Cheshire & Merseyside Joint Fibroscan Project



Cheshire & Merseyside Joint Fibroscan ProjectRequest for expressions of interestIntroductionChamps invites expressions of interest from local areas to act as pilot sites for the innovative use of non-invasive liver scanning to improve access to treatment for alcohol dependence. Champs public health collaborative has successfully bid for capital funding from Public Health England (PHE) to purchase five Fibroscan machines for use across Cheshire and Merseyside. These scanners are to be used in a number of local pilot sites to detect evidence of liver disease and to begin new conversations with people about their alcohol use. Fibroscan can be used to provide a form a bio-feedback in this process by giving patients a score they can work towards reducing by reducing their alcohol use. Rates of alcohol-related health harms, hospital admissions, and mortality are higher in Cheshire and Merseyside (C&M) than the national average. Recent estimates from PHE suggest that the number of adults accessing support for alcohol problems has decreased and that there is a significant unmet need for alcohol treatment across the region. The proportion of dependent drinkers not in treatment is in excess of 70% in most areas of C&M (Figure 1). Figure SEQ Figure \* ARABIC 1: Comparison of C&M local authority population sizes and unmet need for alcohol dependence treatment. Source: PHE FingertipsWe anticipate that by offering local people a non-invasive scan for liver damage, new opportunities will be opened up for conversations with members of the public, making use of alcohol identification and brief advice (IBA). This will enable improved access to alcohol treatment and early-identification and referral of liver disease.Initial use of Fibroscan in this manner in the Royal Liverpool and Whiston Hospitals has already demonstrated that this approach opens up new opportunities for addressing alcohol misuse in people who do not otherwise engage, and that providing patients with a Fibroscan number indicative of liver damage, may improve adherence to treatment (especially when patients and clients experience an improvement). What should local pilots look like? We are seeking innovative approaches to the use of a Fibroscan to attract individuals with previously unidentified alcohol problems into a conversation around alcohol use, advice on reducing intake and/or referral into local treatment service. For all pilots, this should involve offering scans to people who are not currently engaged in alcohol treatment and immediately following this up with alcohol IBA methods. As such, the approach presents a new route into IBA +/- referral to alcohol treatment and a new route into a conversation about alcohol. Pilots can take a variety of formats. Some examples could include, for example:Use of a mobile facility (e.g. a health bus or van) at festivals, community, or sports events targeting members of the public,Use of a mobile facility to target areas where there is a known high level of need,Trialling the use of fibroscan to augment existing NHS Health Check process,Scanning as part of the A&E admission / triage process, Discreet scanning at pharmacies or other community settingsWhat will be required? Providers will need to identify a timeframe in which the pilot project will take place, and a target population. Providers will need to demonstrate that they have agreed local pathways for referring patients newly-identified with liver damage into appropriate treatment. These pathways should be agreed with local liver disease specialist teams and CCGs. Providers will need to demonstrate that staff providing scans will be appropriately trained and competent to: Interpret scan results and provide appropriate advice on the result to individuals being scanned (as appropriate to local projects),Refer patients into agreed parts of local liver disease referral pathways,Carry out alcohol identification and brief advice with all scanned patients, including those with normal liver scan findings,Where individuals are drinking above low-risk guidelines, provide initial advice for reducing alcohol intake and refer for onward support in alcohol treatment services if this is appropriate.Providers will need to articulate the resource implications of the proposed programme and how they will ensure that they will be able to deliver the project within existing resources. Local providers will be required to offer non-invasive liver scans and alcohol IBA to people who are not currently engaged in treatment. The local provider will be responsible for ensuring that machines are used according to memoranda of understanding to be agreed between the provider and Champs and will be used primarily for the purposes of the project. Each pilot project will also need to collect and report a minimum dataset so that the project can be evaluated. Proposed projects should run for at least 3 months and for no longer than 12 months. All projects will be reviewed early in the project timeline to ensure that machines are being used for the intended purpose and to understand early indicators of success. This is to ensure that all scanners are successfully being deployed for the intended purpose of the project. Where projects are failing to deploy or make use of scanners, the implementation group will consider remedial action, which may include moving scanners to another project. A proposed indicator of reporting schedules for different length projects is included below.Project LengthProposed Assessment intervals12 months1 month - Initial monitoring to assess viability3 months –early reporting of project KPIs6 months – mid-point reporting12 months – final summary reporting / evaluation6 months1 month - Initial monitoring to assess viability3 months – Mid-point reporting6 months – Final report3 months2-3 weeks - Initial monitoring to assess viability3 months – final summary reporting / evaluationWhat is being offered?Fibroscan machines will be loaned to local providers at no charge, allowing providers to carry out local projects to offer scans to members of the public and engage clients in identification, brief advice and referral into local alcohol treatment pathways. Champs will provide access to the Fibroscan machines. Any additional revenue costs of pilot projects (such as staff time, consumables, etc.) will need to be met by local providers. There is no revenue funding for this project.Champs will arrange initial training in the use of the machines, although there will be an expectation that local providers will enhance the training offer if required, to ensure that those offered a scan receive appropriate alcohol IBA and are appropriately advised and referred (if necessary) into local liver disease pathways if evidence of liver pathology is identified. What will happen when liver disease is suspected?Each pilot project will need to identify, before the pilot commences, what the local pathway will be for the onward referral of any appropriate person where the liver scan shows evidence of advanced liver disease. They will also need to demonstrate that communication has taken place with local partners and appropriate systems are in place. Local areas should demonstrate sign-off of their project from their local acute liver specialist team and from their local CCG to ensure that individuals with identified liver damage are referred appropriately for any necessary further diagnosis and/or treatment. They should also provide details of the process that will be followed if patients do not attend for follow-up. In addition, local projects should be linked to specialist substance misuse services with clear referral routes for additional support for those with identified alcohol problems including alcohol dependence. How do I apply?We recommend that you work in partnership with the local authority substance misuse commissioner(s) for your area when sending an expression of interest. Please complete the attached form to outline details of your proposed project. Please submit your expression of interest to champscommunication@.uk by 0900 on Monday 8th July 2019. How will applications be reviewed?Expressions of interest will be collated and reviewed by the C&M Fibroscan Implementation Group. Projects will be assessed and selected considering:The extent to which proposed projects meet the need of improving access to alcohol treatmentThe extent to which proposed projects target people with highest level of unmet need for alcohol treatmentThe extent to which proposed projects demonstrate their ability to meet the requirements of the project as outlined aboveThe total mix of proposed projects received and the needs of the project to:Make maximum possible effective use of machines for the proposed purpose,Ensure that residents from all nine C&M places (i.e. local authority areas) are included during the 2-years of the project, andMeet the project key performance indicators on total numbers receiving a scan + IBA, numbers newly referred into alcohol treatment, and total number of active projects across C&M.Cheshire & Merseyside Joint Fibroscan ProjectExpression of interest formTo register your interest in this project, please complete this form and return to champscommunication@.uk by 0900 on Monday 8th July 2019. Please ensure you have the support of your local authority lead public health commissioner(s) for community substance misuse services.Project Name:Local Authority Area:Main Contact:Name:Organisation:Email:Telephone Number:Please provide a brief description of your proposed projectWhat is the timescale for your project?How many scans do you anticipate completing as part of your project?Please briefly describe your target audience? Please describe the resources that you will be bringing to the project and how you intend to meet any revenue costs (i.e. staff time, other equipment needs, venue costs)?Please outline the training requirements that you will have with regards to the use of the Fibroscanner.Please name your local lead Public Health Commissioner(s) for substance misuse. Do you have their support for this project? Yes No Please describe your local community Substance Misuse Service and outline how your project will connect in to local referral mechanisms for this service and maintain close partnerships.Please confirm that you have the agreement of relevant CCG colleagues and are working in close partnership with your acute trust referral pathways for liver disease. Please outline how your project will support people when evidence of liver disease is identified (what will be the onward referral mechanism(s)?.Please explain how you will target your project to those most likely to have unmet need for alcohol dependence treatment.Please use this space for any other comments you wish to include about your projectsProject Lead Signature: ................
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