Transcript Slide 1

Signs for Improvement:
Commissioning Interventions to
Reduce Alcohol-Related Harm
Making this useful for commissioners
Diane Hedges
[email protected]
Alcohol policy
and expertise
MEET
World class
commissioning
How hard can it be?
•Pace
•Purpose
•Passion
Commissioners Dilemma:
Alice in Wonderland, the Dodo Bird’s verdict was that
“everybody has won, so all shall have prizes”
quoted in effectiveness review
Critical points linking alcohol-related harm
in the WCC journey
Decision
makers/partner
enthusiasm
Identify
commissioning
capacity
JSNA with alcohol
specific element
Set priority actions:
whether at Board or
other layers not the
critical issue
Honestly
reflect – feed
into next year
Contracting will &
capacity
Agree , resource
and automate
performance
review process
Get user feedback
into the process;
it is a great tool
Data share to get
hotspots
Implement High
impact changes
Have contract that is
specific with
Clarify market
measures and
strategy
money
Describe service vision
and be uncompromising
on whether current
provision is best placed to
deliver
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
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.
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.
Commissioning cycle
Phase 1: Strategic planning
Review
Review
current
current
service
service
provision
provision
Decide
Decide
priorities
priorities
Assess
Assess
needs
needs
Strategic Planning
Specify
Specify
services
services
Specifying outcomes and
procuring services
Manage
Manage
performance
performance
(quality,
(quality,
performance,
performance,
outcomes)
outcomes)
Phase 3: Managing
demand and
performance
Managing demand and
performance
Clinical
Clinical
decision
decision
making
making
Manage
Manage
demand
demand and
and
ensure
ensure
appropriate
appropriate
access
access to
to
care
care
Shape
Shape
structure
structure of
of
supply
supply
Phase 2: Specifying
outcomes
and
securing services
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
Service review
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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 Alcoholrelated harm: Understanding the
dataset
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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)
What works for alcohol-related harm?
Any good needs assessments to share? What is the learning?
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
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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
What works for alcohol-related harm?
What measures are effective?
Shape structure of supply:
Healthcare market analysis
and prioritisation
Anyone segmented the market?
Phase 3: Managing demand and
performance
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•
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 3
Performance report
Measured against standard in SLA
Specialist care
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
User views of services
Primary care (Aggregate from Practices)
Number of new registrants subject to AUDIT/FAST
Number of brief advice given
Numbers of referrals to specialist services
Acute setting (Aggregate from A&E, fracture clinic)
Number of new registrants subject to AUDIT/FAST
Number of brief advice given
Numbers of referrals to specialist services
User views of services
q1
q2
q3
q4
Performance review cycle
Negotiate objectives
and development plan
for year. Qualitative and
quantitative
Quarter 4 review, and
feed into next SLA
Quarter 1 review
Agree and use
escalation process if
needed
Quarter 3 review, feed
into thinking on future
market shape
What works for alcohol-related harm?
Who has a good performance review process to share?
Quarter 2 review and
publish
WCC Competencies: what could this mean in
alcohol related terms?
1. Locally lead the NHS
Capacity and leadership in CDRP/DAAT
7. Stimulate the market
2. Work with community partners
JSNA with alcohol specifics & outcomes
3. Engage with public and patients
Market segmented and gaps prioritised
8. Promote improvement and innovation
Outcomes delivery incentivised contracts
Local media campaign/user driven review
9. Secure procurement skills
4. Collaborate with clinicians
GPs and relevant staff equipped for IBA
5. Manage knowledge and assess needs
. MoCAM & Effectiveness review driven
6. Prioritise investment
Resources quantified against outcomes
£ per reduced hospital admission known
Alcohol Provider economics evidenced
10. Manage the local health system
Metrics driving required outcomes
11. Make sound financial investments
Joint arrangements with LAs/partners
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?