Identification and Brief Advice (IBA) has incredible potential to prevent and reduce alcohol related harm. The figure of a 15% decrease in alcohol consumption on average for those who receive an IBA is a compelling and significant impact. For the individual this can mean reducing alcohol related hospital admissions and risk of alcohol related mortality by a fifth. For England this could lead to reductions in a wide range of health and social harms.
Despite this, our strategic approach to rolling out IBA in the English population has been lacking. In the last two national strategies IBA has been noted, but with little strategy for implementation. The Safe. Sensible. Social alcohol strategy did highlight a research approach, and the development of web-based commissioning tools. In the 2012 strategy, IBA isn’t raised until after social marketing, the sobriety pilot and licensing amongst others – and all it does, is say is that IBA will be part of the NHS health checks and that Local Authorities should consider it for commissioning in primary care settings. We’re yet to have another national alcohol strategy. Local Alcohol strategies tend to be better, but still, there is very little strategic coherence to IBA implementation.
For years IBA has been highlighted as something to be rolled out, the evidence has been clear and further research has been commissioned; examples of good practice have been collected and shared. However, no real strategic approach to the implementation of IBA has been set out.
Without a clear strategic direction:
- The roll out of IBA in primary care – through both Direct and Local Enhanced Services – did not live up to expectation.
- Other settings, such as pharmacy, have been the site of IBA initiatives and some research and evaluation work, but we are still unclear of the evidence, practice and approaches that might best work for wider implementation.
- Since the move of Public Health to Local Authorities, NHS buy-in at commissioning level has initially been limited. The joint commissioning between Public Health and CCGs that we optimistically hoped for a few years ago is still developing.
- Digital IBA has become increasingly popular. Although there is definite development and innovation in this space, there is still a fragmented approach across local commissioners – there is little clear guidance and little sharing of good practice despite the evidence base being solid and growing.
If we are to realise the potential of IBA and make best use of the learnings of the past few years, we need a strategic approach to IBA implementation. This would need to:
- Make the case: clinically, socially and economically (each being as important for the case as the other). We need to better make the case for IBA implementation. Currently we have failed to win over decision makers, commissioners and clinicians sufficiently for the wide-scale, effective delivery of IBA to take place that would show significant impact.
- Commissioning: we need to be clear that when commissioning IBA it shouldn’t be service by service or project by project, it should be a comprehensive IBA approach – the HIN IBA Commissioning toolkit (Watson, Knight, Hecht and Currie) provides a detailed and effective guide for commissioning IBA strategically and effectively.
- Training and workforce development: We need to learn from our smoking cessation partners and develop a minimum standard of training, possibly with accreditation, and a professionalised training and skills acquisition pathway around IBA for more junior staff’s professional development and career progression.
- Digital integration: We need to work with the existing digital field, in practice, research and innovation; and examine and experiment with how digital and traditional IBA can align, complement and enhance each other for the best ‘merged’ IBA pathways to be available to practitioners and the population.
- Expanding the knowledge and scope: redeveloping a research and evaluation strategy to genuinely enhance and build our knowledge of what works. A collaborative strategy that sees our researchers and evaluators work with commissioners and practitioners to fill in the gaps and expand the boundaries of our knowledge rather than reinventing the wheel.
We think that now is the right time to build an alliance of interested parties to start scoping out and developing what an IBA Strategy would look like and what it could achieve.
We would be keen to hear from anyone who is interested in supporting or being involved in this.
Dr Matthew Andrews
Safe Sociable London Partnership
26th January 2017