Looking back and moving forward

The British Society of Gastroenterology (BSG) has changed in recent years, moving from being a club of gastroenterologists that hold an annual scientific meeting, into to a body campaigning for improvements to patient services, becoming increasingly involved in helping to deliver quality improvements in frontline care. The BSG has developed a broad view of how to promote and advance GI and hepatology services and is getting better at coordinating its different activities to point towards this aim. Old habits die hard and despite developing the society we still think of the beginning and end of our year as the annual meeting, which this year will take place at the ICC in Birmingham in March. The Annual meeting in 2010 saw the launch of a report calling for the adoption of Alcohol Care Teams1 to treat those suffering from alcohol problems and to prevent future admissions and in the worst cases, deaths. The report recommended that hospitals should have a coordinated approach to alcohol-related disease, across hospital and community departments, through an Alcohol Care Team, including a designated consultant lead and a multidisciplinary team, which includes a 7-day Alcohol Specialist Nurse Service and an Outreach Service. We published the report with the Alcohol Health Alliance UK and the British Association for Study of the Liver, to set out an evidence-based case for establishing a joint hospital and community Outreach Service. Together with a 7-day Alcohol Specialist Nurse Service, this could result in a 5% reduction in alcohol related hospital admissions, resulting in the potential for each District General Hospital to save £1.6 million annually. For much of 2010, the BSG promoted the idea by trying to engage the Government and PCTs on the potential costs that could be saved, as well as lives, and by encouraging our members, doctors and nurses, to talk to local commissioners and their hospital chief executives to try and set up a service.

We continue to push on this agenda and our March 2011 meeting will feature a symposium on alcohol. As with other symposia we are increasingly engaged with working out how to deliver changes in practice, rather than only analysing the problems. The symposium will hear evidence from different parts of the country. Dr Steve Ryder in Nottingham, for example, has recently produced evidence showing that nurse specialists can save money by reducing admissions. This is an experience that will be echoed by Lyn Owens, who has pioneered a nurse led alcohol service in Liverpool. The symposium will hear evidence behind Brief Interventions, which seek to ask questions about alcohol intake and a referral to further support amongst the many patients attending A&E departments – although not always recorded, many of the presentations are alcohol related. Evidence shows that Brief Interventions can lead to a significant minority abstaining from future alcohol abuse. Over the three years that I have been BSG chief executive, I have seen the health world change quite substantially. Of course, we have moved to a different economic climate, where the large increases the NHS saw in funding will end and savings must be found. We have also seen the policy environment change and not only as a result of a new government. Before the election of the Coalition Government, the Department of Health had already begun to retreat from its previous role as a central manager of the NHS. The change went so far that by the time the IBD Standards,2 which we produced with partners, were published, the Department of Health was no longer endorsing national standards. Instead, it was saying that NICE was the body that set standards and it was for local commissioners to follow them. Guidance outside of NICE would be accepted at the discretion of commissioners. Such a change in the policy landscape has big implications for the way a society like ours, or any health group, seeks to influence change. This is only set to change more with the reforms set out in the recent NHS White Paper. We have moved from the past, where the aim would be to secure central endorsement, to a situation where we must try to influence commissioners on the ground. One consequence of the change in government is that commissioning will change this, and will make our job harder. Instead of trying to influence the commissioning decisions of 156 PCTs, it is likely that we will be dealing with double this number of bodies in the form of GP consortia. It is clear that to promote the advancement of GI and hepatology services, the BSG must be more vocational as well as academic.

Opportunity for change