Agenda item

NHSE funded pilot to support frequent attenders to ED with complex Alcohol and Mental Health needs

Amanda Marklew, TRFT, to report on the successful pilot supporting frequent attenders to ED with complex Alcohol and Mental Health needs with outreach team


Amanda Marklew, Lead Transformation Nurse Alcohol Liaison Service, gave the following powerpoint presentation:-


¾     Rotherham was identified as a national optimum treatment site and the only one of the of 4 eligible sites to apply for NHS funding,  The brief was non-nursing, specified patient group who had alcohol and mental health problems and model to evidence some positive patient outcomes and showcase same


Identifying patients

¾     All patients would consent when offered the extended care option

¾     Identified current patients known to be high users of services and frequent attenders to A&E

¾     Patients in crisis

¾     In-patients as assessed for need


Community Based Approach

¾     Patients identified

¾     Patient assessment by Specialist Nurse

¾     Patient discharged with option of Community support


Community Outreach and Support Team for Alcohol and Mental Health

¾     Acute Alcohol Care and Mental Health Services identify caseload via HIUG and FF forms

¾     COAST consists of 4 x non-Nursing Community and Lifeskills Mentors

¾     Multi-disciplinary approach out into community

¾     All relevant services involved in care planned approach


Results for Rotherham patients who engagement with Outreach Team

¾     29 patients have completed care under the Outreach Team during this time period

¾     2 patients (7%) had no admissions or attendances in the 6 months period before discharge

¾     Ambulance use 64 pre/26 post

¾     UECC attendances 85 pre/64 post

¾     Admissions 37 pre/21 post


Improved Outcomes

¾     Community partnership approach

¾     Joint initiatives and a shared vision – no longer standalone including commissioning

¾     Greater understanding of the ‘bigger picture’

¾     Shared investment and collaborative multi-disciplinary working

¾     Consideration to improvements within the wider community

¾     ‘Living well for longer’ – Harm to Hope and Suicide Prevention


Discussion ensued with the following issues raised/clarified:-


·        A huge reduction had been seen in the number of A&E attendances.  This would be replicated by South Yorkshire Police and South Yorkshire Ambulance Service

·        The Service was available 7 days a week unlike many services

·        Every patient was assessed by a nurse specialist.  They were discharged with community support

·        A large number of patients were of the older generation/housebound/had learning disabilities or several disabilities

·        Cases were becoming much more complex and the numbers increasing

·        Funding secured for a Drugs Nurse so the project would now cover both drugs and alcohol

·        Hull University had selected the project to carry out research on the model

·        The average cost of 1 frequent attender was £32,000 a year.  The project was stopping that attendance and improving their lives

·        Not all participants were successful in stopping their alcohol dependency but had had a better death from living well for longer.  A typical caseload was 40 patients with most stopping drinking within 6-8 weeks.  Only 5 patients had been referred to Mental Health Services in 10 years


Amanda emphasised that the funding would end in March 2024.  Discussion ensued on the anticipated savings that would have been achieved by the project in relation to the reduced number of frequent attenders at A&E, the use of Police time/ambulances and reduced number of referrals to other service providers.  If there was the evidence basis, it was possible that consideration could be given to options available to continue the Service.


Amanda was thanked for her presentation.


Resolved:-  That the financial information requested be submitted to Leonie Wieser as soon as possible to assist further discussions with partners.

ACTION:-  (1)  Leonie Wieser to follow up with Amanda Marklew


(2)  Chris Edwards and Sharon Kemp, as Chairs of the Place Board, to consider the evidence and future of the project.

Supporting documents: