As part of the Sound The Alarm campaign, the British Liver Trust is calling for every NHS Trust to have an alcohol care team to support those who drink too much and to refer people who have alcohol-related liver disease to specialised teams.
Graeme White, Head of Addiction Services at University Hospitals Dorset NHS Foundation Trust, explains the impact that his alcohol care team has on patients in his area.
Please tell us about your team
"I lead an alcohol care team comprising of specialist addictions nurses, a recovery navigator, a team of assertive outreach alcohol workers and administrators. The team’s clinical lead is a consultant gastroenterologist/physician. The team offers treatment and care to people who have attended hospital due to their use of alcohol, across Dorset, seven days per week."
What can someone expect if they’re referred to your team?
All patients admitted to hospital are asked a series of questions about their use of alcohol (screened). If it’s clear they need some extra support managing their drinking, they’re referred to us. Depending on the patient's ‘score’ they will see either our recovery navigator for a brief intervention, or a qualified addiction nurse for those with a higher score. The specialist addiction nurse will thoroughly assess each person using a ‘bio-psychosocial’ model of assessment. This is a holistic approach that takes into account their mental wellbeing, social needs and physical health before we work together to create a bespoke plan for treatment and recovery.
The plan varies from person to person, but it could include information about how to gradually cut down how much they drink or a referral on to our colleagues in the community. Due to their severity of alcohol dependence, some people may need to start an alcohol detox program of treatment in hospital, while others can be supported at home and complete detox as an out-patient.
We try to make sure patients have consistency in which team member they see, so they can build a good relationship with them. A huge part of our ethos is supporting the patient’s loved ones too, so we always encourage their friends and family to ask us any questions they have at any time. We are also able to signpost friends and families to carer support groups locally.
What difference does the alcohol care team make?
Before the introduction of alcohol care teams, patients who drank too much alcohol might come to hospital for another reason, such as a fall, and after a day or so they’d be sent home with no further support. Readmission into hospital would be more likely, resulting in a deterioration of their health and wellbeing. Now that we are able to see patients, we can ensure they get the support and advice they need which helps them achieve their recovery goals. Of course, addiction is complex so recovery takes time, but I’m really proud of the positive impact our team has on those we see.
A good example of our input with a patient is George. George was admitted to hospital because his physical health was deteriorating. Once it was identified that George's ill health was caused by his use of alcohol over a number of years, he was referred to us. After an assessment, we discovered that George was drinking excessive amounts of vodka on a daily basis, starting earlier each morning. After successfully completing an alcohol detox, George was offered support from our assertive outreach alcohol team at home to help with his ongoing recovery. George’s outreach worker was able to gradually support his attendance with his local community alcohol team, where he continued to improve, resulting in George carrying out some work as a volunteer. Eighteen months on and George is now back in paid employment for the first time in a number of years.
Sadly, not all patients have the same outcome as George, which is one of the reasons why I support the British Liver Trust Sound The Alarm campaign, calling for every NHS Trust to have an alcohol care team.
There has been a big increase in calls to the British Liver Trust’s nurse-led helpline during the pandemic. Has this been reflected in your service too?
Over the last year we have seen a fairly steady flow of referrals numbers wise, however we have noticed that a percentage of patients are a great deal more poorly than usual, which further evidences the need for alcohol care teams in hospitals across the country.