Slide 1

Signs for Improvement:Commissioning Interventions toReduce Alcohol-Related Harm

Diane Hedges

Diane.Hedges@googlemail.com

Making this useful for commissioners

Alcohol policyand expertise

MEET

World classcommissioning

How hard can it be?

•Pace

•Purpose

•Passion

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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 harmin the WCC journey

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Decisionmakers/partnerenthusiasm

Have contract that isspecific withmeasures andmoney

Implement Highimpact changes

Contracting will &capacity

JSNA with alcoholspecific element

Identifycommissioningcapacity

Data share to gethotspots

Agree , resourceand automateperformancereview process

Honestlyreflect – feedinto next year

Set priority actions:

whether at Board orother layers not thecritical issue

Describe service visionand be uncompromisingon whether currentprovision is best placed todeliver

Get user feedbackinto the process;

it is a great tool

Clarify marketstrategy

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 effectivecommissioning

Section 5: World class commissioning competenciesand the commissioning cycle

Section 6: Conclusions and next steps

Section 4: Improving the outcomesthrough effective commissioning

Delivery through partnerships

•Engage in right places

•JSNA - alcohol specific

•Agreeing Priorities

•Capacity and processes

•Data sharing

High Impact Changes

1: Specialist treatment access,capacity and effectiveness:

2: Identification and brief advice inprimary care (new registrants):

3: Identification and brief advice inprimary care ( at risk group):

4: Identification and brief advice inA&E and specialist units (e.g. fractureclinics)

5: Amplify national campaignmessages locally.

Section 4: Improving the outcomes througheffective commissioning (cont)

High Impact Changes

1: Improvements to specialist treatment access, capacity and effectiveness fordependent drinkers: Evidence–based specialist treatment for at least 15% ofdependent 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 alcoholmay contribute to harm, or are perceived by the GP as being at an increased riskof 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 isapparent local need

5 Amplify national campaign messages locally.

Local media and marketing campaign which builds on the language and messages ofthe Know your limits national campaign. Promotes the local available services.

Commissioning cycle

Phase 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 andcommissioning alcohol treatment

•Engagement of partners, service users, and those atrisk, in the needs assessment process

•Agree data needs and sharing protocols to identifyhotspots

•Understand the current service response andexpenditure against known best practice inprevention and treatment and determine how thesemay need to change

•Specify required outcomes and set priorities foraction which enable the PCT to monitor impact onindicator ambitions at strategic level

Developing the tools for phase 1

Needs assessment

•Appendix 3 gives data sources

•National Indicator Set fromNWPHO,

•A trajectory planning tool tocalculate local admissionstrajectories to 2012 and so setbaselines.

•Hospital admissions for Alcohol-related harm: Understanding thedataset

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 TreatmentMonitoring System

•The Alcohol Needs AssessmentResearch Project (ANARP)

Phase 2: Specifying outcomes andsecuring services

•Agree and publish the service visionsupported by alcohol care pathways across allservices

•Commission at minimum, therecommendations from the high impactchanges in line with local need

•Ensure a comprehensive and vibranteconomy of service providers

•Contract for services with clear servicespecifications including quality measures anduser feedback

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Developing the tools for phase 2

Specify outcomes: Determinemeasures and watch progress

•Numbers of people in service

•Level of alcohol intake (at regular points incare)

•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 toAUDIT/FAST

•Number of brief interventions

•Numbers of referrals to specialist services

•User views of services

Shape structure of supply:Healthcare market analysisand prioritisation

What works for alcohol-related harm?

What measures are effective? Anyone segmented the market?

Phase 3: Managing demand andperformance

•Establish a comprehensive performancereview process specific to alcohol-relatedharm

•Feed outcomes of commissioning into theannual planning review cycle

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Developing the tools for phase 3

Performance report

Performance review cycle

What works for alcohol-related harm?

Who has a good performance review process to share?

Negotiate objectivesand development planfor year. Qualitative andquantitative

Quarter 1 review

Quarter 2 review andpublish

Quarter 3 review, feedinto thinking on futuremarket shape

Quarter 4 review, andfeed into next SLA

Agree and useescalation process ifneeded

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 you

Improving the outcomes through effectivecommissioning (Partnerships/High impact changes)

•Do the recommended actions sound about right?

Questions on commissioning cycle

•Any good needs assessments to share? What is thelearning?

•What measures are effective?

• Anyone segmented the market?

•Who has a good performance review process toshare?

•What will help you?