I lead an A&E outreach team. Here’s how we help ‘frequent attenders’ with drug and alcohol problems.
When it works it benefits everyone.
By Lee Derrick, Criminal Justice and Hospital Outreach Team Leader, Addaction Cornwall
Most people use Accident and Emergency (A&E) for something out of the ordinary, an accident or a sudden change in health. However, for some, hospital waiting rooms become part and parcel of everyday life.
These people are known as ‘frequent attenders’. Their regular visits to A&E are often related to underlying drug and alcohol issues. But, although vulnerable, these patients can frustrate NHS staff, who are doing their best to offer a world class service within extremely tight budgets. Alcohol-related admissions alone account for 7% of all visits to A&E.
This is where we come in. In 2018, we secured funding from the Government’s Life Chances Fund to set up a Hospital Outreach Team (HOT) in Cornwall. When a known ‘frequent attender’ finds themselves at the Royal Cornwall Hospital emergency department one of my team will be on hand to meet them. The first thing we explore is why they keep coming into the hospital. Sometimes it’s an elderly person who lives alone and sees hospital as a place of safety and comfort when they’re intoxicated. Or it could be an opiate user who’s been in and out of prison. There’s a huge range.
That’s why for each client we support we create a bespoke discharge and recovery plan involving multiple services. This is tailored to the patient’s needs. I want to stress that this is partnership working at its best, we couldn’t do what we do without the Royal Cornwall hospital staff, local mental health and homeless services among many others.
We recently supported a pregnant woman in an abusive relationship. She was alcohol dependent and coming to hospital when intoxicated. She was also due in court for attempting to damage her mother’s car and was being evicted from her property. We referred her to a women’s domestic violence service, helped secure her new housing and enrolled her in an alcohol programme. We were with her every step of the way, from filling out forms to supporting her in court. Without our service she would have continued to flutter in and out of hospital, receiving emergency care before being discharged back into her old life.
This is why I think the government’s plan to expand alcohol care teams to the 50 hospitals with the highest number of alcohol-related admissions will make a massive difference in helping people find long-term support and cut demand on already overstretched emergency departments. We’ve been doing this in Cornwall for some time now and have seen a reduction in A&E attendances for many of the clients we have worked with.
Hospital outreach teams are just one part of the puzzle and they’re restricted by the resources available in the area. We challenge things and escalate issues, but if we are supporting a homeless client and there’s a large shortage of affordable housing, there’s only so much we can do. That’s why we all need to keep seeing the bigger picture and work together to help people address their issues.
When it works it benefits everyone.
Addaction’s Hospital Outreach Team is funded by the government’s Life Chances Fund. Addaction is also the first substance misuse charity in the UK to run a social impact bond and the Government Outcomes Laboratory (GoLab) based at Oxford University will be monitoring the effectiveness of this project as a funding model for care services.
