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Recommendations for Commissioning

Background papers: Lifestyle and wider determinants :: Alcohol [Update in progress] :: Recommendations for Commissioning


• Commissioners should ensure at least one in seven dependent drinkers can get treatment locally, in line with 'Signs for Improvement'.
• Post-treatment and wraparound provision is currently under-resourced. Future commissioning of services should follow the payment by results key outcomes to improve recovery.
• Managers of NHS-commissioned services must ensure staff have enough time and resources to carry out screening and brief intervention work effectively. Staff should have access to recognised, evidence-based packs. These should include: a short guide on how to deliver a brief intervention, a validated screening questionnaire, a visual presentation (to compare the person's drinking levels with the average), practical advice on how to reduce alcohol consumption, a self-help leaflet and possibly a poster for display in waiting rooms.
• Commissioners of Cancer, Gastro and CVD acute services should ensure that alcohol Indentification and Brief Advice (IBA) and referral mechanisms are explicit within their commissioned treatment pathways, using referral tools and pathways already agreed by commissioners and providers, and give consideration to the financial benefit of contributing to additional treatment service provision which will be needed as a result.
• There is significant evidence as to the impact of Hospital based interventions for alcohol.[1] This is especially relevant for cancer, gastro and CVD services (notably hypertension and stroke) and Accident and Emergency. Commissioners should invest in hospital led alcohol project to realise long-term savings from reduced alcohol-related hospital admissions (ARHA).
• NHS Acute contracting team need to ensure that Hospital Trusts provide accurate data recording and data extraction, to monitor progress of initiatives, by building specifications on this into contracts and service level agreements. This will ensure that relevant data are available for performance management and to inform further JSNA refresh.
• Develop a joint working policy, procedure and care pathway for clients with mental health and alcohol misuse problems (significant co-morbidity with mental illness requires pathway development into alcohol/mental health dual diagnosis services). Use referral tools and pathways already agreed by commissioners and providers.[2]
• Commissioners should include formal evaluation within the commissioning framework so that alcohol interventions and treatment are routinely evaluated and followed up. The aim is to ensure adherence to evidence-based practice and to ensure interventions are cost effective.
• Ensure sufficient resources are available to prevent under-age sales, sales to people who are intoxicated, proxy sales (that is, illegal purchases for someone who is under-age or intoxicated), non-compliance with any other alcohol licence condition and illegal imports of alcohol.
• Raise awareness through Smart Medway Campaigns in the press, radio and through partner newsletters including workforce initiatives about the risks of drinking at increasing and higher risk levels and binge drinking. Give consideration to wider distribution of culturally appropriate resources for new communities.


References

[1]   Moriarty KJ. Alcohol-Related Disease: Meeting the challenge of improved quality of care and better use of resources 2010; British Society of Gastroenterology and Alcohol Health Alliance UK and British Association for Study of the Liver. http://www.alcohollearningcentre.org.uk/_library/bsg_alc_disease_10.pdf .
[2]   Department of Health. Dual Diagnosis: Best Practice Guidance 2002; Department of Health.