Transcript Commissioning Safe and Sustainable Specialised Paediatric

DH West Midlands
Developing and Implementing
Local Alcohol Treatment
Pathways
Workshop - 18th January 2009
Steve Arnold
David Monk
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Alcohol Treatment Pathways – Workshop Programme
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Developing and Implementing
Local Alcohol Treatment Pathways
18th January 2010
Government Office for the West Midlands
Birmingham
Damian Mitchell
Alcohol Improvement Programme
Department of Health
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NHS
Planned delivery on RA-RHAs
learning
Implement High Impact Changes
Alcohol Interventions Improvement
Programme
Enabling change
Priority support to Early
Implementation PCTs.
Tools: Learning sets,
collaboratives, etc
learning
Learning Centre
Collects, co-ordinates and
disseminates learning and good
practice. Tools: SIPS toolkits,
HuBCAPP, e-learning resource
Review
Support
PCTs (Unplanned) delivery on targets
through implementation of elements of the
high impact actions
Support
Influence
Support
Start delivering RA-RHAs
Early Implementation PCTs
Receive priority support from AIIC
Priority
access
Implementation
National Alcohol Improvement Programme
Regional coordinators
(DH/SHA)
Responsibility
to ensure
delivery of
targets
NST(DH)
Supports 18
struggling
PCTs P.A.
Strategic
reports &
follow-up
visits
learning
Evidence
DH Policy Team
Role: Work with outside bodies to facilitate frontline delivery. Develop
policy, Develop Guidance, Commission, co-ordinate and contract
manage support projects and channel expertise
Social Marketing
Insight, evidence,
products and
interventions
NWPHO
Trailblazers (SIPS), ANARP
Effectiveness review, HES data,etc
Provide local
data on need
and key
evidence
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http://www.alcohollearningcentre.org.uk/
20/07/2015
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http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPo
licyAndGuidance/DH_110423
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Developing Alcohol Treatment Pathways – Introduction (1)
Don Lavoie – DH Alcohol Policy Team
• Alcohol Treatment Pathways (ATPs) are locally agreed templates for
best practice
• They map out the local help available for alcohol-related problems at
the various stages of a treatment journey.
• They are commonly made up of a flow diagram showing the
particular pathway and decision points
• Alongside the diagram is background documentation giving
explanatory narrative and clarifying details
• This allows for a wide variation in size, scope and detail.
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Developing Alcohol Treatment Pathways – Introduction (2)
Don Lavoie – DH Alcohol Policy Team
• Builds on locally agreed protocols and developed treatment
guidelines
• Supports more standardised local practice
• Provides practical help and guidance to less experienced workers.
• An ATP is not a substitute for management, supervision and
training,
• But an ATP does offer a means to help ensure consistently high
standards of treatment and care.
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Developing Alcohol Treatment Pathways - Checklist
Don Lavoie – DH Alcohol Policy Team
• ATPs should be:
– agreed and developed locally, taking account of local service
configuration and priorities;
– evidence-based;
– client-focused; and
– agreed and championed so as to ensure ownership by managers,
practitioners and the key stakeholder who can influence success
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Developing Alcohol Treatment Pathways – Key Elements
Don Lavoie – DH Alcohol Policy Team
• Reviewing the existing documentation, and the processes and
pathways currently in use
• Developing or revising local treatment guidelines and protocols
• Deciding on the content of the ATP document – what we need to
know and what would be helpful to know and include
• Producing clearly written documents that are easy to understand
and are user-friendly
– effective editorial control from the ATP lead or champion is needed
– alongside involvement of all stakeholders on drafts; and
• Comparing new drafts with existing paperwork, removing duplication
and including essential new content.
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Developing Alcohol Treatment Pathways – Narrative (1)
Don Lavoie – DH Alcohol Policy Team
Purpose:
• Provides clarity as to the type of client the alcohol treatment
intervention caters for
• States what the client can expect treatment services to provide –
including important detailed practical arrangements when
appropriate
• Sets out the roles and responsibilities of the service within the
integrated care system towards the individual client.
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Developing Alcohol Treatment Pathways – Narrative (2)
Don Lavoie – DH Alcohol Policy Team
Content:
• Definition of the treatment interventions provided (referencing any
key guidance or guidelines)
• Aims and objectives of the treatment interventions
• Definition of the client group served
• Eligibility criteria (including priority groups)
• Exclusion criteria or contraindications
• Referral, screening and assessment processes
• Process for agreeing the treatment goals
• Description of the treatment process or phases
• Description of the co-ordination of care
• Nature of departure planning, aftercare and support
• Relevant onward referral pathways
• Description of the range of services/agencies with which the
interventions interface
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Developing Alcohol Treatment Pathways – Exemplars (1)
Don Lavoie – DH Alcohol Policy Team
• Five specimen template alcohol treatment pathway diagrams. The
diagrams will rarely make complete sense out of the local context
• The aim of the examples is to identify the shape of some typical
ATPs whilst recognising the scope and level of detail will vary
markedly from place to place
• They are not intended to be prescriptive– but rather to be illustrative
of issues that may be of relevance in developing different ATPs
• In addition to the diagrams, some narrative commentary is given for
each pathway, pointing out some issues that may need to be
considered or addressed
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Developing Alcohol Treatment Pathways – Exemplars (2)
Don Lavoie – DH Alcohol Policy Team
• Currently available:
–
–
–
–
–
Identification and brief advice (IBA)
Community based services - assisted alcohol withdrawal
Assisted alcohol withdrawal – inpatient-based
People with combined alcohol and mental health problems
Homeless people who need alcohol treatment
• For further consideration:
– Residential rehabilitation
– People with alcohol problems who also experience domestic abuse
– Service users in drug treatment who also have alcohol problems
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Primary Care Alcohol Care Pathway
Requesting help with
alcohol problem
Initial
Screening
Tools
SASQ
Adults 16-64 visiting GP
New Registration
FAST
Other health complaint
AUDIT - C
AUDIT - PC
Positive
Result
Negative
Result
Full Screen
AUDIT
AUDIT Score
20+
Possible Dependence
Consider Referral to
Specialist Services
Full Assessment
AUDIT Score
16-19
Higher-risk
AUDIT Score
8-15
Increasing-risk
Extended
Brief Advice
Brief Advice
No action
AUDIT Score
0-7
Lower-risk
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ATP 1
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ATP 2
Part 1
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ATP 2
Part 2
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ATP 3
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ATP 4
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ATP 5
Part 1
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ATP 5
Part 2
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Developing Alcohol Treatment Pathways – Final thoughts
Don Lavoie – DH Alcohol Policy Team
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The way in which ATPs are developed locally will depend on the issues that
have been identified as most important for which the development of ATPs
are considered a useful contribution
•
Planning the development of ATPs over a sensible timeline will be needed
in order to ensure that high quality and robust ATPs are developed rather
than simply quickly achieving a comprehensive but superficial coverage of
topics
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It is important for all the key contributors to the care described in any
particular ATP to be engaged in the development of that care pathway, at
least at key development points and for final sign-off
•
Establishing effective treatment pathways can therefore also involve
developing and strengthening partnerships between relevant local
organisations
•
ATP development can be a helpful mechanisms to involve service users
and carers in governance processes
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Developing Alcohol Treatment Pathways
What Else Might be Useful?
• Access to good data and combined intelligence
–
–
–
–
–
–
PH/quality observatory
Benchmarking capability
NI 39 groups
Learning sets
Gaining collaborative advantage
Using map of medicine – getting alcohol pathways on this resource
• The Royal Colleges - ‘expert power message’
• Better local modelling
• Consistency of the ‘science’ – social market messaging e.g.
pregnancy
• Balance between ‘crime and health’ consequences in the marketing
imagery
• A minimum unit price
• National Minimum Dataset for A&E to include ‘Alcohol’ related
diagnoses
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Developing Alcohol Treatment Pathways
What Else Might be Useful?
• QOF requirement – DH to lobby
• Positioning of alcohol advertising (NB new campaign form February
2010)
• CQUIN requirements – national, regional and local incentives
• QIPP/QaP
• Innovation funds – available through SHA’s
• Links to other initiatives, e.g.
– Links to the ‘Quality’ agenda – advancing quality via Pathway
Metrics, Clinical engagement and User experience
– Need to lobby for ‘Alcohol’ awareness across all services (similar
to e.g. work on Medically Unexplained Symptoms)
– Mental Health service use of GPs with a special interest in Psychiatry
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Developing Alcohol Treatment Pathways
Local Experience in the West Midlands (1)
• Sandwell (Neil Parkes):
– Overview pathway supported by specific pathways for:
• GP/Self Referral to Tier 2 Services
• Tier 2 services (designated provider)
• Referral to Tier 3
• A&E Referral and A&E Attendance
• Generic inpatient services
• Tier 3 service (designated provider)
– Framed around the NHS but other agencies provide support
– Interagency Alcohol group established from January 2010 – will
help to formalise work done so far
– SLA in place for Tier 2 services – under development in respect
of Tier 3
– The ‘Pathway’ is not the only output – improving the process of
working together through experience is a key deliverable
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Developing Alcohol Treatment Pathways
Local Experience in the West Midlands (2)
• North Staffordshire (Tim McGreggor) - new model for commissioning
services to reduce alcohol related harm in the South Staffordshire:
– Build on recent needs assessment and utilise the DH Ready
Reckoner and Rush Model tool
– Bring together key players to achieve ownership
– Invest time with Practice Based Commissioners to ensure PCT
ownership
– Integrated pathways reflect the DH Local pathways document
– ICPs need to go through PCT PECs
– Difficult to move investment out of mental health trusts as it is
part of a bigger lock contract
– Need to work very closely with drug commissioners to check for
impact or disinvestment in drug treatment services
– Inpatient detox needs to addressed at a regional level
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Developing Alcohol Treatment Pathways – Generic
Approach (1)
5. Care Coordination
Navigation and Advocacy
Segmentation
Access,
Entry &
Re-entry
Knowledge of people needing
services
1.Quality of Information
Signposting
‘Ease of entry’
Formulation
D
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A
G
N
O
S
I
s
C
L
U
S
T
E
R
S
2.The Assessment
Process
Right 1st time
Dynamic
Currency
Currency
Currency
Currency
Exit
&
Aftercare
Care
Currency
3.The
Delivery
Experience
Personalised
care
packages
4.Information
Planning
Signposting
‘Ease of Exit’
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Developing Alcohol Treatment Pathways – Generic
Approach (2)
Innovation
Clear
objectives
Barriers
Review
(local
context)
A clear
strategy
Enablers
The
evidence
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Developing Alcohol Treatment Pathways – Generic
Approach (3)
• Clarity about population targeted
• A good case behind choices
– Strategic analysis
– Knowledge of stakeholders
– High level health economic case well made and
understood
– Understand the policy competition
• Innovation (and funds)
• Evidence of what works
• Quality of assessments
• Choosing the right intervention
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Developing Alcohol Treatment Pathways – Local Treatment
Pathways – Group work - Briefing
Working in designated groups:
• Identify any key local implementation issues
• Begin the preparation of a local action plan
• Consider further action beyond the workshop, inc any
joint working and external support required
• Keep written notes of the key points
• Summarise the 3 key messages
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Developing Alcohol Treatment Pathways – Local Treatment
Pathways – Group work – Summary of Key Messages (1)
• Starting with a Simple pathway makes sense – the basis
for a sensible dialogue with stakeholders
• Learn from experience – create the environment to share
knowledge
• Up our game on information, data and its utility - ‘better
metrics - better ‘Commissioning'
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Developing Alcohol Treatment Pathways – Local Treatment
Pathways – Group work – Summary of Key Messages (2)
• Better stakeholder buy in – ‘right people engaged at right
time’ - a clear business case
• Understand the resource implications in more detail –
understand demand and the time it takes (time-lag) to
realise a return
• Realism in the pathway - linking with other pathways
where it makes sense e.g. Sexual health pathways
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Developing Alcohol Treatment Pathways – Local Treatment
Pathways – Group work – Summary of Key Messages (3)
• Leadership vital – on the payroll and driving the issue Alcohol champions across partners
• Good local needs assessment driving commissioning
and better benchmarking
• Learning exchanges – ‘more sharing’ – roll for the RAM
to ‘match make’
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Developing Alcohol Treatment Pathways – Local Treatment
Pathways – Action
• PCTs to consider options for joint working on the further
development of ATPs e.g.
– Region-wide user support group
– Sub-regional geographic groups
– PCTs at the same stage of preparation work together
• Initial assessment of current position in each PCT to be
undertaken to inform the process – Deryn B to lead, using the
recently developed PCT self-assessment tool or similar
• Regional support to continue for local initiatives via Deryn B
• The ALC team to provide dedicated website space for the
West Midlands, enabling storage of locally developed
pathways
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