NHS AND HEALTH SUB-COMMITTEE OF THE COMMUNITY SERVICES OVERVIEW AND SCRUTINY COMMITTEE 19 JUNE 2007 FUNDAMENTAL REVIEW OF DRUGS AND ALCOHOL

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1 NHS AND HEALTH SUB-COMMITTEE OF THE COMMUNITY SERVICES OVERVIEW AND SCRUTINY COMMITTEE 19 JUNE 2007 FUNDAMENTAL REVIEW OF DRUGS AND ALCOHOL Report from: Author: Robin Cooper Director Regeneration and Development Peter Holbrook, CEO Sunlight Development Trust, Gavin Wilders, Safer Communities Manager 1 Purpose of item 1.1 The review was identified in the Performance Plan. The purpose of this report is to update Members on the progress made thus far and to seek support for the recommendations made within. 2 Recommendations 2.1 That the Sub-Committee comments upon Medway s responses to illicit drug and alcohol misuse 2.2 That the Committee appoints a joint task group of Members from both the NHS and Health Sub-Committee and Regeneration and Development Overview and Scrutiny Committee to focus the review and work with the review team in identifying possible options to the issues identified within this report. 2.3 Identify whether at this stage this Fundamental Review should be taken forward by the Regeneration and Development Overview and Scrutiny Committee due to its clear connection with the Community Safety Partnership, which falls under the remit of this Committee. 3 Background The organisation of Drugs and Alcohol services in Medway 3.1 In February 2002, following consultation, The Community Safety Partnership merged with the Drug Action Team and Youth Offending Team Steering Groups in order to rationalise partnerships, help develop a strategic response to problems and to improve and clarify the structure and delivery mechanisms for tackling community safety in its broadest sense.

2 3.2 Through external funding, Medway Council employ a Drug Action Team Manager and Youth Drug Worker on behalf of the Community Safety Partnership to coordinate and commission drug and alcohol services within Medway, these include education and prevention, treatment and appropriate Drug Intervention Programmes (DIP) to the criminal justice system. 3.3 The majority of funding for treatment is provided by the National Treatment Agency (a special NHS authority) that provides Medway with 1.6m per year for drug treatment. Medway Primary Care Trust (PCT) adds 400,000 per year to this to commission treatment services for alcohol misuse, most of the total funding for treatment centres around adults, with 150,000 being dedicated to treating drug and alcohol misuse in children and young people. 3.4 Drug and alcohol treatment is commissioned through a joint commissioning arrangement between Medway Community Safety Partnership and Kent Drug and Alcohol Action Team, with services being provided through the Mental Health Trust, Addaction, Cranstone Drug service, Medway Cyrenians, Kaleidoscope and Drug Treatment Ltd (DTL) in the case for adults and KCA (UK) in the case of children and young people. The Fundamental review Process 3.5 Following the Local Government Act 1999 and subsequent guidance, the best value framework was amended through the white paper Strong Local Leadership Quality Public Services. The changes to the Best Value framework were informed by the review of legislation and guidance, which was reported by government in The key legislative changes revoked the need to review all services over a five year cycle and made provision for councils to carry out strategic reviews to support their work in delivering integrated services that meet the needs of the customer. 3.7 The amendments to legislation also meant that authorities were no longer required to make 2% efficiency gains through reviews. The main purpose of reviews were to improve the outcomes of delivering services to the people of Medway. 3.8 The fundamental review process falls into four phases: Scope - This is agreed by Cabinet and sets the broad framework for the review. Research This is directed by the relevant Overview and Scrutiny Committee and should examine existing information from a range of sources to identify potential areas for improvement. Options appraisal This again is directed by the relevant Overview and Scrutiny Committee and identifies the potential ways of meeting the agreed aims of the review.

3 Final report The Overview and Scrutiny Committee concludes the review and presents its recommendations to Cabinet. 4 Progress of the review to-date 4.1 Cabinet agreed the scope of the review in December The review would evaluate the current commissioning framework and identify whether this provides the best outcomes for the service users and other communities in Medway. In addition the review would map the current provision of drug and alcohol services in Medway and identify good practice, areas that require improvement and identify any current gaps in delivery. 4.2 The NHS and Health Sub-Committee considered the scope in January 2007 and asked for the review to report back with initial findings after the elections and that at this time a task group of members would be appointed to take forward the development of options. Financial Mapping 4.3 A comparison of the current funding arrangements between Adults and children/young people services are at appendices A and B. This comparison shows the source of funding, how the funding is broken down into the 4 tiers of service from low level universal interventions to high level inpatient services and to which commissioned agencies the funding is allocated. 4.4 Adult service budget allocations from the National Treatment Agency (NTA) which provides the Council with its annual budget may only be spent on drug treatment services and not used for the treatment or prevention of alcohol related issues. 4.5 Services provided for adult alcohol treatment and prevention of abuse are funded by Medway PCT. 4.6 Children s Service budget allocation from the National Treatment Agency can be applied to the treatment and prevention of drug or alcohol use. Collation and initial analysis of existing research 4.7 The review panel has collected data from a range of sources including Kent Police, Medway Council, Medway PCT, Medway Maritime NHS Trust, National Treatment Agency, Medway DAT, Kent DAT, Department of Health, Home Office and research commissioned and conducted by voluntary organisations. This data has been collated, analysed and interpreted externally by Information by Design. 4.8 Initial analysis suggests there is a correlation between drugs and alcohol related hospital admissions, crime and rates of multiple deprivation particularly in wards such as River, Gillingham North, Chatham Central, Gillingham South and Luton and Wayfield.

4 4.9 Between 2001 and 2004 the number of drug offences rose by 64.7% from 371 to 611 offences, accounting for 2.5% of all crime in the region in This rise is mainly attributable to targeted enforcement to stifle the availability of drugs Initial interpretation of data suggests that alcohol misuse has a greater impact on health, crime and community well-being than illicit drug use Despite this, data at this stage suggests that more services and health resources are available for people suffering with drug related problems than alcohol related problems. Senior stakeholder interviews 4.12 David Hatcher, a retired chief superintendent and independent consultant has been conducting a series of one to one interviews with senior stakeholders and commissioners of services to identify perceptions and priorities across agencies and sectors including Police, public health, licensing, treatment and youth services. There is interest from some stakeholders in understanding the costs and benefits of Medway specific commissioning versus the current arrangements of commissioning through the Kent and Medway DAT. Performance management and information reporting protocols need to be established in order that stakeholders can easily assess the effectiveness of services. Current contracting arrangements (contracts are based on an annual tendering arrangements) lead to inconsistent and at times confusing service provision for users. Community Consultation 4.13 The panel has identified the need to engage with those directly involved in drug and alcohol abuse and has devised opportunities for service users and those not accessing services to feed into the review process by way of a free text messaging service, , focus groups, and surveys. The same opportunities exist for the wider community who may be or have been affected by other people s misuse of alcohol and drugs A news article highlighting the work of the review and explaining to the community the opportunities to inform the panel, will appear within the next 2-3 weeks. Community consultation is being undertaken to ensure that the review is as comprehensive and accessible as is feasible and assists the panel in verifying its conclusions and recommendations The review team are aware of the Alcohol Strategy undertaken by Medway PCT and will review this once published and ensure that the recommendations made within the alcohol strategy are recognised and reflected within this fundamental review.

5 5 Emerging findings 5.1 The Community Safety Partnership is undertaking work to restructure itself to better deliver the Community Safety Plan including the Drug Action Plan. There is a need for the new structure to provide focused direction and close performance monitoring of the work of the Medway Drug Action Team in coordinating the treatment services available within Medway. This will be achieved by the Drug and Alcohol Action Team (DAAT), having its own specialist sub group sitting within the partnership structure. The sub group, along with others, will be serviced by the newly appointed partnership officer to ensure that the targets within the Community Safety Plan and the Local Area Agreement are monitored. Any exceptions to those targets will be reported back through the Operational Management Team, of which the DAAT manager is a member. This reporting will be on a quarterly basis and will ultimately be shared with the partnership s Strategic Executive Group. 5.2 Medway needs to develop a clear and strong client role in its commissioning arrangements. The effectiveness of the current imbalance between prevention and treatment services, the funding overwhelmingly in favour of adults over children and drugs over alcohol treatment needs to be understood and redressed where possible to provide the most effective mix of services that meets Medway s needs. 5.3 Current contracting arrangements (contracts are based on an annual tendering arrangements) lead to inconsistent and at times confusing service provision for users. 5.4 Performance management and information reporting protocols need to be established in order that stakeholders can easily assess the effectiveness of services. 6 Members task group 6.1 Community safety and heath problems caused by drug and alcohol misuse in Medway, as elsewhere, are complex and need to be tackled at a national, regional and local level. The NHS and Health Sub-committee in January identified a role for a Member s task group to help focus the review during the next phase, where options to tackle some of these problems are identified before recommendations are made to Cabinet. As a large part of this Review is connected with Community Safety and the Community Safety Partnership, which merged with the Drug Action Team and Youth Offending Team Steering Groups, it would seem appropriate that a Member s task group is made up of Members from the NHS and Health Sub-Committee and the Regeneration and Development Overview and Scrutiny Committee. This would ensure that Community Safety aspects and health aspects are accounted for in the work of the task group. 6.2 It is proposed that a series of workshops are held with the task group and review team to gain a better understanding of what is coming out of the research and identify areas where Medway Council and its partners can make effective improvements to the organisation and delivery of drug and alcohol services.

6 6.3 Due to a large element of the scope of the review involving work carried out by the Community Safety Partnership it would be more appropriate for the Review to report back to the Regeneration and Development Overview and Scrutiny Committee, as Community Safety falls within the remit of that Committee. 7 Timetable Activity Date Scope Present Scope to Cabinet. 12 December 2006 Present Scope to NHS and Health Sub Committee. 24 January 2007 Research and initial findings Present research to NHS and Health Sub Committee. June 2007 Options and initial recommendations Present options report to Overview and Scrutiny September 2007 Committee Final report Present final report to Overview and Scrutiny September 2007 Committee. Present final report to Cabinet. October Financial implications 8.1 Currently there are no financial implications arising from this report. 9 Legal implications 9.1 Currently there are no legal implications arising from this report.. 10 Background papers Fundamental review of Drugs and Alcohol Services, NHS and Health Sub- Committee, 12/12/2007. Analysis of Local Drug and Alcohol Data, Information by Design, May Contact for further details: Peter Holbrook, CEO Sunlight Development Trust, peter@sunlighttrust.org.uk Gavin Wilders Safer Communities Manager, , gavin.wilders@medway.gov.uk

7 Appendix A Breakdown of funding for Adults services in Medway Source:

8 Appendix B Breakdown of funding for Children and Young people services in Medway Source: