Alcohol Service Specification 2010

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 1

Alcohol Service Specification 2010 Service User Consultation

The Adult Alcohol Treatment Services are due for re-tender in 2010. As part of the tender process a consultation exercise was conducted to seek the views of current, previous and potential users of alcohol services and their carers within Cambridge, Huntingdon and Fenland. The consultation ran from 20

July 2009 to the 13

November 2009, but specific public focused work was carried out between 23rd September 2009 until 6th November 2009.

In order to gain a wide perspective of views, contact was made with service users who access existing alcohol treatment services who have alcohol as their primary substance use. Contact was also made with service users who access Drug treatment services where alcohol may be secondary, tertiary or part of poly drug use. Views were also obtained from members of the prison population where alcohol use had been identified and with offenders on probation orders within the community. Contact was also made with homeless services and views were obtained from people who use alcohol who maybe without accommodation. A number of people also made contact with the Commissioners of the adult alcohol treatment services to give their views and these views have been used within this report.

The consultation took the form of questionnaires and interviews focussing on the main themes of the Service Specification for Adult Alcohol Treatment Service, version 1.5. Two versions of a questionnaire were made available to the respondents; a long version gathering views about experiences of services, opportunity for suggestions and comments of the key themes of the proposed service specification. The short version asked for views about the key themes and opportunity for comment. The respondents also had the opportunity to complete the questionnaire independently, as part of an interview with the service user engagement worker or with support of a keyworker/counsellor at the service they accessed.

Consultation

Through the period of the consultation, a total of 39 respondents completed the questionnaire. Of those, 56% (22 respondents) completed the long version questionnaire.

38% (15 respondents) of the questionnaires were completed in interviews with Adele McCormack - Service User Engagement Worker.

36% (14 respondents) completed the questionnaire unaided and independently.

26% (10 respondents) were assisted in the completion of the questionnaire. Of those 70% had

assistance from an employee of Alcohol treatment services, 2% were assisted by an employee of the

Probation service and 10% with assistance of employee from Drug services.

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 2

Demography of Respondents

To maintain the anonymity of the respondents, limited demography information was asked.

Information about geographical location, gender and age range were gathered to ensure a range of views were obtained across gender, age and location. An evaluation of any relationship between this demographical information and type of response to the key themes will not be addressed in this report.

Further information was requested about occupational status of the respondents and this will be linked to information gathered in relation to service accessibility.

As a commissioner directive, the service access status was requested. The primary focus being on ensuring views were gathered from 1

Time service users, current users of service who have had previous episodes of treatment, street drinkers, ex service users and people not accessing services.

Added to this were carers of current and/or previous service users after some carers made contact about the consultation.

The distribution of service users within each demographic category will be demonstrated below.

Gender

Number of respondents

Male: 20

Female: 15

Not stated: 4

Total Respondents: 39 male female not stated

51%

39%

10%

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 3

Geographical Location

Age Range

Cambridge 33%

Huntingdon 13%

Fenland 51%

not stated 3%

18-25 26-35 36-45 46-55 56-65 66+

5%

33%

36%

18%

5% 3%

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 4

Occupational Status

Service Use Status

Employed 28%

Self-employed Seeking 3%

employment 23%

Unable to work 37%

College 3%

Retired 3%

Not disclosed 3%

1st Time service user 31%

Current and previous use of

services Street Drinker 26%

10%

Carer 5%

Never accessed

services 18%

Ex- Service user

10%

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Results

The following topics were addressed as part of the long version of the questionnaire. Of a total of 39 respondents, 22 people completed the long version.

GP Services.

Of the 22 people who answered this question, 59% had sought advice from their GP regarding alcohol issues. Of those, 62 % found that there GP was helpful regarding this issue. 15% found their GP to be unhelpful with a remaining 23% stating their GP was neither helpful nor unhelpful.

50% of the respondents felt that GPs did not know enough about alcohol issues. 32% felt that they did, 14% answered ‘don’t know’ and 4% left the question unanswered. Where the question was answered as don’t know, all respondents had sought advice from their GP.

However, 86% felt that they would feel more comfortable asking their GP for help if they were more knowledgeable about alcohol use (5% disagreed, whilst 9% did not answer).

Respondent Recommendations

Respondents were asked to comment about what would improve the services offered by GPs for alcohol treatment.

It was felt that increased knowledge of alcohol issues would improve services and better signposting to specialist services. A list of phone numbers and service details should be given and/or a referral to specialist services. Suggestions were made to have alcohol specialists within local practices but that the key for better treatment is the relationship with the GP. Some people felt their GP dealt with them negatively because of alcohol use disclosure.

Services within Accident and Emergency

It was found that 45% had received treatment in A&E with regards to their alcohol use. Of those 60%

were being treated for physical effects of alcohol use, 20% for an accident whilst under the influence of alcohol and 20% have been treated for both reasons.

40% strongly agreed and 40% agreed that hospital staff were knowledgeable about alcohol use (10%

strongly disagreed and 10% neither agree nor disagree). 30% strongly agreed and 30% agreed that staff were understanding about alcohol issues (20% neither, 10% disagree and 10% strongly disagree).

30% strongly agreed and 30% agreed that the treatment of people with alcohol use when using A&E

could be improved. 40% disagreed.

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The questionnaire then asked whether someone available to A&E staff to advise about alcohol use and treatment of patients would make the service better. 50% strongly agreed with this statement, 40% agreed and 10% disagreed.

Respondent recommendations

The experiences in A&E varied from being positive to being negative. There were reports that staff had been abrupt and needed to be more understanding. Others reported that they were treated very well and that A&E staff can only do so much.

Police Custody

Of the respondents questioned, 55% reported to being in police custody with regards to their alcohol use (4% did not answer). When questioned whether the police were knowledgeable about alcohol use, the following responses were given; Strongly Agree – 8%, Agree – 23%, Neither – 15%, Disagree – 23% and Strongly Disagree – 31%.

Whether they were treated appropriately; Strongly Agree – 8%, Agree – 54%, Neither – 15%, Disagree – 15%, Strongly Disagree – 8%.

Treatment of people under the influence of alcohol could be improved when in police custody;

Strongly Agree – 14%, Agree – 36%, Neither – 43%, Disagree – 7%.

The respondents also felt that if there was someone available to police custody staff to advise about alcohol use, this would make the service better; Strongly Agree – 29%, Agree – 57%, Neither – 14%.

Respondent recommendations

It was felt that more information needs to be given about alcohol issues. There were comments that people were treated fairly because how people are treated depends on how they are acting.

Specific Specialist Services

23% of the people questioned had received a detox for their alcohol use. 80% of those were home detoxes and 75% of those found the process to get a detox an easy one.

50% of the respondents said that they were aware of the process to receive a detox (27% said they were not, 9% were not sure and 14% did not answer).

36% felt that the process to access a detox needed to be improved and 27% felt that it was okay as it is.

Respondent recommendations

One of the respondents felt that there needs to be more help. Another said that they were not

aware that services existed until they were advised by GP and that the GP needs to have all the

information about services and options. It was also suggested that there needs to be a telephone

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 7

number where people can ring for advice as the information on the internet is overwhelming and a 10 minute appointment with GP is not enough time to talk options through.

Another respondent felt that detox is not an option when they have work commitments.

Opening Times

55% of the respondents felt that opening times between 9am-5pm is suitable to their lifestyle, 45%

disagreed. 86% felt that out of office hours would improve the current services with 91% saying that if the service was available at evenings or weekends they would use it.

Respondent recommendations

Many of the respondents said that support is needed 24 hour and that evenings and weekends are the worse for people who use alcohol. It was mentioned that for people who are working, 9am-5pm support is not easy for them to access the service. When looking at the demographics, 34% of the respondents were either employed, self employed or at college with a further 23% seeking employment.

Access to Services – Waiting Times

The respondents were asked when would be a reasonable amount of time to wait for an assessment;

The same day – 27%

The next day – 18%

Within 3 days – 9%

Within a week – 32%

Within a month – 14%

And after an assessment, it was felt that a reasonable amount of time to receive treatment is;

Within 1 week – 64%

Within 2 weeks – 23%

Within 3 weeks – 4%

Within 1 month – 9%

The respondents were asked that when accessing services for alcohol use i.e. prescribing, would they rather access this through their GP, Specialist alcohol services or a combination of both. The results are as follows;

GP – 0%, Specialist Alcohol Service – 18%, Combination of Both – 82%

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 8

New Service Proposal

The key themes of the alcohol treatment proposed service specification were then presented to the respondents for their views. A total of 39 respondents gave their views about the following (as this was the basis for the short questionnaire).

Where people have disagreed or strongly disagreed with this, they have stated that 3-6 weeks is too long for people to wait for treatment.

51%

41%

3% 0% 5%

Strongly Agree Agree Neither Disagree Strongly Disagree

When someone refers to the alcohol service, they should be assessed within 7 days

44%

28%

0%

15% 13%

Strongly Agree Agree Neither Disagree Strongly Disagree

After being assessed, most people should get treatment within 3 weeks

but all people should receive treatment within 6 weeks

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 9

59%

36%

2.50% 2.50% 0%

Strongly Agree Agree Neither Disagree Strongly Disagree

People should be able to access services in the evening or at a weekend

41% 44%

10% 5%

0%

Strongly Agree Agree Neither Disagree Strongly Disagree

An on call nurse service should be available Friday and Saturday evenings within A&E departments for people under the influence of

alcohol

36%

51%

10% 3% 0%

Strongly Agree Agree Neither Disagree Strongly Disagree

Cambridgeshire police and custody staff should be able to get advice from alcohol service staff on Friday and Saturday evenings for people

under the influence of alcohol

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 10

56%

38%

3% 3% 0%

Strongly Agree Agree Neither Disagree Strongly Disagree

GPs should be given advice and support to enable patients to access alcohol services

46%

33%

13%

5% 3%

Strongly Agree Agree Neither Disagree Strongly Disagree

GPS should be able to offer treatment and prescribing for alcohol problems i.e. detox medication

56%

41%

3% 0% 0%

Strongly Agree Agree Neither Disagree Strongly Disagree

There should be a clear pathway to get a detox

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 11

Respondents Views about Alcohol services

At the end of the consultation the respondents were asked for any additional comments. They are documented below:

“Need quicker access than 3-6 weeks. Greater access to detox”

“In A&E there needs to be security to deal with violent people. Not just treat alcohol need to treat underlying issue”

“Need people with experience of alcohol to work with people who drink. Weekends are the highest risk factor particularly for people who work. Object to an Off licence in the concourse of

Addenbrookes hospital”

“The suggestions all sound pretty good”

“Need quicker access to treatment. Would only work with GP if the GP was working with a specialist.”

“Need quicker access to treatment. Needs people to listen and understand and not treat people the same because everyone is different”

“Need more options than cutting down. Want group therapy but not AA 'higher powers'. Previously waited 2 months sometimes people can't wait that long. Need parking space so no barriers to get services. Have different support groups on different days. Detox- need it to be available when motivated.”

“2nd time accessing services but difficult to get key worker due to short staff. Need 1:1 sessions, don't benefit from AA”

“Need 12 step programme and AA”

“Keep the same keyworker so as to build a better rapport. Get treatment quicker”

“Need more alcohol services at Addaction as this is limited. Alcohol is just as much of a problem as drugs but there is more recognition for drug users. Alcohol can cause the same amount of problems with your health and state of mind.”

“Should be assessed a.s.a.p and at home if can't make it to yourselves.”

“Concerns for people who need a normal family life but to outsiders the alcoholic shows few signs of the life they lead behind closed doors. Family experience of alcoholic is different. Support needs to be offered asap and be done in a suitable environment.”

“I think you shouldn't have to wait long for appointments and should always keep the same key

worker.”

Alcohol Service Specification 2010

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“GPs have enough to do without having to prescribe for and treat alcohol users.”

“Treatment should be quicker as people can die whilst waiting. 3-6 weeks is too long. GP is there to deal with the body and alcohol use should not be GP problem, it is a psychiatric issue.”

“Abstinence as treatment. Short term detox is appropriate if person is danger of fitting or has history of fitting in the past”

“Generally received good services apart from waiting times”

“I feel it is difficult to explore options with GP in only 10 mins. Services need to be provided as a combination of both but 80% specialist services, 20% GP. Very happy with support I have got in Huntingdon. Liked being able to self refer. Very accommodating with work time.”

“Doctors will put you in touch with local services if you approach them ”

“Service provided has been supportive non-judgemental and personable”

“On call nurse and custody staff being available and having advice at the particular time of Friday and Saturday night I don't think will help. I think giving the offender info later on i.e. During/after interview and/or treatment may be of benefit so that they can realise the extent of their actions.

Whilst drunk I don't think this would work as most drunks don't care or are bothered with advice whilst under the influence. Cold hard facts when sober is a real wake up call.”

“I would like to have been seen a bit quicker but I do understand that you are the only place in Cambridge that helps people as far as I Know. I think you should be given more funding so that you can employ more people and publicise your services more. Assessment times should depend how needy the person is. On call nurse in A&E - once sobered up otherwise pointless.”

“A clearer pathway for access to services would be useful. This could be done with closer partnerships between GPs and charities like Drinksense.”

“Services very helpful, helped me to look at drinking differently, it’s not the alcohol, it's everything

else, can see that now”

Alcohol Service Specification 2010

Adele McCormack | Service User Engagement 13

Conclusion

In conclusion to this consultation, it was felt that the respondents felt strongly about three key themes:

Opening Times – There were many comments that services need to be available at evenings and weekends. This was not specific to people who are employed. It was mentioned on several occasions that for some people their alcohol use is worse at these times which is when they would need greater support.

Access to services – It generally seemed acceptable to the respondents to be assessed within 7 days, although there would need to be flexibility about prioritising people if necessary. However some people felt very strongly that 3-6 weeks was not soon enough to get treatment because the moment they ask for help is the time that they need it.

Better links between GP and specialist alcohol services – A large majority felt that there needs to be a greater link between their GP and alcohol services.

There were also some strong views about having greater options of treatment such as abstinence focused options and support groups.

Thank you

A big thank you to all the people who took time to complete the questionnaires. Thank you to the people who came forward independently to take part in the consultation.

Thank you to the following organisations for assisting with the consultation Drinksense Alcohol services

Addaction Drug services Wintercomforts, Cambridge HMP Littlehey

National Probation Service