LTP Priority: Alcohol
Population Intervention Triangle:Segments (link to Section 1 PHE PBA): Service
Type of Interventions: Alcohol Care Teams
Major driver of health inequalities in your area of work
Alcohol contributes to a wide range of conditions including cardiovascular disease, cancer and liver disease, as well as harm from accidents, violence and self-harm. 12 to 15% of A&E attendances are alcohol-related and over 1.1m hospital admissions each year have alcohol as a causal factor in the patient’s diagnosis.
In England, the average age at death of those dying from an alcohol-specific cause is 54.3 years. The average age of death from all causes is 77.6 years. More working years of life are lost in England because of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.
The harm from alcohol is not equally distributed among the population and alcohol dependence is particularly correlated with deprivation. Alcohol misuse rates for the most deprived are more than double those for the least deprived and those from lower socioeconomic circumstances experience higher levels of alcohol-related mortality. Individuals living in high deprivation areas suffer disproportionate alcohol-related harm at a given level of alcohol consumption compared to people in low deprivation areas.
Therefore, people living in deprivation are over-represented in hospitals. ACTs are often the first services to identify alcohol problems, as only a small proportion (<20%) of people with alcohol dependence access specialist addiction services or are identified and referred by their GP. ACTs are therefore well placed to carry out early identification and initiate treatment. Improving ACT provision will therefore facilitate access of more people from poorer socioecconomic groups to structured alcohol treatment for dependence.
Deprivation. Inclusion health groups: Homeless and rough sleepers, sex workers, LGBTQ and Gypsy, Traveller and Roma communities are also likely to have high rates of alcohol dependency.
Alcohol Care Teams in District General Hospitals
Alcohol Care Teams (ACTs) provide specialist interventions and input into the care of alcohol dependent patients admitted to District General Hospitals (DGHs) for any reason, ensuring high quality and appropriate care. ACTs liaise with community alcohol services and others, to ensure continued alcohol treatment, where necessary, following discharge from hospital. By identifying and ensuring treatment for patients with alcohol dependence, they reduce the likelihood of future ill-health and alcohol-related readmissions.
Where patients are in acute alcohol withdrawal, the ACT will stabilise their condition and manage a medically assisted withdrawal (MAW) regimen alongside providing support such as psychosocial intervention addressing their immediate needs in relation to alcohol dependence. When patients are medically fit for discharge but before their MAW is complete, ACTs reduce unnecessary bed days by managing safe discharge to complete MAW under the supervision of a local authority community alcohol service.
In addition, assertive alcohol outreach approaches can be implemented alongside or as part of ACTs. These identify vulnerable patients who have multiple alcohol-related hospital admissions, frequent A&E attendances or ambulance call-outs and engage them proactively so they can make use of alcohol treatment, stop drinking and recover from their alcohol-related ill health.
Public Health England has published an assessment of the public health burden of alcohol which includes an analysis of the unequal burden of alcohol related ill health on those from lower socioeconomic groups.
NICE Guidance [CG115] sets out the expectations for delivering interventions with alcohol dependent individuals in all settings including hospitals. It pays particular attention to those with inclusion health needs.
In 2010 a paper was published by the British Society of Gastroenterology which began to articulate the benefits of ACTs. There is good evidence for the benefits of fully optimised ACTs providing specialist interventions to alcohol dependent inpatients. A NICE Proven Case Study describes how ACTs in Bolton, Salford, Nottingham, Liverpool, London and Portsmouth have significantly reduced bed days and readmissions. ACTs also reduce ambulance call-outs and A&E attendances.
Guidance for Commissioners
- PHE has included a section on ACTs in this 2016 guidance on preventative measures:
- PHE 2018 guidance: Alcohol and drug prevention, treatment and recovery: why invest? for commissioners and providers ‘to help make the case for investing in drug and alcohol treatment and interventions’