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?

‘ ’ QIPP for alcohol care teams Evidence summary Implementability Evidence of change Quality Savings 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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. 3500 3000 2500 Rate per 100,000 2000 Chronic Conditions Rate CHRONIC Wholly Attributable Rate CONDITIONS 1500 Acute Consequences Rate 1000 DEPENDENCE 500 0 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009

Activity upstream reduces costs, reduces the need for complex interventions and improves outcomes £ ££ Potential for intervention Risk assess Early £££ diagnosis Stop ££££ £££££ “ insult ” ££££££ Treat Monitor for Treat for cancer or cancer or complications incl complics transplant Liver Consequences of Liver insult Liver fibrosis Cirrhosis inflammation cirrhosis Impact on individual/ health services over time (10-20 years)

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