Alcohol Commissioning - The role of Public Health - A view from Tower Hamlets

1. Alcohol Commissioning - The role of Public Health- A view from Tower Hamlets Chris Lovitt- AD Public Health Rachael Sadegh- DAAT Joint Commissioning Manager

2. Knowledge, Insight and Action Commissioning & Public Health

3. Overview • Local work on developing a strengthened Public Health role in commissioning • Developing a framework for commissioning • Prioritising areas for engagement • Reality 2

4. Strengthening local commissioning • Developing an Inner London Health Intelligence Unit • - strengthen acute commissioning • City and Hackney, Newham and Tower Hamlets • Supported by McKinsey's • interviews, research & workshops • Develop model of commissioning • Identified 6 priority areas • Focus action on priority areas to further strengthen commissioning 3 3 3

5. KEY PUBLIC HEALTH/ HEALTH INTELLIGENCES ACTIVITIES THAT TAKE PLACE ALONG THE COMMISSIONING PROCESS – A B C D Health needs assessment and strategic planning Condition management & influencing health behaviours Specification, contracting and procurement Performance, contract and quality management E Informatics F Public & Clinical & Partner Engagement D A B C • Assess needs and prioritise • Care pathway design • Strategic planning • Condition prevention and management • Condition and risk monitoring • Patient engagement • Define contract specifications • Contract & procure • Market Management • Quality and performance • Claims management and coding review • Treatment cost management • Informatics • Public and clinical engagement E,F

6. SIX AREAS FOR FOCUS ALONG THE COMMISSIONING PROCESS x Priority area A B C D Health needs assessment and strategic planning Condition management and influencing health behaviours Specification, contracting and procurement Performance, contract and quality management E Informatics F Public and Clinical and Partner Engagement A B C D E,F 1 4 5 6 • Condition prevention and management: • Identification and Management of high-risk groups with pro-active engagement, targeted interventions and health promotion campaigns and evidence of effectiveness • Condition and risk monitoring: • Trends analysis and anticipation of predispositions to disease states by individual • Patient engagement : Effective patient registration, capturing transient populations; ensure patients understand available services and quality to inform choice; Facilitate and respond to feedback and work to improve patient experience • Define contract specifications : • Specify delivery target, outcome and quality metrics in contracts; prepare tender specifications • Contract and procure: • Run open and fair procurement processes, negotiate contracts and appointing high quality providers with best value-for-money • Market Management: Ensure competitive market, and an adequate number and diversity of providers to meet London’s healthcare needs; Monitor and manage service delivery networks • Quality and performance:Track and regulate performance and compliance against contracts. Monitor quality indicators; adjust or terminate contract where necessary • Claims management and coding review: • Review and validate invoices; Check for clinical coding errors in handling of patient episode; Negotiate disagreements with providers • Pharmaceutical/ treatment cost management: • Analyse activity, intervention costs and effectiveness; Create incentives for GPs and monitor compliance • Informatics: Ensure effective data storage, management and availability to support commissioning • Public and clinical engagement:Build effective channels of communication with the public and clinicians to understand opinion on services and optimal care pathways • Assess needs and prioritise: • Data driven assessment of the health needs of the population leading to agreed commissioning priorities that will improve health outcomes • Care pathway design: • Use clinical knowledge and experience and evidence base to develop pathways and ensure joined up approach across service lines and a common currency across London • Strategic planning: • Work with key strategic partners to agree commissioning priorities that will improve health outcomes; plan resource allocation over long term, map desired service configuration and provider market 2 3 5

7. REALITY • Implementation of new projects & evidence reviews • Patient pathway mapping • Valuation and outcome monitoring • Social marketing • Training • Research and publications • Representation at meetings • Health needs assessments • Integrating data from multiple local & national sources • Annual Report • NAO report • Integration with other healthy lifestyle activity • Capacity modelling • Commissioning Intentions Support • Audit of A&E alcohol related admissions

8. Action • Overview & scrutiny review of young people & alcohol • Alcohol LES • Retender of Enhanced Community Alcohol Service • Alcohol Social Marketing • A&E diversion intervention • Forthcoming alcohol NST Support visit • Young People Alcohol Health Improvement Officer • Alcohol Public Health Strategist

9. Knowledge, Insight and Action Commissioning & Public Health

10. Conclusion Public Health & CommissioningTogether providing:KnowledgeInsightAction

11. Some resources A B C D E,F • Condition prevention and management: • Identification and Management of high-risk groups with pro-active engagement, targeted interventions and health promotion campaigns and evidence of effectiveness • Use tools such as SASQ, FAST, AUDIT C, AUDIT PC Use of tools such as SASQ, FAST, AUDIT C, AUDIT PC • Role of Primary Care • http://www.emphasisnetwork.org.uk/events/alcoholnov2008/presentations/donlavoie.ppt • Condition and risk monitoring: • Trends analysis and anticipation of predispositions to disease states by individual • Patient engagement : Effective patient registration, capturing transient populations; ensure patients understand available services and quality to inform choice; Facilitate and respond to feedback and work to improve patient experience • Define contract specifications : • Specify delivery target, outcome and quality metrics in contracts; prepare tender specifications • Contract and procure: • Run open and fair procurement processes, negotiate contracts and appointing high quality providers with best value-for-money • Market Management: Ensure competitive market, and an adequate number and diversity of providers to meet London’s healthcare needs; Monitor and manage service delivery networks • Quality and performance:Track and regulate performance and compliance against contracts. Monitor quality indicators; adjust or terminate contract where necessary • Claims management and coding review: • Review and validate invoices; Check for clinical coding errors in handling of patient episode; Negotiate disagreements with providers • Pharmaceutical cost management: • Analyse prescribing activity, drug costs and effectiveness; Create incentives for GPs and monitor compliance • Informatics: Ensure effective data storage, management and availability to support commissioning • Public and clinical engagement:Build effective channels of communication with the public and clinicians to understand opinion on services and optimal care pathways • Assess needs and prioritise: Data driven assessment of the health needs of the population leading to agreed commissioning priorities that will improve health outcomes • http://www.empho.org.uk/Themes/alcohol/alcohol4.aspx • http://www.alcohollearningcentre.org.uk/Topics/Browse/Data/ • http://www.homeoffice.gov.uk/rds/pdfs2/dpr6.pdf • Care pathway design: • Use clinical knowledge and experience and evidence base to develop pathways and ensure joined up approach across service lines and a common currency across London • http://www.alcohollearningcentre.org.uk/Topics/Browse/PrimaryCare/?parent=4608&child=4618 • http://www.sussedprofessionals.net/node/441 • Strategic planning: • Work with key strategic partners to agree commissioning priorities that will improve health outcomes; plan resource allocation over long term, map desired service configuration and provider market • http://www.nao.org.uk/publications/0708/reducing_alcohol_harm.aspx