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Fiona is clinical nurse specialist and team leader for the Alcohol Care Team at Bradford Teaching Hospitals. This is her story about what she’s doing to reduce inequalities within alcohol care in Bradford.

What’s the inequality?

People living in deprived areas are much more likely to experience an alcohol-related hospital admission or die of an alcohol-related cause. We also know that approximately 30% of the reasons for ill health are due to our lifestyles, alcohol intake included in this.

Alcohol dependence contributes to conditions including cardiovascular disease, cancer and liver disease, harm from accidents, violence, and self-harm, and puts substantial pressure on the NHS. Over 1.1 million hospital admissions each year have alcohol as a causal factor in the patient’s diagnosis.

Bradford has the 5th highest population of dependent drinkers in England and is one of the most deprived cities in the UK. At the Bradford Royal Infirmary hospital, Fiona leads the newly formed Alcohol Care Team (ACT) to support patients with alcohol and drug dependency.

What action was taken to address this inequality?

Fiona said: “Before the ACT was created, Bradford was recognised nationally by NHS England as one of the places in England with the highest dependency drinkers, without such a team within the hospital. Because of this, funding was received to set up a service to engage people and provide education around alcohol and what impact it can have on a person’s health.

“We provide training for staff to help them understand patients who are alcohol dependent better, and also educate patients on the harms of alcohol.

“We know that people with alcohol and substance dependency face barriers to accessing healthcare. There is a lot of stigma that stops them from engaging with health and care services. They don’t come into hospital because of these stereotypes, they feel they are going to be judged.”

Through staff education and clinical presence with patients, the ACT are advocating for these patients to receive care they are entitled to. “We act as an advocate for the patients, getting staff to reflect on their own practice – there’s always a story behind why a person has got to this point in the first place, we see them as people.

“Sometimes staff find patients experiencing withdrawal difficult – they can be very chaotic and make it hard for them to do their job, which means their health needs get overlooked. So, we help educate the staff to understand why they are chaotic.

“Most people have experienced trauma in their lives and choose to cope with it in various ways – eating, or exercise for example. The people we come into contact with have chosen alcohol or drug use, and just because they have it doesn’t make them any less entitled to receiving care. This is where it is important to educate staff around preconceptions or stereotypes they may have about drug and alcohol users.

“We deliver training to all new starters and provide ad hoc training in the hospital – by going to various wards and just having conversations with staff. We’re established on the junior medical doctors rotation and deliver lunch time training sessions. We also work with Bradford nursing students and with the multidisciplinary team (MDT) learning forum.

“We help patients access the right support whilst an inpatient in Bradford Royal Infirmary. Drinking culture in the UK makes it hard for people to understand they may have a dependency on alcohol.

“For patients with a strong dependence on alcohol, we develop a recovery-focused care plan, look at the psychosocial too and can refer them to mental health services – the plan is different for each person. We make adaptations for different cultures. We try to avoid withdrawal where we can because it can be very distressing for patients and their families. We work closely with New Vision, the homeless team at Bevan, sex workers and signpost to Lotus.

“Ultimately we want to make sure they have a good experience while they are in the hospital, so they feel comfortable coming back if they need to, but also making them aware of other services.”

What is the impact of this action?

“Since the Alcohol Care Team was established at Bradford Teaching Hospitals in January 2023, we have holistically assessed 1,235 patients, referred 641 into community support services and reduced length of stay by 21%.”

ACTs significantly reduce A&E attendances, bed days, readmissions and ambulance callouts. The team has close working links with the emergency department, which means patients can get support as soon as they present at A&E.

“We had a gentleman who recently used our service – he’d given up and didn’t have any hope. He didn’t think recovery was possible. We asked a colleague with lived experience at New Vision to come and chat with him, where they discussed rehab. Following this he agreed to give it a go. He was then assessed and offered a space for a 10-month residential rehab place.

“This gentleman remains in rehab and has been abstinent from illicit substances since 14th November 2023. He finished his methadone reduction before the New Year as he wanted to go into the New Year completely substance free. Without the Alcohol Care Team and working closely with partners like New Vision Bradford, who have lived experience, this wouldn’t have been possible.”

Thank you, Fiona, for sharing your story. You can view more inequality action stories from our workforce here.

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