Signs for Improvement: Commissioning Interventions to Reduce Alcohol-Related Harm
Diane [email protected]
Making this useful for commissioners
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?