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Referral to specialist alcohol services

Quality statement

People who may benefit from specialist assessment or treatment for alcohol misuse are offered referral to specialist alcohol services and are able to access specialist alcohol treatment.

Quality measure

Structure

a) Evidence of local arrangements to ensure effective identification of people who may benefit from specialist assessment or treatment for alcohol misuse.

b) Evidence of the use of a local referral pathway in accordance with NICE public health guidance 24 and NICE clinical guideline 115 to ensure that people who may benefit from specialist assessment or treatment for alcohol misuse are offered referral to specialist alcohol services.

c) Evidence of a local needs assessment highlighting gaps in and barriers to accessing specialist alcohol treatment as well as prevalence of alcohol misuse. Estimated burden of alcohol misuse and uptake of specialist treatment should be broken down by key equality groups such as women, people from minority ethnic groups, people who are homeless and people in different age groups.

d) Evidence of audit of waiting times in specialist alcohol services from initial referral to assessment, assessment to treatment start, and total waiting time from referral to starting treatment.

Process

Proportion of people meeting NICE guidance criteria for referral to specialist alcohol services who are referred to specialist alcohol services.

Numerator - the number of people in the denominator referred to specialist alcohol services.

Denominator - the number of people meeting NICE guidance criteria for referral to specialist alcohol services.

Outcome

a) Proportion of people in the local population estimated to be dependent on alcohol who access specialist alcohol services.

Numerator - the number of people in the denominator accessing specialist alcohol services.

Denominator - the number of people in the local population estimated to be dependent on alcohol.

NICE public health guidance 24 recommends that commissioners should ensure at least one in seven dependent drinkers can get treatment locally.

b) Decrease in the quantity and frequency of alcohol consumption in people who misuse alcohol.

Description of what the quality statement means for each audience

Service providers ensure that access pathways are implemented for referring to specialist alcohol services and that appropriate arrangements are in place for self-referral for people who may benefit from specialist assessment or treatment for alcohol misuse.

Health and social care professionals ensure they are aware of local access pathways and offer referral to specialist alcohol services to people who may benefit from specialist assessment or treatment for alcohol misuse.

Commissioners ensure they commission services that implement effective access pathways to specialist alcohol services and commission specialist alcohol services with capacity for at least one in seven of the estimated dependent drinking population to access treatment.

People who may benefit from specialist assessment or treatment for alcohol misuse are offered referral to specialist alcohol services and are able to access specialist alcohol treatment.

Source clinical guideline references

NICE clinical guideline 115 recommendations 1.2.1.2 and 1.3.4.1 (key priorities for implementation) and NICE public health guidance 24 recommendations 5, 8, 9, 11 and 12.

Data source

Structure

a), b), c) Local data collection.

d) Local data collection. The National Alcohol Treatment Monitoring System (NATMS) collects data on people presenting for structured treatment in specialist alcohol services; ‘date referred to modality', ‘date of first appointment offered for modality' and ‘triage date' are collected. ‘Modality start date' records when the person actually starts a treatment modality.

Process

GP practices delivering the Directed Enhanced Service (DES)specification for the Alcohol-related risk reduction scheme, England are required to send to commissioners an audit of:

  • Numberof newly registered patients scoring 20 or more on the full ten-question alcohol-use disorders identification test (AUDIT) questionnaire who have been referred for specialist advice for dependent drinking during that period.

The National Alcohol Treatment Monitoring System (NATMS)collects data on referral routes into specialist alcohol services for people who present for structured specialist treatment, that is, those who complete a structured treatment assessment.

Outcome

a) Data on prevalence of alcohol misuse in adults is available from the NHS Adult Psychiatric Morbidity Survey in England. The NATMS collects data on people receiving structured alcohol treatment, but does not differentiate between harmful drinkers and people with alcohol dependence.

b) Local data collection. Data on prevalence of alcohol misuse in adults is available by region from the NHS Adult Psychiatric Morbidity Survey in England.

Definitions

See quality statement 2 on opportunistic screening and brief interventions for a definition of brief interventions.

NICE public health guidance 24 recommends that referral for specialist treatment is considered for people aged 16 years and older if they:

  • show signs of moderate or severe alcohol dependence or
  • fail to benefit from structured brief advice and an extended brief intervention and desire to receive further help for an alcohol problem or
  • show signs of severe alcohol-related impairment or related comorbid condition (for example, liver disease or alcohol-related mental health problems).

Referral for young people aged 16 or 17 years must be to services that deal with young people.

NICE clinical guideline 115 recommends that people should be referred to specialist services for assessment of need where staff making the referral are not competent themselves to identify harmful drinking or alcohol dependence. It also recommends that service users who typically drink over 15 units of alcohol per day and/or who score 20 or more on the AUDIT should be considered for assessment and management in specialist alcohol services if there are safety concerns about a community-based assisted withdrawal.

Figure 5 in the full version of clinical guideline 115 provides a care pathway for case identification and possible diagnosis for adults, including referral to specialist assessment.

Access to specialist alcohol services for those who might benefit from specialist treatment requires a responsive treatment system. A responsive treatment system is a pathway that ensures appropriate case identification and subsequent referral to specialist services, which respond appropriately to referrals and provide ease of access to treatment. Treatment access should include appropriate arrangements for self-referral.

People who are likely to benefit from specialist alcohol treatment who accept a referral to specialist alcohol services should expect the service to make contact with them as soon as possible. During any period of waiting, the service user remains under the care of the referrer (for example, their GP), who should continue monitoring and address any urgent needs as appropriate.

Equality and diversity considerations

This statement promotes equality by ensuring that all people who may benefit from specialist alcohol services are offered a referral and can access specialist alcohol services for assessment and treatment.

Currently, some equality groups may be under-referred, such as older adults (due to a lack of clinical suspicion or misdiagnosis) and young adults presenting at emergency departments or in primary care.

Homeless people can have difficulty accessing appointment-only services, women can regard services less suited to their needs in terms of children and childcare, and people from minority ethnic groups may find a lack of ethno-cultural peers and staff a barrier to treatment access. There is a risk that people who are housebound (which may include a large number of older people) currently wait longer to access specialist treatment.

Outreach and assertive engagement techniques should be considered with some of these groups who may otherwise find it difficult to engage in treatment.

This page was last updated: 25 August 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.