Working with the tide of change

The BSG annual multidisciplinary meeting covers all aspects of medical and surgical gastroenterology and hepatology, featuring the latest cutting-edge research. Commenting on some of the topics and themes which will be in evidence at this year’s event, Dr Tom Smith, BSG chief executive, said: “With the incoming reforms to the NHS, this year’s conference has some great events on clinical services and how the BSG is working with the tide of change. At last year’s conference we launched the BSG Commissioning Guidance for best practice gastroenterology and liver services. In 2013-14 we will be promoting each strand of the guidance to improve services for patients and to help gastroenterologists influence their local service design. The BSG’s work on acute upper gastrointestinal bleeding, for example, looks set to gather pace over the next year and I very much look forward to hearing Professor Denton’s initial findings relating to a survey of acute upper gastro- intestinal bleeding out-of-hours provision. “Sir Richard Thompson, president of the Royal College of Physicians, is also going to be giving the New Perspectives talk. He will explore ideas around ‘The Future Hospital’ and this looks set to be a very thought-provoking session.” The event will see speakers discussing some of the BSG’s current campaigning issues. In relation to acute upper gastrointestinal bleeding (AUGIB), for example, Professor Erika Denton, the National Clinical Director for Diagnostics, will give a presentation on improving geographical variation in access to emergency endoscopy services. Prof. Denton works part-time at NHS England and is parttime consultant radiologist at Norfolk and Norwich University Hospitals NHS Foundation Trust. In her role, she provides expert advice and research on diagnostics and imaging to the medical directorate, playing a key role in the development of clinically-led care in the sector. AUGIB is a common medical emergency that has a 10% hospital mortality rate. Despite changes in management, mortality has not significantly improved over the past 50 years. Out-of-hours cover of AUGIB is an extremely important issue for the BSG. Currently, it is estimated that 50% of hospitals do not have any specialist cover in place, in contradiction to National Institute for Health and Care Excellence (NICE) guidelines, which aim to identify which diagnostic and therapeutic steps are useful in managing AUGIB.1 Treatment of AUGIB requires a highly competent individual, usually a consultant. However, while urban and city areas’ AUGIB out-of-hours services are relatively comprehensive, there are large variations in coverage and service design. The BSG has, therefore, been working with NHS Improving Quality and Prof. Denton, towards the roll-out of out-ofhours AUGIB services in England. Prof. Denton brings much experience from her previous role as Clinical Lead for Imaging, in which she was successful in increasing nationwide out-of-hours coverage of interventional radiology services. At the conference, Prof. Denton will be presenting the results of a recent survey of AUGIB out-of-hours provision and outlining the way forward for improving service design. The BSG’s collaboration with Prof. Denton has also been supported by Professor Sir Mike Richards, NHS Director for Reducing Premature Mortality, Professor Keith Willett, NHS Director for Acute Episodes, and Professor Sir Bruce Keogh, the NHS Medical Director, who is exploring the implementation of seven-day working. Commenting on Prof. Denton’s presentation, Dr Adam Harris, chair of the BSG Clinical Services and Standards Committee, said: “Out-of-hours cover for AUGIB is patchy across the country, particularly in areas outside the major cities and teaching hospitals. This puts patients at risk, especially at weekends when they may be admitted on Friday evening but have to wait until Monday morning to see a consultant. Establishing consultant on-call rotas for out-of-hours AUGIB, in line with the NICE Guidelines, is a vital part of any endoscopy service and we are therefore looking at ways to support colleagues in this. I look forward to Professor Denton’s analysis of the findings of our survey as it is vital we have an accurate picture of where cover is inadequate.”

Alcohol services

Another important topic that will covered at the event is that of alcohol policy. The Liver Section Symposium will include a presentation by Professor Sir Ian Gilmore, president of the BSG, and a leading campaigner on alcohol policy. He will discuss the impact of clinical research in hepatology. It is estimated that the annual cost of alcohol-related harm to the NHS in England is £2.7 billion (Department of Health 2008). Of this amount, 78% of the costs were incurred as hospital-based care. Inpatient costs alone were responsible for 45% of this spend (NHS Confederation and Royal College of Physicians 2010). A significant proportion of this spending is avoidable and alcohol services could be more effective, cheaper and person-centred if each area had a plan to deliver evidencebased care in an appropriate setting, integrated between primary and secondary care. However, very few hospitals have dedicated alcohol services, and a 2009 survey showed that only 42% of acute hospitals had any alcohol specialist nurse support (Ward et al 2009). For some years the BSG has taken a prominent role in campaigning for measures to reduce alcohol consumption and provide better support for those suffering with alcohol-related-problems. It believes strongly in the need for improvement of alcohol services for those with alcohol-related health problems and has been promoting the national up-take of Alcohol Care Teams for some time.2 It has certainly been a turbulent time for alcohol policy, with an imminent Government u-turn on the introduction of minimum unit pricing on the cards. The Government’s Alcohol Strategy remains weak on measures to improve alcohol related health and this is why the BSG is working with NHS England and Public Health England to ensure alcohol services receive due recognition in commissioning decisions.