Public Health England. Alcohol & alcohol related harm

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1 Public Health England Alcohol & alcohol related harm

2 Mission To protect and improve the nation s health and to address inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector. 2 2

3 Outcome-focused priorities 1. Helping people to live longer and more healthy lives 2. Reducing the burden of disease and disability 3. Protecting the country from infectious diseases and environmental hazards 4. Supporting families to give children and young people the best start in life 5. Improving health in the workplace 3 3

4 Local presence Four regions, 15 centres Eight Knowledge and Intelligence Teams London South West South East West Midlands East Midlands North West Northern and Yorkshire East Other local presence ten microbiology laboratories field epidemiology teams Additional support Local teams can also draw on national scientific expertise based at Colindale, Porton Down and Chilton 4 4

5 Alcohol Why is PHE concerned? Alcohol is the third biggest risk factor for illness and death in the UK (after smoking and raised blood pressure) 7% of all hospital admissions 1.1 million alcohol related hospital admissions in 2009/10 An increase of 12% compared with 2008/9 Alcohol misuse is calculated to cost the health service 3.5bn per annum 7

6 PHE alcohol objectives and actions Increasing awareness of the harmful effects of alcohol Develop and disseminate the evidence base concerning effective interventions Supporting and promoting effective use of licensing legislation and local powers to create a safer drinking environment Encouraging and supporting people who drink to do so within the lower risk levels Reducing the harmful impact of alcohol on individuals who already experience harm Supporting improvements in treatment provision in line with NICE guidance 6

7 What we want to see local areas deliver Local behaviour change campaigns that include alcohol Local Responsibility Deals that include alcohol DsPH effective use of their statutory powers in the Licencing Act Local use of powers to restrict the irresponsible sale of alcohol Implementation of the alcohol Health Check in line with guidance Significant expansion of IBA in a range of settings, particularly primary care Effective use of hospital based alcohol services Specialist treatment that is accessible and matched to local need Treatment services that are good quality and compliant with NICE guidance 7

8 Purpose of today To discuss with the Expert Group and the Pilots: Your experience of using the clustering tools Your continued use of the clustering tools Our analysis of the clustering data submitted by the pilots We want to determine: Is it possible and feasible to cluster alcohol treatment patients? Do we have the right number of clusters? Can we recommend to the alcohol treatment field that clustering patients is a good thing? 8

9 PbR Models so far Historic Block Contracts Activity based PbR Outcome based PbR How NHS hospital were funded Historical costs Local NHS family & budgets How NHS Acute Trusts funded today Health Resource Groups (HRGs) Tariffs PROMs Transfers risk to providers Experimental Recovery PbR Prisons Work Programme Immigration 9

10 Products to be developed 1. National approach to assign individual into needs based clusters (= to Health Resource Groups) Clustering tools 2. Define needs-based packages of care 3. Identify outcome measures 4. Develop a Minimum Data Set to capture Assessment / Clusters Treatment journey Outcomes 5. Capture costs for treating each cluster To inform local tariff setting 10

11 Treatment clusters Alcohol Harm Clusters Dependence Health Needs HoNOS / SARN scale Social Needs HoNOS / SARN scale Harmful & Mild Dependence Moderate Dependence Severe Dependence Moderate & Severe + Complex Need AUDIT 16+ SADQ <15 Units/day <15 AUDIT 20+ SADQ Units/day >15 AUDIT 20+ SADQ >30 Units/day >30 AUDIT 20+ SADQ >15 Units/day >15 2. Non-accidental selfinjury 3. Problem-drinking or drug-taking 4. Cognitive problems 5. Physical Illness 6. Hallucinations and delusions 7. Depressed Mood 8. Other Symptoms A. Agitated behaviour (historical) B. Repeat self-harm (historical) 1. Aggressive behaviour 9. Relationships 10. Activities of Daily Living 11. Living Conditions 12. Occupation and Activities 13. Strong unreasonable beliefs C. Safeguarding children D. Engagement E. Vulnerability 11

12 Cluster definition 12

13 NICE Package of care: Harmful drinking & mild dependence (Cluster 1) Assessment / Engagement / Motivational enhancement: Use AUDIT, SADQ/LDQ and units per day to determine dependence Determine level of risk and the presence of co-existing problems recorded by use of HONOS/SARN In-depth medical assessment will most likely not be necessary Deliver motivational enhancement to promote engagement Care Planning / Care co-ordination and Case management: A care plan Monthly follow-up for 3 months Withdrawal management: Most likely, there will not be a need to provide medical assistance But if so, will probably be met through outpatient management Psychosocial interventions: Brief advice should be given and assessed for effectiveness If needed, a package of less intensive (4 sessions) CBT/MET based treatment Pharmacotherapy: Prescribing for relapse prevention is not supported by evidence for this group. Recovery / Reintegration / Aftercare: Will depend on presenting need. Encouragement should be given to engage in selfhelp groups such as AA or SMART Recovery

14 NICE Package of care: Moderate / Severe dependence with complex needs (Cluster 4) Assessment / Engagement / Motivational enhancement: Use AUDIT, SADQ/LDQ and units per day to determine dependence Determine level of risk and the presence of co-existing problems recorded by use of HONOS/SARN In-depth medical (physical & psychiatric) assessment will be necessary Deliver motivational enhancement to promote engagement Care Planning / Care co-ordination and Case management: A care plan Case management lasting at least 12 months (frequent appointments in the first 6 months) Withdrawal management: Most likely inpatient care (but upon assessment may be met through outpatient care) Post withdrawal assessment of mental health issues and cognitive function Psychosocial interventions: A package of 12 weeks of CBT (based in a day treatment programme) Residential rehabilitation of up to 12 weeks may be required Pharmacotherapy: For relapse prevention - acamprosate or naltrexone (or disulfiram if indicated) for one year. This should be delivered in conjunction with psychosocial interventions Physical and Psychiatric co-morbidity: These should be managed according to appropriate NICE guidelines 14 Recovery / Aftercare / Reintegration: Encouragement should be given to engage in self-help groups such as AA or SMART Recovery. Referral to employment services, assistance with housing and benefits may be required. 14

15 Relationship between MH and alcohol clusters 15

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