Alcohol services have been changed in east Kent thanks to a co-design process involving staff, service users, local people and stakeholders. It has led to more consistency in services, boosted innovation and improved performance.
Alcohol and drug treatments in Kent are split between the east and the west. The service in the east covers the areas of Swale, Thanet, Canterbury, Ashford and Dover.
Historically drug and alcohol treatments have been run as separate services, but that changed in 2013 when they were integrated. In 2017 a new provider, Forward Trust, was appointed to run services in the east of Kent.
Alcohol support was identified as a key area that needed reviewing as over time variations in practice had developed and there was a desire to achieve better outcomes. The council requested a co-design to be undertaken as a part of development of a new model, involving staff, service users, local people and key stakeholders.
The Forward Trust partnered with mental health charity, Rethink, and placed service users and partner organisations at the heart of the process.
A service design group was established along with five local co-design branches covering the east Kent region. In total 250 services users and more than 70 stakeholders were involved in the six-month exercise, which involved in-depth analysis into the state of current services and what was needed for the future.
The work on alcohol led to a recommendation that dedicated pathways be established. These were established in July 2018.
All service users presenting to treatment are assessed at the point of entry to establish their level of alcohol. This helps to identify their treatment needs and which alcohol pathway is most appropriate. This assessment includes the use of an Audit C questionnaire and Severity of Alcohol Dependence questionnaire if required.
Pathway one is for the most dependent drinkers – those who score 16 on the alcohol screening tool assessment. It involves one-toone support with a key worker and five group sessions aimed at changing behaviour.
This is then accompanied by a range of other support, including family support, longer-term detox if required and a structured 13-week day programme, which combines a range of different therapies; from cognitive behavioural therapy to motivational enhancement therapy.
Meanwhile, pathway two is aimed at the less dependent drinkers and is much shorter with clients being offered three group sessions. Those that need it can then be referred into pathway one.
The introduction of the pathways has had an immediate impact. The number of people starting a structured treatment episode between April to June 2018 – the final quarter before the changes – was 114.
Helping to support and transform the lives of people affected by alcohol 11 In the first full quarter since the changes – October to December 2018 – that figure had risen to 180, a jump of more than 50 per cent. That level has been consistently achieved ever since.
The benefits of the changes can also be seen in the innovative way the service engages families. Herne Bay resident Rachel contacted the service about her husband’s drinking. He had been a heavy drinker for more than 30 years and his alcoholism was destroying their relationship. He had no intention of stopping.
The service worked with her about her approach to his drinking. It was considered her actions, which she described as being confrontational and detective-like – hunting for drinks hidden at home and disposing of them – was actually making the situation worse.
She was taught to put her feelings of anger to one side and work on improving their relationship. Soon her husband began accessing treatment himself.
The service has also been praised by the Care Quality Commission. Inspectors reported that clients found staff “friendly, welcoming, helpful and responsive”.
East Kent Substance Misuse Strategic Commissioner Chris Beale said: “The results are really pleasing. It’s a difficult client group to engage, but the fact we are keeping them involved and getting greater numbers is great.”
When running a co-design process, coordinating partners and maintaining momentum can be a challenge.
Mr Beale said: “It took a little longer than first envisaged and that caused problems in terms of maintaining people’s engagement. We saw the number of people taking part in the codesign process drop quite significantly, which was a shame.
“But these approaches are certainly worthwhile. It helps you build partnerships and find the right solutions. The Forward Trust has started working with some of the local partners that were part of the co-design process to find solutions.”
An example of this can be seen at the Canterbury service, which has partnered with Catching Lives, an independent charity aimed at supporting rough sleepers and homeless people. It is seeing a more holistic approach taken to this vulnerable client group involving health trainers alongside substance misuse support.
How is the approach being sustained?
A formal evaluation of the new pathway is being carried out by The Forward Trust, while the council is in the process of carrying out a full needs assessment for both alcohol and drugs misuse. The review will be available later this year and help inform the future direction of services.
Council Public Health Specialist Lin Guo, who is carrying out the needs assessment, said: “This will be a very important process. It will give us a clear idea of what we need to do and build on what has been achieved so far.”
Chris Beale Strategic Commissioning Kent County Council email@example.com