Alcohol Policy UK

Ministers back call for NHS staff to make "every contact count" to improve health

The Health Secretary Andrew Lansley has accepted recommendations for NHS staff to take every opportunity to promote good health. The NHS Future Forum called for action to ensure that "every contact counts" in helping address the impact of alcohol misuse, poor diet, smoking and lack of exercise. See here for the Forum's Public Health report and coverage from the BBC and The Telegraph.

The report warns millions of opportunities to improve patients' health and well-being are missed - every day GPs and practice nurses see over 800,000 people, dentists see over 250,000 and 1.6 million people visit a pharmacy. A recent report by Cancer Research UK suggested 40% of cancers were preventable through lifestyle changes, and over one million  hospital admissions each year are alcohol-related - and rising.

However, Dr Clare Gerada, Chair of the RCGP, expressed concerns suggesting that not every contact is an appropriate time to question lifestyle behaviours. Other concerns have highlighted that helping patients to change does not address the wider causes such as health inequalities, poverty and poor housing.

Making "every contact count" is based on brief intervention principles of behaviour change - motivating an individual to explore the pros and cons of unhealthy behaviours. This often leads to change where an individual further realises the benefits of acting, or the risks of not changing.

Brief interventions for alcohol - or 'Identification and Brief Advice' (IBA) - have been shown to be the most effective health behaviour intervention. However challenges to mainstreaming IBA appear to include staff's fears about raising the subject, although NICE suggests 62% of people will accept alcohol advice when offered it.

North East Lincolnshire have developed an Every Contact Counts website and the West Midlands have developed an E Learning package. Yorkshire and Humber have developed a competence framework to underpin the Every Contact Counts agenda.

IBA in Sexual Health Settings Resource Pack

A resource pack outlining the case and key resources for delivering 'Identification and Brief Advice' (IBA) in Sexual Health Settings has been released.

Download the Delivering Alcohol Identification and Brief Advice in Sexual Health Settings RESOURCE PACK

The pack was developed to support commissioners of sexual health and/or alcohol services and those delivering alcohol IBA in sexual health settings. It was developed in partnership between NHS South of England and Sexual Health South West.

It coincides with the recent release of Alcohol and sex: a cocktail for poor sexual health, a report highlighting the missed opportunities to respond to alcohol misuse within sexual health settings - see the press release here.

See the South West alcohol pages here or more information on IBA here.

Findings brief interventions bulletins: all Primary Care staff can deliver; dependent drinkers respond to extended brief interventions in A&E

Recent research bulletins from the drug and alcohol Bank:

Alcohol brief interventions: doing without the Doctor

It works when the doctor does it, but what if the nurse or other primary care staff briefly counsel risky drinking patients? According to this synthesis of the research, it still works - maybe not as well, but perhaps more patients can be reached more cheaply. Modest impacts and imperfect methodologies mean it remains an open question whether meaningful drinking reductions would be found in usual practice.

Even dependent drinkers respond well to alcohol brief interventions

In the north of England just a few (and often just one) counselling sessions by a specialist alcohol nurse had a remarkable impact on drinkers seeking medical care at an accident and emergency department. What made it remarkable was the fact that these patients were not just heavy drinkers, but dependent and drinking as much as patients at alcohol clinics.

Brief interventions, also know as 'Identification and Brief Advice' (IBA) are a key part of alcohol harm reduction approaches as identified in NICE alcohol prevention guidance. However the difference between simple IBA, extended brief interventions and brief treatment approaches has been much debated, as explored in the briefing 'Clarifying brief interventions'.

See here for a recent briefing paper on mainstreaming brief interventions, or here for resources, e-learning or the INEBRIA webpage.

A forthcoming SIPS conference will release the results of the largest brief intervention pilot study conducted in the UK in March next year.

SIPS brief interventions findings conference: 5th March 2012, King's College London

Results from the UK's largest brief intervention study, the SIPS trial, will be officialy released at a conference on Monday 5th March 2012, Institute of Psychiatry, King's College London.

Download the flyer for Alcohol Screening and Brief Interventions: From Research into Practice [pdf]. The event is a one day conference including the launch of SIPS Junior, a new trial into brief interventions for adolescents.

The Screening and Intervention Programme for Sensible drinking (SIPS) research programme was funded by the UK Department of Health as part of the national Alcohol Harm Reduction Strategy for England.

The programme comprised three cluster randomised controlled trials for different methods of screening and brief intervention across three settings: Primary Health Care, Emergency Departments, and Probation Services. It involved and trained 670 members of staff across all these settings. During the 13-month data collection period 10,530 patients were screened and almost 2,500 recruited  into the study, making it the largest alcohol screening and brief intervention pilot study so far conducted in the UK.

See here for the draft programme and here for online registration. Due to the limited number of places available SIPS advise the earliest possible registration, which will close on 24 February 2012.

Alcohol brief interventions in the workplace? Feasibility study finds opportunities for IBA at work do exist

A research project into the feasibility of alcohol brief interventions (or 'IBA') in the workplace has shown that opportunities to deliver IBA do exist - though may have limitations and are not without barriers.

A project delivered by the North London alcohol hub saw hundreds of workplace roles - ranging from senior managers to staff supervisors - trained in alcohol awareness and how to deliver 'Identification and Brief Advice' (IBA). Roles completed pre and post-training surveys to assess their attitude and knowledge around alcohol use.

An independent evaluation by the University of Middlesex (download full report here) found that the training resulted in many roles going on to deliver IBA, or at least discuss alcohol with colleagues or share information and resources.

However whilst some roles such as Occupational Health workers or health leads were readily able to integrate IBA into their work, many managers were not generally confident about delivering routine IBA with staff. Nonetheless, many did feel that training increased their confidence to discuss alcohol use and make use of opportunities such as through return to work interviews.

Another issue facing the success of the IBA training was managers focusing soley on existing alcohol problems within the workforce, such as where alcohol dependence was causing or linked to poor performance or absenteeism. The project in fact aimed to emphasise that whilst proper alcohol policies and responses were needed to address existing problems, IBA offered the opportunity to improve employees' health and prevent future alcohol problems in at-risk drinkers.

An event took place in Covent Garden in October to launch the report - presentations available here. A briefing paper on Alcohol & the workplace was also produced, highlighting the importance of early intervention and workplace policies in reducing the health and business impact of alcohol misuse.

'From one to many: The risks of frequent excessive drinking' - report calls for understanding of 'risky drinking'

A report from 2020health, a health and technology policy body, has emphasised the importance of addressing 'risky drinking' as a key part of public health policy. The report highlights the importance of brief interventions [or IBA] for risky drinkers, the need to promote alcohol-free days, and Government action including minimum pricing.

Download From one to many: The risks of frequent excessive drinking [pdf]

A foreword by Dr Clare Gerada, Chair of Royal College of General Practitioners, states:

"This report focuses on what we term ‘risky drinking’, where a person drinks often, perhaps even every day, but does not necessarily get drunk or display dependence on alcohol. It is these people, a million miles away from the classic image of the teenage binge drinker, who may not even realise they are drinking above the recommended amounts, and are quietly, slowly paving the way to serious health problems in the future."

The report re-emphasises many recent recommendations from health bodies over recent years, including NICE public health alcohol guidance, Alcohol Concern reports, Department of Health commissioning guidance and calls to mainstream brief intervertions.

It specifically calls on the use of new technologies to deliver brief interventions, which should also be included in a 'universal alcohol assessment' offered at age 30. Brief interventions should be included in all NHS health checks, integrated within the QOF and delivered by dentists.

Further information on alcohol and 'risky drinking' can be found from NHS Choices alcohol pages, Drinkaware, and resources and guidance are available from the Alcohol Learning Centre.

Brief interventions: achieving widespread delivery?

A briefing paper has been released exploring the barriers and challenges to implementing routine alcohol brief interventions (or 'IBA') across England. The paper also explores whether the 'lifestyles agenda' - a wider focus on all health behaviours - offers an opportunity or threat to mainstreaming alcohol brief interventions.

Download the report 'Brief interventions: achieving widespread delivery? Opportunities and challenges for the further delivery of alcohol ‘Identification & Brief Advice’ (IBA) across England'  [pdf]

The briefing follows a recent Alcohol Academy event and outlines much of the discussion on the day. The event looked at delivering brief interventions across a range of settings. Findings from the SIPS trial in Primary Care, A&E and Criminal Justice settings were also presented, although the official reports are yet to be released.

Speakers and audience members agreed overall that the 'lifestyle agenda' presented an important opportunity for integrating alcohol, particularly given the strong links between unhealthy behaviours and universality of health behaviour intervention approaches. However concern that alcohol specific tools or advice might be 'left-off' need to be carefully considered, especially given the efficacy for alcohol specific interventions.

The need to address practical and commissioning barriers were also raised. The implementation of IBA within Primary Care is still regarded as patchy or lacking, despite national incentive schemes. Many non-alcohol workers who should routinely deliver IBA may need further support, training or resources to be confident in asking about alcohol use. Whilst many areas are making progress, the paper calls on commissioners and public health leads to sustain and build on what has been achieved.

See here for further information and resources on IBA, including an e-learning course and a previous Academy briefing paper on 'Clarifying brief interventions'. Local DES implementation guidance is available, as is NICE alcohol guidance.

Implementation of brief interventions evaluated in Scotland

An evaluation to assess the implementation of NHS delivered alcohol brief interventions in Scotland has been released. NHS Health Scotland had a target to deliver 149,449 brief interventions across three priority settings of primary care, Accident & Emergency (A&E) and antenatal care between 2008-2011. The programme is currently within a one year extension.

According to the evaluation abstract:

The evaluation found a considerable degree of variation across Scotland in organisational structures and models of delivery. However, a number of common features were also identified. Those which appeared to support implementation included: the availability of funding; nationally co-ordinated and locally supported training opportunities; and national, health board and setting level ‘leaders’ able to support and encourage implementation.

Perceived barriers included: the lack of ‘lead in’ time to set up organisational structures; competing priorities; an initial lack of adequately trained staff and difficulties maintaining trained staff levels; and problems associated with the mechanisms for recording delivery. These within-setting and across-board differences and difficulties in recording ABI delivery made it difficult to accurately determine or compare who the programme was reaching. Nonetheless, by March 2011 most boards had met, if not exceeded, the three-year target.

In England, Primary Care brief interventions (also known as 'Identification and Brief Advice') are incentivised through a Direct Enhanced Service (DES), though there is no national target. See here for DES guidance.

Alcohol Direct Enhanced Service (DES) Guidance released

Guidance to improve the delivery of alcohol brief interventions (Identification and Brief Advice) for Primary Care practices incentivised through the DES has been released:

Improving Delivery of the Alcohol Direct Enhanced Service: A Step-By-Step Guide for Commissioners, Primary Care Practitioners and Practice Managers [pdf]

Background

Last year, Haringey Drug and Alcohol Action Team (DAAT) and HAGA decided to review local alcohol DES delivery to inform best practice guidance on how to deliver the alcohol DES. The review found, to give just a few examples, that 75% of practices were using incorrect screening questions, and that only 50% of practices were offering face-to-face Brief Advice. Crucially for practices, we also found that practices were losing money due to DES returns that did not reflect the work that they had done.  

What the Step-By-Step Guide offers

Following the Step-by-Step Guide which is based on our review findings and HAGA's years of experience in delivering IBA projects will help practices to maximise their income, whilst also offering better healthcare for patients. This guide updates and collates various guidance documents on the alcohol DES and Identification and Brief Advice (IBA) in primary care, so that you can get all the information you need in one place.

About the guidance and review

This guidance has been written by HAGA, Haringey's local alcohol service; commissioned by Haringey DAAT; and is supported by the Department of Health. The review on which we have based this guidance has been cited as an example of best practice in Intensive Support in Reducing Hospital Admissions (Currie 2010).

See here for further IBA resources and materials including the IBA e-learning module.

Latest Findings alcohol research: Web-based interventions can work & what works best for young drinkers

Recent research from the drug and alcohol Bank:

REVIEW CONFIRMS THAT COMPUTER-BASED ALCOHOL INTERVENTIONS CUT DRINKING
Computer-based and in particular internet-based therapies open doors to treatment for drinkers who cannot get or do not want face-to-face-help. This review finds they do curb drinking, but its sub-finding that they are as effective as alternative therapies should not be taken to mean computers can replace therapists.

MODERATE DRINKING OVER THE WEB: THERAPY PROGRAMME BOLSTERS MUTUAL AID
Does it help to add a structured internet-based therapeutic programme to web access to a mutual aid network also geared to moderate drinking? Sustained extra moderation in the form of fewer days drinking was the clearest positive effect; less clear was whether it led to greater reductions in drink-related problems.

REVIEW OF STUDIES ON WHAT WORKS BEST WITH YOUNG DRINKERS
Though some studies may have been persuasive, this review of recent attempts to find which therapeutic approaches work best for young risky drinkers was unable to reach firm conclusions due to variability in the studies and methodological inadequacies. Still, the tentative verdict favouring cognitive-behavioural therapy, family therapy and community reinforcement accord with UK guidance.

Other recent Findings bulletins include:

• Emergency department nurses can screen for risky drinking
• Opioid antagonists useful supplement in alcohol treatment
• Spanish GPs target binge-drinking patients
• New Zealand commission calls for alcohol price rises and licensing reform

Hot topic searches can also be run on key issues including:

• Matching alcohol treatments to the patient
• Alcohol licensing, price and taxation