Transcript Presentation: A case for change.

Alcohol:
a Case for Change
Chief Executives’ Forum
NHS North West Chief Executives’ Challenge:
To reduce by 5% alcohol related admissions to hospital
by 2011 (NI39 target)
Approach
Consultation: Establishment of review groups
including: chief executives, consultants, specialist
nurses, commissioners, Department of Health
Alcohol Team.
National Activity (Activity Analysis): Review
NI39 information to establish: the basis for the
target reduction (5%); regional profile.
Acute Activity (Activity Impact Assessment: Establish
the data collection requirements for alchol related
activity to HRG level. Review local implications of a 5%
reduction.
Modelling: Review and application of modelling
options; assessment of economic evaluation.
Scale of the Challenge
– this isn’t going to be easy
180,000
160,000
North West SHA Alcohol Related
Number of Hospital Admissions
2002-2009
Number of Admissions
140,000
120,000
100,000
80,000
2002-2003
11% Change
2003-2004
12% Change
2004-2005
13% Change
2006-2007
2005-2006 7% Change
9% Change
2007-2008
8% Change
163,564
151,427
141,493
+ 8% over
3 years
129,919
114,946
102,841
92,339
+ 11% over
7 years
60,000
40,000
20,000
77% Increase over a 7 year period
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
Impact of the 5% Objective
3 Options have been tested :▫ 5% reduction in the NHSNW projections.
▫ Zero line reduction i.e. maintenance of the 2009/10 levels.
▫ 5% reduction in the baseline (2009/10).
Section A.
Current
Projections
Projected
Reduction of 5% off
the projection
Zero Line Growth
179,808 6.36% 191,238
7.75% 206,062
-5%
179,808 1.36% 182,247
2.75% 187,262
8,991 
0
0%
179,808
0%
179,808
11,430 
(Number)
In Baseline
(Number)
2011/12
7.43%
(Number)
Section B.
Revised
Projections
2010/11
2009/10
-5%
-5.00% 170,818
20,420 
18,800 
0%
179,808
26,254 
-5.00% 162,277
43,786 
Hospital admissions are 3 times the NI39 figures quoted
% impact required
each year
5%
7%
12%
. Data Source: (Centre for Public Health NW Public Health Observatory, derived from the Hospital Episode Statistics (HES)
All NW PCTs
are in the
national
‘worst half’
Hospital
Admissions for
Alcohol Related
Harm (NI39)
Hospital
Admissions for
Alcohol Related
Harm (NI39)
2007/08 - 2008/09
bottom
nationally
Liverpool
Knowsley
Manchester
Salford
Heywood, Middleton and Rochdale
Wirral
Halton and St Helens
Ranked in the
bottom
quartile
nationally
Ashton, Leigh and Wigan
Central Lancashire
Tameside and Glossop
Blackpool
Warrington
Blackburn with Darwen
Sefton
Bury
Oldham
East Lancashire
Bolton
Cumbria
Ranked in the
bottom half
nationally
Stockport
2008/09
2007/08
Trafford
Western Cheshire
North Lancashire
Central and Eastern Cheshire
0
500
1000
1500
2000
Per 100.000 population
2500
3000
What is an Attributable Fraction?
37 Alcohol Related Hospital Admissions
= 6 NI39s
2 X Ethanol
poisoning
+
+
2NI39s
25 X Breast cancer
10 X Hypertension
2NI39s
2NI39s
5% reduction required on NI39s not hospital admissions
Typical Hospital
70,000
Hospital Admissions
20,000
Alcohol Related Admissions
6,500
NI39
1000
=
325 NI39s
30% admissions are alcohol related
1/3 of alcohol related admissions equate to NI39
5% reduction in NI39
Hospital Activity Profile
No. of Admissions by Length of Stay
0 days
34%
Half of
patients stay
1 day or less
1 day
16%
2-10
days
33%
SRFT Occupied Bed Days
2-10 days
23%
>10 days
17%
>10 days
70%
But
2/3 of bed days are
occupied by patients staying
10+ days
≤ 1 day
7%
Dynamic Modelling
Brief Intervention
stop very high risk
stop risky pa
Increased Alcohol Liaison
Nursing Service or Tier 3
and 4 aftercare and
rehab services
stop inc risk pa
Abstinent & low risk
reaching drinking
age pa
Increasing Risk
net abst & low to
increasing risk pa
Identification and
Brief Advice
net to risky pa
Social Marketing
death abst & low
death increasing risk
Risky
Very High Risk
net to v high risk pa
Extended Brief
Intervention
death risky
death v high risk
Binge drinkers
net to binge pa
net binge to risky pa
Enforcement
Activity
Pricing
stop binge pa
death binge
Understanding Case Mix and Solutions
Cohort 1
Cohort 2
Patients staying
zero to 1 day
(low ‘fraction’ patients)
Patients staying 10+ days
(high ‘fraction’ patients)
e.g. 1:6 hypertensions have an
alcohol misuse problem.
Solution
Need to screen / triage and
provide ‘brief intervention’
e.g. Alcoholic Liver Disease
1:1 have alcohol misuse
problem
Solution
Needing greater
intervention and assertive
outreach
Modelling Solutions
Benefits Realisation
Investment
£270k
400 admissions
Hospital Alcohol
Nursing Service
6 Wte
7 day Service
133 NI39s
=
-1%
Leadership
£390k
Assertive
Outreach
30+30
High Fraction /
Frequent
Admissions
475 admissions
475 NI39s
=
- 4%
Benefits Realisation
Service Cost
£
Bed Liberation
Tariff Liberation
£
Hospital Alcohol
Nurse Team
£270k
2 beds
£698k
Assertive
Outreach
£390k
8 beds
£895k
£660k
£275k
£1,593k
Strategic
Context alcohol
related
admissions
• 69% increase over
the last 7 years. 7%
increase in activity in
the last year.
• Nationally the NW is
the second highest
after the North East.
• NW has the most
actual alcohol related
admissions.
• 15/24 of the NW PCTs
in the bottom quartile
nationally.
Objective
Impact
(NI39
Reduction)
*5%
reduction
off
projected activity =
9,000 (annual)
*Zero growth = 11,400
reduction (annual)
*5% off growth
=
20,410
reduction
(annual)
Hospital
Context –
alcohol
related
activity
*NW
–
500,000
admissions, 3 million bed
days
*55% of beds are utilised
for alcohol related activity.
Approx 12% of activity is a
wholly attributable.
*Approx 60% admissions
are emergency related.
*Over 34% activity= zero
LOS. (60%= Hypertension,
48% in the over 70’s)
*16% activity = 1 day LOS.
Service Context
Service Context
Executive Summary
Dynamic
Modell
ing
•Modelling provides a
basis for assessing a
range of interventions,
effectiveness is subject
to current services and
the profile of patients i.e.
classification of drinker
(harmful, hazardous etc)
The most effective
solutions include:• Alcohol Liaison Nursing
• Brief Advice
• Extended Brief Advice
• High Intensity
interventions.
Economic
Modelling
• Health Economy
Implications
• Assertive Outreach
• Alternative
Commissioning
Solutions
Observed
Findings
(Recomme
ndations)
• Commissioning – health
economy level reviews
required to develop
unified structures to the
conduct of
commissioning
arrangements.
• Pathways – health needs
assessment required to
inform commissioning
plans.
• Alcohol Liaison Service –
review to manage service
development (training,
staffing etc.)
Case for Change
Case for Change
Reduce
admissions by
5%
In a Nutshell
Do you want to crack the problem?
Personal involvement as Chief Executive will be crucial.
The Business Case stacks up – but needs local adaption
You need to agree a risk share arrangement
- close beds, share liberated costs and tariff
Every £1 frees up £3
and you reduce admissions by 5%
Over to you…… are you up for it?