Ian Gilmore Chair, UK Alcohol Health Alliance President, British - - PowerPoint PPT Presentation

Ian Gilmore Chair, UK Alcohol Health Alliance President, British Society of Gastroenterology

Reflections on the ……

• challenges for hepatology
• challenges for gastroenterology
• challenges for the acute

hospital

• Challenges for the system
• Challenges for society

Challenges for hepatology

Challenges for hepatology

• Existing workforce (consultant, juniors,

nurses

• Recruitment into specialty
• Relationship with gastroenterology
• Relationship with G(I)M

Challenges for gastroenterology

Challenges for gastroenterology

• Maintaining hepatology

expertise

• Relationships with ITU
• 24/7 therapeutic

endoscopy for bleeding

• Repository for wider

alcohol admissions?

‘ ’

Evidence summary

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Savings Quality Evidence of change Implementability

QIPP for alcohol care teams

QIPP for alcohol care teams

Challenges for the acute hospital

Debate : is continuity now best delivered by a generalist ?

Challenges for the system

The new NHS – April 2013

Alcohol Related Admissions for Liverpool PCT (residents) 2002/03 to 2008/09 by Condition Group.

500 1000 1500 2000 2500 3000 3500 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 Rate per 100,000

Chronic Conditions Rate Wholly Attributable Rate Acute Consequences Rate

CHRONIC CONDITIONS DEPENDENCE

£ ££ £££ ££££ £££££

Impact on individual/ health services over time (10-20 years) Potential for intervention

Liver insult Liver inflammation Liver fibrosis Cirrhosis Consequences of cirrhosis Risk assess Early diagnosis Stop “insult” Treat Monitor for cancer or complics Treat for cancer or complications incl transplant ££££££

Activity upstream reduces costs, reduces the need for complex interventions and improves outcomes

What can we do as clinicians?

Start applying the four ‘P’s of Advocacy

• Advocate for a Population / Public health approach

to alcohol

• Advocate for Protection of the vulnerable, especially children
• Advocate that for alcohol there is a Product, not People

problem

• Advocate to Policy-makers, the Public and the Press to turn

the tide of liver disease

Challenges for society

Where international evidence on consumption and harm should point politicians towards regulation:

• availability
• promotion by the alcohol producers and

retailers

• price of alcohol

What to do about price?

• increase duty / VAT
• use duty to promote lower strength
• tackle discounting / bulk offers
• minimum unit price