1 Executive summary
This commissioning guide aims to support commissioners in England to implement NICE guidance on alcohol, and to commission high-quality services that meet the quality standard on alcohol dependence and harmful alcohol use, by commissioning services for the identification and care of hazardous and harmful drinkers and people with alcohol dependence.
The guide highlights the benefits of commissioning for outcomes (see section 2.1) – principally reducing consumption, alcohol-related hospital admissions and alcohol-related mortality by improving access to evidence-based interventions that promote recovery.
It is estimated that only a small proportion of the £2.7 billion annual expenditure on alcohol-related harm is spent on identifying and treating alcohol misuse. NICE guidance advocates an invest-to-save approach by prioritising the prevention of alcohol-use disorders. This commissioning guide sets out a whole-system approach (see section 3.4) to commissioning integrated alcohol services across the whole spectrum of care, from preventing harmful drinking through opportunistic screening and brief interventions, to specialist treatment programmes for children, young people and adults, and their families or carers.
The commissioning guide describes the following service components required to deliver a high-quality service:
opportunistic screening and brief interventions for adults who are hazardous and harmful drinkers (see section 3.1)
diagnosis, assessment and management of harmful drinking and alcohol dependence in adults, in specialist services (see section 3.2)
services for children and young people who are vulnerable to alcohol-related harm (see section 3.3)
whole-system commissioning of high-quality alcohol services (see section 3.4).
Each section offers examples of service models, including case studies and ideas for using Quality, Innovation, Productivity and Prevention (QIPP) and Commissioning for Quality and Innovation (CQUIN) to drive improvements to alcohol services. There is also an outline service specification (see section 4) to assist commissioners when tendering or contract-managing alcohol services.
The benchmark section (see section 5) contains further information to help commissioners to assess levels of alcohol dependence and hazardous and harmful drinking in their population. A population benchmark has been provided for the number of people in England aged 16 or above who are hazardous, harmful or dependent drinkers.
The guide contains a commissioning and benchmarking tool that can be used to calculate the costs of increasing access to opportunistic screening and brief interventions and to specialist alcohol treatment for adults. Providing evidence-based packages of care using the stepped-care model may reduce the unit cost of treatment per person by offering the least intensive, most cost-effective intervention that is appropriate. Whole-system commissioning may generate savings by reducing alcohol-related harm and alcohol-attributable hospital admissions.