Health First: An evidence-based alcohol strategy for the UK

Health First: an evidence-based alcohol strategy for the UK
related problems. This requires leadership, crossdepartmental
collaboration and partnership with
primary care, specialist community alcohol services
and patient groups. There is good evidence that
this can be achieved by the establishment of multidisciplinary
alcohol care teams 12 . Alcohol care teams
aim to reduce acute alcohol-related hospital admissions
and readmissions not only by providing high quality
support to those who present with alcohol-related
illness but also by developing broad-based strategy to
prevent the development of such illness. Interventions
initiated by alcohol care teams include 13 :
• 7-day hospital-based alcohol specialist nurses;
• psychiatry services specialising in alcohol;
• multi-agency assertive outreach alcohol services;
• integrated alcohol treatment pathways between
primary and secondary care; and
• training in alcohol and addiction for alcohol
specialist nurses and trainees in gastroenterology
and hepatology, acute medicine, accident and
emergency medicine and psychiatry
For example, the Royal Bolton Hospital has an alcohol
care team that includes consultant gastroenterologists,
a liaison psychiatrist, a psychiatric liaison nurse, a liver
nurse practitioner and a dedicated social worker. The
team initiated a hospital-based alcohol specialist nurse
service which provides 7-day support for patients with
any level of alcohol-related problem. The alcohol
specialist nurses assess all alcohol-related admissions,
provide brief interventions and initiate care plans
which may include rapid outpatient appointments with
the community alcohol team and/or detoxification
starting in the hospital. The nurses also run their own
liver disease course for staff and seek to improve
alcohol-related risk management across the hospital.
Outcomes include improvements in the quality of care
received by patients with alcohol-related problems,
substantial cost-savings due to reduced admissions
and readmissions and fewer clinical incidents and
assaults on other patients and nursing staff 14 .
The British Society of Gastroenterology, Alcohol Health
Alliance UK and the British Association for Study of the
Liver have published a detailed set of recommendations
for British district general hospitals serving a population
of 250,000 focussing on the creation of consultant-led
alcohol care teams 15 . These recommendations provide
a framework for the improvement of alcohol services
in hospitals and the development of more effective
collaboration between hospital and community
services to reduce alcohol-related harm.
In the hospital setting, specialist alcohol care teams
have a crucial role to play in the early identification
and management of patients with alcohol-related
problems. However such services must be supported
by adequately resourced specialist community
alcohol services to provide on-going treatment and
rehabilitation of people with alcohol dependence
after they leave hospital. A comprehensive range of
hospital-based and community alcohol services are
needed in each locality based on the level of identified
alcohol-related need.
This diversity of services must deliver for everyone
with alcohol-related problems. Commissioners and
providers should undertake regular health equity
audits to identify and address the range of potential
obstacles faced by local people in accessing specialist
alcohol services. It is crucial that inequalities in alcoholrelated
harm (see page 16) are not exacerbated by
inequalities in access to services. As attendance at
specialist alcohol services can be stigmatising, great
care is needed in the design of these services to ensure
that they are welcoming to all. Here the voluntary and
community sector plays an important role in building
links with communities, promoting specialist alcohol
services and supporting individuals to access the
services they need.
Recommendation
Every acute hospital should have a
specialist, multi-disciplinary alcohol care
team tasked with meeting the alcoholrelated
needs of those attending the
hospital and preventing readmissions.
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