George Howie Health Improvement Programme Manager NHS Health Scotland The National Support Programme for the H4: HEAT target for Alcohol Brief Interventions George Howie Health Improvement Programme Manager NHS Health Scotland

Scotland’s HEAT H4 target: Alcohol brief interventions Screening and delivery of alcohol brief interventions is national policy – everyone is doing it! National total of alcohol brief interventions to be achieved to be achieved -149,449 between 2008 – 2011 (within Primary Care, A & E and Antenatal settings), using setting appropriate screening tools and in line with SIGN 74 guidance. Targeted, opportunistic, approach within Primary Care in line with presentations highlighted within SIGN 74. Longer term vision is for alcohol brief interventions to become core business of NHS Scotland. Supportive alcohol social marketing work longer term.

Progress to date National Guidance on implementation issued. National Guidance on data reporting issued and a minimum dataset agreed with health boards (including definitions; guidance notes and data standards). Delivery Support Team established. All health boards visited by Scottish Government and NHS Health Scotland to review progress, identify support needs and to provide feedback on achievements. Health Board Local Delivery Plans (LDPs) reviewed – most health boards on trajectory. All health boards have Primary Care Local Enhanced Service (LES) negotiated and in place (financial reward for screening, ABI delivery and follow-up). Monitoring and Evaluation Reference Group for Alcohol (MERGA) established.

Progress to date 100+ pool of trainers trained to deliver ABI training in health board areas. Over 3200 practitioners trained across Scotland (need for training in many LESs). 3 RCGP Scotland courses – 130+ GP’s and Practice nurses trained. Training manual, CD, flyers, posters, guidance sheets and Training DVD developed to support trainers and Primary Care practitioners. Virtual learning environment (VLE) – on line Units and ABI web pages. ABI training standards and competency framework.

Alcohol brief interventions training/training for trainers evaluation Evaluation from May 2008 through to March 2010 and covers Alcohol Brief Interventions (ABI) for Trainers (T4T) ABI training for practitioners Methodology consists of pre (275 to date) and post (307 to date) questionnaires telephone and face-to-face interviews after 6-9 months Exploring ‘role legitimacy’ or relevance knowledge, skills and tools confidence what difference it makes to practice?

Alcohol brief interventions training/training for trainers evaluation Health Scotland ABI training effective in conveying knowledge, skills and tools. Boosts practitioner confidence prior to training almost half (47%) felt ‘quite’ or ‘very’ confident about delivering an alcohol brief intervention on completion of training this rose to 93% 16% reported limited (or no) confidence in delivering an alcohol brief intervention prior to training, this fell to only 2% after training. Majority continue to use skills regularly, confidence largely maintained by practitioners (6-9 months after training).

Progress to date Practitioner and public facing resource material published and disseminated to all health boards. Learning and Development Advisers in NHS Education for Scotland – work across the organisation to embed alcohol in the professional development curriculum. Supporting screening and ABI delivery within the context of Anticipatory Care through Keep Well & Well North. Funding direct to health boards to support training delivery and local infrastructure development.

Issues arising to date Support needs around delivery in antenatal care and A&E. Data collection and reporting – health boards at different stages of development. Some health boards implementing follow-up (different models). Services for onward referral and clear care pathways are crucial. Increased alcohol funding has provided opportunity for local infrastructure development and revised strategies/processes for commissioning and delivering services. Requests for networking/learning opportunities and summary of activity across Scotland.

Alcohol brief interventions – a flavour of the patient experience? ‘Of course, I mean how many people ask for advice. Normally we try to keep away from it; we don’t want to hear the truth half the time. How many people say they don’t drink a lot until somebody shows them that they do?’ (male, aged 69) ‘I didn’t mind being asked. It was quite interesting, yes, I didn’t find it embarrassing, no…’ (female, age unknown) ‘She done it very well, how she questioned you. Put it this way, you weren’t judged.’ (female, age 43) ‘Aye, I don’t see any problem with it. Aye, they can give you a guide or something like that; I don’t see anything wrong with that. It’s always better talking.’ (male, age 55)

What’s next? Maintain clear and consistent communication. Continue to identify, nurture and support local champions. Continue to build delivery capacity and sustain momentum, supporting health boards focus their efforts where we believe the greatest difference can be made. Consolidate delivery in Primary Care. Supporting expansion of delivery into antenatal care and A&E. Tailored support to health boards through Delivery Support Team where required. Monitoring and evaluation arrangements finalised through MERGA group.

Thank you for listening…any questions? George Howie Health Improvement Programme Manager NHS Health Scotland Thistle House 91 Haymarket Terrace Edinburgh EH12 5HE Tel: + 44 (0)131 313 7505 Email: george.howie@health.scot.nhs.uk Web: www.healthscotland.com