Appendix: 3.4 MEETING: Clinical Commissioning Group Shadow Governing Body DATE: Thursday 22 November 2012 TITLE: Drug treatment performance report LEAD Dr Jeanelle de Gruchy, Director of Public Health DIRECTOR/MANAGER: AUTHOR: Marion Morris, Drug and alcohol strategy manager CONTACT DETAILS: marion morris@haringey.gov.uk SUMMARY: The paper highlights the high estimated prevalence of crack cocaine and opiate users in. The number of crack and opiate users seeking treatment has decreased since 2008, which follows a national trend. The paper provides an overview on key performance and remedial action where appropriate. Key Points: The rate of successful treatment completions, as a proportion of all adult drug users in treatment, has decreased but local performance (18%, n=226) is higher than the national average (15%), and in comparison to similar boroughs. Non opiate users outcomes as the proportion completing treatment successfully (27.5%, n=125) is lower than the national average (40%). Service users average length of time spent in treatment is considerably less than national average (1.6 year and 2.9 respectively). This demonstrates s commitment to move people through treatment into recovery. The percentage accepting Hepatitis B vaccinations is higher than the national average (46% and 34% respectively) but s performance was 4% lower for Hepatitis C tests. Plans are in place to both improve and maintain performance particularly in relation to improving successful completion of non opiate users e.g. a new Drug-Club clinic has recently opened which aims to attract more non opiate users. The planned re-tender of substance misuse provision aims to rebalance the system to be more recovery focused and integrated. This will be complete in December 2013. SUPPORTING PAPERS: Drug Treatment Performance Report (November 2012) RECOMMENDED ACTION: The Governing Body is asked to: Note progress made and remedial actions
Objective(s) / Plans supported by this paper: Health and Wellbeing Strategy 2012-15, National Drug Strategy 2011 Audit Trail: Approved by Director of Public Health Patient & Public Involvement (PPI): N/A Equality Impact Assessment: None Risks: The drug element of the Public Health Grant is performance related. Any reduction in performance could impact on the allocation. Reduction in effectiveness of drug treatment also impacts on crime. Resource Implications: N/A Next Steps: Implementation of the wider action plan to improve performance. is putting itself forward to be one of the London Wide pilots aimed at improving access to hepatitis C testing and treatment for drug users. 2
PERFORMANCE REPORT DRUG TREATMENT Helping people overcome their addictions November 2012 The Home Office s British Crime Survey (BCS) estimated that in 2010/11 around a third of adults resident in England and Wales have used an illegal drug in their life time, with 8.8% doing so in the last year. Meanwhile, drug misuse causes a number of social ills, affecting health, family and social aspects of life. Tackling drug misuse is a complex problem and requires integrated solutions and coordinated delivery of services involving education, health and social care, intelligence and enforcement, and economic policy. Trends and current picture Fig. 1: Numbers of opiate and/or crack users estimated and in effective treatment*,, 2009/2010 15 OCU (opiate and/or crack users) per 1,000 resident population aged 15-64 in 2009/2010 *Effective Treatment in treatment for 12 weeks or more, or left treatment before 12 weeks drug free Fig.2: Number of all adults in effective treatment in the latest 12 months, NCL PCTs, Q1 2010-11 Q4 2011/12 Note: cluster Information in brackets indicates PCTs NDTMS comparison group
Fig. 3: Number of all adults and OCU in effective treatment in the latest 12 months,, Q1 2010-11 Q4 2011/12 1,163 adults in effective treatment in Q4 2011/2012 864 OCU in effective treatment in Q4 2011/2012 Fig. 4: Successful completions* as a percentage of all people in treatment, by month, NCL PCTs, 2011/12 13% Successful completion rate in opiate users in Q4 2011/2012 28% Successful completion rate in non-opiate users in Q4 2011/2012 *Successful completions leaving treatment drug free and not returning for 6 months ** July 2011 figure is for August 2011 due to freeze period in July Tab.1: Diagnostic outcomes monitoring summary,, Q4 2011/12
Commentary from the drug and alcohol lead The estimated prevalence of crack cocaine and opiate users in is 2424 (Confidence interval = 2,220-2,714). The rate of 14.96 per 1000 population is higher than in London and England (9.45 and 8.93 respectively) owing to pockets of high deprivation in the east of. The number of crack and opiate users seeking treatment has decreased since 2008, which follows a national trend. As a result, saw a reduction in effective treatment by almost a tenth (9%, n=75) since the previous year. The proportion of crack and opiate users in effective treatment has in fact remained stable (86% of new treatment journeys in 2010-11 in comparison to 87% in the latest financial year). The slightly smaller percentage decrease in all drug users 7% (n=87) in effective treatment suggests that the number of non opiate users is not dropping at the same rate with crack and opiate users. On outcomes fares well in comparison to the national average and the borough cluster (E) with similar drug user and deprivation profiles. The rate of successful treatment completions, as a proportion of all adult drug users in treatment, has decreased by 3.4 percentage points since the last financial year but local performance (18%, n=226) is higher than the national average (15%), and in comparison to similar boroughs (cluster E). There are concerns, however, for non opiate users outcomes as the proportion completing treatment successfully (27.5%, n=125) is lower than the national average (40%), and 8th lowest in the cluster. Service users average length of time spent in treatment is considerably less than nationally (1.6 year and 2.9 respectively. Data from Q4 2011/12). For the first harm reduction measure, the percentage who accepted HBV vaccinations was higher than the national average (46% and 34% respectively) but for the second indicator, which measures the percentage of HCV tests, s performance was four percentage points lower. Data source: National Drug Treatment Monitoring System (www.ndtms.net - restricted statistics). Figures accurate as at 9 th of August 2012) Drug treatment action plan for 2012/13 Numbers in effective treatment The services within s drug treatment systems will be retendered in 2013 with the intention of redesigning services to attract increasing numbers of drug users into treatment. During 2012 existing services are working to improve access into treatment of drug using populations not currently using services. Work will include targeted publicity and the opening of a new service in September 2012, offering an evening clinic for those using cocaine powder and legal highs. Successful completions The re-tendering process aims to improve successful completions through a rebalance of treatment to create more recovery focused options. Resources will be redistributed to develop a new recovery service, which will offer social reintegration services including training and education, family work and life skills. In line with National institute of Clinical Excellence and National Treatment Agency guidance, these will be combined with medical interventions including substitute prescribing, key working and counselling, to maximise successful completions. During 2012 a review of current opiate substitute prescribing services is being conducted in line with Medications in Recovery: re-orientating drug dependence treatment (2012). Hepatitis testing Performance has been improving over the last year due to the introduction of a form of testing that is non invasive, dried blood spot testing. Performance continues to be managed through a health and wellbeing steering group made up of a public health specialist, nurses from provider services and the commissioner For more information on the action plan for drug treatment, contact Sarah Hart (Joint Commissioner - Substance Misuse) at sarah.hart@haringey.gov.uk, or 0208 489 1480.