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Ian Gilmore Chair, UK Alcohol Health Alliance President, British Society of Gastroenterology Reflections on the …… Ian Gilmore Chair, UK Alcohol Health Alliance President, British Society of Gastroenterology Reflections on the …… •challenges for hepatology •challenges for gastroenterology •challenges for the acute hospital •Challenges for the system •Challenges for society Challenges for hepatology Challenges for hepatology • Existing workforce (consultant, juniors, nurses • Recruitment into specialty • Relationship with gastroenterology • Relationship with G(I)M Challenges for gastroenterology Challenges for gastroenterology • Maintaining hepatology expertise • Relationships with ITU • 24/7 therapeutic endoscopy for bleeding • Repository for wider alcohol admissions? Quality and Productivity: Proven Case Study Alcohol Care Teams: reducing acute hospital admissions and improving quality of care Provided by: The British Society of Gastroenterology and Bolton NHS Foundation Trust Publication type: Quality and productivity example QIPP Evidence provides users with practical case studies that address the quality and productivity challenge in health and social care. All examples submitted are evaluated by NICE. This evaluation is based on the degree to which the initiative meets the QIPP criteria of savings, quality, evidence and implementability; each criterion is given a score which are then combined to give an overall score.r The overall score is used to identify the best examples, which ahn e then sow n or NHS Evidence as ‘eco mmended’. Our asseQIPPssment of the dforegree to walcoholhich this particular casecare study mee teamsts the criteria is represented in the evidence summary graphic below. Evidence summary Implementability Evidence of change Quality Savings 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Page 1 of 11 This document can be found online at: http://www.evidence.nhs.uk/qipp QIPP for alcohol care teams Challenges for the acute hospital Debate : is continuity now best delivered by a generalist ? Challenges for the system The new NHS – April 2013 Alcohol Related Admissions for Liverpool PCT (residents) 2002/03 to 2008/09 by Condition Group. 3500 3000 2500 2000 Chronic Conditions Rate CHRONIC Wholly Attributable Rate 1500 CONDITIONS Acute Consequences Rate Rate per 100,000 1000 DEPENDENCE 500 0 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 Activity upstream reduces costs, reduces the need for complex interventions and improves outcomes £ ££ Risk assess Early diagnosis £££ Stop ££££ “insult” £££££ ££££££ Treat Monitor for cancer or Treat for cancer or complics complications incl transplant Potential for intervention for Potential Liver Consequences of Liver insult Liver fibrosis Cirrhosis inflammation cirrhosis Impact on individual/ health services over time (10-20 years) What can we do as clinicians? Start applying the four ‘P’s of Advocacy • Advocate for a Population / Public health approach to alcohol • Advocate for Protection of the vulnerable, especially children • Advocate that for alcohol there is a Product, not People problem • Advocate to Policy-makers, the Public and the Press to turn the tide of liver disease Challenges for society Where international evidence on consumption and harm should point politicians towards regulation: • availability • promotion by the alcohol producers and retailers • price of alcohol What to do about price? • increase duty / VAT • use duty to promote lower strength • tackle discounting / bulk offers • minimum unit price .
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