Certain secondary healthcare providers will be incentivised to carry out alcohol 'Identification and Brief Advice' (IBA), also known as brief intervention, as part of the NHS Commissioning for Quality and Innovation (CQUINs) payments framework from 2017-2019.
IBA has been a central component of alcohol prevention strategies in the UK and in other countries, but whilst there may be good evidence from research trials, the extent of effective routine implementation remains questionable. By introducing smoking intervention and IBA targets as part of the CQUIN, it is hoped that further progress will be made in delivering the NHS Five Year Forward View for achieving a healthier population.
How will the IBA CQUIN 'work'?
CQUINs work by allocating a percentage of the total value of an NHS contract with a provider for sufficient delivery of specified activity. The 2017/19 CQUIN covers 13 indicators, including indicator 9: 'Preventing ill health by risky behaviours – alcohol and tobacco'. Together the alcohol and smoking targets will add up to 0.5% of the total 2.5% potential total contract value. Whilst these may sound like small numbers, the incentive value can be significant given the size of some NHS contracts.
From 2017/18, the alcohol (and smoking) CQUIN will apply to inpatients of Mental Health Trusts and the relatively small number inpatients in Community Trust services. However from 2018/19 the CQUIN additionally applies to hospital inpatients, meaning a far larger potential population to reach.
The CQUIN separates alcohol IBA delivery into two equally weighted metrics - firstly screening using a validated tool (9d), and secondly the delivery of alcohol 'brief advice or referral' (9e), with appropriate data collection for each. Definitions of the IBA required are as defined in the NICE alcohol pathways.
For the first quarter, providers will be required to identify an appropriate data collection system, carry out a baseline audit, and ensure staff are trained. Subsequent quarters will require the delivery of targets agreed locally. See page 118 of the CQUIN Indicator Specification [doc] for further details.
A springboard for routine IBA in hospitals?
Many local areas will have already been seeking to implement IBA across a range of settings, either via previous locally commissioned CQUINs or other service provider agreements. As such, front line roles across a range of settings will have received IBA or other brief intervention training such as 'MECC', but the extent to which training without other changes results in delivery is questionable.
Within hospitals, the existence of Alcohol Care Teams (ACTs) may be seen as an important resource to support implementation, although it is often emphasised that IBA involves front line roles routinely offering interventions for non-dependent drinkers, but not by specialist drug or alcohol workers. However the existence of pathways and support for dependent drinkers is still important, and around two-thirds of hospitals are thought to have some kind of ACT provision.
Last year a briefing paper warned the alcohol brief intervention agenda could be at a 'turning point' and that without further efforts to embed IBA, longer term implementation may ‘fail’. The CQUINs may represent a significant boost to those wishing to see routine IBA delivery extended, particularly within Mental Health services and hospital wards. Local level leadership and other resources may prove crucial in any success, which may ultimately prove varied across the regions.
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