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NHS - Healthcare shines in Bolton

www.gmw.nhs.uk

30 March 2011

An innovative project to increase the number of people successfully completing treatment for alcohol abuse and decrease the number of people relapsing in Bolton has been awarded £75,000 of funding.

Bolton Alcohol Team at Greater Manchester West Mental Health NHS Foundation Trust, NHS Bolton and d2 Digital by Design are working in partnership as one of 14 teams, which have been selected for the Health Foundation’s Shine programme. The teams are testing innovative ideas to improve the health service by reducing the need for acute hospital care while improving quality and saving money.

Bolton Alcohol Team is implementing an alcohol relapse prevention programme that uses mobile phone technology. This is the first time mobile phone technology has been used to engage with people undergoing treatment for alcohol problems.

High rates of alcohol-related relapse have been identified both nationally and internationally. Research data show that within the first year of detox, relapse rates vary from 80% to 90%. The data show that the first three to six months are crucial periods for relapse, and that additional support for people with alcohol problems during this time is required.

The NHS partnership team identified a lack of client engagement with their aftercare programme, with only 60-70% of clients who have been through detoxification attending aftercare meetings. In addition, even when clients attend aftercare services, engagement times are necessarily limited.

The mobile phone alcohol relapse programme consists of multiple phases that can overcome communication barriers between the client and the service, and provide contact during the periods between formal appointments, when the client is most in danger of relapsing.

The first phase is a text-based appointment reminder system, with an opportunity for the client to confirm whether they will be attending their aftercare appointments or not.

The second phase is a ‘mood monitoring’ survey where clients are contacted a few times a week via text message with simple questions about their feelings and emotional state. This will trigger a response, the level of which depends on the answers given.

The third phase allows clients to contact the service in the event of a relapse or if they are experiencing cravings. This provides clients with a secure way of obtaining support and advice when they most need it.
Consistent texts will help clients focus on their goals and stay on track. If a client is in an emergency situation, motivational advice or personal contact will help drive abstinent behaviours and help prevent relapse.

If the project is successful, there will be an increase in the number of clients successfully completing treatment and a decrease in the number re-entering the system at a later stage because of relapse. This will reduce the need for repeated detoxification for these clients, resulting in cost savings.

Dr Louise Sell, FRCPsych Consultant Addictions Psychiatrist and Service Director for the Alcohol and Drugs Directorate at Greater Manchester West Mental Health NHS Foundation Trust, said: “People with alcohol problems often relapse due to a lack of commitment to aftercare programmes; a problem that is exacerbated by the lack of contact between the client and keyworker during aftercare. This can be due to the high cost of providing one-to-one contact.

“Using mobile phone technology as an engagement tool to monitor and help prevent relapse is innovative, and has not previously been used in the alcohol field. The team hope to show how text message interventions can be used to enhance self-sufficiency for clients, for example through reminder and feedback on treatment success, which will help people to beat their addiction to alcohol.”

Martin Marshall, Clinical Director and Director of Research and Development, the Health Foundation, said: “Ensuring people receive care in the right place for their clinical needs is an important part of providing a high quality and cost effective service. There are many situations where care does not need to be provided in a hospital or inpatient setting; when the experience for service users and carers could be improved by providing care closer to home and at lower cost.

“Shine has been designed to support teams working in the health service to test their ideas to reduce the need for acute hospital care while improving quality and saving money. We aim to generate a new body of learning in this important area, as part of our wider work on how health services can provide better value for money.”

Each year the Shine programme focuses on a different aspect of healthcare quality that reflects a key issue facing the UK health service by finding new approaches to improving services in ways that can be measured and proven.

Over one year, Shine teams, supported by the Health Foundation, will develop and test their approaches, put their ideas into practice and gather evidence about what works and what doesn’t. Each team will receive £75,000 of funding, a package of support as well as the chance to share their experiences with other Shine teams.

The Shine programme is part of the Health Foundation’s stream of work researching and testing how health services can provide value for money, while maintaining or improving the quality of healthcare.