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

1. Signs for Improvement: Commissioning Interventions to Reduce Alcohol-Related Harm Making this useful for commissioners Diane Hedges Diane.Hedges@googlemail.com

2. Alcohol policy and expertise MEET World class commissioning

3. How hard can it be? Pace Purpose Passion

4. Alice in Wonderland, the Dodo Bird’s verdict was that“everybody has won, so all shall have prizes” quoted in effectiveness review Commissioners Dilemma:

5. Critical points linking alcohol-related harm in the WCC journey Identify commissioning capacity JSNA with alcohol specific element Decision makers/partner enthusiasm Data share to get hotspots Set priority actions: whether at Board or other layers not the critical issue Honestly reflect – feed into next year Contracting will & capacity Agree , resource and automate performance review process Implement High impact changes Get user feedback into the process; it is a great tool Have contract that is specific with measures and money Describe service vision and be uncompromising on whether current provision is best placed to deliver Clarify market strategy

6. Outline of the guide Section 1: About the guidance Section 2: Background Section 3: Why a focus on alcohol-related harm? Section 4: Improving the outcomes through effective commissioning Section 5: World class commissioning competencies and the commissioning cycle Section 6: Conclusions and next steps

7. Section 4: Improving the outcomes through effective commissioning High Impact Changes 1: 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. Delivery through partnerships • Engage in right places • JSNA - alcohol specific • Agreeing Priorities • Capacity and processes • Data sharing

8. Section 4: Improving the outcomes through effective commissioning (cont) High Impact Changes 1: 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 need 5 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.

9. Commissioning cycle Phase 1: Strategic planning Phase 2: Specifying outcomes and securing services Phase 3: Managing demand and performance

10. 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

11. Developing the tools for phase 1 Needs assessment Service review 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) • 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 What works for alcohol-related harm? Any good needs assessments to share? What is the learning?

12. 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

13. Developing the tools for phase 2 Specify outcomes: Determine measures and watch progress Shape structure of supply: Healthcare market analysis and prioritisation • 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 What works for alcohol-related harm? What measures are effective? Anyone segmented the market?

14. 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 

15. Developing the tools for phase 3 Performance report Performance review cycle Agree and use escalation process if needed What works for alcohol-related harm? Who has a good performance review process to share?

16. WCC Competencies: what could this mean in alcohol related terms? 1. Locally lead the NHS Capacity and leadership in CDRP/DAAT 7. Stimulate the market 2. Work with community partners Market segmented and gaps prioritised JSNA with alcohol specifics & outcomes 8. Promote improvement and innovation 3. Engage with public and patients Outcomes delivery incentivised contracts Local media campaign/user driven review 9. Secure procurement skills 4. Collaborate with clinicians Alcohol Provider economics evidenced GPs and relevant staff equipped for IBA 10. Manage the local health system 5. Manage knowledge and assess needs Metrics driving required outcomes . MoCAM & Effectiveness review driven 11. Make sound financial investments 6. Prioritise investment Joint arrangements with LAs/partners Resources quantified against outcomes £ per reduced hospital admission known

17. Over to you Improving 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?