Adult drug treatment plan 2007/08 Part 1 Section A: Strategic summary Section B: National targets Section C: Partnership performance expectations

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1 name Adult drug treatment plan Part 1 Section A: Strategic summary Section B: National targets Section C: expectations Published by NTA: 2 October This strategic summary incorporating national targets and partnership expectations, together with the funding profile, self assessment and attached planning grids have been approved by the and represent our collective action plan. Signature: Vivienne Lukey Signature: Wendy Ryan Chair, Westminster DAAT Acting Chair, Westminster Adult Joint Commissioning Group 1

2 Section A: Strategic summary A1: drug treatment strategy: Westminster DAAT is committed to providing a broad range of drug treatment services to meet the wide ranging and ethnically diverse communities located within Westminster. The DAAT continues to work towards providing a high quality range of services that are responsive to the ever changing needs of the local drug using population within the financial constraints. Whilst saw a significant increase in the Pooled Treatment budget, it was substantially less than government office had led us to believe and as a result placed some pressures on the DAAT budget to achieve the full commitments laid out in last year s plan. In addition, the partnership has seen a considerable change over the last year since the introduction of testing on arrest in April with a recorded rise in drug testing on arrest of up to 650 drug tests being conducted in Westminster custody suites per week 60% of these are not Westminster residents. This has led to an increased pressure on treatment services, particularly residential services and community-based prescribing services. It is worth noting that the DIP caseload now reflects a 50/50 split of homeless to housed clients and with this comes some fairly challenging decisions around treatment options for this hard to reach client group. It is with this in mind that the DAAT make a commitment to continue to commission high quality services but acknowledge the need for service review and re-design in certain areas of the treatment system to reduce financial pressures, maximise efficiency and ensure pathways into services are accessible and equitable. The DAAT continues to place the treatment effectiveness agenda at the heart of its strategy and seeks to improve the quality and accuracy of data provided by all treatment providers in the partnership. Substantial work was undertaken in -07 to capture GP shared care data and improve the overall quality of NDTMS submissions. This will continue to be a focus during to ensure targets for numbers in treatment and retention are achieved. This goal is supported by increased investment in Tier 3 services to commission a new Aftercare service, continue weekend service provision, and increase the number of treatment places available. In addition a recent review of inpatient provision should improve our response to the needs of chaotic and homeless clients by providing a more suitable mix of inpatient services. While the local needs assessment has identified our strong points in terms of engagement, there is still more work to be done to successfully engage our BME, homeless and female clients and improve retention overall. Pilot projects specific to each of these groups will be conducted during the year to improve knowledge and/or develop more appropriate and accessible services. A review of the screening and referral tool and care pathways will also serve to improve coordination and onward referral. To support this, the DAAT will be working to ensure the Workforce Development Strategy is implemented across both Tier 1 and specialist treatment providers within the City of Westminster. It is the DAAT s intention to continue to utilise the active resources within Westminster User Group as members of the group have shown a keen interest in being involved in service review and redesign, as well as specific areas of work e.g. female retention. Good work started in on the carers agenda and it is a key priority to ensure this work is continued and built upon in. Finally, the DAAT recognises the importance of improving data quality and our understanding of local need to inform commissioning decisions. As such, information and management systems will be the focus of continuing review and improvement as begun in

3 A2: Summary of outcome of needs assessment in relation to problem drug situation: PDU population and trends of use Using the revised Treatment Demand Model, there are an estimated 2906 PDUs needing structured treatment in Westminster in any one year. A Home Office report entitled Estimates of the prevalence of opiate use and/or crack cocaine use (2004/05) estimated Westminster had a problem drug rate of per 1,000 (aged from yrs), considerably higher than the London rate at A breakdown of these estimates found opiate use in Westminster was nearly twice the London rate (19.40 Westminster; London) while crack use was also significantly higher at as compared with London at The same report also indicated the drug injecting population is again higher at Westminster (5.04 per 1,000 population aged 15 64) as compared with the overall rate for London (3.45). Issues for further consideration: Westminster continues to experience many challenges in providing an appropriate level of services to meet the needs of its large problem drug using population. Geographical spread NDTMS data indicates the Westminster drug using population resides mainly in four areas: W9 (Harrow Road area), SW1 (Victoria), W2 (Paddington) and W1 (Soho). In part, this reflects Westminster s highly transitional population and the highest proportion of rough sleepers in London. The Harrow Road area in the north of the City is part of one of the most deprived wards in the UK. Issues for further consideration: The concentration of distinct north and south drug using populations presents challenges in providing a range of services that is accessible for all service users. Demographics and outcomes Westminster had a slightly lower than regional average proportion of T3 & T4 presentations from black ethnic group clients (13.17% compared with 14.37%) however over 20% of DIP clients were from black ethnic groups. While the percentage of Asian ethnic group clients in structured treatment is greater than the percentage in DIP (5.18% as compared to 4.28%), it is significantly lower than the overall London figure of 8.66%. The percentage of mixed ethnic group clients for both DIP clients and those accessing structured treatment is similar (DIP 4.28%; NDTMS 4.29%) however is less than the regional rate (5.36%) The percentage of females accessing treatment remains similar to previous years (26.86%). There is no significant difference between local and regional gender participation rates. NDTMS identifies that women do access Westminster treatment services but the attrition rate is high after triage. Although 22% of DIP clients are aged under 25 years, this age group represents only 13.58% of those engaged in structured treatment. The percentage of clients less than 35 yrs engaged in treatment (49.35%) is lower than the regional rate of 56.71%. NDTMS identified that there is a considerable lack of onward referral to other treatment services within the treatment system in Westminster. Data suggests a lack of care coordination. Westminster has a higher percentage of people than the rest of London or nationally who attend triage but do not go on to engage in treatment. This is particularly apparent within specialist prescribing services 3

4 Issues for further consideration: There is a need to improve the access and engagement of people from BME groups, particularly within Black and Asian communities. There is a need for improved access and engagement for younger adults, particularly those engaged in the DIP system. Further investigation is required to identify why female attrition rates are high and what the barriers are to treatment. Continued work is required to improve overall engagement and retention in treatment services. Other identified issues: In the care management team faced significant financial difficulties in the year; data suggests this was attributable to an increased homeless DIP population needing to access treatment and residential being deemed the only suitable option to assist them maintain abstinence given the lack of suitable housing available in Westminster. There is an evidenced need that suitable housing is required for substance misusing clients through all stages of the treatment journey in order to maximise treatment effectiveness. Please note: The Needs Assessment and associated data bulls eyes are attached in Appendices 1-6. A3: key treatment priorities: To ensure that CJS clients have access to treatment services on a 1 for 1 basis with the mainstream population. To continue to build on the good work to date around workforce development and to implement the workforce strategy in partnership with key stakeholders. To continue to engage service users and carers in the development and planning of all treatment services and to involve and consult with Westminster User Group regarding any re-modelling or changes to service delivery. To work in partnership with service providers to improve data management and reporting to NDTMS to ensure accurate reports are produced to reflect the actual wait times, numbers in treatment, retention and planned discharges. To continue to develop Westminster s Harm Reduction Strategy with a focus on developing a multi-agency Blood Borne Virus (BBV) strategy and improve BBV data collection across all service providers. To increase engagement and retention rates for all services, particularly by BME, homeless and female clients. To coordinate several developmental strands, namely DIP s external services work with homeless & rough sleepers, DIP BME engagement & attrition study and the working group on women and sex workers. To work in partnership with Supporting People to remodel existing housing accommodation into drug-free accommodation for the rough sleeping and DIP populations. To begin a review process of all community-based services with an emphasis on access, retention and value for money. 4

5 Section B: National targets B1 Numbers of drug users in treatment (Adults and Young People) B1.1 Estimated number of problem drug users (PDU) in area 2906 Source Drug Treatment Demand Model DATA TO BE USED IS ALWAYS DAT OF RESIDENCE B1.2 Total number in treatment 2005/6 Target Target LDP(T43) Target Note CNWL data were not valid to be included in the quarter 2 statistics. B2 Retention rates Adults only DATA TO BE USED IS ALWAYS DAT OF RESIDENCE B2 Percentage retained in treatment for 12 weeks or more (LDP and partnership target) Target /7 July 2005 June Target Note CNWL data were not valid to be included in the quarter 2 retention rates. B3 Waiting times - Adults only B3.1 Waiting time to first treatment intervention See Models of care for definitions of structured treatment interventions % Quarter end - 30 % Inpatient drug treatment Residential rehabilitation Specialist prescribing Primary care/shared care prescribing Day programmes Psychosocial interventions Other structured treatment Note Include updated CNWL data issued by NTA on 5/12/06 5

6 B3 Waiting times - Adults only B3.2 Waiting time to subsequent treatment intervention See Models of care for definitions of structured treatment interventions % Quarter end - 30 % Inpatient drug treatment Residential rehabilitation Specialist prescribing Primary care/shared care prescribing Day programmes Psychosocial interventions Other structured treatment Note Includes updated CNWL data issued by NTA on 8/12/ Section C: expectations C1 discharges discharges who complete treatment drug free, complete treatment or are referred on for other services See Models of care for definitions of structured treatment interventions April - National upper quartile ** Inpatient drug treatment Residential rehabilitation Specialist prescribing Primary care/shared care prescribing * Day programmes Psychosocial interventions Other structured treatment Note Includes CNWL updated data issued by NTA on 5/12/06 * The set target of 82% may be too high as the national upper quartile average is 65% and the range is 49% - 86%. This means that WDAAT s 50% falls in the upper quartile range. ** These revised targets are higher than those set previously and are brought up to at least the bottom end of the national upper quartile range 6

7 C2 Places in treatment See Models of care for definitions of Number of places commissioned structured treatment interventions Actual Proposed Inpatient treatment Residential rehabilitation Specialist prescribing Primary care/shared care prescribing Day programmes Psychosocial interventions Other structured treatment C3 Care planning Proportion of individuals starting treatment who have a care plan 2005/6 % No Target set 100 C4 GP Prescribing Actual C4.1 Percentage of GPs who provide treatment within a locally or JCG defined shared care arrangement. 46% 54% C4.2 Percentage of GPs in the partnership area who are prescribing to drug users outside of shared care, but within a commissioned service model. (Waiting for info from PCT) (Waiting for info from PCT) C4.3 Percentage of GPs in the partnership area who have completed successfully Part 1 of the RCGP Certificate in the Management of Drug Misuse 5% 10% C4.4 Percentage of GPs in the partnership area who have completed successfully Part 2 of the RCGP Certificate in the Management of Drug Misuse Not known* Not known* C4.5 Number of GPs employed either as practitioners with a Special Interest in drug and alcohol treatment or as addiction specialists within a local treatment system. (Waiting for info from PCT) (Waiting for info from PCT) * % not known as CNWL do not fund Part 2 of the RCGP Certificate and RCGP will not release information to external agencies 7

8 C5 Criminal Justice Drug Treatment C5.1 Drug Interventions Programme Compact targets RAG Number Intensive areas : Key indicators as at October 1 95% of adults arrested for a trigger offence to be drug tested 97 2a 95% of adults who test positive and have a required assessment imposed, to attend and remain at the required assessment. 76 2b 85% of adults who test positive and who are not already on the caseload, with whom contact is made via the required assessment, to engage further with the CJIT % of adults who have not tested positive, with whom initial contact (as defined in the DIR guidance) is made and who are not already on the caseload, to be assessed by the CJIT % of adults assessed as needing a further intervention, to be taken onto the caseload % of adults taken onto the caseload to engage in treatment % of CARAT clients who are transferred to a CJIT to have follow up action taken by that CJIT Not available Non Intensive areas : Key indicators 1 60% of adults with whom initial contact (as defined in the DIR guidance) is made and who are not already on the caseload, to be assessed by the CJIT 2 85% of adults assessed as needing a further intervention, to be taken onto the caseload Not available Not available 3 95% of adults taken onto the caseload to engage in treatment Not available 4 80% of CARAT clients who are transferred to a CJIT to have follow up action taken by that CJIT. Not available Note Provisional October figures C5.2 Community sentences with drug rehabilitation requirement C5.2.1 Commencements (actual) C5.2.2 Successful completions (actual) NPD Target NPD Target (111%) Not yet released (129%) Not yet released 8

9 C5.3 Integrated drug treatment in prisons Please complete Section 5.3 for each prison in the partnership area. See guidance for more details about which prisons this applies to. Name of Establishment: Assessment and Care Planning C5.3.1 Number Receiving Comprehensive Assessment C5.3.2 Number of Drug Users with Care Plans Treatment Delivery C5.3.3 Number of stabilisations commenced C5.3.4 Number of detoxifications completed C5.3.5 Number Maintenance Prescribed C5.3.6 Number of 28 day psychosocial interventions successfully completed C5.3.7 Number of drug users discharged into DIP schemes Harm Reduction C5.3.8 Number of drug users who are assessed for harm reduction needs C5.3.9 Percentage of drug users offered HBV vaccination in the prison setting C Percentage of drug users offered HBV vaccinations who take up HBV vaccination, who are not already immunised C Percentage of current or ever injecting drug users in the prison tested for HCV who do not know their HCV status and have injected within the past six months /7 Baseline Not known Not known Not known C5.3.8 C refer to interventions that should already be planned for and funded by PCTs as part of their wider responsibilities for prison healthcare C6 Supported housing Number identified with a primary drug problem by supporting people providers Number identified with a primary drug problem by supporting people providers Proportion identified with a primary drug problem in current contact with treatment services Target proportion to be in current contact with treatment services % 4 Note C6 The 2007_08 data definition is different from _07. Therefore, the number is much lower compared with the data definition used in _07 9

10 C7 Harm reduction initiatives C7.1 Vaccinations against Hepatitis B Virus (HBV) C7.1.1 Percentage of new presentations offered HBV vaccinations C7.1.2 Percentage of new presentations who accept the offer of HBV vaccination who commence the vaccination programme C7.2 Hepatitis C Virus Screening Percentage of current or ever injectors in treatment tested for HCV C7.3 General healthcare assessment Percentage of new presentations completing a general healthcare assessment Not available C7.4 Specialist and pharmacy-based needle exchange programmes C7.4.1 Number in contact with specialist needle exchanges C7.4.2 Number in contact with community pharmacy exchange schemes C7.4.3 Total number of community pharmacies in partnership area C7.4.4 Percentage of community pharmacies providing needle exchange as a locally enhanced service C7.4.5 Percentage of community pharmacies providing basic healthcare advice and referral ,445-22, C7.5 Supervised consumption Percentage of community pharmacies - providing dispensing, supervised consumption and shared care as a LES /7 2007/

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