Transcript Alcohol Harm Reduction Strategies in London

Alcohol Harm Reduction
Strategies in London
Frameworks for sustainable delivery?
Martyn Penfold
Alcohol Strategy Lead NHS
Wandsworth PCT
Aaron Mills
Policy Officer
Regional Public Health Group
What we know about alcohol harm : A recent history.
Report
Alcohol Can the NHS Afford it (2001) Royal College of Physicians
Alcohol Related Needs Assessment Project (2004)
Alcohol Harm Reduction Strategy for England (2004) Strategy Unit
Safer Sensible Social (2007 ) Strategy Unit
Reducing Alcohol Harm - health services in England for alcohol misuse
National Audit Office (2008)
Too much of the hard stuff –what alcohol costs the NHS (2010)
NHS Confederation and Royal College of Physicians
Public Health White Paper (Dec 2010)
How to manage alcohol dependence and harmful drinking:
National Institute of Clinical Excellence (Feb 2011)
Objectives and methodology.
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Objectives:
To review progress against the delivery of alcohol harm reduction
strategies in local partnerships across the capital.
To identify the extent to which progress reflects a comprehensive and
sustainable response.
Methodology:
A brief (49 point) online questionnaire sent to all 31 London Primary
Care Trusts.
Follow up telephone contact to:
- Validate data
- Follow up with supplementary questions
Frameworks for strategic delivery
Does your partnership have :
YES
NO
Missing
A full time strategy lead for alcohol
10
(33%)
20
(67%)
1
A post holder who leads on the alcohol
harm reduction strategy as part of a
wider brief
18
(90%)
2
(10%)
0
An alcohol harm reduction strategy
26
(87%)
4
(13%)
1
Advisory group that oversees the
delivery of your strategy
22
(73%)
7
(23%)
2
Reported Progress against Objectives
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The most common strategic objectives identified were ‘improving access to
effective treatment’ (71%) and ‘reducing related crime and disorder’ (71%).
•
45% of strategies identified ‘preventing alcohol related harm to children and
young people’ as an objective.
•
Other objectives included ‘reducing alcohol related admissions’ (19%) and an
overarching objective of ‘preventing alcohol related harm’ (19%) .
•
The objective most commonly cited as making good progress was ‘improving
access to effective treatment’ (59%)
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The two objectives most commonly cited as making limited progress were
‘preventing alcohol related harm to children and young people’ (85%) and
‘reducing alcohol related admissions’ (61%)
•
Almost half (49%) of those who cited reducing alcohol related crime and
disorder as an objective reported making limited or no progress.
Average London Spend on
Alcohol Misuse
• Of the 14 PCTs that have (to date) responded to the supplementary audit
questions 12 were able to clarify the projected budget for 2010/2011
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Identified alcohol funding ranged from £120,000 to £3,000, 000
On average the budget for 2010/2011 is £1,089,000 for each partnership
compared to an average of £600,00 reported by the National Audit Office in
2008.
• This figure compares with an average partnership spend (09/10) of £4.8m on
treatment for drug users. (excludes 4 DAAT areas)
• A number of partnerships were unable to alcohol related funding due to it being
integrated with drug treatment services.
Dedicated IBA posts in Tier 1 settings
Yes
No
Missing
Recurrent
funding
Non
recurrent
funding
Unsure
Primary Care
19
(61%)
11
(35%)
1
13
(68%)
6
(32%)
0
Acute health care incl
A&E
19
(61%)
11
(35%)
1
8
(42%)
4
(21%)
7
(37%)
Police custody/courts
8
(26%)
22
(71%)
1
3
(38%)
3
(38%)
2
(24%)
Probation
5
(16%)
25
(81%)
1
3
(60%)
1
(20%)
1
(20%)
Community Mental
heath
5
(16%)
25
(81%)
1
2
(40%)
1
(20%)
2
(40%)
Screening in Primary Care
No.(%)
Yes
No.(%)
No
No.(%)
Missing
Do you have an DES for alcohol IBA in general practice
23
(74%)
6 (19%)
2
(7%)
Do you have an LES for Alcohol IBA in general practice
10
(32%)
19
(61%)
2
(7%)
• Out of the 10 PCTs that have an LES, on average 52% of GP practices in each
PCT has signed up for Alcohol IBA
• On average, there is one IBA worker to every twenty GP practices signed up
to the LES
Community Alcohol Teams
Do you have :
Yes (%)
A dedicated community alcohol team
9 (30%)
Integrated drug and alcohol team
17 (57%)
Both
3 (10%)
Other
1 (3%)
Who does your CAT treat?
Only the most severely dependant drinkers
4 (13%)
All severely dependant drinkers
6 (20%)
All drinkers, including moderately dependant
20 (67%)
Assisted alcohol withdrawal in Primary
Care
YES
No. (%)
No
No.(%)
No
response
Do you have a an alcohol LES for Assisted
Alcohol Withdrawal
5
(16%)
22
(71%)
4
(13%)
Do you commission any GP led alcohol clinics
5
(16%)
19
(61%)
6
(19%)
Do you commission alcohol nurse specialists in
primary care
11
(35%)
19
(61%)
1
(3%)
Comprehensiveness in response
Structured interventions
Yes
No
Missing
Average no
per annum
Structured Counselling
25 (81%)
0
5
50
Structured Day Care
22 (71%) 2 (6%)
6
45
Inpatient detoxification
25 (81%)
0
5
35
Residential rehabilitation
24 (81%)
0
5
25
Targeted interventions
Yes
Parental alcohol misuse
15 (48%)
Alcohol related offenders
13
(42%)
Alcohol related repeat A&E attenders
20 (65%)
Rough sleepers
11 (35%)
Treatment resistant drinkers
11 (35%)
Sustainability
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14 (52 %) of PCT’s reported that additional investment had been made available
to increase alcohol prevention and treatment activity. Evidence suggests that a
significant percentage this may come from Choosing Health budgets.
•
10 (32%) of PCT’s reported that some level of commissioned activities were non
recurrently funded with a further 11 (35%) unable to confirm whether posts were
recurrently funded
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8 or 26% of PCT’s reported choosing health as a source of funding for IBA or
treatment activity. A further 6 or 22% reported using under spends against drug
treatment or other commissioning budgets
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The most common mechanisms for increasing alcohol related activity were
service redesign 19 (61%), integration 15 (48%) and procurement 15 (48%) with
many using a combination of all three
Preliminary observations:
:
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There has been good progress in developing alcohol harm reduction frameworks
in the majority of local partnerships, but data submitted suggests that further work
is required to measure whether this progress is sustainable.
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A range of strategies have been used to reduce waiting times for treatment.
These have shown a downward trend since 2007 to an average of three weeks
in 2010.
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Evidence suggests that capacity in other structured interventions remains limited
which could impact on the effectiveness of services.
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Despite evidence of some growth in investment it is likely that capacity across all
modalities falls short of estimated need .
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The level of activity commissioned using non recurrent funding suggests that
some progress may be at risk, particularly that relating to IBA . Further work is
required to identify what exit or continuation strategies are in place for activity at
risk due to non - recurrent funding.
Preliminary observations continued
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Whilst progress against improving access to effective treatment is generally
reported as good, there is less success in delivering to objectives linked to
crime and disorder, children and young people.
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Despite the majority of PCT’s investing in specialist alcohol nurses in the
acute health care setting, progress in reducing alcohol related admissions
(NI39) is reported as limited or poor. This may in part be attributable to
ineffective treatment pathways between hospital and community services.
•
Investment in primary care based interventions for prevention and treatment
of alcohol misuse is limited. This can increase pressure on specialist services
and fails to ‘capture’ a significant amount of treatment capacity.
Preliminary observations continued
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Despite evidence of a higher risk incidence of alcohol use disorders
amongst offender and adult mental health populations there appears to be
limited focus on developing IBA strategies targeted at these groups.
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Substance misuse commissioners have employed a range of mechanisms
to increase access to alcohol misuse interventions most notably redesign,
integration and procurement. These offer a part solution, but will only
deliver sustained benefits if alcohol outputs are protected from any
acceleration on drug treatment outputs.
Options for improvement
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Further work is needed to understand funding structures for alcohol treatment
within partnerships to ensure that the use of under spends or non recurrent
funding does not put progress at risk.
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Information should be provided to GP commissioning consortia and other
commissioning bodies highlighting the health gain and cost benefits
associated with direct investment in alcohol interventions as well as the
evidence highlighting the effectiveness of these treatments.
•
There is a strong ‘invest to save’ case for investment in alcohol services
across all health care sectors and commissioning streams.
Options for improvement
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Flexibility in the use of drug related funding to support the development of
alcohol services.
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Further work is needed to establish robust frameworks for identifying and
effectively treating alcohol use disorders in general practice .This will allow
specialist teams to act as an expert resource, focusing on those with more
complex needs.
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Future commissioning frameworks should give consideration to integrating
alcohol screening into ‘mainstream’ assessments in areas such as CMHT’s,
NHS health checks and IAPT.
Options for improvement
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Where integration and procurement are employed as mechanisms to
increase treatment capacity for alcohol misuse, commissioners should
consider protect ing alcohol activity to avoid it being compromised by any
acceleration of drug treatment outputs.
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Increased efforts should be made to develop more effective, targeted
screening and intervention strategies of offender and mental health
populations who are not only high risk groups for alcohol misuse but present
with multiple risks including co-morbidity and drug misuse.
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The DOH funded alcohol hubs have offered frameworks for shared leaning
across partnerships and there needs to be a commitment at both
government and partnership level to put in place structures to retain the
benefits delivered by the hubs.
Next steps
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Brief audit of Liaison nurses to identify barriers for effective interventions
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Brief audit of probation alcohol workers to identify current treatment
pathways for offender populations.
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Review early lessons from integration and redesign strategies
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Detailed analysis of audit data
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Review conclusions/recommendations with alcohol leads
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Publish full report January 2011
Thank you