AERC ALCOHOL ACADEMY
Alcohol Commissioning
Pilot (Workshops) Seminars*
Trevor McCarthy
21 September 2010
* Correction after Alexei Sayle
Alexei Sayle: Glastonbury 1985
And another
thing. Anyone
who uses the
word ‘workshop’
who isn’t actually
involved in Light
Engineering is a
f***ing tw*t.
Trevor McCarthy: September 2010
Alcohol: It’s a drug
Jim, but not as we
know it.
Alcohol:
It’s a drug Jim, but
not as we know it.
Trevor McCarthy: September 2010
Remember this?
Trevor McCarthy: September 2010
Trevor McCarthy: September 2010
2007 review of
AHRSE :
a commitment
made in 2004
Trevor McCarthy: September 2010
The prevention paradox
• The majority of alcohol related harms are
associated with people whose drinking is
hazardous & harmful
• Dependent drinkers are likely to experience
and be linked with greater degrees of harm
• But there is so much drinking that the
hazardous & harmful drinkers harm
outweighs that of dependent drinkers
Trevor McCarthy: September 2010
So Whither Alcohol Treatment?
It is important to understand that the
evidence for brief interventions in nonspecialist settings, such as primary care,
cannot be interpreted as evidence that more
intensive interventions in specialist settings
are unnecessary – this is not true.
Review of the Effectiveness of Treatment for Alcohol Problems
Duncan Raistrick, Nick Heather & Christine Godfrey (NTA 2006)
Trevor McCarthy: September 2010
NHS White Paper
July 2010
Trevor McCarthy: September 2010
Some of what it says…
Trevor McCarthy: September 2010
Alcohol use disorders: diagnosis, assessment and management
of harmful drinking and alcohol dependence: February 2011
Trevor McCarthy: September 2010
NICE: Alcohol Prevention Guidance
NICE Public Health Guidance 24
Published June 2010
12 recommendations
Trevor McCarthy: September 2010
Policy Recommendations (1-3)
• 1 Price: Consider minimum price per unit.
• 2 Availability: Consider licensing legislation;
protecting public’s health as an objective;
availability and alcohol-related harm &
immediate sanctions on premises in breach
Consider reducing personal import allowances
• 3 Marketing: Minimise young’s exposure to
alcohol advertising - consider complete ban
Trevor McCarthy: September 2010
Practice Recommendations (4-8)
•
•
•
•
•
4
5
6
7
8
Licensing
Resources - screening & brief interventions
Supporting children & young people 10 - 15
Screening people aged 16 & 17 years
Extended brief interventions - 16 & 17
Trevor McCarthy: September 2010
Practice Recommendations (9-12)
•
•
•
•
9 Screening adults
10 Brief advice for adults
11 Extended brief interventions for adults
12 Referral
Trevor McCarthy: September 2010
Recommendation 5
• Prioritise prevention as ‘invest to save’
• Joint alcohol needs assessments & alcohol
treatment pathways
• Screening & brief interventions for hazardous
and harmful drinkers (inc. disadvantaged groups)
• Make provision for increase in referrals to tier
two, three and four alcohol treatments
• Capacity to treat at least 1 : 7 dependent drinkers
Trevor McCarthy: September 2010
Recommendation 5 (highlight)
Commissioners should include formal
evaluation within the commissioning
framework so that alcohol interventions and
treatment are routinely evaluated and followed
up. The aim is to ensure adherence to
evidence-based practice and to ensure
interventions are cost effective.
Trevor McCarthy: September 2010
NICE PH24 & Andrew Lansley
“Regarding NICE's recommendations on
minimum pricing for units of alcohol, it is
not clear that the research examines
specifically the regressive effect on low
income families, or proves conclusively that
it is the best way to impact price in order to
impact demand.”
Published 2 June 2010
• http://www.dh.gov.uk/en/MediaCentre/Statements/DH_116534
Trevor McCarthy: September 2010
Caring about low income families ….
• Alcohol not an equal opportunities substance:
economically disadvantaged people experience
disproportionate levels of harm
• Increasing the price of any basic commodity
has a disproportionate effect on the poor
• When outweighed by health gain legitimate
public health intervention c.f. smoking
• Suppressing the price of beverage alcohol is
not an effective strategem to address poverty
Trevor McCarthy: September 2010
Bogus arguments against pricing
• Price alone is not the answer
• Which is why it’s only one of 12 integrated
recommendations in NICE PH24
• We support not selling below cost price
• 50p / unit 2l of 7.5%abv cider £7.50 & bottle
of spirits - £14.00 (vs £3.70 & £7.97 Tesco)
• Government won’t get the money
• Fortunately retailers believe in capitalism
Trevor McCarthy: September 2010
Trevor McCarthy: September 2010
Trevor McCarthy: September 2010
Trevor McCarthy: September 2010
Evidence based practice …
Despite clear evidence for its effectiveness
and cost-effectiveness, and despite
considerable efforts over the years to
persuade them to do so, most health
professionals have yet to incorporate
screening and alcohol brief interventions in
their routine practice
Review of the effectiveness of treatment for alcohol problems
Duncan Raistrick, Nick Heather and Christine Godfrey. NTA 2006
Trevor McCarthy: September 2010
Primary Care: Barriers
1.
2.
3.
4.
Lack of time among busy healthcare
professionals
Lack of appropriate training to do
screening & brief interventions
Little support from government health
policies
Don’t believe patients will take advice to
change drinking
Eileen Kaner et al (1999) British Journal of General Practice
Trevor McCarthy: September 2010
Primary Care: Barriers cont.
5.
6.
7.
8.
Lack of suitable screening and
intervention materials
Lack of reimbursement
Wouldn’t want to cause offence
Negative attitudes based on experience
Eileen Kaner et al (1999) British Journal of General Practice
Trevor McCarthy: September 2010
Primary Care: Barriers
1.
2.
3.
4.
Lack of time among busy healthcare
professionals X
Lack of appropriate training to do
screening & brief interventions X
Little support from government health
policies X
Don’t believe patients will take advice to
change drinking X
Eileen Kaner et al (1999) British Journal of General Practice
Trevor McCarthy: September 2010
Primary Care: Barriers cont.
5.
6.
7.
8.
Lack of suitable screening and
intervention materials X
Lack of reimbursement X
Wouldn’t want to cause offence X
Negative attitudes based on experience ?
Eileen Kaner et al (1999) British Journal of General Practice
Trevor McCarthy: September 2010
Primary Care – history & future
•
•
•
•
•
GP Fundholding
Negotiating the QOF
DES & LES
GPs are normal …
Knowing their caseload has not
spontaneously generated intervention, but
• Smoking interventions …
Trevor McCarthy: September 2010
‘It sometimes seems that we
work in a field in which people
seem to believe that it is
cheating to read the literature.’
Gossop M. Addiction 2008; 103, 89-90
Trevor McCarthy: September 2010
“Brains first
and then
Hard Work.”
THE HOUSE AT POOH CORNER A. A. Milne London 1928
Trevor McCarthy: September 2010
Facing the future …
If nothing else works,
a total pig-headed
unwillingness to look
facts in the face will
see us through.
Blackadder Goes Forth Episode 4: Private Plane
General Melchett (Stephen Fry) (bbc.co.uk)
Trevor McCarthy: September 2010
The poor
end up
paying
for the
mistakes of
the entitled
This Week BBC July 2009
Trevor McCarthy: September 2010