Recovery does not stop at discharge: A qualitative evaluation of Alcohol Recovery Navigators in North East England.

Background

Rates of alcohol-related harm are disproportionately high in the North East England and North Cumbria (NENC) region. People who attend emergency hospital care regularly with alcohol-related problems do not always get the support they need post-discharge. This limits their opportunities to recover, impacts their health negatively, and results in increased costs to the health system. There is currently limited evidence on how to effectively support continuous care when people who drink heavily are discharged from hospital. To address this, Alcohol Recovery Navigators have been introduced in six secondary care hospitals in NENC to support people with multiple alcohol related attendances to access holistic support in hospital and the community. As part of a wider mixed-methods evaluation, with public and patient involvement (PPI) throughout, we explored experiences of the impact of introduction of Recovery Navigators for heavy drinking adults, unpaid carers, and hospital and community sector practitioners.

Methods

Semi-structured interviews were conducted with patients supported by an Alcohol Recovery Navigator, their carers, and care professionals to understand views on and experiences of accessing or delivering the role. Interviews were held face to face, online or via telephone, and were audio-recorded and fully transcribed. Data were analysed using reflexive thematic analysis informed by Normalisation Process Theory, alongside shared sense-making sessions with PPI members.

Results

25 interviews were conducted with patients (n=7), carers (n=1), and care professionals (n=17) across five secondary care hospitals in NENC. Two hospitals had their Alcohol Recovery Navigator leave post during the study and were not replaced within our recruitment period. Themes identified include: the importance of the Recovery Navigator to ‘Building connections that enable change’; A valued role of Navigators was ‘Listening to patients who used to come and go unheard’; Participants described Recovery Navigators being at the ‘Right place at the right time?’; Participants felt that ‘Navigators make a difference’ despite identifying that this may be difficult to quantify; and staff participants discussed ‘Creating the conditions where Navigators flourish’ including factors such as  fixed-term contracts impacting on the recruitment and retention of Alcohol Recovery Navigators.  

Conclusions

Our study found that Alcohol Recovery Navigators’ work was perceived to be invaluable by patients and care professionals. The gradual trust-building between Navigators, patients and wider services was seen as essential for providing a robust alcohol intervention. Factors to support the wider implementation of the role were identified and have been aided by the use of the implementation science framework.  Future research and service development should ensure ongoing PPI involvement and must consider how to meaningfully measure the effectiveness of Navigator roles.