South East Alcohol Innovation Programme: evaluation report.
Lundbeck UK Limited and Centre for Public Innovation, 2011.

In the south east of England a bidding exercise spawned a spate of short-term innovative projects to reduce alcohol-related harm, from which five models were assessed as most promising and taken forward for further implementation and assessment the following year – a rapid and intensive test bed from which others can learn as well.

Summary
The South East Alcohol Innovation Programme was initiated by the Regional Alcohol Manager at the Government Office for the South East of England. From 2010 to 2011 it funded innovation activities in the public and voluntary sectors designed to reduce alcohol-related harm as measured by the level of alcohol-related hospital admissions, and to influence the adverse impact on population health and criminal justice challenges associated with violence and anti-social behaviour.

Primary care trusts (which fund public health services) and their partners were encouraged to bid for £300,000 to test out innovative approaches to meeting these objectives for between six and eight weeks. Successful bidders were encouraged to report the outcomes using a common framework.

In year one the aim was to fund as many innovative ideas as possible to tackle alcohol-related hospital admissions. In all 26 projects were funded across three thematic grant rounds:
• Seasonal alcohol campaigns;
• High impact grant programmes;
• Joint commissioner-provider pilots.

Using 'innovation funnelling', these projects were then scored against several criteria to agree which would be taken forward. The top five which had the greatest impact were selected as models for the year two bidding round, which resulted in 10 projects running between December 2010 and April 2011. The five models are described below. The projects based on these models in year two may have varied somewhat from these models.

Frequent flyers:
A specialist community-based worker was appointed to work intensively with the 10 patients with the most alcohol-related repeat hospital admissions, to coordinate their care, reduce the impact on other services and ultimately reduce the likelihood of further admissions. Candidate patients were identified through medical assessment unit records and referred to the worker, who proactively contacted them and sought to engage them in a full assessment of their needs, linking with, and coordinating care and treatment from other specialist services. Offering dedicated care management was intended to achieve a more effective and coordinated approach to their treatment, freeing up the resources of those currently working with them in a more sporadic, unplanned way.

Pharmacy brief advice:
The aim was to engage with staff in community pharmacies to enable them to proactively offer brief advice on alcohol to their customers. Information for pharmacy staff covered health awareness, understanding units of alcohol, early identification of possible excess, data capture on awareness and units consumed, and signposting/referral for additional support where required. This aim was to raise awareness of what constitutes safe alcohol consumption amongst low and increasing risk customers unaware of how much they are drinking.

Hostel clinical nurse:
The project funded a clinician to provide clinical support and training for hostel staff to enable them to support previous rough sleepers who are dependent drinkers, with the aim of reducing their drinking and addressing attendant health problems. It extended the opportunities for alcohol-dependent residents to address their substance misuse as well as improve their mental and physical health, a group whose severe dependence and chaotic lives mean they tended not to access existing services. The project targeted drinkers for whom inpatient detoxification does not work, usually ending with a return to the hostel and resumed drinking, aiming to replace this cycle with personalised, gradual detoxification within the hostel environment.

Supported housing self-help group:
Using the vehicle of alcohol workshops, the project aimed to encourage the formation of a self-help group on drinking problems in a supported housing setting, addressing some of the issues which made residents reluctant to access specialist services while raising awareness of levels of alcohol consumption and how to reduce this to safer levels. The self-help format enabled participants to support one another, drawing on their own skills and experiences. By eliciting and identifying reasons for non-engagement with treatment services, group discussions helped put in place mechanisms to manage these obstacles.

Brief intervention by hospital healthcare support workers:
Healthcare support workers in accident and emergency, medical assessment unit and gastroenterology wards were trained in simple techniques to enable them to identify and briefly advise risky drinkers among the patients they came in to contact with. These workers contact all patients admitted and usually have more time than nursing and other medical staff. They were trained how to screen and advise patients while performing basic care tasks, effectively delivering information at a time of crisis for the patient in a way which it was hoped would affect their drinking and reduce repeat admissions for alcohol-related conditions.