Intelligent Commissioning in Alcohol Services Beyond the Units…Bradford Airedale Craven &

Wharfedale Alcohol Project – BACWAP

"Data! Data! Data!” he cried impatiently

"I can't make bricks without clay."

Declaration of Interests 2013/14

Current roles and affiliations Lead Partner Bradford Student

Health Service – Bradford City CCG

Bradford & Aidedale Clinical Specialities Commissioning Lead Drugs & Alcohol (Airedale Wharfedale & Craven CCG, Bradford Districts CCG, Bradford Districts CCG, Bradford City CCG

Specialist GP Drugs & Alcohol Bradford District Care Trust

Honoraria Lundbeck – ‘Consensus on Commissioning Principles for Alcohol Related Harm’

CCGs’ Priority – reduction in Alcohol related admissions

ALCOHOL FCEs100% alcohol attributable

Appendix A: Alcohol-attributable chronic and acute conditions and finished care episodes in England for 2012/13 Table 1: Chronic conditions: 100% attributable

Description ICD-10 code(s) Attributable fraction FCEs

Males Females Males Females

Alcoholic liver disease K70 1.00 1.00 22,212 11,308

Chronic pancreatitis (alcohol induced) K86.0 1.00 1.00 2,142 622

Alcoholic gastritis K29.2 1.00 1.00 1,752 747

Degeneration of nervous system due to alcohol G31.2 1.00 1.00 451 177

Alcoholic cardiomyopathy I42.6 1.00 1.00 267 31

Alcoholic myopathy G72.1 1.00 1.00 23 8

Alcohol-induced pseudo-cushing’s syndrome E24.4 1.00 1.00 1 0

Alcoholic polyneuropathy G62.1 1.00 1.00 - -

Table 2: Acute conditions: 100% attributable

Description ICD-10 code(s) Attributable fraction FCEs

Males Females Males Females

Ethanol poisoning T51.0 1.00 1.00 608 469

Toxic effect of alcohol, unspecified T51.9 1.00 1.00 71 66

Methanol poisoning T51.1 1.00 1.00 25 13

Accidental poisoning by and exposure to alcohol X45 1.00 1.00 - -

ALCOHOL FCEsA bigger problem:<100% attributable-Chronic

Appendix A: Alcohol-attributable chronic and acute conditions and finished care episodes in England for 2012/13

Table 3: Chronic conditions: less than 100% attributable

Description ICD-10 code(s) Attributable fraction FCEs

Males Females Males Females

Oesophageal varices I85 0.73 0.46 7,586 4,217

Liver cirrhosis K73, K74 0.72 0.47 4,288 3,865

Epilepsy and status epilepticus G40, G41 0.55 0.50 31,619 27,595

Gastro-oesophageal laceration-haemorrhage syndrome K22.6 0.47 0.47 2,374 1,436

Malignant neoplasm of lip, oral cavity and pharynx C00-C04 0.45 0.26 16,998 6,778

Psoriasis L40, excl L40.5 0.34 0.24 6,581 6,734

Cardiac arrhythmias I47-I48 0.31 0.23 87,351 74,031

Malignant neoplasm of larynx C32 0.28 0.14 4,518 952

Malignant neoplasm of oesophagus C15 0.26 0.12 26,195 10,847

Hypertensive diseases I10-I15 0.25 0.10 7,444 8,541

Acute and chronic pancreatitis K85, K86.1 0.22 0.09 23,147 18,397

ALCOHOL FCEsA bigger problem:<100% attributable Acute

Table 4: Acute conditions: less than 100% attributable

Description ICD-10 code(s) Attributable fraction FCEs

Males Females Males Females

Fire injuries X00-X09 0.38 0.38 - -

Pedestrian traffic accidents V02-V04 (.1-.9), V06.1, V09.2, V09.3 0.36 0.18 - -

Drowning W65-W74 0.34 0.34 - -

Intentional self-harm/event of undetermined intent X60-X84, Y10-Y34 0.34 0.31 - -

Road traffic accidents (driver/rider)

V12-V14 (.3-.9), V19.4-V19.6, V19.9, V20-V28 (.3-.9), V29-V79 (.4-.9), V80.3-V80.5, V81.1, V82.1, V82.9, V83-V86 (.0-.3), V87.0-V87.9,

V89.2, V89.3, V89.9

0.32 0.11 - -

Assault X85-Y09 0.27 0.27 - -

Inhalation of gastric contents/inhalation of food causing obstruction of respiratory tract

W78-W79 0.25 0.25 - -

Accidental excessive cold X31 0.25 0.25 - -

Firearm injuries W32-W34 0.25 0.00 - -

Spontaneous abortion O03 - 0.21 - 39,887

Water transport accidents V90-V94 0.20 0.00 - -

Air/space transport accidents V95-V97 0.16 0.16 - -

Fall injuries W00-W19 0.15 0.05 - -

Work/machine injuries W24-W31 0.07 0.07 - -

The Treatment Gap

• SHA stated objective was ‘Industrialising’ Alcohol Screening in Primary Care.

• An ad hoc approach in the context of a routine consultation is more cottage industry.

Radically Obvious Principles of Intelligent Alcohol CommissioningIf we know alcohol abuse is

associated with so much morbidity then commissioning just for ‘less drinking’ is:

silo thinkingblinkered vision‘hit & hope’

‘We’ll hit the problem … and keep our

fingers crossed that all those associated

conditions get better…’

Really Intelligent Commissioning in Alcohol Services

Integrated Care /Service delivery interface

Addressing 100% and < 100% and even non-causal physical morbidity

Dual Diagnosis District-Wide Register

Alcohol is the most commonly misused drug in patients with SMI

SAFEGUARDING – Adult & ChildDon’t just commission for fewer units!

Where is the patient in all of this?

‘Data Data Data…’