives may require a degree of investment to get them up and running.
After the annual review of this case study, updated information was added to the ‘Savings delivered/anticipated’, 'Evidence of effectiveness’ and ‘Details of implementation’ sections of this document.