National Institute for Health and Care Excellence.
National Institute for Health and Care Excellence, 2011.
From England’s gatekeeper to the public provision of health services, guidance for commissioners on how to organise and procure alcohol treatment and brief intervention services in an area which implement related national clinical guidance and satisfy policy requirements.
Summary This guidance from the UK National Institute for Health and Care Excellence (NICE) aims to support commissioners in England to in their attempts to provide services for the identification and care of hazardous, harmful and dependent drinkers which implement other relevant NICE guidance on alcohol, and to commission high quality services that meet the quality standard on alcohol dependence and harmful alcohol use. Essentially it extracts the messages for commissioners from related NICE and other official guidance and distils these in to a single document to guide the organisation and procurement of treatment and brief intervention services in an area which embody those messages. In doing so it offers reasons for organisations responsible for spending health service resources to devote these to services for drinkers.
The guide highlights the benefits of commissioning for outcomes – principally reducing consumption, alcohol-related hospital admissions and alcohol-related mortality by improving access to evidence-based interventions that promote recovery.
It is estimated that only a small proportion of the £2.7 billion annual expenditure on alcohol-related harm is spent on identifying and treating alcohol misuse. NICE guidance advocates an invest-to-save approach by prioritising the prevention of alcohol-use disorders. This commissioning guide sets out a whole system approach to commissioning integrated alcohol services across the whole spectrum of care, from preventing harmful drinking through opportunistic screening and brief interventions, to specialist treatment programmes for children, young people and adults, and their families or carers.
The guide describes the following service components required to deliver a high quality service:
• opportunistic screening and brief interventions for adults who are hazardous and harmful drinkers;
• diagnosis, assessment and management of harmful drinking and alcohol dependence in adults, in specialist services;
• services for children and young people who are vulnerable to alcohol-related harm;
• whole system commissioning of high quality alcohol services.
Each section offers examples of service models, including case studies and ideas for using Quality, Innovation, Productivity and Prevention (QIPP) and Commissioning for Quality and Innovation (CQUIN) to drive improvements to alcohol services. There is also an outline service specification to assist commissioners when tendering or contract managing alcohol services.
The benchmark section contains further information to help commissioners to assess levels of alcohol dependence and hazardous and harmful drinking in their population. A population benchmark has been provided for the number of people in England aged 16 or above who are hazardous, harmful or dependent drinkers.
The guide contains a commissioning and benchmarking tool that can be used to calculate the costs of increasing access to opportunistic screening and brief interventions and to specialist alcohol treatment for adults. Providing evidence-based packages of care using the stepped-care model may reduce the unit cost of treatment per person by offering the least intensive, most cost effective intervention that is appropriate. Whole system commissioning may generate savings by reducing alcohol-related harm and alcohol-attributable hospital admissions
Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Assessment of what evaluation research means for alcohol dependence treatment in Britain, featuring reviews of the literature on the topics it covers.
Alcohol-use disorders: preventing the development of hazardous and harmful drinking Prevention guidelines which prioritised population-wide changes like price rises and outlet restrictions which affect everyone, independent of the choices they make.
Alcohol use disorders: diagnosis and clinical management of alcohol-related physical complications Clinical guidelines on the medical care of people suffering acute alcohol withdrawal or alcohol-related lack of thiamine, liver disease, or inflammation of the pancreas.
Alcohol dependence and harmful alcohol use quality standard Concise statement of 13 practices which constitute high quality health care for problem drinkers and good practice in identifying and advising hazardous drinkers. The standards may be used to assess and reward providers and health service commissioning authorities.
Last revised 03 March 2012. First uploaded