Sandwell Metropolitan Borough Council: Targeting the most problematic drinkers

Sandwell MBC has partnered with Alcohol Change UK to run a project aimed at the most change-resistant drinkers. It targets those who are alcohol dependent, a burden on public service and not engaging with treatment, by surrounding them with support.

The challenge

Sandwell is the 13th most deprived borough in England. It has significantly higher levels of alcohol-related hospital admissions – more than 2,000 a year - and premature mortality – 170 a year - than the national average. Furthermore, more than 1,400 alcohol-related crimes are committed every year.

It is estimated there are around 4,700 dependent drinkers in the borough. The numbers being reached by alcohol treatment services has been rising, but still only 16 per cent of them get support.

Among those are a few hundred core problem drinkers who are very resistant to treatment and have a huge cost to the public purse in terms of policing, housing and antisocial behaviour.

Alcohol Change UK estimates these highimpact, change-resistant drinkers cost society up to £100,000 a year.

The solution

Sandwell MBC partnered Alcohol Concern to launch the Blue Light Project in 2015. It is aimed at people who are alcohol dependent, a burden on public service and not engaging with treatment. The goal is to provide a more holistic range of support to these drinkers.

A multi-agency group was established to oversee the work, involving the local hospital trust, Clinical Commissioning Group (CCG), public health, social care and police.

More than 200 specialist and non-alcohol specialist staff, including emergency service workers, social workers, housing officers and police attended a series of one-day workshops to learn how to identify Blue Light clients and how to provide brief advice.

A new system has also been set up whereby referrals are sent into a central Blue Light Operational Group, which appoints a lead worker for each client accepted. This is normally the alcohol treatment specialist, although it does not need to be.

The lead worker then coordinates support from all the different services – whether it is benefits, housing, the criminal justice system or social care.

It starts off very intensive – sometimes several times a week – before being phased out gradually as issues are resolved. This process can last several months and support is never taken away until the client is ready.

Sandwell Public Health Director Dr Lisa McNally said: “The thing we found was that these drinkers were coming into contact with plenty of services, but each service was just responding in isolation.

“The police service was not asking or trying to address the drinking, the alcohol service was not helping the client with housing. It was like a leaky bucket – unless you plug the holes there is no point pouring water in.

“What this new way of working does is surround the individual with support, helping resolve all the issues that are contributing to their drinking.”

The impact

Sandwell focused on a small number of individuals at first, evaluating the impact of the support after one year. The support given was then analysed.

In the year before the Blue Light intervention Sandwell was responsible for costs to the public purse of £244,000, but a year later that had been reduced to £93,000. The intervention costs £25,000, resulting in a return on investment of more than 400 per cent.

The success led to the continuation of the Blue Light project with funding provided by public health. Around 50 individuals are being helped each year and the impact continues to be significant. One individual who has been helped recently is Mike, referred to the service by police.

He had made 150 calls to police in the previous two years, complaining about an exgirlfriend. He also had a history of domestic abuse and was facing charges of affray. He had been alcohol dependent for 16 years.

With encouragement, he accepted joint home visits by the police and alcohol treatment service. A mental health assessment was carried out and brain scan organised. He was eventually diagnosed with organic brain syndrome, which had been causing his erratic behaviour.

He is now in treatment, attending regular hospital appointments and has been helped to claim benefits.

Lessons learned

As the project has progressed, the importance of working with the voluntary sector has become increasingly apparent. Voluntary sector members now sit on the operational group, helping key workers to link clients in with a whole range of community groups and activities.

Dr McNally said: “Voluntary sector groups are part of the solution. These people are often really socially isolated so linking them in with walking groups or football teams can play a vital role in tackling their drinking. It is not just about the statutory services.”

Just as important is the need to get senior leadership on board. “Public health has provided funding for this, but the biggest cost is the time and commitment of different people. We are working with a wide range of staff now and what is important is that we close the gaps between services. Where gaps exist, things go wrong. But staff need permission to do this, to work across boundaries.”

How is the approach being sustained?

This year funding has been secured from another source, the Better Care Fund. Some £200,000 of investment has been provided to expand the work of the Blue Light Project over the next year.

The principles developed over the last four years will now be extended to drug users and homeless people.

“We have proved it works – and this is the chance to benefit even more people in Sandwell. It is exactly what the Better Care Fund should be used for,” added Dr McNally.

Contact details

Dr Lisa McNally Public Health Director, Sandwell MBC