Surrey County Council has set up a specialist outreach team to work with the most hardto-reach drinkers.
It was tested in a one year pilot and has now been extended after achieving impressive results with £4 saved for every £1 invested.
Surrey County Council runs a successful alcohol treatment service, but three years ago it decided it wanted to do something different to reach out to those with multiple disadvantage and who were not engaged with services.
So in 2015 the council carried out a review with the Royal Surrey County Hospital to look at the case for change.
It identified that there were 22 adults who had attended A&E four times or more in the preceding 12 months with alcohol as a contributory factor.
The average number of attendances was more than 12, with one person having been to A&E nearly 50 times.
A similar review of admissions data found there were 25 people with four or more admissions where alcohol was coded as a factor.
Laura Saunders, the council’s Public Health Lead for Substance Misuse, said: “It was clear there was a cohort of drinkers who were frequently presenting in crisis, resulting in high costs and little long-term improvement. These individuals were not getting the help they needed.”
In spring 2015 the council’s public health team funded two community outreach workers.
They were employed at the Surrey and Borders Partnership NHS Foundation Trust, which runs the substance misuse service.
In order to develop an approach which would meet the needs of these challenging and vulnerable people, they focused primarily on motivational interviewing and harm reduction with the aim of engaging the clients and working through some of their challenges to be in a better position to engage with structured treatment.
The community outreach workers were given the time to engage in the community in different settings rather than requiring individuals to present at clinics.
The Royal Surrey County Hospital alcohol liaison team provided the referrals with the outreach workers taking it from there.
“The first step was making contact,” Ms Saunders said. “That can involve phone calls, knocking on doors or visiting hostels depending on where the individuals are.
“It is about building trust and then looking at the issues that may sit alongside the drinking – housing, criminal justice or mental health issues. It is a highly skilled form of assertive outreach which needs to be robust, flexible and sensitive.”
The one-year trial ended in April 2016 and showed a good level of success among those it engaged.
A total of 13 clients were supported by the outreach workers for periods of between three weeks and a year.
Nine were successfully transferred into treatment with drinking rates halving among this group. Improvements were recorded in both psychological and physical health, while attendances and admissions recorded by Royal Surrey Hospital fell.
A cost-benefit analysis found a £4 saving for every £1 invested, which is in line with similar work undertaken nationally.
The results convinced the council to expand the size of the outreach team to 4.5 staff – as part of phase two – which was done with the help of funding from the Office of the Police and Crime Commissioner for Surrey.
Catalyst, a local not-for-profit organisation, now provides the service.
Referrals now come from both the hospital and community harm and risk management groups, which consists of police, community safety and housing officers.
Surrey Police and Crime Commissioner David Munro said he was “proud” to be part of the project.
“With the current strains on the police, health and social care services, it doesn’t come as a shock to learn that these people can be in great despair, having often been turned away from other services. Having this support available is invaluable in ensuring client recovery and a safer community.”
Marilyn Davis, the Team Leader at Catalyst, is also impressed. “The approach means that we can work with people to make meaningful change – it can take a few weeks, sometimes even months but the reward is getting someone to where they can engage with support, and to see the positive change. These are very complex and vulnerable people.”
Changes in the thresholds for referral have been a major development.
When the project began, the criteria were narrow as there was only limited capacity.
Only those individuals who were attending A&E regularly, had not been engaged with treatment and drinking a certain amount could be referred to the outreach workers.
But this proved to be too inflexible. Partners struggled to find people that met every criteria.
The focus is now on a wider range of multiagency groups to identify clients they think will benefit from additional support.
The result has been a rise in the rate of referrals and increased focus on the multiagency partners providing a joined-up support and care package.
Last year more than 50 people were supported by the outreach team.
How the approach is being sustained
The outreach work has funding in place until April 2019. In order to ensure that impact and outcomes can be properly evidenced, there are two evaluations currently taking place.
One is by Alcohol Concern, which is looking at the best way to provide the support.
Meanwhile, a broader evaluation is measuring the economic impact by analysing multiagency data across health, social care and criminal justice. The review will also undertake qualitative research to understand operational and cultural barriers and shifts throughout the two-year period.
Once the results of these are known a decision will be taken about the long term future of the programme.
Substance Misuse Public Health Lead Surrey County Council firstname.lastname@example.org