Daily Archives: 26/04/2015

Calling time on missed opportunities: commissioning alcohol services to reduce avoidable harm

This was an interesting supplement that was covered by Guidelines in Practice a best practice online resource and was titled: Calling time on missed opportunities: commissioning alcohol services to reduce avoidable harm.  It carried a big old disclaimer before you even read the piece outlining Lundbeck’s, the pharmaceutical company responsible for Selincro (nalmefene) the new drug recently approved by NICE for use in alcohol harm reduction.

This was the abstract:

A multidisciplinary group of professionals involved in the clinical and societal management of patients with alcohol dependence met in Spring 2014, with the objective of defining themes for future developments in the management of alcohol dependence. Six themes were identified and 40 consensus statements were developed across these themes. The statements were presented as questionnaires, either as paper documents or electronically, and distributed to professionals engaged in the management of alcohol dependence in the UK. Questionnaires were completed by 194 respondents in a variety of roles associated with the management of alcohol dependence. Thirty-one of the 40 statements (77.5%) achieved agreement scores in excess of 66%, and 26 statements achieved very high consensus >90%. Only nine statements failed to achieve consensus agreement of >66%. The responses from the contributors to this consensus process informed the three recommendations put forward by the expert advisory group:

  1. addressing alcohol-related harm must be a commissioning priority
  2. collaborative approaches between clinical commissioning groups and local authorities are needed to develop and fund effective alcohol services
  3. local strategies are needed to increase the number of people accessing services and to engage a wider group of people using alcohol.

And they conclude:

The expert advisory group welcomes the very high levels of agreement from the treatment and commissioning communities on the importance of tackling alcohol problems. However, the responses to statements about the services currently being commissioned and delivered make challenging reading and require a clear and rapid response to drive improvement.

Put simply, the majority of the respondents do not believe that alcohol misuse is appropriately prioritised by CCGs, HWBs, and Local Authorities; the responsibility for addressing alcohol problems is unclear and therefore funding is often insufficient.
The large numbers of drinkers who are at risk of harm are not covered by the current services, and the services that are ultimately delivered are not seen as effective in improving physical or mental health by almost one-half of the respondents.

This must change rapidly to minimise mortality and morbidity and ensure appropriate use of NHS and Local Authority resources. Failure to do so will represent a significant missed
opportunity in addressing this urgent health and public health need.

The full research supplement can be read here.

I agree with all that they say but find myself gnashing my teeth somewhat.  Yes, yes we know all of this but it doesn’t make a blind bit of difference does it?  And why does it take the involvement of the pharma industry to point out the bleeding obvious? <sigh>

What do you think?