Gateshead PCT. Adult Drug and Alcohol Treatment Needs Assessment 2011/2012

Transcription

1 Gateshead PCT Adult Drug and Alcohol Treatment Needs Assessment 2011/2012

2 Contents Executive Summary Page 2-3 Introduction Page 4 5 Current Service Provision Page 6 8 Gateshead Demographics Page 9 12 Demographics of Referrals into Structured Treatment Page Prevalence and Unmet Needs Page The Treatment System Page Harm Reduction Page Drug Related Deaths Page Reducing Supply Page 48 Crimes under the Influence Page Service User Involvement Page 53 Housing Page Education, Training, and Employment Page Alcohol Page Appendices Page 74 1

3 Executive Summary Problem drug use affects local communities, families and children as well as individual people with drug problems. Problem Drug use in Gateshead Home Office research estimates that Gateshead is home to between 1350 and 1575 users of opiates and/ or crack cocaine. The estimated unmet need (people requiring treatment but not in contact with services) is between 140 and 360 people. Prevalence of opiate and / or crack use is higher than the North East average and also higher than the national average. Who is getting in to treatment? 1375 Adult drug users were in treatment services, of which 1175 were in effective treatment for 12 weeks or more in 2010/11 equating to 6.1 per 1000 population. The number of adult drug users in effective treatment grew by 0.4%. In terms of geographical distribution, the main cluster of drug users in treatment are in Dunston and Teams, Felling, Deckham, High Fell, Bridges, and Saltwell. Dunston and Teams has seen the greatest growth of numbers coming into treatment during 2010/11. Self referral is the common referral route both locally and nationally indicating that there is good information and publicity available around treatment services. There were 318 referrals into treatment in 2010/11, of which 35% had never been in treatment before. The number of referrals decreased by 23% compared to 2009/10. Opiates remain the predominant substance of clients coming into treatment but comparisons for treatment naïve clients shows a narrowing gap between opiates and cannabis Looking across all adult drug users in treatment, heroin is by far the most common primary problem substance and substitute prescribing is the most common type of treatment. Almost two thirds of people in treatment are receiving treatment for more than one problem drug substance with alcohol, benzodiazepines, and cannabis being common substances also. Who is leaving treatment? 263 people left treatment in 2010/11 (20% of those in treatment). 41% completed treatment successfully, which is higher than the regional average but below the national averages. The rate, at which people are 2

4 Increasing the number of people who leave treatment successfully will be a key area of focus for the coming year and this means looking holistically at a range of factors that contribute to a person being prepared to leave treatment and continue with a drug-free life. Increasing recovery from drug dependence Suitable housing and employment are important to achieving and sustaining recovery and reintegration into the community. There is a need for a qualitative assessment of service users education, skills and employment related needs and a map of provision of projects across Gateshead that service users could access. Service users identified a range of factors that would help to promote recovery including more flexible community services and better links with mental health. Drugs, Alcohol and Crime Drug use, particularly of the class A drugs heroin and crack cocaine, is strongly associated with crime and offending. We know that offenders with drug problems are more likely to commit acquisitive crime, such as burglary, thefts and vehicle crime, to provide funds for their addiction and to be convicted of drug specific crime, such as possession and supply. We have established routes into treatment from the various points of contact with the criminal justice system. Integrated Offender Management programme is now embedded in the Safer Neighbourhoods process and should present opportunities to attract and engage offenders before their substance problem and their offending escalates. 21% of Drug Intervention Programme tests were positive, the vast majority which related to opiates. The presence of alcohol in recorded violence has increased is now present in 51% of all recorded violence. Alcohol was identified as a contributory factor in almost 8% of all recorded crime and drugs was an influencing factor in 5% of recorded crime. Drug Related Deaths There were 21 suspected related deaths between Oct-10 and Sept-11. The drugs used are often a mixture of illicit and prescribed drugs with a trend mixing alcohol and benzodiazepines continuing along with the suspected use of diverting methadone. Since 2008, The Bridges 20, Deckham 14, Felling 9, and Low Fell 6 have had the highest number of deaths giving a clear indication of further promotion of harm reduction messages in these areas. 3

5 Introduction The Safer Gateshead Partnership is responsible for the co-ordination and delivery of the Drug Strategy The three key themes of the strategy are: Reducing demand creating an environment where the vast majority it people who have never taken drugs continue to resist any pressures to do so, and making it easier for those that do to stop Restricting supply reducing drug supply through a co-ordinated response across Government and law enforcement Building recovery in Communities working with people who want to take the necessary steps to tackle their dependency on drugs by getting them into treatment and into full recovery and off drugs for good Commissioned services should meet the needs of problematic drug users, their families and carers as well as the wider community. The National Treatment Agency (NTA) has tasked local drug partnerships with producing an annual needs assessment for adult drug misuse to ensure that the priorities included in the adult treatment plan reflect and respond to local need. The partnership will continue to refine the local needs assessment as an ongoing process and study emerging trends and unmet need. A Needs Assessment is a robust systematic process to enable the production of an evidence-based adult drug treatment plan. The needs assessment should be seen as a strategic process which is owned and understood by all stakeholders within the local partnership. The process should also be an integral part of treatment planning, implementation and performance management. In previous years, Gateshead has produced separate needs assessments for Adult Drug treatment and Alcohol. However, with an integrated drug and alcohol treatment service in Gateshead, and the recognition in the drug strategy that many of the challenges and opportunities are common to both drugs and alcohol, it was decided to produce a combined assessment across both elements of delivery. The Substance misuse/alcohol needs assessment is based on analysis of people currently receiving treatment within the treatment services and is not a population based assessment. That information is shown in the 2011/12 Joint Strategic Needs Assessment section 17 and will also be available following analysis of the 2012 Health and Lifestyle survey which is being carried out during February and March

6 The purpose of the needs assessment is to facilitate an understanding of the needs of the local community, the resources available and the ability of the current treatment system to meet those needs. The NTA criteria for an effective needs assessment process include the identification of: What works among those in treatment and what the unmet needs are Where the system is failing to engage and retain people Hidden populations and their risk profiles Enablers and blocks to treatment pathways Relationship between treatment engagement and harm profiles This needs assessment will be used to develop commissioning priorities for the 2012/13 Substance Misuse/Alcohol Adult Drug Treatment Plan. The priority for alcohol in 2012/13 is to maintain links between the population who are in working communities with people who drink unsafely and work, focused on other people in treatment. This needs assessment for drug treatment is informed by the Joint Strategic Needs Assessment for Gateshead which identifies current and future health and wellbeing needs in light of existing services, and informs future service planning taking into account evidence of effectiveness. The Safer Gateshead Strategic Assessment which provides an overview of the key crime, disorder and anti-social behaviour issues also informs the needs assessment process. In parallel to this process a separate needs assessment is also conducted which focuses on identifying the needs of young people requiring specialist substance misuse treatment. 5

7 1. Current Service Provision The Adult Joint Commissioning Group, whose membership consists of health, police, probation, local authority, housing and Jobcentre Plus, is responsible for the commissioning and effective delivery of drug and alcohol treatment services that reflect best practice in terms of quality and effectiveness whilst reflecting the needs of the local population. Community Integration Team Gateshead s Community Integration Team, provided by Turning Point, is an integrated team made up of staff from several specialist agencies. The team assists service users to access housing support, relevant training (in preparation for the employment market) and help find employment at the appropriate time. It also supports and signposts service users into community services and activities. Criminal Justice Intervention Team The Drug Intervention Programmes key aim is to get adult drug-misusing offenders who misuse specified Class A drugs (heroin and cocaine/crack cocaine) out of crime and into treatment and other support. NHS South of Tyne and Wear Substance Misuse Services are the lead organisation for the Criminal Justice Intervention team which provide the Drug Intervention Programme. This team also includes staff from North East Council on Addictions and Turning Point. They provide advice, information, assessment and support at arrest and for people leaving prison. Referral to this team is through contact with the criminal justice system. NHS South Tyneside Foundation Trust Substance Misuse Services This is an integrated drug and alcohol treatment service provided by NHS South Tyneside Foundation Trust. It provides specialist treatment and care to people who experience problems with alcohol and/or drugs, by working closely with other health, public and voluntary services. Huntercombe Centre The Huntercombe Centre is a 34 bedded specialised alcohol and drug treatment service. The detoxifcation unit currently provides 14 dedicated beds to assist with stabilisation and/or detoxification for problem drinkers or drug users. North East Council on Addictions (NECA) NECA provide a variety of interventions including (but not limited to) assessment, brief interventions, psychosocial interventions, group work, women s outreach service, community development services. 6

8 The Cyrenians Oaktrees offers abstinence-based, structured day treatment. They offer a 12 week programme which is full time, although those accessing the services will continue to live in their own home. This gives clients the opportunity to bring their home experiences back to the next day s treatment. They also provide a recovery centre at Cyrenians. Phoenix Futures Phoenix Futures operates a residential rehabilitation facility for up to 37 adults with alcohol and/or drug issues. The service provides a safe supportive and structured environment where residents participate in groups and one-to-one sessions to explore the underlying reasons for their dependency. Gateshead Hospital Alcohol Services Key workers from Turning point and STFT Substance Misuse Services provide advice and on ward referral to structured treatment from the Queen Elizabeth Hospital Gateshead A&E department and admissions to the wards for clients with alcohol addiction. 7

9 TIER 1 Interventions from general healthcare and other services that are not specialist drug and alcohol services. Tier 1 services offer facilities such as information and advice, screening for alcohol addiction, drug misuse and referral to specialist drug and alcohol services: GP s Ambulance Service Pharmacies Hospital A & E Departments Social Care Agencies TIER 2 Open access drug and alcohol treatment services (such as drop in services) offering facilities such as triage assessment, advice and information and harm reduction by specialist drug and alcohol treatment services: STFT Substance Misuse Service (Harm Reduction Team) NECA Turning Point (Community Integration Team) STFT Substance Misuse Service, Turning Point and NECA (Drug Intervention Programme) Turning Point, STFT Substance Misuse Service (Gateshead Hospital Alcohol Service) TIER 3 Drug and Alcohol treatment delivered in the community by specialist drug and alcohol services offering prescribing, structured day programmes and structured psychosocial interventions: NHS STFT Substance Misuse Service (Community Drug and Alcohol Team) Specialist GP Prescribing NECA Oaktrees (Tyneside- Cyrenians) TIER 4 Inpatient treatment and residential rehabilitation Huntercombe - inpatient detoxification Residential rehabilitation (spot purchase): Phoenix Futures 8

10 2. Gateshead Demographics Gateshead has a population of 190,800 according to ONS mid year population estimates It is the second smallest area within Tyne and Wear with South Tyneside the lowest with 152,400 and Newcastle upon Tyne the highest with 284,300. It has more females (97,500) than males (93,300). Figure 2.1 Population by age band 2009 Source: Gateshead JSNA Fig 2.2 Male Population by age band 2009 Source: Gateshead JSNA 9

11 Fig 2.3 Female Population by age band 2009 Source: Gateshead JSNA Gateshead has a relative high proportion of the population within the following age range Most of the females fall into the age group and Likewise most of the males fall into the age groups and Social and Environmental context There is a strong relationship between social and economic disadvantage and health outcomes. Communities with low incomes or live in poor housing for example, will typically experience poorer health. The Department for Communities and Local Government has created the 2010 Index of Multiple Deprivation (IMD) to quantify disadvantage across a range of factors. The IMD measures deprivation within 7 domains. Income Employment Health and disability Education, skills, and training Barriers to housing and services Living environment Crime 10

12 Gateshead is ranked 43 rd out of 326 local authorities in terms of overall deprivation (where 1 is the most deprived). Nine of Gateshead s wards contain Lower Super Output Areas within the most 10% deprived in England. The indices are calculated for each of the 32,482 Lower tier Super Output Areas in England. A Lower Tier Super Output Area (LSOA) is a geographical area which was first used within the 2001 Census. The exact size of each LSOAs varies, but an LSOA covers, on average, a population of 1,500. There are 126 LSOAs in Gateshead. A good measure of average deprivation is the proportion of the population of Gateshead that live within areas that are amongst the 10% or 20% most disadvantaged across England. Fig 2.4 Gateshead Index of Multiple Deprivation Map 2010 Source: Gateshead JSNA The relationships between deprivation and illegal drug use have been highlighted in a number of research studies. The Advisory Council for the Misuse of Drugs report Drug Misuse and the Environment (1998) stressed the following points: Deprivation is associated with the problematic use of particular drugs such as heroin and crack cocaine. Deprivation is linked most strongly with the extremes of problematic use and least with casual, recreational or intermittent use of drugs. 11

13 Deprivation often means a user is less likely to get care and treatment. The chances of overcoming drug problems are less among people who are disadvantaged. They have fewer positive alternatives and less access to meaningful employment, housing etc. Deprived areas often suffer from greater and more visible public nuisance from drug taking and supplying Poor areas with high unemployment levels can provide an environment where drug dealing becomes an established way of earning money. Deprived areas might, at community level, find it more difficult to deal with drug problems. People living in overcrowded and sub-standard accommodation are more likely to share injecting equipment and more likely to get hepatitis, HIV and Tuberculosis. There is a clear link between problematic drug use and deprivation. However this does not mean all problematic drug users come from deprived areas or backgrounds, but it does indicate that a disproportionate number do. 12

14 3. Demographics of referrals into structured treatment during 2010/11 Fig 3.1 Referrals by Age Band Source: NDTMS The majority of clients who were referred to the treatment services during 2010/11 are aged years old. Comparisons to the previous year show that referrals are increasing from the years old age group and decreasing from the and years old age groups. There are a larger proportion of treatment naïve clients, those for one reason or another who have not accessed services coming in for both the years and years age bands than clients who have previously been in treatment. Fig 3.2 Referrals by Age bands and referral source Source:NDTMS A high percentage of clients coming into treatment for the first time are coming through non criminal justice system routes with a high number of self referrals. The gap between clients previously in treatment referred through criminal justice and non criminal justice routes is a lot smaller especially in the lower age band groups. 13

15 Fig 3.3 Referral by Gender type Source:NDTMS Gender split remains in line with the region around the ¾ male to ¼ female proportions as last year Fig 3.4 Referral Sources by Gender type Source:NDTMS Males previously in treatment predominately referred from Carats but treatment naïve clients are predominately self referrals Treatment naïve Females are predominately self referrals and those previously in treatment are mainly referred from other drug services. 14

16 Fig 3.5 Presenting Substance Source:NDTMS Heroin 54% Cannabis 21% Cocaine 12% Fig 3.6 Presenting substance by client type Source:NDTMS Opiates remain the predominant substance but comparisons for treatment naïve clients shows a narrowing gap between opiates and cannabis 15

17 Nationally, the number of drug seizures has decreased by approximately 5% in 2010/11 compared to 2009/10. The biggest decreases were noted in the seizure of class A drugs, which fell by 15% in 2010/11; while class C seizures increased by 16%. In Gateshead, there has been a fall in the numbers of individuals claiming to use opiates; while an increase in alcohol and cannabis use by individuals has increased, as reported in the North East Public Health Observatory Trends in Drug Use in the North East report, published in November It is not known if this change is due to the changing preferences of individuals or if this is as a result of a crack down and reduction in the supply of opiates. The increase in cannabis use and the decrease in heroin use is also reflected in the European Monitoring Centre for Drugs and Drug Addiction s Annual Report 2011, which also reports a sharp drop in the availability of heroin in the UK in 2010/11. This is supported by figures showing a considerable drop in the purity of heroin seized in the UK between 2009/10. Whilst there has been a decline in the use of heroin as first choice drug, it should also be noted that the purity and quantity of heroin coming into the North East has declined which could also play an important part in the changing drug use trend within Gateshead. Drug seizures of heroin and purity needs to be monitored in case heroin availability and purity increase and therefore sees an upward trend in the use of heroin in the area. 16

18 Fig 3.7 Main Drug use for treatment naïve clients

19 Fig 3.8 Injecting behavior Source:NDTMS The majority of treatment naïve clients referred during 2010/11 have stated they have never injected which could be related to the lower number of heroin users coming into treatment. Fig 3.9 Parental Status Source:NDTMS A high percentage of clients entering treatment are not parents but higher proportion of treatment naïve clients are parents 18

20 Fig 3.10 Housing status Source:NDTMS There are clients with urgent housing and housing problems who have been in treatment previously. Treatment naïve clients have a reducing need for housing assistance. Fig 3.11 Referrals by Area Source:NDTMS extracts 19

21 As indicated in previous needs assessments there are still high numbers of clients living in Dunston and Teams, Saltwell, Bridges, Deckham, High Fell, Windy Nook and Whitehills, and Felling. Significant areas of deprivation exist in Gateshead and these areas are ranked within the most deprived areas in Gateshead highlighting the link between deprivation, socioeconomic aspects and substance misuse. North East Ambulance call outs During the period 01/01/2011 to 30/06/2011 there were 140 call outs for drug related overdoses. This information is recorded using postcode sector making it difficult to pinpoint hotspots but the common sector was NE10 8 which includes: Bridges, Pelaw and Hedworth, Wardley and Leam Lane, Windy Nook and Whitehills. Fig 3.12 Ambulance call outs for Drug Overdoses NEAS Callouts for Drug overdoes to call outs of No NE10 8 NE10 9 Source:NEAS NE8 1 NE9 6 NE10 0 NE11 9 NE8 2 NE8 4 NE8 3 NE11 0 NE9 7 Postcode sector NE9 5 DH3 1 NE16 3 NE17 7 NE21 4 NE21 5 NE21 6 NE16 5 NE39 2 NE40 4 DH3 2 NE16 4 Fig 3.13 Ambulance call-outs for Drug and Alcohol Overdose 2010/11 North East Ambulance Services callouts for Drug and Alcohol overdoses 2010/ Number APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Month Source:NEAS "ALCOHOL INVOLVED" "DRUGS INVOLVED" 20

22 Fig 3.14 Ambulance callouts 2010/11 by Drug Type Source:NEAS Analysis of the referral patterns over the last five years highlight that referrals to treatment services peaked in 2007 and there has been a gradual reduction year on year with the lowest number of referrals during One of the possible reasons for this is a large number of clients have been in treatment for over 2 years and therefore will not influence referral patterns if they did represent to treatment services. Prevalence estimates suggest there are still potential clients in the community who are not known to treatment services and work needs to continue to engage treatment services with this group. The common referral route is self referrals which have remained fairly high over the last 5 years with numbers starting to fall during the last 2 years. Arrest referral/dip was the main referral source in 2007 but year on year reductions especially during 2011 has seen it fall to provide only a small number of referrals. Further work is required to understand the reasons for this. There has also been a reduction in the number of clients referred from CARAT/Prison. The Gateshead Treatment Map for 2010/11 (see appendix 1) shows there were 318 referrals to structured treatment, a fall of 97 against the previous year. There are been a large reduction from arrest referral/dip and CARAT which mirrors the reduction seen across the service in Gateshead. The number of clients retained in treatment between 2 and 4 years and over 4 years has increased during 2010/11. The number of clients discharged from structured treatment has remain at the same level but there has been more planned exits. Further work will help us to understand when and why patients are being referred on. 21

23 Key Points Number of referrals to treatment has reduced Males predominant client group Self referrals are the common referral source with less referrals coming from criminal justice sources. Main presenting substance is Heroin with a shift towards Cannabis for new clients entering treatment There are fewer clients with injecting behavior entering treatment The majority of treatment naïve clients coming from the Bridges, Felling and High Fell. A high percentage of clients entering treatment are not parents Treatment naïve clients have a reducing need for housing assistance. Recommendations/actions The number of clients coming from criminal justice sources to be investigated further to understand why the numbers coming from this source are falling. Monitor the main substance of use for new clients entering treatment to identify if the trend towards cannabis use continues to outpace heroin use. 22

24 4. Prevalence and unmet need The prevalence of Opiate and Crack users has been published on the NDTMS website for 2009/10, produced by Glasgow University on behalf of the Home Office. The figures have been produced for the third year covering 2006/07, 2008/09 and 2009/10 and comparisons between all three years help to show where there are any variations between the estimates and also act as a guide to gauge how accurate these figures might be. Fig 4.1 Prevalence estimates 2006/07 to 2009/10 The figures show small increase for opiate/crack users and opiate users compared to 2008/09 estimates unlike the increases seen when compared to the 2006/07 figures. The number of crack users has fallen significantly compared to the previous estimate for 2008/09 and are more in line with the 2006/07. The figures show Gateshead has a higher prevalence of Opiate/Crack and Opiate users than the rest of the North East and England but a lower prevalence of crack users than the North East figure and England. 23

25 Fig 4.2 Prevalence estimates comparisons 2009/10 Source:NDTMS NDTMS data has been used to apply the NTA s Bulls Eye Technique to examine numbers in treatment in the context of the Glasgow estimate of the prevalence of opiate and/or crack cocaine use for 2009/10. This disaggregates the population accessing treatment into mutually exclusive groups. - Those in treatment at the end of the 2010/11 - Those in treatment during 2010/11 - Those known historically to treatment, but not during 2010/11 A comparison can then be made with the Glasgow estimate to give a sense of the size of the population not accessing treatment. This shows the estimate for the treatment naïve clients, those who for one reason or another have not accessed services. The Glasgow estimate 2009/10 puts the number of Opiate and/or crack users at 1441 with a 95% confidence interval of 1356 to The estimated number of treatment naïve clients is therefore 227 but 41 of these clients were in contact with DIP during 2010/11 but not with the treatment system. 24

26 Fig 4.3 The Treatment Bullseye for Opiate/ or crack users in Treatment 2010/11 The treatment bulls eye for Opiate /or crack users in Treatment 2010/ Not known to treatment Source:NDTMS Known to treatment but not treated in last year Known to DIP not known to treatment In-treatment during last financial year In treatment now The Glasgow estimate 2009/10 puts the number of crack users at 413 with a 95% confidence interval of 281 to 671. The estimated number of treatment naïve crack users is of these clients were in contact with DIP during 2010/11 but not in contact with the treatment system. Fig 4.4 The Treatment Bullseye for crack users in Treatment 2010/11 The treatment bulls eye for crack users in Treatment 2010/ Not known to treatment Source:NDTMS Known to treatment but not treated in last year Known to DIP not known to treatment In-treatment during last financial year In treatment now 25

27 The Glasgow estimate 2009/10 puts the number of opiate users at 1362 with a 95% confidence interval of 1293 to The estimated number of treatment naive crack users is 167 who are not known to the treatment system. 39 clients were in contact with DIP during 2010/11 but not the treatment system. Fig 4.5 The Treatment Bullseye for Opiate users in Treatment 2010/11 The treatment bulls eye for Opiate users in Treatment 2010/ Not known to treatment Known to treatment but not treated in last year Known to DIP not known to treatment In-treatment during last financial year In treatment now 26

28 The Treatment Bullseye for Opiate/ or crack users in Treatment 2010/11 by age bands Source:NDTMS Further analysis highlights that the highest number of treatment naïve clients are from the age band and 22 of these are known to DIP. Small Increase of the estimated number of opiate users in Gateshead Large reduction of estimated crack users in Gateshead Prevalence of Opiate users in Gateshead higher than the North East Average There are an estimated 227 Opiate/Crack Users not known to treatment services 41 of these are known to the Drug Intervention Program There are an estimated 99 opiate/crack users who are aged year olds not known to treatment services Recommendations/Actions Continue to find methods to encourage treatment naïve clients to engage with treatment services and work with treatment providers to promote the services provided. 27

29 5. The Treatment System Fig 5.1 Percentage of population in effective treatment 2010/11 *Total Population Total Service Users in Area **effective treatment 2010/2011 Population percentage of service users per 100,000 South Tyneside Gateshead Sunderland Source: Local NDTMS data analysis *1000 ** More than 12 weeks or left in a planned way if less than 12 weeks. Gateshead has the highest percentage of clients in effective treatment with 613 per 100,000 population compared to 470 per 100,000 in South Tyneside and 462 per 100,000 in Sunderland Fig 5.2 Proportion of population in effective treatment 2008/09 to 2010/11 Source: Local NDTMS data analysis 28

30 Fig 5.3 Numbers in Treatment Source: Local NDTMS data analysis The numbers in treatment during 2010/11 have reduced by a small amount compared to 2009/10 but the numbers who have been in treatment between 2 and 4 years and over 4 years have increased highlighting a stagnated treatment system. Analysis shows that the majority of clients who have been in treatment over 2 years and beyond are part of the specialised or GP prescribing and other structured intervention treatment programmes. The number of clients coming into treatment is slowing down which is also reflected in national figures. The focus has now moved to successful completions for clients entering treatment away from retaining clients in treatment. The table above shows a decrease from 2010/11 compared to 2009/10 but the clients who remain in effective treatment for a period of 12 weeks or more has increased by a small percentage. There are a smaller number of treatment naïve clients entering treatment but the numbers who are in treatment are remaining in treatment for a longer length of time with large increases in clients who are retained for 2-4 years and over 4 years. 29

31 Fig 5.4 Numbers in Treatment over 2-4 years and over 4 years Source: NDTMS There were 318 new treatment journeys during 2010/11 with 67% coming from Non Criminal Justice System sources and 33% Criminal Justice system. There has been a reduction of 97 new treatment journeys compared to 2009/10 and this has resulted in a significant change to the numbers coming from criminal justice sources with a reduction of 14% reducing from 47% in 2009/10 to 33% in 2010/11. (see appendix 1) There were 1375 clients in treatment during 2010/11 which was a small reduction compared to 2009/10 with There were 263 exits form the treatment system of which 41% were planned and 36% were referred onto other treatments. 18% of clients dropped out, 5% left in an unplanned way and 1% was transferred to prison. Fig 5.5 Referral Sources to Structured treatment 2009/11 and 2010/11 Source: Local NDTMS data analysis 30

32 The number of referrals has slowed down across the treatment system both nationally and at a local level but the rate has slowed downed significantly in Gateshead during 2010/11. Fig 5.6 Number of Referrals 2009/10 and 2010/11 Area 2009/ /11 change % change Local % Regional % National % Source: Local NDTMS data analysis Fig 5.7 Primary Drug Usage 2010/11 Source: Local NDTMS data analysis The primary drug of use for clients from Gateshead continues to be Heroin which has maintained a high proportion among clients in treatment over the last 3 years. The number of clients presenting to treatment services highlighting Cannabis as the primary problematic substance has increased. Cocaine usage among clients in treatment has continued to decrease but there is an. Cannabis and other opiates usage has increased during 2010/11 31

33 Fig 5.8 Primary Drug Use comparisons 2010/11 Source: Local NDTMS data analysis Comparison to other areas in the South of Tyne and Wear area highlight that Gateshead has a far higher usage of Heroin compared to its neighbours with percentages that are comparable to both the regional and national averages. The chart shows a high usage of methadone for Gateshead but it has been found that methadone has been recorded when this is the substance prescribed as part of the treatment for heroin users. Any changes made to data when this has happened will not be reflected until the next needs assessment data is produced but there have been a number of alterations made to correct the data. Fig 5.9 Primary Drug use changes in pattern 2008/09 to 2010/11 Source: Local NDTMS data analysis The largest change across the 3 different period s show the use of other opiates has increased by the largest percentage, as has heroin and cannabis. There has been a significant reduction where cocaine is recorded as the main drug. 32

34 Fig 5.10 Secondary drug use 2010/11 Source: Local NDTMS data analysis Secondary drug use in Gateshead is primarily around Benzodiazepines usage and alcohol. The number of clients using no second drug has fallen but a greater emphasis around data completion could impact on this area and continuous monitoring which help understand the reasons for the change. Fig 5.11 Secondary Drug Use comparisons 2010/11 Source: Local NDTMS data analysis 33

35 Comparisons to local areas and regional and national averages show Gateshead has a greater usage of Benzodiazepines than these areas and alcohol usage is higher than the regional and national averages. Fig 5.12 Secondary Drug use changes in pattern 2008/09 to 2010/11 Source: Local NDTMS data analysis Alcohol use as the secondary drug had fallen during 2009/10 but has now returned to higher levels than shown for2008/09. Fig 5.13 Tertiary drug use 2010/11 Source: Local NDTMS data analysis Alcohol has increased significantly as a tertiary drug in Gateshead as well as Benzodiazepines and cannabis. 34

36 Fig 5.14 Tertiary Drug Use comparisons 2010/11 Source: Local NDTMS data analysis Fig 5.15 Tertiary Drug use changes in pattern 2008/09 to 2010/11 Source: Local NDTMS data analysis The overall conclusions of drug use in Gateshead highlight it has a significant usage of Heroin compared to its local neighbours. Other problem substances are Cannabis, Benzodiazepines and an increasing use of Alcohol. 35

37 Fig 5.16 Clients by Area 2010/11 Source: Local NDTMS data analysis As indicated in previous needs assessments there are still high numbers of clients living in Dunston and Teams, Felling, Deckham, High Fell, and the Bridges. Significant areas of deprivation exist in Gateshead and these areas are ranked within the most deprived areas in Gateshead highlighting the link between deprivation, socioeconomic aspects and substance misuse. Fig 5.17 Age bands comparisons 2009/10 and 2010/11 36

38 Source: Local NDTMS data analysis The age band with the highest number of clients in treatment per 1000 population are the age band with significant numbers also in the and age bands. The largest increase has been in the age bands when comparing 2009/10 to 2010/11. Fig 5.18 Retention Rates 2010/11 Source:NDTMS The treatment system is very good at retaining new referrals for the first 12 weeks but there are a number of clients who exit the treatment system during the first few weeks from referral including a number of clients who have been in treatment previously. This might indicate that the client is not ready to engage with treatment services and has possibly been referred in via the criminal justice system and not voluntarily. Further work around this cohort of clients would help identify the reasons for engagement with the treatment service and the reasons why they have exited treatment at a very early stage. The treatment system has a high percentage of clients that are retained in effective treatment and this is above both the regional and national average achievements. Analysing both the group of CJS clients and non CJS clients separately also identifies high retention rates compared to both the regional and national indicators. 37

39 Fig 5.19 Waiting Times 2010/11 1st Presentation Waiting Time Under 3 weeks % Inpatient Detoxification % Residential Rehabilitation % Specialist Prescribing % GP Prescribing % Structured Day Programmes % Psychosocial Intervention % Other Structured Intervention % Subsequent Waits Waiting Time Under 3 weeks % Inpatient Detoxification % Residential Rehabilitation % Specialist Prescribing % GP Prescribing % Structured Day Programmes % Psychosocial Intervention % Other Structured Intervention % Source:NDTMS Waiting time standards state that all clients should be seen within 3 weeks of referral to treatment. The majority of clients are seen within this period with only a small number of exceptions. Fig 5.20 Successful Completions baselines at 31/03/2011 Number in treatment in the last 12 months Successful completions as a proportion of all in (o18) treatment (o18) April 2010 to March 2011 Baseline April 2010 to March 2011 Baseline (All) % (116) (OCU) % (35) (Non OCU) % (81) Source:NDTMS One of the priorities with drug treatment is to discharge clients from the treatment system where they no longer have a dependency for Class A drugs. The baseline taken at the end of 2010/11 highlights Gateshead had 116 clients successfully completing structured treatment and this will require a lot of targeted work to implement methods that work well to improve the rate of clients successfully completing structured treatment. Gateshead has been grouped to a 38

40 cluster with similar characteristics and is expected to mirror the performance of the top performing quartile over the coming months. Fig 5.21 Treatment Exits and Retentions 2010/11 Source:NDTMS In 2010/11 41% of all discharges were planned compared to a national average o f 43 % and a regional av erage of 40%. The main issue of concern here is the relatively low rate of planned discharge from the NHS SoTW Substance Misuse S ervices at 26% compared against the national and regional averages. In comparison NECA has an 77% planned discharge rate. However it should also be noted that the 18% unplanned/dropped out exit figure for Gateshead is better than the regional and national figures of 24% and 24%. Fig 5.22 Treatment Outcomes 2010/11 Treatment Exits 2010_11 36% 41% 23% Source:NDTMS Planned Unplanned Referred On 39

41 There are 41% planned treatment exits which is comparable to the Regional and National levels. There are 36% of clients referred on which could be transfers to other providers or into custody. This makes up a high proportion of the clients and raises concerns around why is it necessary for clients to move to other providers unless it is part of the excepted treatment journey. Additional work in this area will help to understand the reasons for this. There are 23% unplanned exits from the partnership which is better than the Regional and National levels but there is not a good understanding of the reasons for clients leaving the treatment system. With a greater emphasis placed on successful completions the partnership will look to place a higher degree of importance on understanding the reasons for unplanned exits through data collection and feedback. Fig 5.23 Transfers 2010/11 Source:NDTMS Transfer within the partnership can occur when the client is ready to move onto the next stage of the treatment journey which is delivered from a different provider. A lot of transfers are to the community integration team who provide wrap around services for the client and also to Neca highlighting that Gateshead has good interagency pathways. 40

42 Gateshead has a high proportion of clients in treatment per population size compared to Sunderland and South Tyneside The number of clients in effective treatment has increased by 0.4% when compared to 2009/11 Clients who are engaged with structured treatment are remaining in treatment for long periods of time The predominant referral source to structured treatment is self referrals. There has been a significant reduction in the number of clients being referred from criminal justice/dip sources. Heroin remain as the main substance of use for clients in structured treatment Cannabis is increasing as the main problem substance Alcohol use is increasing and along with Benzodiazepines these are the common secondary substances. Dunston and Teams, Felling, Deckham, High Fell, Bridges, Saltwell, and Lobley Hill and Bensham are the areas where the majority of the clients live is the commonest age band for clients in treatment and the largest increase when compared to 2009/10 has been across the age band Retention rates are above both the Regional and National levels Waiting time targets are being maintained Successful completions are now one of the priority areas. Gateshead will be aiming to perform in line with the top performing quartile within the cluster with similar characteristics it has been placed in There are 23% of unplanned exits that need to be investigated to understand the reasons A high number of clients are being referred on to other partnerships or to prison where further analysis will help to understand the reasons why Recommendations/Actions Identify methods that will contribute to improving the successful completion rate in Gateshead identifying the reasons why clients leave treatment in an unplanned way. Understand the reasons for clients transferring to other providers to ensure the partnership is able to deliver the appropriate care package. Continue to engage clients into treatment. 41

43 6. Harm Reduction The Harm Reduction Service is a nurse-led service which is based at the Needle Exchange in central Gateshead. It offers a confidential and anonymous service that predominantly operates on a drop-in basis. Needle Exchanges are vital in helping to reduce the transmission of blood borne viruses. They provide new, clean injecting equipment to clients as well as providing a means of disposal for used injecting equipment. This also gives them a safe method of disposing potentially hazardous injecting equipment. Other services include (but not limited to) advice and training to reduce the harm associated with injecting drug use, blood borne virus screening, Hepatitis B vaccinations, sexual health advice, healthcare assessments, stimulant and steroid clinics, smear clinics. In addition to the central needle exchange facility a further 9 needle exchange operate across Gateshead located in pharmacies in the following areas. 1. Chopwell 2. Whickham 3. Wrekenton 4. Felling 5. Teams 6. Birtley 7. Winlaton 8. Low Fell 9. Blaydon Fig 6.1 Location of Needle Exchanges in Gateshead Source:Gateshead Council Crown copyright and database rights 2011 Ordnance Survey Gateshead Council

44 Needle Finds Almost half of all needle and syringe finds were in the Bridges and Felling wards (47%). The worst affected area was Felling High Street, where discarded needles and syringes were reported on five separate occasions. While Felling High Street appears to be the hotspot, the majority of discarded needles and syringes found in the Felling ward appear to be located within very close proximity of Felling High Street however the data provided does not stipulate how many needles or syringes were reported on each occasion. A higher number of discarded needles and syringes were also reported in the Bridges ward, particularly on Gateshead High Street, Warwick Street and High West Street. Since the Neighbourhood Wardens Service was disbanded in March 2011 there has been a reduction in intelligence on drugs paraphernalia. This is a gap which will need to be addressed by our partners particularly in relation to the reporting and recording of discarded syringes (e.g. Local Environmental Services, the Street Action Enforcement Team, The Gateshead Housing Company and Children and Young People s service and the Fire service). It is hoped that training can be rolled out across services during the next strategic period to help provide a better indication of potential drug use and drug dealing within localities which in turn will influence treatment, harm reduction and enforcement strategies. Fig 6.2 Needle Find Locations in Gateshead 2010/11 Source:Gateshead Council Crown copyright and database rights 2011 Ordnance Survey Gateshead Council

45 There is a national expectation that 100% of clients should complete a general healthcare assessment, and 100% of clients should be offered Hepatitis B vaccination and Hepatitis C testing. The table below compares quarter 3 performance for 2011/12 against quarter 4 performance for 2010/11. Fig 6.3 Harm Minimisation Performance Percentage of new presentations YTD offered (or assessed as not requiring ) Hep B vaccinations Percentage of new presentations YTD offered (or assessed as not requiring ) Hep C test Percentage of new presentations completing a general healthcare assessment Source:NDTMS 2010/11 Quarter 4 performance 2011/12 Quarter 3 performance 87% 98% 87% 96% 89% 99% There has been a significant improvement in performance during 2011/12 indicating the recommendations from the previous needs assessment have been implemented with very high percentages of clients being offered or assessed as not requiring harm reduction interventions highlighting the need to continue the work around this area to ensure that 100% of clients are monitored for harm reduction interventions. 44

46 7. Drug Related Deaths The number of drug-related deaths in Gateshead has steadily increased year on year since 2007 and has been monitored by the Drug-related Death Panel whose remit is to mine all suspected drug-related deaths in Gateshead. Between Oct-10 and Sept-11 there were 21 suspected drug-related deaths, 86% of which were males. Toxicology reports are still pending for a number of cases therefore it has not been possible to determine the exact number of drug-related deaths during this period. In addition there have been three deaths involving people who did not reside in Gate shead but who were in the area at the time of their death (two individuals were from Newcastle and one from Northumberland). A quarter of all suspected drug-related deaths during this strategic period involved individuals between the ages of 25 and 39yrs (which positively correlates to the treatment profiles of those in treatment); while worryingly almost a fifth of deaths were young people und er the age of 20. The data shows that the drugs involved are often a mixture of ill icit and prescribed drugs, w ith the trend for mixing alcohol and benzodiazepines continuing, along with the suspected use of diverting methadone. Fig 7.1 Drug related deaths by age bands Oct-10 to Sept-11 Source:Gateshead Local Authority As can be seen from the map below, there is a correlation between the location of discarded needles and syringes, and the location of suspected drug-related deaths. It must be noted, however, that the types of drugs identified in these deaths differ from the drug litter found. 45

47 Fig 7.2 Correlation between Drug related deaths and needle finds Source:Gateshead Local Authority Crown copyright and database rights 2011 Ordnance Survey Gateshead Council Certain wards have higher levels of drug-related deaths; those that have had the highest number of deaths since 2008 include: Bridges 20 deaths Felling 9 deaths Deckham 14 deaths Low Fell 6 deaths As would be expected these areas tend to suffer from a higher degree of deprivation and unemployment and are traditional hotspots in Gateshead in relation to high levels of crime and anti-social behaviour. It also closely mirrors the geographical layout of both our offenders and victims. This evidence also gives a clear indication of where the need for further promotion of harm reduction messages to service users and their respective families/peers should be targeted. During the Bank Holiday periods, e.g. over Christmas and Easter, there is an increased potential for drug-related deaths to occur. A primary reason for this is that pharmacies opening during these times are limited and as a result those in treatment in receipt of methadone scripts pick up enough medication to cover them during these periods which has the potential for more methadone to be diverted or misused at these times in the year (e.g. it is known anecdotally that methadone is traded on the street for illicit drugs and money.) In 2010/11 there were two deaths over the Christmas period and one over the Easter Bank Holiday 2011, making it quite a volatile time for drug-related deaths which heightens the importance and need for further promotion of harm reduction messages to service users and their respective families/peers. 46

48 There has been a significant amount of media coverage relating to a spate of deaths in Gateshead linked to methadone. Communications leads from the Local Authority, Police, PCT and Probation have worked to deliver a campaign highlighting the dangers of mixing drugs and alcohol. 47

49 8. Reducing Supply Nationally, the number of drug seizures has decreased by approximately 5% in 2010/11 compared to 2009/10. The biggest decreases were noted in the seizure of class A drugs, which fell by 15% in 2010/11; while class C seizures increased by 16%. In Gateshead, there has been a fall in the numbers of individuals claiming to use opiates; while an increase in alcohol and cannabis use by individuals has increased as reported in the North East Public Health Observatory Trends in Drug Use in the North East report, published in November It is not known if his change is due to the changing preferences of individuals or if this is as a result of a crack down and reduction in the supply of opiates. The increase in cannabis use and the decrease in heroin use is also reflected in the European Monitoring Centre for Drugs and Drug Addiction s Annual Report 2011, which also reports a sharp drop in the availability of heroin in the UK in 2010/11. This is supported by figures showing a considerable drop in the purity of heroin seized in the UK between 2009/10. Whilst there has been a decline in the use of heroin as first choice drug, it should also be noted that the purity and quantity of heroin coming into the North East has declined which could also play an important part in the changing drug use trend within Gateshead. Drug seizures of heroin and purity needs to be monitored in case heroin availability and purity increase and therefore sees an upward trend in the use of heroin in the area. 48

50 9. Crimes under the Influence This part of the report is extracted from the Safer Gateshead Partnership Strategic Assessment. It will explore the main drivers and motivations that influence offending patterns and behaviour in Gateshead. The influence of alcohol and drugs is a cross-cutting issue that negatively impacts on all crime, disorder and substance misuse categories. Fig 9.1 Number of offences by crime type Source:Gateshead Council The table above identifies the percentage of all crimes that have been influenced by alcohol, drugs and/or both by crime type. This will help to identify if a specific driver is more prevalent within a particular crime type. It has not been possible to identify from the data if it is the victim and / or the offender that is under the influence of alcohol / drugs when an offence takes place. It is therefore quite difficult to establish suitable measures to tackle problems (i.e. different tactics would be required if it is intoxication of the victim that has resulted in an offence compared to if an offender actually was abusing a substance and committing offences whilst under the influence of alcohol). It does however provide a general indication of what influences offending behaviour and victimisation as a whole. Alcohol was identified by Northumbria Police as a contributory factor in almost 8% of all recorded crime that occurred between Oct 10-Sep 11 falling by 3% on last year. Alcohol-related offences have proportionally increased across in all but 2 crime categories with sexual and fraud related offences reducing. The effect of drugs and drug-use within Gateshead has a profound impact on the level and attitudes linked to high offending behaviour and often influences and heightens the perception and fear of crime issues within local communities. 49

51 Northumbria Police recorded that drugs played an influencing role in 5% of crime committed within Gateshead during 2011 increasing by a 5% margin on the previous year. It is anticipated that this rise is primarily down to improved reporting procedures as well as the pro-active targeting of drug-related offences. The level of crime linked with drugs is likely to be much higher than the figure reported with national research suggesting that drugs influence approximately a third to a half of all theft and acquisitive crime categories. The age-standardised alcohol-related hospital admissions were found to be significantly higher in Gateshead than in the whole of the South of Tyne and Wear which provides strong evidence to suggest how dominant alcohol is in influencing crime and disorder. The introduction of the Cardiff Model in early 2010 provided a greater picture of alcohol-related admissions and a truer extent of its impact in Gateshead. There have been 1,178 presentations at Accident and Emergency between Oct-10 and Sept-11 (averaging 98 per calendar month) from patients suffering from injuries as a result of a violent assault of which almost half were deemed to be alcohol-related. Geography of Offending The vast majority of offenders reside within the Gateshead borough (68%) and remains a similar proportion to that found last year. There has been an increase in the number of offenders that were cautioned or charged with an offence that had been committed in the Gateshead area but where the offender resided in North Tyneside. These are relatively small volumes but indicates that outside non-gateshead resident offenders are coming into Gateshead with intention of offending. Fig 9.2 Geography of Offending comparison Oct 09-Sept 10 and Oct 10 Sept 11 Source:NDTMS A review of the offence location reveals that offenders that reside out of Gateshead predominately tend to offend within the outer lying wards of the borough as well as the high profile traditional areas such as the Metro Centre and Town Centre environments. 50

52 The map below examines those ward areas that have higher levels of offenders residing within them compared to the Gateshead average (of 9.7 offenders per 1000 population). Ward areas that are higher than the Gateshead average include: Felling 18.3 Dunston and Teams 18.0 Bridges 17.0 High Fell 15.5 Deckham 14.7 Lobley Hill 14.3 Saltwell 12.0 Blaydon 11.4 As would be expected these areas tend to suffer from a higher degree of deprivation and unemployment and are traditional hotspots in Gateshead in relation to high levels of crime and anti-social behaviour. It also closely mirrors the geographical layout of our victims showing that certain areas continue to suffer from disproportionately high levels of both victimisation and offending behaviour. A&E Data The Cardiff Model The Cardiff Model was introduced in Gateshead in January 2010 with the aim of improving data sharing between Accident & Emergency Departments and Safer Gateshead. Large numbers of assaults result in hospital treatment, and a large number of those are not reported to Police. During this strategic period there have been 1,178 admissions to the Queen Elizabeth Hospital s A&E department. 905 admissions were residents who live in Gateshead. The remainder of this section is therefore based on 905 admissions. Of these, 61 were admitted on more than occasion. The High Fell and Saltwell wards suffered from the highest rate of admissions per 1000 population, with rates double the Gateshead average in both of these wards. Higher than average rates were also recorded in the Bridges, Felling and Deckham wards. 51

53 Temporal profiles show that the number of admissions increases dramatically from Thursdays, when the lowest number of admissions is recorded, peaking on Sundays. Levels of admissions are relatively evenly spread out throughout the day, reaching their highest peak between 23:00hrs and 04:00hrs. 46% of all admissions were young people aged 24 years old or younger; the majority of whom are between the ages of 15 and 19 years old. Half of all young people were deemed to have been drinking alcohol. Males were the main victims in alcohol-related Fig 9.3 Drug Intervention Programme Source:SOTW Substance misuse team Number of tests has reduced compared to previous years Number of Positive tests has reduced compared to previous years Opiate numbers have increased. Cocaine numbers have reduced. 52

54 10. Service User Involvement Consultations have been carried out with service users including the following activities: Development of a service user group in collaboration with other agencies Requested alcohol clients experience of the treatment journey (patient experience) Consulted on how service users want to be communicated with on service developments and involvement - November 2011 Development of a service user action plan which outlines a programme of developments re service user involvement Consulted with service users on the new vision for the service Service user surveys Weekly Community Meetings for clients to share experience of treatment Monthly Community Meetings for Continuing Care making use of graduates. Recovery Centre - have monthly community consultation meetings so that again people can influence what happens at the centre The following feedback was received from the service users: Service users would like to see more consistency from staff and also be able to spend more time with them. Service users feel there is not enough Mental Health support. Service users feel there are not enough services and housing mentioned as an area where more support is required. Would like to see more activities especially exercise activities to relieve the boredom that leads to drug and alcohol abuse. Stable users do not like coming into contact with chaotic users when doing activities Service users would like to have more say in the planning and design of services. Service users feel there is little opportunity to provide peer support. Some rooms look a bit tired and would like music in the reception area. More service provision especially at weekends 53

55 11. Housing Evidence suggest that housing along with the appropriate support can contribute to improved outcomes for drug users in a number of areas such as increasing engagement and retention in treatment, improving health and social well being, improving outcomes and reducing re-offending. Data from the National Drug Monitoring System has indicated that during 2010/11 there was 318 referrals into the treatment system. 207 of the referrals have been in treatment previously and 31 of these have a housing problem and 13 have a urgent housing problem. The are 111 treatment naïve clients coming into treatment where 8 have a housing problem and 1 an urgent housing problem. An urgent need is identified as having no fixed home/place to sleep. This can mean living on the streets, living in hostels or sleeping in another location such as; staying with friends/family as a short term guest, overnight shelter, and short term bed and breakfast/hotel or squatting Fig 11.1Housing status of referrals to treatment during 2010/11 Source:NDTMS 54

56 Fig 11.2 Clients in Treatment 2010/11 Housing Need Source:NDTMS 12% of the clients currently in treatment indicate they have a housing problem and a further 5% indicate they have an urgent housing problem. Fig 11.3 Housing Risk of Clients in Treatment from the TOPs Source:NDTMS 55

57 A client s accommodation status is monitored on a regular basis when completing treatment outcome profiles. Measurements taken from the start of treatment show Gateshead has a lower percentage of clients with A housing problem than the national figure but during the first 5 to 26 weeks in treatment it appears that the problem increases for both clients with a housing problem and an acute housing problem but the national figures go the other way with substantial reductions. Recommendations Data from Treatment Providers to be fed into Vulnerable Persons Housing Group to help inform future strategies and action plans and address housing need for those with substance misuse problems. Continue to work with Vulnerable Persons Housing Group in multi agency forum identifying and meeting the needs of returning prisoners and offenders in the community and review current action plan and policy to meet offender housing need. Further analysis of housing problems attributed to clients who start a treatment journey to understand the reasons why the problem appears to worsen. 56

58 12. Education, Training, and Employment The government s Drug Strategy emphasises the need for supporting clients into work as there are clear benefits to an individual getting a job which can support to keep people in recovery. There are also wider benefits to society from reduced costs to the welfare system and associated public health and crime costs. Substance users however are statistically more likely to be unemployed, either for health reasons, or other difficulties related to their substance use. According to NOMIS ( data for Gateshead shows: the most recent rate of unemployment of those residents classed as economically active is 10.4%, which is higher than the North East (which shows 9.8%) and also higher than the national average (which shows 7.7%) there is a ratio of 0.80 total job vacancies available for every resident aged which is higher than the North East (which shows 0.66%) and also higher than the national average (which shows 0.78%) 4.7 % of the population are claiming Jobseekers Allowance which is equal to the North East (also 4.7%) but is higher than the national average (which shows 3.6%) 16.3% of the population are claiming key out-of-work benefits (i.e. job seekers, employment and support allowance and incapacity benefits, lone parents and others on income related benefits) which is higher than the North East (which shows 15.5%) and also higher than the national average (which shows 12.1%). Drug and alcohol treatment providers already discuss education, skills and employment-related needs as part of the assessment, with goals being agreed between client and key worker as part of an individuals care plan. Data is subsequently collected via TOPs Data which provides a record of the employment or education status of individuals entering community drug treatment in Gateshead. TOPs Employment and Education status The TOPs completed for all clients entering community drug treatment show the following % who have paid work, and who are in education compared to national figures obtained. Regular monitoring at defined intervals show how the trend changes over a period of time where employment improves the longer the client is in treatment but the education and training reduces the longer a client is in treatment. 57

59 Fig 12.1 Employment and Training status from TOPs Source: NDTMS TOP reports Jobcentre Plus The Gateshead Partnership has developed both strategic and operational re lationships with Jobcentre Plus (JCP). JCP offer for claimants with a drug or alcohol issue The Government estimates nationally 1 in every 5 benefits claimants are dependent on drugs and alcohol. On the 6 th June 2011 JCP launched a new offer where they are able to direct clients to treatment services and also take into account the treatment commitments to tailor the jobseekers action plan. Data Protection Act To comply with the Data Protection Act, JCP must obtain the customer s freely given, fully informed and explicit consent to record sensitive information on their Labour Market System (LMS) database. LMS holds details about people using our services, as well as details about jobs, training and other available opportunities. JCP can use markers on LMS to record whether a customer is: Currently serving a community sentence, custodial sentence or is an exoffender A current/recovering/stabilised drug mis-user A recovering/stabilised alcoholic Has a health problem or disability affecting their day-to-day activities. 58

60 This information is used by JCP to make sure the best possible service is provided by taking into account an individual s particular circumstances to deal with their claim for benefit, or to help them find work. Where barriers are not recorded on LMS, a JCP Adviser would treat the individual as any other Jobseeker therefore possibly placing the individual at greater risk of failing to meet benefit requirements where barriers actually exist. Disclosure issues Despite the obvious benefits in disclosing sensitive information for an individual, historical barriers to disclosure are known to exist. Indeed of the 6727 Jobseekers registered with Gateshead Jobcentres at the end of October 2011, data from Jobcentre Plus indicated that approx 195 customers in Gateshead had given consent for Jobcentre Plus to record their drug and/or alcohol problem on their Labour Market System (LMS) however we acknowledge that there is likely to be under reporting due to the fact that drug & alcohol markers only stay on the LMS for 12 months unless reviewed and reset with further customer consent. NTA/JCP Joint Working Protocol Furthermore an NTA and JCP joint-working protocol was developed to support closer collaboration between agencies to promote more effective action to address the employment-related needs of substance misusers and to contribute towards more positive treatment outcomes. The joint protocol outlined a common approach for treatment providers and JCP to work more closely through a series of steps to ensure that employment-related needs are addressed early on in the client s recovery journey. The process of sharing relevant information gathered as part of the assessment and care planning process with JCP is only done with the client s consent which as NTA guidance states, requires staff to sell the benefits of joint-working to promote recovery. For treatment providers consent is captured using form TPR2, whereas for DRR/ATR clients, coordination of education, training and employment needs are usually part of the offender manager s remit using a separate NOMS data sharing consent form (although responsibility can be negotiated and agreed between the offender manager and key worker and clearly set out in the client s care plan). Extent of closer working In Gateshead the actual number of TPR2 consent forms received by JCP from treatment services are extremely low (less than 50 in total across all treatment services during 2011). JCP are however continuing to promote joint working where claimants are known to be engaged with treatment using the TPR2 consent from. Overall many Probation teams appear to be proactively engaging with JCP (using the NOMS data sharing consent form) and as a result both JCP and Probation are re porting positive outcomes in terms of supporting individuals to comply with sentencing conditions; benefit conditionality; any mandatory interaction with JCP 59

61 and enable JCP Advisers to tailor jobseeker s agreements to take account of any treatment commitments claimants might have. Employment Agenda Performance Monitoring The level of current data collection does not allow the partnership to effectively monitor or benchmark any employment agenda performance improvements. For Gateshead, there may be a need to review data collection and provision within the treatment monitoring system in order to be better informed about employment activity within the client groups. Summary Levels of disclosure of substance misuse issues to JCP by claimants remains low however this is not specific to Gateshead but part of a wider issue which often relates to claimants perceptions of the impact of disclosure to JCP. Although in some cases substance misuse or offending may impact on the type of employment and individual may ultimately enter (i.e. where restrictions apply), disclosure of these issues within JCP is key to ensure that individuals are supported to access to the full range of employment and skills support to which they are entitled and also that the support offered is relevant to suit the individual s needs. To coordinate employment activity effectively, treatment services must ensure the Joint Protocol process is embedded into all care plan assessments and offered and promoted positively to all JCP claimants at regular intervals throughout the review periods. Similarly Probation teams, JCP and treatment services must continue to assess the training needs of staff and promote effective links to all services, understanding that sharing employment related information on the client s care plan via engagement between the Key Worker and JCP can help to support a client back to work. For all services effective engagement in the employment agenda can help to share individual performance targets. Feedback on any successes or concerns highlighted should be fed back through service managers at the Drug and Alcohol Reference Group (DARG) meeting to ensure the process is continually evaluated. Finally although there is an expectation that links will continue with Jobcentre Plus, the partnership should also established links with local Work Programme providers Ingeus and Avanta in an attempt to further enhance recovery prospects for individuals in treatment in Gateshead. 60

62 13. Alcohol Evidence suggests that alcohol consumption across the UK has increased sharply in recent years The UK has one of the highest proportions of binge drinking, particularly amongst young people, and one of the worst problems with underage drinking. Evidence from 3 major reviews for the effect of alcohol suggests that the number of deaths attributable to alcohol is 43-54% of unspecified liver disease. Source: Public Health Intelligence North East Alcohol Prevalence 22.41% (28,603) Increasing risk drinking in Gateshead compared to National 20.77% North East 24.6% figures % (12,975) Higher risk drinking in Gateshead compared to National 7.1% North East 7.8% figures. 8.3% (13,178) estimated dependant drinkers in Gateshead compared to National 7.1% and North East 6.7% figures. NICE Public Health guidance 24 on preventing harmful drinking recommends that Commissioners should ensure one in seven dependant drinkers can get through treatment locally, in lines with Signs for Improvement (15% of people with alcohol dependence receiving specialist treatment each year). Gateshead had 6.8% of the dependent drinkers in treatment during 2010/11. Alcohol Treatment entry The data below shows the number of adults in contact with alcohol treatment in the last year; average treatment duration and waiting times. Also shown is the severity of drinking reported by adults in contact with your alcohol system (by alcohol units drunk in the month before starting treatment); how many adults complete their treatment free of dependency and the proportion of your drug treatment population who also require alcohol treatment. Your alcohol commissioning lead can provide more information about current alcohol treatment need and provision. These statistics are restricted and provided for briefing purposes only. They cannot be released into the public domain until after the publication of the national alcohol treatment statistics for which are scheduled for release in February

63 Fig 13.1 Gateshead Alcohol Treatment Providers Referral Sources 2010/11 Source:NDTMS The majority of referrals into alcohol treatment services are either self referrals, from family and friends, or form mental health services. Fig 13.2 Gateshead Alcohol Clients 2010/11 Gender Profile 2010/11 Source:NDTMS Two thirds of clients in treatment are male and one third are females. 62

64 Fig 13.3 Units consumed one month prior to entering treatment 2010/11 The number of adults with alcohol Local National treatment Missing Units consumed in 28 days prior to entering treatment Proportion of new presentations 5% 8% 13% 22% 12% 12% 27% 0% National proportions for 9% 17% 17% 18% 11% 9% 14% 6% comparison Source:JSNA Support pack for Strategic Partners Fig 13.4 Age Range of Clients accessing Treatment Source:NDTMS Alcohol seems to be problematic for people aged 20 through to 60 with the majority of clients in treatment from age 30 to 54. There has been an increase of clients entering treatment across nearly all of the age bands during 2010/11 compare to 2009/10 with the largest increase in the age band. The exception has been a reduction across the and age bands. 63

65 Fig 13.5 Treatment Outcomes 2010/11 Source:NDTMS Treatment outcomes for alcohol clients during 2010/11 indicate 46% planned discharges and 39% unplanned highlighting the challenges faced to treat alcohol clients and achieve positive outcomes. Adjunctive Drug Use National Alcohol Monitoring System (NATAS) shows that around 12% (85) of clients presenting for alcohol support have adjunctive drug use, Q4 2010/11 shows 6% use cannabis, 2% use amphetamines and 2% used Benzodiazepine, following the national trends. Adult drug users with alcohol dependency Gateshead has 256 Adults in drug treatment that also have alcohol problems which is 21% of the proportion in treatment, the same as the national proportion. Waiting Times Alcohol Treatment In terms of waiting times for treatment 97% of clients waited less than three weeks for their first intervention. Time in treatment The mean average time in treatment for all adults in alcohol treatment is 0.61 years compared to 0.7 nationally. Successful completions Gateshead had 29% of clients completing treatment successfully during 201/11 compared to 32% nationally. 64

66 North East Ambulance Service - Alcohol Callouts During 2010/11 there were 934 ambulance callouts where alcohol was involved. The total for Drugs and Alcohol was 1111 of which 40% (n444) were overdoses. Fig 13.6 Ambulance call-outs for Drug and Alcohol Overdose 2010/11 North East Ambulance Services callouts for Drug and Alcohol overdoses 2010/ Number APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Month Source:NEAS "ALCOHOL INVOLVED" "DRUGS INVOLVED" 65

67 Fig 13.7 Rate of alcohol-related admissions per 100,000 population (EASR) The rates of hospital stays for alcohol related harm are higher than the national and regional average. When looking at the rates Gateshead has significant worse rates per 100,000 population than the England average. The % change in year on year figures indicates that the rate of increase had slowed to 1% from 08/09 to 09/10 to 10/ 11. Rate of alcoholrelated admissions per 100,000 population (EASR) 2002/ / / / / / / / /11 by Primary Care Organisation Gateshead ,544 South Tyneside ,855 Sunderland Teaching ,907 North East ,600 England ,898 Source: North West Public Health Observatory - Local Area Profiles for England Rate of alcoholrelated admissions per 100,000 population (EASR) Percentage change 2002/ / / / / / / / / / / / / / /10- Average 2010/11 Gateshead 6% 14% 13% 14% 0% 10% 0% 1% 7% South Tyneside 6% 5% 18% 6% 4% 5% 15% 13% 9% Sunderland 20% 13% 9% 4% 5% 16% 9% 13% 11% Teaching North East 11% 13% 14% 9% 7% 10% 7% 8% 10% England 11% 12% 13% 8% 6% 7% 10% 9% 9% Source: North West Public Health Observatory - Local Area Profiles for England 66

68 Fig 13.8 Alcohol-specific mortality - Males all Ages Deaths from alcohol-specific conditions in Males in Gateshead have declined over the past monitoring above the national average and the regional average. year the rate is still ( ) ( ) ( ) ( ) ( ) Number of male deaths specifically due to alcohol, all ages ( ) Gateshead South Tyneside Sunderland North East England Fig 13.9 Alcohol-specific mort ality - Fem ales all Ages Deaths from alcohol-specific conditions in Females in Gateshead has increased over the last monitoring year, the rate is still above the national and below the regional average. ( ) ( ) ( ) ( ) ( ) Number of female deaths specifically due to alcohol, all ages ( ) Gateshead South Tyneside Sunderland North East England

69 Fig Mortality from Chronic Liver Disease: Male, all ages The rate of deaths from chronic liver disease in males from Gateshead remains above the National average and the regional average. Number of male deaths, all ages, DSR per population (2007- from chronic liver disease ( ) 2009) Gateshead South Tyneside Sunderland North East England Fig Mortality from Chronic Liver Disease: Females, all ages The rate of deaths from chronic liver disease in females from Gateshead remains above the National average and below the regional average. Number of female deaths, all ages, DSR per population ( ) from chronic liver disease, ( ) Gateshead South Tyneside Sunderland North East England

70 Fig Alcohol-Attributable Mortality: Male, all ages The rate of Alcohol-Attributable mortality in males (all ages) for Gateshead rates higher than the national average and the north east average. The trend in recent years has seen an increase following a period of reduction Number of male deaths attributable to alcohol (2009) Gateshead South Tyneside Sunderland North East England Fig Alcohol-Attributable Mortality: Female, all ages The rate of Alcohol-Attributable mortality in females (all ages) for Gateshead are lower than the national/regional average Number of female deaths attributable to alcohol (2009) Gateshead South Tyneside Sunderland North East England

71 Fig <18 Alcohol specific Hospital admissions The rate of <18 Alcohol specific hospital admissions for Gateshead is significantly higher than the national average but higher than the regional average. Number of under 18s admitted for alcohol specific (2003/ 04- (2004/05- (2005/06- ( 2006/07- (2007/ 08- causes (2007/ /06) 2006/07) 2007/ 08) 2008/09) 2009/10) 2009/10) Gateshead South Tyneside Sunderland North East England Fig Alcohol specific Hospital admissions Males The rate of Alcohol specific hospital admissions for males in Gateshead is significantly higher than the regional and national average. ("2005/06") ("2006/07") (" 2007/08") (" 2008/09") ("2009/10") Number of males admitted to hospital with alcohol specific conditions (2009/10) Gateshead South Tyneside Sunderland North East England

72 Fig Alcohol specific Hospital admissions Females The rate of Alcohol specific hospital admissions for females in Gateshead is significantly higher than the national rate and just above the regional rate. Number of females admitted to hospital with alcohol attributable conditions, all ages ("2005/06") ("2006/07") ("2007/08") ("2008/09") ("2009/10") (2009/10) Gateshead South Tyneside Sunderland North East England Fig Admission episodes for alcohol related conditions (previously NI39) During 2009/10 there were 5705 admissions, giving a local rate of 2526, significantly higher than the national average and above the regional rate. Admission episodes for alcoholattributable conditions (" 2005/06" ) (" 2006/07") (" 2007/08") (" 2008/09" ) (" 2009/10") (previously NI39) (2009/10) Gateshead South Tyneside Sunderland North East England

73 Fig Recorded crime attributable to alcohol During 2010/11 the rate of record crime attributable to alcohol was lower than the national and regional rate following the trend in less alcohol attributable crime. "2006/ 07" "2007/ 08" "2008/0 9" "2009/1 0" "20010/ 11" Number of all recorded crime attributable to alcohol (2010/11) Gateshead South Tyneside Sunderland North East England Fig Recorded violent crime attributable to alcohol During 2010/11 the rate of recorded violent crime attributable to alcohol was lower than the national and regional rates, trends show steady decline in this area. "2006/ 07" "2007/ 08" "2008/0 9" "2009/1 0" "20010/ 11" Number of all violent crimes attributable to alcohol (2010/2011) Gateshead South Tyneside Sunderland North East England

74 Fig IB/SDA where main medical reason is alcoholism As at Aug 2010 there were 200 claimants for benefits where their main medical reason was alcoholism, the rate for the area is higher than the national and regional average. ( Aug 2010) Number of claimants of IB/SDA whose main medical reason is alcoholism (Aug 2010) Gateshead South Tyneside Sunderland North East England Increasing numbers coming into treatment Secondary substances primarily Cannabis but also Benzodiazepines and Amphetamines 2/3 rd Males, 1/3 rd Females 27% of ne w presentations consumed over 1000 units of Alcohol in month prior to entering treatment 6.8% of dependent drinkers in treatment Largest increase into treatment across age group High numbers of Alcohol related admissions 73

75 Appendix 1 Gateshead Treatment Map 2010_2011 Referral Routes 318 GP 24 (21, 3) CARAT 59 (59) Arrest referral/dip 13 (11, 1, 1) Drug Services 55 (33, 9, 5, 8) Self 103 (68, 34, 1) Other 34 (6, 14, 3, 11) Probation 15 (8, 5, 1, 1) CJS Other 15 (8, 5, 2) In Treatment 1375 A NHS STFT Substance Misuse Services and Drug Team yrs = yrs = 267 B Gateshead NECA yrs = 0 +4 yrs = 0 C Gateshead Community Integration Team yrs = yrs = 0 D Other yrs = 6 +4 yrs = 5 Onward Referrals Discharge 263 Planned 108 (42, 56, 7, 3) Referred On 94 (78, 5, 6, 5) Unplanned Dropped Out (30, 9, 1, 8) Unplanned Prison 1 (1) Unplanned Other 12 (7, 2, 3)

76 Glossary of Terms Adult A client s age is calculated at the midpoint of the period reported for that item. A client is counted as an adult from the age of 18. Opiate and/ or Crack User(OCU) A OCU is defined as a client presenting with opiates and / or crack cocaine as their main, second or third drug at their latest episode. [Please note that episodes where alcohol is cited as the primary substance are excluded from all drug reporting so will not be included in OCU figures irrespective of having opiates and / or crack cocaine as second/third drug]. Effective Treatment Retained for 12 weeks (84 days) or more, ha ving starte d an intervention or planned exit within 12 weeks, having started an intervention. Treatment Naïve A C lient has not been in contact with the treatment services previously. Penetration Rates The rate of the number of clients in treatment against the number of estimated drug using people in the local population. Prevalence The estimated number of drug using people in the local population. CARAT Counselling Assessment, Referral Advice, Throughcare - CARAT prison drug services are designed to identify people in the prison system who misuse drugs and take them through the treatment process from start to finish, including through release from prison and back into the community. DIP Drug Intervention Programme - 75