A social care organisation is identifying and engaging dependent drinkers at three hospitals to help them turn their lives around
The first thing Graham Woods notices when he goes into Sunderland Royal Hospital is the large poster with Turning Point's name on it. "It's a great sense of achievement to see health and social care integrated so well in an NHS setting," he says. Mr Woods is a business director for social care organisation Turning Point, which is now an established third sector provider in the hospital.
Mr Woods has worked with Sunderland Royal Hospital to spearhead a pioneering partnership service which enables frontline health staff to identify dependent drinkers and refer them to one of the Turning Point liaison workers based at the hospital. In October the two workers saw 51 people. Their role is to offer one to one support, give information on the effects of alcohol use and safer drinking practices, assess ongoing support needs and refer to specialist community based alcohol treatment services.
These services look not only at alcohol use but also wraparound issues such as housing, employment and mental health.
Cost to society
Alcohol is known to feature in an increasing proportion of hospital admissions, either due to drink related illnesses or to incidents that take place when alcohol is being consumed. In 2007, alcohol cost the health service£1.7bn in England alone, directly accounting for 12 per cent of its budget in hospitals.
The savings to the public purse can be substantial. Mr Woods says: "We are trying to stop people becoming NHS 'frequent flyers', where they end up in accident and emergency and other hospital departments and are patched up, only to return to see the same staff in a week or two.
"This scheme gives staff a chance to do something different with these patients, and that can only be a good thing on, say, a busy night shift. This also means that fewer resources are spent supporting people in hospital because there is nowhere else for them to go."
Mr Woods is passionate about how problematic alcohol users can be identified and engaged and also differentiated from people who have been binge drinking on a night out (perhaps at a Christmas party) and who ended up in hospital as a result, but will be back at work within a few days.
The Turning Point project aims to identify which of these people need extra support because they are in danger of developing, or already have, a dependent drinking habit with the associated damaging impact on their health.
Turning Point workers operate the scheme in three hospitals. Along with Sunderland, there is a service in Gateshead and one in Watford.
Hospital based interventions
"When people ask me if we 'chose' these hospitals because the towns have a bad drinking reputation, I respond by explaining that there is problematic alcohol use in the catchment area of any English or Welsh hospital," says Mr Woods.
"What our partner primary care trusts did was to take a chance at innovation and they commissioned us to deliver hospital based alcohol interventions."
A unique form of "social care triage" takes place through the service. Nurses carry out an assessment questionnaire and it soon becomes clear who may need to be offered an appointment with Turning Point.
One vital factor, though, is the patient's agreement. "No one is forced into treatment because we know that would backfire.
"Also, often people don't consider themselves to be 'drinkers'. We had a case recently where someone ended up in hospital with pancreatitis, even though their alcohol intake was low in comparison with most of our referrals," says Mr Woods. "This underlines the message that even moderate regular alcohol use above government guidelines can be damaging to health, but if we tried to force people into treatment, they would probably walk out.
"The key is in motivating people to change, but we also look at other issues in their lives. They're not just problem drinkers: a high proportion have a range of co-existing problems such as debt and mental health issues.
"However, some people will turn us down point blank and we spend a significant amount of time attempting to plant the idea of treatment in their head."
The aim of providing targeted support in hospital wards and A&E departments is to ensure that patients can get support at a time when the need for change may be most apparent to them. Ending up in a bed in a hospital because of drinking presents a unique window of opportunity as this may be a "denial-breaking" moment for an individual.
Mr Woods is keen to point out that in this process of identifying people who are at risk of alcohol dependency, it is the NHS that starts the ball rolling with the referrals. "But there's no hierarchy - everyone works together," he says. "Staff are very happy to have our workers on the premises."
He says Turning Point has a clear understanding of what it aims to achieve. "Half of this is about what we are providing; the other half is culture change."
Professionalising and equalising the relationship between the NHS and the third sector is an important feature of this new way of working.
The organisation has just heard that following a successful pilot in Watford, Turning Point colleagues have the go-ahead from the local PCT, as part of the area's crime reduction partnership, to develop the services across Hertfordshire. In the North East, local PCTs have a clear priority to expand this service where possible.
"It would be great to see this type of service being the norm in every hospital across the country," says Mr Woods.
Alcohol misuse costs the UK£18bn-£20bn a year (Cabinet Office, 2003)
Despite the widespread harm caused by alcohol misuse, estimates from Alcohol Concern have shown a shortfall of up to 200,000 places in treatment each year
Every£1 spent on treating people with alcohol problems would save£5 in spending on other aspects of health and social care and the criminal justice system
In 2003 the Strategy Unit alcohol harm reduction project showed alcohol was implicated in around 35 per cent of accident and emergency department attendances and ambulance costs - at a cost of£500m per year
Source: Alcohol Concern