Oxfordshire’s substance misuse has seen an improvement in performance for clients with alcohol problems after re-organising the way clinics are delivered. The service introduced segmentation – grouping together clinics with similar clients.
Oxfordshire covers a largely rural area as well as the city of Oxford. More than 680,000 people live in the county, and recent estimates indicate there are more than 5,500 people with alcohol dependence.
Like many areas it has moved to an integrated substance misuse service, covering drugs and alcohol.
Kate Holburn, Oxfordshire County Council’s Head of Public Health Programmes, said: “There is a lot of sense to integrating services – it allows a seamless and coordinated approach for people who need alcohol or drug support.
“However, there are concerns this can lead to some people who solely have alcohol problems being put off. They may not feel that a service also offering support for drug users is right for them.
“A few years ago we were aware that we needed to look at our alcohol performance – and also at how this could be an issue.”
In 2015 a new provider, Turning Point, was appointed to run the service. Working with the public health team, Turning Point looked at how services were organised.
The decision was taken to introduce a new way of working called segmentation. The substance misuse service is operated from four hubs – in Oxford, Banbury, Didcot and Witney – along with a number of satellite clinics in locations such as community centres and GP surgeries. Segmentation involves ensuring people with a similar scale and type of problem are attending the clinics at similar time.
Timetables of clinics were reorganised, creating times of the week when only those with alcohol problems would be at the clinics as well as dedicated sessions aimed at people in similar circumstances.
Wednesday afternoons were cleared to run a series of clinics for people with complex drug misuse problems. “During those times other clients, such as those already engaged on an alcohol treatment programme will not attend,” said Ms Holburn.
“Segmentation allows the same space to be used for treating clients with a range of severities of addiction, while avoiding them being in the same place at the same time.
“For example clients who have detoxed from alcohol and are engaged with recovery clinics attend at different times to clients who are currently using drugs. This ensures they are not distracted from their own treatment focus.”
Father-of-three Rob is the perfect example of the type of client segmentation benefits. He is 48 and works in Oxford as an accountant. His drinking had escalated in recent years due to pressures at work and home. He started drinking five evenings a week, consuming four to five bottles of lager at a time.
He put off seeking help, worried about using the substance misuse services. Eventually things got so bad he contacted the service and was given an appointment at the Resolution Clinic; a dedicated evening alcohol service aimed at workers who would like to reduce their drinking to safer limits.
He attended five weekly one-to-one appointments and was able to look at different strategies to reduce his drinking and improve his general wellbeing.
He said: “It was great and not what I expected. It was really practical. It feels good to be drinking less and I have even started walking to work.”
The benefits of segmentation can also be seen in terms of the improvement in overall performance. The latest successful completion rate of courses relating to alcohol use in Oxfordshire is 52.7 per cent, compared to a national average of 37.8 per cent. This has grown from 27.8 per cent three years ago - close to a two-fold rise.
Ms Holburn says changing services in this way requires patience. “When Turning Point came in they had build new relationships within the system, assess services and the need among the population, and support staff moving to the ethos and culture of a new provider”.
“All that takes time – so you have to be patient. It was several months before they could start the segmentation approach. We are seeing the benefits now, but you do need a close relationship with your provider.”
“In the first year we monitored progress with strategic implementation meetings, which were attended by partners from across the system. We also have quarterly contract monitoring meetings to look at performance and service developments to ensure the service is meeting the evolving need.”
How is the approach being sustained?
The idea of better targeting services at specific populations is being further developed thanks to £215,000 of alcohol capital grant funding provided by Public Health England. The money was announced in spring 2019 as part of PHE’s capital grants programme. This will be used to create a dedicated alcohol service within a new homelessness hub in Oxford and a clinic at the Salvation Army’s homelessness centre at Bicester.
The money is also being used to develop family-focused alcohol services at community venues, and a new alcohol-only wing is being created at another local hub.
Ms Holburn said: “It will give people with alcohol problems their own space. The aim is to make services more appealing and accessible – if people can’t easily get to services or don’t feel like the service is aimed at them they are less likely to engage with treatment.”
Kate Holburn Head of Public Health Programmes, Oxfordshire County Council firstname.lastname@example.org