NHS Inpatient Detoxification Units are unique in many ways. The RADAR (Rapid Access Detox Acute Referral) system developed by the Greater Manchester Mental Health NHS Foundation Trust during 2012/13 is an example of the innovative ways in which IPUs provide enhanced quality of care, based on the needs of service users and the demands presented at frontline healthcare services.
What is RADAR and why was it developed?
RADAR stands for Rapid Access Detox Acute Referral. RADAR and was first piloted by the Greater Manchester Mental Health NHS Foundation Trust during 2012/13. This groundbreaking model of care was developed to help ease the burden on local acute trusts who were seeing high levels of alcohol-related admissions. The data at the time indicated that 35% of A&E attendances, and as many as 70% of night time presentations, were alcohol-related. 1 in 8 hospital admissions were also due to alcohol.
It was also recognised that a high number of service users were presenting again and again at A&E because their underlying issues with alcohol were not being addressed. To improve these clinical outcomes it was widely acknowledged that the best way to support these individuals would be in a therapeutic setting, dedicated to treating substance misuse; rather than a general acute hospital ward.
The RADAR model was therefore developed to provide rapid access for patients to Inpatient units directly from acute hospitals across Greater Manchester who are presenting with alcohol dependence, acute alcohol withdrawal, and who would otherwise require admission to an acute hospital bed.
A RADAR case study
RADAR admissions across Manchester are to the Chapman-Barker Unit on the Greater Manchester Prestwich site. The Chapman-Barker Unit is a specialist NHS IPU with 24-hour medical cover and a multidisciplinary team support.
Dr Chris Daly is the Lead Consultant Psychiatrist at Greater Manchester Mental Health NHS
Foundation Trust, and explains why RADAR was created: “We were aware of the increasing demands through A&E of patients arriving due to alcohol. If an individual was presenting at A&E due to an alcohol related problem - that could be because they have had a seizure, a serious fall, or liver problems; and they needed to be admitted to hospital, but the primary problem was alcohol, then why not let them come to a specialist unit for a 5-7 day detox and actually deal with the issue that is causing the problem in the first place? It just felt like an opportunity that you could take. It was based on the idea of “the treatable moment”, so someone has presented “in crisis” and that might be the best time to intervene”.
“In the first 2 years of opening, we had just over 600 people come through RADAR and 95% of them successfully completed their detox.
The decision to refer a patient to RADAR is made between A&E (usually the alcohol specialist nurses) and the nurses on the Chapman-Barker IPU. It is essential that a quick response is made to prevent an admission to a general hospital. The patients only come into RADAR if they were going to be admitted to the general hospital anyway. Patients also have to give their consent to come over, and they have to want to attempt to stop drinking.
As Dr Daly continues: “In the first 2 years of opening, we had just over 600 people come through RADAR and 95% of them successfully completed their detox. Even though they came into the hospital not knowing that RADAR was what they were going to get, they did it, and it really helped. We evaluated it against their use of the NHS prior to, and after, their admission to RADAR and there was a significant reduction in terms of A&E admissions and general hospital attendances. It was reducing the burden on the acute trusts”.
Whilst this model of care is revered by service users and has evidently made excellent progress in the rehabilitation of patients; what remains unknown to many, is the incredibly challenging manner in which the Chapman-Barker IPU is funded.
Due to reduced funding, alongside the current short-term, contracts being offered by Local Authority commissioners (who themselves are under significant pressures) the units are vulnerable. They are being funded by a financial model which is not sustainable.
Why is it essential that RADAR and IPUs remain active?
The rapid referral to an Inpatient detox Unit reduces the burden on the acute hospital sector by reducing length of stay, successfully completing detoxification and reducing the rates of relapse and admission. Care and treatment is delivered in a timely and effective manner in order to promote recovery. Service users are approached following their arrival at an A&E department, then, If medically appropriate, individuals are offered a five to seven day, medically-managed detox. This allows patients the opportunity to attempt to break the cycle of addiction and the frequent need for acute hospital care. Admissions take place 24/7 with a simple referral pathway.
During an inpatient stay at RADAR, not only is detox appropriately managed, but a range of evidence-based, psycho-social interventions are delivered. Care includes physical health management and mental health treatment, with a strong focus on engagement and aftercare. This leads to better recovery outcomes from detoxification and reduced representation to acute hospitals in future
The unique care package offered by the RADAR system means that the most complex and acute patients, who other service providers may feel unable to manage, are able to be successfully treated. Without secured funding of NHS Inpatient Detox Units those with the most complex needs will have a greatly reduced opportunity for recovery and in many cases will experience premature death.
How Successful is RADAR?
An external evaluation of RADAR has been completed by Liverpool John Moores University. The results have been incredibly positive. In the first two years, 636 patients were admitted, from across 11 A&E/acute hospitals. The findings showed that:
64% of patients were not previously known to alcohol services, indicating that RADAR was capturing people at their treatable moment who were otherwise not accessing services.
95% completed the RADAR treatment and left the unit fully detoxified.
60% were either abstinent or drinking in a controlled way three months after admission.
75% had no hospital admissions in the three months following their RADAR treatment.
50% of the people included in the sample were what are known as ‘frequent fliers’ (regular presenters at A&E) so it can be concluded that RADAR is impacting positively on reduced acute hospital usage.
80% of service users reported they were delighted with the service and referenced the therapists’ “non-judgemental approach” and the environment as contributing factors to this.
Alcohol admissions are costly, however, due to RADAR addressing the issue of alcohol dependency directly and effectively, the external economic evaluation indicated that over £1.3million was saved over the first two years of RADAR being operational.
What was RADAR’s response to the Covid-19 pandemic?
When responding to the COVID-19 pandemic, an increase in demand for acute hospital beds in relation to alcohol withdrawal was anticipated. It was recognised that individuals with alcohol dependence may be becoming increasingly concerned about their drinking, and due to lockdown and the need to self-isolate, individuals may be finding supplies of alcohol more difficult to obtain. As a result of this, the decision was made to expand the capacity of RADAR to support acute colleagues, increasing the number of beds from 8 to 15. This ensured that frontline emergency colleagues would not be diverted from COVID-related care. The number of RADAR admissions noticeably increased during the pandemic. The trust is currently evaluating what the impact of the COVID19 pandemic has been on the patients presenting through RADAR.
Dr Daly explains: “We’re still analysing the data, but it does look like there was a definite increase in referrals through A&E, and through the general hospitals, during that time [lockdown]. It looks like there was a 30-40% increase in RADAR admissions. We don’t know yet what the delayed presentations for alcohol problems are going to mean in the short to medium term. We may continue to see an increasing number of patients coming in with alcohol problems through the A&E department. We’ve returned back to 8 RADAR beds now as we’ve opened up all the other beds in the unit, but we’re nearly always full. There’s still a big need out there for the RADAR referrals. We might even need to increase the capacity further. We’ve also been asking our patients who came through RADAR during covid, whether covid was a factor. We’re about to start analysing that data”.
Conclusion
The RADAR model of care is just one example of the outstanding and essential work that takes place within an IPU. This innovative model is much coveted by other IPUs who are looking to emulate its success and funding.
Although RADAR provides a proven and successful model for acute referrals, sadly the current funding streams for RADAR alone will not sustain these units. It has been reported by all 4 NHS IPN members that the current funding system is not working and their future is precarious. The loss of these units would have disastrous consequences for service users and other healthcare providers who would be left to fill the void created.
How you can support the campaign
NHS APA and the NHS Inpatient Network recommend that the commissioning arrangements for NHS IPUs be changed to allow NHS England to directly commission and fund all existing NHS Inpatient Detox Units under a single specification in line with similar Tier 4 specialist services. NHS APA and the Inpatient Network believe there would be substantial improvements to patient care planning and interventions if NHS IPU’s were directly commissioned and funded in this way, preventing the continued erosion of this specialty under the current localised commissioning arrangements.
We appreciate NHS APA and NHS IPN supporters taking the time to support our #KeepTheFewNHSIPUs campaign and supporting our business case advocating for Tier 4 funding and specialist commissioning via NHSE.
We have now launched an IPU petition in which you can pledge and offer support to the campaign.