A new report reviewing the provision of alcohol services in England's hospitals has been released by Public Health England (PHE).
The report, Alcohol care in England's hospitals [pdf], identifies that the majority of hospitals have at least some specialist alcohol provision, although delivery varies widely and key issues such as integration with community services is crucial.
The report summarises the available evidence and includes results of a national survey into existing provision. It found at least 139 (73%) of hospitals large enought to merit some level of specialist alcohol service did so. Only five hospitals were identified as having no alcohol service at all. The report states most of the current evaluation evidence for hospital alcohol services is for multi-disciplinary 'alcohol care teams' (ACTs) in larger hospitals, but identifies the delivery of 'in-reach alcohol care teams' and 'high impact user services' in a number of hospitals.
In terms of service provision, it states all hospital based services should be able to provide:
- case identification/identification and brief advice (IBA)
- comprehensive alcohol use assessment
- contribution to nursing and medical care planning
- psychotherapeutic interventions
- medically assisted alcohol withdrawal management
- planning of safe discharge, including referral to community services
In terms of cost effectiveness, it states the return on investment from alcohol care teams can be between £3.50 and £3.85 per £1.00 invested. Assertive outreach services that aim to reduce hospital admission and A&E visits among frequent attenders can deliver a return of £1.86 per £1.00 invested.
The recommendations from the report are that:
- every district general hospital should consider the best way to provide effective specialist alcohol care for its patients in light of the benefit to patient care and the available efficiency savings
- local partners should engage with the health and wellbeing board to ensure existing services for alcohol and other drugs are maintained and developed on the basis of local needs assessment
- hospital alcohol care teams should accelerate identification and brief advice (IBA) delivery throughout the hospital by supporting the training of colleagues in all clinical areas
- local partners should review the response to alcohol-related harm in all district general hospitals, using this document as a guide, and they should ensure that existing services are adequately integrated across primary and secondary care and that new services are implemented where there are none
- local partners should consider employing assertive out-reach or in-reach services for high impact service users in all major hospitals and existing services should be comprehensively evaluated to assess their impact on hospital and community services
- system planning should ensure that community services are accessible and available to ensure continuation of detoxification with psychosocial interventions outside of the hospital
A recent Alcohol Research UK report, A national study of acute care Alcohol Health Workers, found that services were 'frequently precarious, with limited management support, short-term funding and a lack of ownership from key agencies'.
Data on alcohol-related hospital admissions are used as a key indicator for local areas and part of the Public Health Outcomes Framework. An evaluation of a national led programme to reduce alcohol-related hospital admissions and improve local level action was published in 2013.
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