Alcohol: a Case for Change

Chief Executives’ Forum

NHS North West Chief Executives’ Challenge:

Approach

To reduce by 5% alcohol related admissions to hospital by 2011 (NI39 target)

Scale of the Challenge – this isn’t going to be easy

92,339 102,841

114,946

129,919 141,493

151,427 163,564

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

Num

ber o

f Adm

issio

ns

North West SHA Alcohol Related Number of Hospital Admissions

2002-2009

2002-2003 11% Change

2003-2004 12% Change

2004-2005 13% Change

2005-2006 9% Change

2006-2007 7% Change

2007-2008 8% Change

77% Increase over a 7 year period

+ 11% over

7 years

+ 8% over

3 years

Impact of the 5% Objective3 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).

2009/10

Projected7.43% 179,808 6.36% 191,238 7.75% 206,062

Reduction of 5% off the projection -5% 179,808 1.36% 182,247 2.75% 187,262

(Number) 0 8,991 18,800

Zero Line Growth 0% 179,808 0% 179,808 0% 179,808

(Number) 11,430 26,254

In Baseline -5% -5.00% 170,818 -5.00% 162,277

(Number) 20,420 43,786

Section B. Revised

Projections

2011/12Section A. Current

Projections

2010/11% impact required

each year

5%

7%

12%

Hospital admissions are 3 times the NI39 figures quoted

All NW PCTs are in the national ‘worst half’ Hospital Admissions for Alcohol Related Harm (NI39)

0 500 1000 1500 2000 2500 3000

Central and Eastern Cheshire

North Lancashire

Western Cheshire

Trafford

Stockport

Cumbria

Bolton

East Lancashire

Oldham

Bury

Sefton

Blackburn with Darwen

Warrington

Blackpool

Tameside and Glossop

Central Lancashire

Ashton, Leigh and Wigan

Halton and St Helens

Wirral

Heywood, Middleton and Rochdale

Salford

Manchester

Knowsley

Liverpool

Per 100.000 population

2008/09

2007/08

Hospital Admissions for Alcohol Related

Harm (NI39) 2007/08 - 2008/09

Ranked in the bottom half nationally

Ranked in the bottom quartile

nationally

bottom nationally

. Data Source: (Centre for Public Health NW Public Health Observatory, derived from the Hospital Episode Statistics (HES)

What is an Attributable Fraction?

Ethanol poisoning

2 X Hypertension10 X Breast cancer25 X

5% reduction required on NI39s not hospital admissions

37 Alcohol Related Hospital Admissions = 6 NI39s

2NI39s 2NI39s2NI39s

+ +

Typical Hospital

70,000Hospital Admissions

20,000Alcohol Related Admissions

30% admissions are alcohol related

6,500NI39

1/3 of alcohol related admissions equate to NI39

= 325 NI39s 5% reduction in NI391000

Hospital Activity Profile

Half of patients stay 1 day or less

But2/3 of bed days are

occupied by patients staying 10+ days

Dynamic Modelling

Abstinent & low risk Increasing Risk Risky

net abst & low to increasing risk pa

net to risky pa

death abst & low death increasing risk death risky

reaching drinkingage pa

net to v high risk pa

death v high risk

stop inc risk pa

Very High Risk

stop risky pa

Binge drinkers

net to binge pa

stop very high risk

net binge to risky pa

stop binge pa death binge

Brief InterventionBrief Intervention

Increased Alcohol Liaison Nursing Service or Tier 3

and 4 aftercare and rehab services

Increased Alcohol Liaison Nursing Service or Tier 3

and 4 aftercare and rehab services

Identification and Brief Advice

Identification and Brief Advice

Enforcement Activity

Enforcement Activity

PricingPricing

Social MarketingSocial MarketingExtended Brief

InterventionExtended Brief

Intervention

Understanding Case Mix and Solutions

Cohort 1

Patients staying zero to 1 day

(low ‘fraction’ patients)

e.g. 1:6 hypertensions have an alcohol misuse problem.

SolutionNeed to screen / triage and

provide ‘brief intervention’

Cohort 2

Patients staying 10+ days (high ‘fraction’ patients)

e.g. Alcoholic Liver Disease 1:1 have alcohol misuse problem

Solution Needing greater

intervention and assertive outreach

Assertive Outreach

30+30High Fraction /

Frequent Admissions

Hospital Alcohol Nursing Service

6 Wte7 day Service

Leadership

Modelling Solutions

£270k

£390k

400 admissions

133 NI39s

= -1%

475 admissions

475 NI39s

= - 4%

InvestmentBenefits Realisation

Benefits Realisation

Service Cost £

Bed LiberationTariff Liberation

£

Hospital Alcohol Nurse Team

£270k 2 beds £698k

Assertive Outreach

£390k 8 beds £895k

£660k £275k £1,593k

Executive Summary

Reduce admissions by 5%

Ser

vice

Co

nte

xtS

ervice Co

ntext

Cas

e fo

r C

han

ge

Case fo

r Ch

ang

e

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?