‘Signs for improvement’: policy into practiceIain ArmstrongDH Alcohol Policy Delivery Team

The last five years

Since the Alcohol Harm Reduction Strategy for England in 2004 recognition of alcohol as a health issue has risen enormously.

ANARP MoCAM, Guidance on developing a local programme of

improvement, Know your Limits campaigns Safe.Sensible Social, PSA25, Vital Signs Indicator 26 (98 PCTs), NI39 (78 LAs)

Alcohol indicator 2nd most popular in PCT WCC plans Alcohol Improvement Programme NAO report on alcohol, Signs for improvement Alcohol IBA DES Early implementor PCTs Health Select Committee report NICE alcohol guidance

2005

2006

2007

2008

20092010

The Public Health Service: known facts (1)

• There is going to be a new Public Health Service (PHS); it will not be a separate legal entity from the Department of Health;

• Many functions that are currently in ALBs, especially the Health Protection Agency, will be brought into the Department;

• Directors of Public Health (DsPH) will be jointly appointed by the PHS and Local Authorities (LAs). They will be employed by the LA. Whether DsPH will sit within upper tier authorities will be open to consultation;

• The Secretary of State will have the ability to dismiss DsPH on the basis of their discharge of LA responsibilities in the area of health protection and emergency preparedness but not in relation to their performance on health improvement functions;

• DsPH will lead on health improvement for their area and will have use of a ring-fenced budget;

• There will be elements of the ring-fenced budget that will recognise differences in need and elements that will recognise good performance;

• The first allocations to LAs will be in 2013/14;

• The Secretary of State will establish an outcomes framework for the PHS;

• The PHS will need to work closely with the NHS to deliver public health interventions and to promote uptake of prevention opportunities in clinical practice;

• There is a Cabinet sub-committee on Public Health, chaired by the Secretary of State;

• A Health Bill will be introduced in autumn 2010, which is the route by which any necessary changes to primary legislation will be made to establish the new system.

The Public Health Service: known facts (2)

What’s survives from Signs for Improvement

• Evidence base still shows us what’s effective. – Improve access to evidence-based Specialist Treatment– Improve widespread delivery of IBAs– Appoint AHWs in appropriate acute hospital settings

• Data still relevant and updated• Tools still work• Rate of admissions still rising

• Public Health service is not due to come into being for 18 months • How do we maintain momentum in the interegnum?

The challenge

• Not to lose momentum• Invest to save – IBA, AHWs (investment returns across partnerships)• Make savings by commissioning more efficient and effective

treatment systems • Ensuring The right services with the right skills in the right places

– Needs analysis – how many of which and where– Evidence based treatment system design – Clinical governance in commissioned services - Workforce

competencies, National Transferable Roles and qualifications– Improved treatment pathways – Meaningful, measurable outcomes

Thankyou

• …the brief interventions agenda has really caught on and a national Alcohol Improvement Programme has delivered leadership and resources, such as the online Alcohol Learning Centre and increased PCT support in reducing hospital admissions.

• So, as the changes happen, robust needs assessments must be presented to GP consortia with invest-to-save cases for implementing NICE and ‘signs for improvement’ alcohol commissioning guidance.

• James Morris, DDN Sept 2010