Signs for Improvement: Commissioning Interventions to Reduce Alcohol-Related Harm

Diane HedgesDiane.Hedges@googlemail.com

Making this useful for commissioners

Alcohol policy and expertise MEET

World class commissioning

How hard can it be?

•Pace •Purpose •Passion

Alice in Wonderland, the Dodo Bird’s verdict was that“everybody has won, so all shall have prizes”

quoted in effectiveness review

Commissioners Dilemma:

Critical points linking alcohol-related harm in the WCC journey

Decision makers/partner enthusiasm

Have contract that is specific with measures and money

Implement High impact changes

Contracting will & capacity

JSNA with alcohol specific element

Identify commissioning capacity

Data share to get hotspots

Agree , resource and automate performance review process

Honestly reflect – feed into next year

Set priority actions:whether at Board or other layers not the critical issue

Describe service vision and be uncompromising on whether current provision is best placed to deliver

Get user feedback into the process; it is a great tool Clarify market

strategy

Outline of the guide

Section 1: About the guidanceSection 2: BackgroundSection 3: Why a focus on alcohol-related harm?Section 4: Improving the outcomes through effective commissioningSection 5: World class commissioning competencies and the commissioning cycleSection 6: Conclusions and next steps

Section 4: Improving the outcomes through effective commissioning

Delivery through partnerships• Engage in right places

• JSNA - alcohol specific

• Agreeing Priorities

• Capacity and processes

• Data sharing

High Impact Changes1: Specialist treatment access, capacity and effectiveness:

2: Identification and brief advice in primary care (new registrants): 3: Identification and brief advice in primary care ( at risk group):

4: Identification and brief advice in A&E and specialist units (e.g. fracture clinics)

5: Amplify national campaign messages locally.

Section 4: Improving the outcomes through effective commissioning (cont)

High Impact Changes1: Improvements to specialist treatment access, capacity and effectiveness for

dependent drinkers: Evidence–based specialist treatment for at least 15% of dependent drinkers

2: Identification and brief advice in primary care (new registrants): DES for all newly registered patients.3: Identification and brief advice in primary care ( at risk group): Local Enhanced Service to extend to all with a pre-existing condition where alcohol

may contribute to harm, or are perceived by the GP as being at an increased risk of developing health conditions of alcohol use. Consider extending further .

4: Identification and brief advice in A&E and specialist units (e.g. fracture clinics) Specialist alcohol nurse linked to every accident and emergency unit where there is

apparent local need5 Amplify national campaign messages locally. Local media and marketing campaign which builds on the language and messages of

the Know your limits national campaign. Promotes the local available services.

Assess needs

Assess needs

Review current service

provision

Review current service

provision Decide prioritiesDecide

priorities

Specify servicesSpecify services

Shape structure of

supply

Shape structure of

supply

Manage demand and

ensure appropriate access to

care

Manage demand and

ensure appropriate access to

care

Clinical decision making

Clinical decision making

Manage performance

(quality, performance,

outcomes)

Manage performance

(quality, performance,

outcomes)

Strategic Planning

Specifying outcomes and procuring services

Managing demand and performance

Commissioning cyclePhase 1: Strategic planning

Phase 2: Specifying outcomes

and securing services

Phase 3: Managing demand and performance

Phase 1: Strategic planning• PCT to take a leading role in JSNA and

commissioning alcohol treatment• Engagement of partners, service users, and those at

risk, in the needs assessment process • Agree data needs and sharing protocols to identify

hotspots• Understand the current service response and

expenditure against known best practice in prevention and treatment and determine how these may need to change

• Specify required outcomes and set priorities for action which enable the PCT to monitor impact on indicator ambitions at strategic level

Developing the tools for phase 1

Needs assessment• Appendix 3 gives data sources • National Indicator Set from NWPHO, • A trajectory planning tool to calculate

local admissions trajectories to 2012 and so set baselines.

• Hospital admissions for Alcohol-related harm: Understanding the dataset

Service review

What works for alcohol-related harm?Any good needs assessments to share? What is the learning?

• Models of Care for Alcohol Misusers (MoCAM)

• Effectiveness review• QuADS, DANOS• HubCAPP,

www.alcohollearningcentre.org.uk• National Alcohol Treatment

Monitoring System• The Alcohol Needs Assessment

Research Project (ANARP)

Phase 2: Specifying outcomes and securing services

• Agree and publish the service vision supported by alcohol care pathways across all services

• Commission at minimum, the recommendations from the high impact changes in line with local need

• Ensure a comprehensive and vibrant economy of service providers

• Contract for services with clear service specifications including quality measures and user feedback

Developing the tools for phase 2

Specify outcomes: Determine measures and watch progress

• Numbers of people in service• Level of alcohol intake (at regular points in

care)• Length of time in service (<3 months,

<3>6months, >6months)• Did not attend rates DNA• AUDIT/FAST score pre and post treatment• Numbers of patients subject to

AUDIT/FAST• Number of brief interventions• Numbers of referrals to specialist services• User views of services

Shape structure of supply: Healthcare market analysis and prioritisation

What works for alcohol-related harm?What measures are effective? Anyone segmented the market?

Phase 3: Managing demand and performance

• Establish a comprehensive performance review process specific to alcohol-related harm

• Feed outcomes of commissioning into the annual planning review cycle

Developing the tools for phase 3Performance report

Performance review cycle

What works for alcohol-related harm?Who has a good performance review process to share?

Measured against standard in SLA q1 q2 q3 q4Specialist careNumbers of people in service Level of alcohol intake (at regular points in care)Length of time in service (<3 months, <3>6months, >6months) Did not attend rates DNA AUDIT/FAST score pre and post treatmentUser views of services Primary care (Aggregate from Practices)Number of new registrants subject to AUDIT/FASTNumber of brief advice givenNumbers of referrals to specialist servicesAcute setting (Aggregate from A&E, fracture clinic)Number of new registrants subject to AUDIT/FASTNumber of brief advice givenNumbers of referrals to specialist servicesUser views of services

Agree and use escalation process if

needed

1. Locally lead the NHS

WCC Competencies: what could this mean in alcohol related terms?

2. Work with community partners

3. Engage with public and patients

4. Collaborate with clinicians

5. Manage knowledge and assess needs

6. Prioritise investment

7. Stimulate the market

8. Promote improvement and innovation

9. Secure procurement skills

10. Manage the local health system

11. Make sound financial investments

Capacity and leadership in CDRP/DAAT

. MoCAM & Effectiveness review driven

GPs and relevant staff equipped for IBA

JSNA with alcohol specifics & outcomes

Local media campaign/user driven review

Resources quantified against outcomes£ per reduced hospital admission known

Metrics driving required outcomes

Market segmented and gaps prioritised

Alcohol Provider economics evidenced

Joint arrangements with LAs/partners

Outcomes delivery incentivised contracts

Over to youImproving the outcomes through effective commissioning

(Partnerships/High impact changes)• Do the recommended actions sound about right?Questions on commissioning cycle• Any good needs assessments to share? What is the

learning? • What measures are effective? • Anyone segmented the market?• Who has a good performance review process to share?

• What will help you?