Report to Community Services Overview and Scrutiny Panel October 2012 Item No.. Norfolk Drug and Alcohol Partnership: Drug and Alcohol Services Commissioning Project Update. Report by the Director of Community Services. Summary This paper outlines and updates on the progress made in the implementation of the Norfolk Drug and Alcohol Partnerships (N-DAP) vision for the future of substance misuse services in Norfolk. Action required The paper is presented for the panel s information and comment. 1 Background 1.1 The Norfolk Drug and Alcohol Partnership (N-DAP) leads on the strategic delivery of national drug and alcohol strategies across the county and substance misuse service commissioning. 1.2 The work of the partnership is supported by a team of officers (the Drug and Alcohol Action Team) who sit within NCC Community Services. Funding for the current commissioned services and for the DAAT comes from a variety of sources including: a. Partnership Pooled Budget under a Section 75 agreement between Norfolk County Council and NHS Norfolk and Waveney b. Drug Intervention Programme (DIP) Main Grant. A national grant of which a proportion comes from the Home Office c. N-DAP partners funding contributions including from Norfolk County Council NCC) Children s Services, and Norfolk Constabulary 1.3 In Autumn 2010 the N-DAP approved a business case and project plan to bring together current funding relating to adult drug and alcohol treatment services and to take forward a whole systems commissioning project to redesign services in line with identified local needs and Drug Strategy 2010. 1.4 The Partnership took forward a five month engagement and development phase. The evidence gathered from this was used to develop the Partnership s vision for the future Drug and Alcohol Treatment System (see Appendix A). 1.5 This report outlines the progress to date in the implementation of this vision and its associated commissioning objectives and supporting projects.
2 Progress Update 2.1 Adult Drug and Alcohol Treatment System 2.1.1 The first piece of procurement activity taken forward was for the new adult drug and alcohol treatment system. Procurement was due to be finalised by April with service delivery commencing from 1 October this year. However a legal challenge was made against the procurement and although NCC were successful in its application for this to be struck out, timescales for service delivery have had to be adjusted accordingly and this will now commence from 1 April 2013. Existing contracts are being extended for a further six months from 1 October to enable this new commencement date to be set. 2.1.2 The contract for the system is being awarded to the Norfolk Recovery Partnership (NRP) made up of the Mental Health Foundation Trust, The Matthew Project and The Rehabilitation for Addicted Prisoners Trust (RAPt). 2.1.3 Key system components are as follows: a. Single Assessment and Care Coordination Service: The system will have available a central point of telephone contact for anyone wishing to make contact/access with the system. This part of the system will also deliver the assessment services and care coordination services for those accessing structured packages of treatment. b. Low intensity intervention and outreach: Assertive and proactive outreach and in reach will engage with people who are currently not accessing services and to motivate people in lower intensity services to enter structured treatment. The system will also provide a range of low intensity interventions for example, advice and information, motivational interviewing and brief interventions. c. Volunteering and Peer Mentoring System: The volunteers and peer mentors who are in recovery, will be supported to become recovery champions and have a growing visible presence within the wider recovery system d. Psychosocial interventions: A range of evidence based psychosocial interventions delivered from within a range of settings including prisons and primary care. This will include the development and provision of family focused interventions. e. Clinical interventions: A range of flexible recovery focused clinical interventions including prescribing interventions and community detoxifications (except in prisons 1 ) f. Harm Reduction Interventions: Blood Bourne Virus interventions will also be delivered. A full range of harm reduction advice and support will be available including needle exchange facilities and measures to prevent drug related deaths, particularly on release from prison or following detoxification or rehabilitation. g. Primary and Secondary Health Care liaison and diversion. h. Criminal justice pathway: Provision across the whole criminal justice pathway, subsuming the current function of the DIP and the assessment, care coordination 1 The responsibility for the prescribing and other clinical interventions within Norfolk Prisons and costs associated with this service is under the remit of the county Prison Health Care provider Serco.
and psychosocial interventions in prisons in Norfolk. The provider will also deliver required treatment elements of Drug Rehabilitation Requirements (DRRs) and Alcohol Treatment Requirements (ATR). 2.1.4 Service user engagement and involvement will be at the heart of system development and delivery. NRP have involved service users in the development of their delivery model. 2.1.5 Although the new system is countywide delivery will be focused and tailored to the identified needs across five geographical delivery areas (as illustrated below). These will be co-terminus (within the boundaries of Norfolk) with the Clinical Commissioning Groups (CCGs). 2.1.6 Moving to contract award means that Phase 6 of the original project plan commences. This is new service development and commencement or the transition from existing services to the new single system. 2.2 Needle Exchange and Supervised Consumption 2.2.1 The second piece of procurement activity was the procurement of the system for the coordination and management of county needle exchange and supervised consumption services.
2.2.2 This procurement aimed to ensure that the effective coordination and management of these services continued. 2.2.3 The contract has been awarded to East Coast Community Health and Care CIC. 2.3 Services for Sex Workers 2.3.1 N-DAP currently commission drug and alcohol support services for sex workers primarily within the Norwich area. The provision of these services was felt to sit outside of the remit of the drug and alcohol treatment system. 2.3.2 The current contract held is subject to a CSO exemption that ends in October 2013. This exemption was granted due to the opportunities faced in developing joint commissioning approaches between N-DAP and Public Health. 2.3.3 Discussions are being taken forward with the view to bringing together both contracts under a single service specification. 2.4 Family and Friends 2.4.1 Part of the vision statement outlined the need to commission more robust Family and Friends services across the county ensuring easier access and greater levels of support. 2.4.2 Support for family and friends has been strengthened within the service specification for the adult drug and alcohol treatment system, with the new providers ensuring that assessment and care coordination takes into account the wider family. Where appropriate, family and friends will be encouraged and supported to be care planning partners. NRP will also contribute to the delivery of parenting programmes and will be working with the NCC parenting lead to develop and deliver specialist parenting interventions. 2.4.3 However support services directly to family and friends that sit outside of the system requirements need further development. Services are needed for two main groups: a. Adults affected by a significant others use of substances b. Children affected by a significant others use of substances. 2.4.4 Initial review work has begun to identify a number of commissioning potentials and opportunities to link developments in this area within the Troubled Families and Early Intervention Strategy work streams. 2.5 Tier 4 Review 2.5.1 Tier 4 refers to high intensity complex treatments mainly comprising of community and inpatient detoxification, residential rehabilitation and post detox/rehabilitation support. Residential rehabilitation is funded from an NCC Purchase of Care budget. 2.5.2 The provision and further development of community detoxification is part of the new adult drug and alcohol treatment system requirements. However a full review of Tier 4 services was not possible during the original Engagement and Development Phase of the project and has not been taken forward within the last 10 years. 2.5.3 A review has been commissioned to ensure that robust commissioning intentions are identified with the aim of ensuring that these support a recovery focused vision for
drug and alcohol services and are delivered in accordance with needs and National Institute of Clinical Excellence (NICE) guidelines. 3 Next Steps 3.1 Adult Drug and Alcohol Treatment System 3.1.1 As outlined in 2.1.6 the project has now moved into the transition phase for the adult drug and alcohol treatment system. The transition phase is vital in ensuring that services are ready for delivery to commence by 1 April 2013. 3.1.2 The scale of the shift from 10 providers and multiple contracts to a single system across both community and prisons cannot be underestimated and that is why such as long transition period has been planned and is needed. 3.1.3 Key to it s success will be staff TUPE and client transfers, an effective communications strategy and robust risk management. 3.1.4 The transition is being monitored and overseen by the N-DAP Transition Monitoring and Implementation Group (TMIG). This group will meet on a monthly basis and will report progress to both the partnerships Commissioning Group and the Board. 3.1.5 TMIG is a multi agency group with representatives from each of the Partnerships commissioning bodies along with support from expert staff (including clinical governance, HR and training and workforce development). 3.1.6 In addition to TMIG the DAAT Joint Commissioning Officer will be meeting with NRP representatives at least fortnightly to review transition plans, advise, guide and identify any risks or issues that may need escalating. 3.1.7 Clear expectations during the transition phase for NRP to deliver against have been embedded within the systems contract, including the development and implementation of a full transition plan and communications strategy. 3.2 Needle Exchange and Supervised Consumption 3.2.1 Transition for the Needle Exchange and Supervised Consumption Coordination service will be one month, with the service starting on 1 of October 2012. The risks associated with this transition are much lower than those of the treatment system. 3.2.2 In addition to the coordination contract, agreements need to be put in place with pharmacies who provide the needle exchange and supervised consumption services within the county. 3.2.3 Draft agreements are in development, these will be further negotiated with the Local Pharmaceutical Committee (TMIG) before being finalised and will be a standard specification that any pharmacy wishing to provide these services will need to agree to. 3.3 Services for Sex Workers 3.3.1 A joint approach to consider the future of these services has been agreed with Public Health, this will start with a needs assessment phase between August and December 2012.
3.3.2 A steering group will be formed to support this project and the resulting procurements. This group will have its first meeting in December. 3.4 Family and Friends Services 3.4.1 A Family and Friends work stream will be set up to further develop the commissioning intentions for these two groups, this will report to N-DAP but also feed into the Troubled Families project. 3.4.2 This work stream will report with its recommendations in early 2013. 3.5 Tier 4 Review 3.5.1 The review is due to report to N-DAP in December 2012. Commissioning intentions will need to be finalised by March 2013. 4 Resource Implications 4.1 Finance 4.1.1 All services and projects outlined within this report are funded from the N-DAP partnership funding streams outlined in 1.2 of this report. Community Services contributes 447,000 to this. 4.1.2 From April 2013, funding for existing health elements of substance misuse service commissioning will form part of wider Public Health budgets in accordance with the Health and Social Care Act 2012. The Home Office elements of the DIP grant will form part of the Police and Crime Commissioners budget. 4.2 Staff 4.2.1 There is limited impact on the County Councils staff resources. Two staff members are eligible to TUPE over to the new system adult drug and alcohol treatment system provider. However, the transition of this system will involve a high number of staff from across health, voluntary sector and probation services. 5 Other Implications 5.1 Legal Implications 5.1.1 There are no outstanding legal implications for the procurement of the adult drug and alcohol treatment system and no identified legal implications for the other projects. 5.2 Equality Impact Assessment (EqIA) 5.2.1 An EqIA was completed on the original project plan. Further assessments will be completed as necessary and EqIA s will form part of the transition planning for the adult drug and alcohol treatment system. 6 Any Other Implications 6.1 Officers have considered all the implications which members should be aware of. Apart from those listed in the report (above), there are no other implications to take into account.
7 Environmental Implications 7.1 There are no environmental implications at present as this report is asking that existing contracts are extended. 8 Section 17 Crime and Disorder Act 8.1 Reducing drug and alcohol related crime is an objective that N-DAP shares with the County Community Safety Partnership. Drug and alcohol treatment provision significantly contributes towards this objective. 9 Risk Implications/Assessment 9.1 Risks and implications to service delivery and client care during the transition period of the new adult drug and alcohol treatment system will be embedded within the transition plan and monitored by TMIG. 9.2 Due to the delay in moving to the transition phase a number of risks and implications have been identified including heightened staff uncertainty and concern in relation to the future of their jobs and a resulting impact on staff morale. Heightened service user anxiety and uncertainty relating to future care and services and a drop in performance, that although cannot be solely attributed to the current situation, is felt to be a contributory factor. 10 Action Required 10.1 The paper is presented for the panel s information and comment Background Papers Report to Community Services Overview and Scrutiny 05.07.11; Norfolk Drug and Alcohol Partnership: 2012 Adult Drug and Alcohol Treatment System Commissioning Project. Report to Cabinet 12.09.11; Norfolk Drug and Alcohol Partnership: Joint Commissioning Developments and Adult Services Procurement. Report to Cabinet 05.03.12; Report on the proposed exemption to Contract Standing Orders for an extension to service agreement contracts for DAAT Service. Officer Contact If you have any questions about matters contained in this paper please get in touch with: Anne-Louise Schofield (01603) 638299 anne-louise.schofield.dat@norfolk.gov.uk If you need this Agenda in large print, audio, Braille, alternative format or in a different language please contact Jill Blake 0344 800 8020 or 0344 800 8011 (textphone) and we will do our best to help.
Appendix A N-DAP Vision Adult Drug and Alcohol Treatment System 2012 Commissioning Project: Vision Statement Our vision: To have a drug and alcohol treatment system for adults in Norfolk, that increases the number of people able to achieve sustained recovery from dependence by providing individual support and treatment packages of care. These will be enhanced by increasing opportunities for individuals to continue their recovery within the community and by providing further support to affected family and friends. We aim to do this by commissioning a single system across Norfolk which: delivers a client pathway across the county both within community and criminal justice settings including prisons; aims to ensure equity of access to services by enabling flexible delivery options across the county; develops and supports recovery mentors and volunteers as a core part of service delivery; guarantees a simplified pathway into open access support and structured treatment services for individuals via a single access and care coordination system; ensures that all service users in structured treatment have an recovery focused care plan that is tailored to identified needs and goals, improves client outcomes and where agreed includes the needs of their family and friends; delivers a personalised package of care for service users that is jointly developed and delivered with a wide range of agencies and services; ensures that future services will be able to provide a continued focus on and services to identified vulnerable groups including those who are in unsuitable accommodation or are homeless, children affected by a parent s or significant other s substance misuse, sex workers and domestic violence victims. We will also: work with existing and ex-service users to develop a network of peer led community recovery support projects with the aim of ensuring continued access to support for when the period of structured treatment ends; seek to further develop alcohol brief interventions across a broader range of agencies in the county and particularly within Primary Care. We will aim to do this by rolling out alcohol brief interventions training across Norfolk and further enhancing current agreements with GPs; work with housing support commissioners in the Integrated Community Health and Social Care Commissioning Team to increase access to appropriate accommodation for those who are at risk in this area and explore ways in which to deliver community based detoxification for people living in supported housing environments; commission more robust Family and Friends services across the county ensuring easier access and greater levels of support;
explore opportunities with pharmacies to further enhance the services they can offer to substance misusers; continue to ensure that the county has an effective system to coordinate the delivery of needle exchange, supervised consumption and shared care services; continue to offer and further develop training to support non-specialist workers who have contact with substance misusers in making effective brief interventions (for example in supported housing, domestic abuse support services and services for older people).