1. Signs for Improvement: Commissioning Interventions to Reduce Alcohol-Related Harm Diane Hedges Diane.Hedges@googlemail.com Making this useful for commissioners

2. Alcohol policy and expertise MEET World class commissioning

3. How hard can it be? Pace Purpose Passion

4. Alice in Wonderland, the Dodo Bird’s verdict was that “everybody has won, so all shall have prizes” quoted in effectiveness review Commissioners Dilemma:

5. 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

6. 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 effective commissioning Section 5: World class commissioning competencies and the commissioning cycle Section 6: Conclusions and next steps

7. 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 Changes 1: 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.

8. Section 4: Improving the outcomes through effective commissioning (cont) High Impact Changes 1: 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 need 5 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.

9. Commissioning cycle Phase 1: Strategic planning Phase 2: Specifying outcomes and securing services Phase 3: Managing demand and performance

10. 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

11. 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)

12. 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

13. 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 ( 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?

14. 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

15. 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 objectives and development plan for year. Qualitative and quantitative Quarter 1 review Quarter 2 review and publish Quarter 3 review, feed into thinking on future market shape Quarter 4 review, and feed into next SLA Agree and use escalation process if needed

16. 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

17. Over to you Improving 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?