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Evidence-based Treatments for Alcohol Problems: are they being implemented?

Evidence-based Treatments for Alcohol Problems: are they being implemented?. Dr Jane Marshall SSA Meeting, York, November 2010. Britain: “open 24/7”. Britain: “open 24/7”.

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Evidence-based Treatments for Alcohol Problems: are they being implemented?

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  1. Evidence-based Treatments for Alcohol Problems: are they being implemented? Dr Jane Marshall SSA Meeting, York, November 2010

  2. Britain: “open 24/7”

  3. Britain: “open 24/7” • Over past 50 years the per capita consumption in the UK has doubled from approx 4 litres to over 8 litres of pure alcohol per year

  4. At risk drinking: Britain • Men drinking >21units per week • 1992: 27% • 2002: 27% • Women drinking >14 units per week • 1992: 12% • 2002: 17%

  5. The Size of the Problem • In England: • 18% of the adult population are drinking at “hazardous” levels: 7.6 million • 7% are showing harm to their own mental and physical health: 2.9 million • 4% are alcohol dependent: 1.1. million

  6. Consumption and harm • Alcohol-related ill-health has increased as alcohol consumption has increased • There are no more services to deal with these problems • Shift in resources to treating dependent drug use • We need to reduce overall consumption

  7. The Size of the Problem • Hospital admissions for the three main alcohol-specific conditions have more than doubled in the 11 years from 1995-6 to 2006-7 • 1995-6 : 93,459 • 2006-7 : 207,788 • Alcohol-related liver disease • Mental health disorders linked to alcohol • Acute intoxication

  8. Mortality 1971-2007

  9. Alcohol-related death rates by sex 1991-2005

  10. Liver Cirrhosis Deaths

  11. Alcohol Policy • 2004: Alcohol Harm Reduction Strategy for England • 2006: MoCAM • 2007: Safe, Sensible, Social • April 2008: Alcohol misuse subject to a cross-departmental Public Service Agreement (PSA) • DH a partner in delivering the new PSA 25, led by the Home Office • To be monitored annually until 2011 • Performance indicator to reduce rate of increase of alcohol-related hospital admissions

  12. Alcohol Policy • November 2008: DH sets up an Alcohol Improvement Programme • National Alcohol Treatment Monitoring System • Alcohol Learning centre • New Network of Regional Alcohol Offices (funding of £2.7 m per year) • November 2008: National Audit Office report

  13. House of Commons Health CommitteeJanuary 2010 • Each PCT should have an alcohol strategy • Targets for reducing alcohol related admissions should be mandatory • Acute hospital services should be linked with specialist services via teams of specialist nurses • There should be more alcohol nurse specialists

  14. House of Commons Health Committee January 2010 • Treatment budgets should be pooled to allow cost savings from reduced admissions to be fed back into treatment and prevention • Access to community based treatment should be improved • Alcohol services should be more proactive in seeking and retaining people in treatment • Funding should be approved for a National Liver Plan

  15. Models of Care for Alcohol Misusers (MoCAM): June 2006 • Best practice guidance for local health organisations and their partners in delivering a planned and integrated local treatment system for alcohol misusers • Aimed at commissioners and providers of care

  16. Alcohol Needs Assessment Research Project (ANARP): 2005 • First national alcohol needs assessment in England • Used a systems model to estimate access to specialist alcohol treatment • Estimated gap between the prevalence of need in the population and access to treatment

  17. ANARP: Region

  18. Gap between need and access

  19. ANARP: Gap Analysis • Only 1 in 18 (5.6%) of the alcohol dependent population was accessing specialist alcohol treatment in England each year • More than twice as many were referred than were accessing treatment • [An estimated 1 in 2 (55%) problem drug users gain access to treatment each year]

  20. Alcohol agencies • Estimated annual spend: £217 million • cf £95 million (PMSU, 2004) • Whole time equivalent staff: 4,250 • Average number of clients on Waiting List: 15.2 • Average waiting time: 4.6 weeks • shortest waits in South East: 3.1 weeks • longest waits in North east: 6.5 weeks

  21. Commissioning of Alcohol Services • PCTs and DAATs accord drug services a higher priority • In 2004: • an average of £197 was spent on each dependent drinker • Corresponding figure for each dependent drug user was £1,744 • 2009-2010: pooled treatment budget was £406m, mostly directed at drug services

  22. NAO Report, 2008 • PCTs responsible for setting their own local health priorities but.. • 25% had not carried out a local needs assessment • Despite having access to the Local Alcohol Profiles in England • 20% were not making use of them • From April 2008 PCTs required to undertake a formal assessment of need with the Local Authority

  23. Commissioning of Alcohol Services • 2006-7: PCTs spent an average of £600,000 on commissioning alcohol services • Approx. 0.1% of a typical PCT’s total annual expenditure of about £460 million • Included: • Provision of brief advice from GPs • Weekly alcohol clinics • Intensive specialist treatment • Little correlation between PCT spending on alcohol services and the extent of alcohol problems in the local population

  24. PCT expenditure patterns for services to reduce alcohol harm NAO, 2008

  25. Annual estimated costs of alcohol to the NHS, 2006-7

  26. Specialist Alcohol Services • Wide regional variation in availability • Local provision not based on a good understanding of the local need or of the likely results • Services are fragmented • Need for better integration of hospital services with follow on services to improve outcomes

  27. Provision of liver units and specialised inpatient alcohol units

  28. Provision of Specialist Services by PCTsNAO, 2008

  29. Specialist Alcohol Services • February 2009 • 55,000 people in treatment for AUDS in England • [Govt had increased the number of treatment places from 63,000 to 100,000, thus reaching 10% of the in-need population] • Drugs • >190,000 people engaged in drug treatment in 2009

  30. Voluntary Sector • Most specialist alcohol treatment provision is in the voluntary sector • In 2003, of £95m spent on specialist alcohol services: • £71m was spent in voluntary sector

  31. National Alcohol Treatment Monitoring Service https://www.ndtms.net/ • Data collection started from 01/04/2008 • Data 1 April 2008-31 March 2009: • 100,098 clients in contact with structured treatment (where alcohol the primary substance) • 29,938 in contact (alcohol adjunct substance) • Median age first contact: 41 years • 64% male and 87% White British • 35% self-referred; 22% referred by GP

  32. Comparison of Drug and Alcohol Treatment Expenditure and % in Treatment

  33. Investment in Alcohol Services • Investment in alcohol services would yield net savings for the NHS • UKATT: for every £1 spent in treatment, £5 is spent elsewhere • Provision of alcohol treatment to 10% of UK dependent drinkers would reduce public sector resource costs by between £109 – 156 m

  34. The present situation • Focus on public health • Screening and brief interventions • NICE guidelines • Alcohol still being treated as an ordinary commodity • Alcohol is no ordinary commodity

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