Somerset County Council Health Scrutiny Sub-Committee 9 March 2009 Drug and Alcohol Treatment Services Author: Amanda Payne Somerset DAAT Co-ordinator Contact Details: Amanda.Payne@somerset.nhs.uk Paper E Item No. 8 1. Summary 1.1. Somerset Drug & Alcohol Action Team (DAAT) is a strategic partnership which commissions drug & alcohol treatment services in Somerset for adults and young people. The membership of the DAAT comprises core public sector organisations who work together to ensure the best use of all available resources to meet the needs of the local population. 1.2. Over the last 2 years significant improvements have been made to the treatment system in Somerset especially in relation to adults. Following extensive consultation with stakeholders including service users and carers, Somerset DAAT decided to tender for a single organisation to provide an integrated drug and alcohol treatment service for adults aged 18 years and over from April 1 st 2008. The contract was awarded to Turning Point a large national voluntary sector organisation. 1.3. In the 10 months the Turning Point service has been operating, significant benefits have been realised including: increased access for people to the service through e.g. extended opening times and self referral; increased range of treatment interventions e.g. group programme, blood borne virus testing and vaccination, community detox and services for carers/family/friends integration of drugs and alcohol services improved provision of needle exchange & other harm reduction services improved provision of specialist prescribing by reconfiguring the way prescribing doctor time is utilised and having more clinic time available. improved use of the drug & alcohol workforce increased collaboration countywide with volunteer programmes such as McGarvey Fellowship and In Touch 1.4. For the DAAT this has meant: more sustainable attainment of national key performance indicators; more efficient use of resources available; and the ability to more effectively respond to the needs of alcohol misusers through an integrated drug & alcohol system. 2. Issues for consideration 2.1. a) Treatment services in Somerset are commissioned through a partnership arrangement to ensure the best use of resources and achieve shared goals for our community. b) The adult treatments system has undergone significant change in the last year with the commissioning of an integrated drug and alcohol treatment service for adults. 1 of 5
c) The benefits for the new system for adults are beginning to be realised with more people presenting to access treatment for drug & alcohol misuse than before. 3. OVERVIEW OF DRUG & ALCOHOL ISSUES IN SOMERSET 3.1. There are estimated 2,137 problem adult drugs users in Somerset based on those who use opiates (for example heroin) and crack. Comparing this to population data suggests that about one in 100 adults aged between 18 and 59 experience problems with these drugs or 0.042% of the population as a whole. 3.2. Of the 2,137 current data at February 2009 indicates that 1118 are engaged in structured treatment ; this figure rises to 1200 for all drugs. Turning Point data indicate that 1390 individuals are engaged in treatment and this difference in numbers is explained by the inclusion of alcohol and the wider level of interventions that are not included in the official national figures. 3.3. The ages of people engaging in structured treatment is similar to previous years and reflects the national profile, with 20 to 39 year olds accounting for 74% of the in treatment population. It is also worth noting that the proportion of those aged over 40 years is increasing. Similarly the gender profile of adults who engage in treatment, 75% male to 25% female, reflect the national profile. The ethnicity of adults engaging in treatment in Somerset is similar to the general population of Somerset. Almost all service users identify as White British, accounting for 93% of records over the last two years. 3.4. The main problem drug reported to treatment services by people engaging in structured treatment continues to be heroin (74%). In Somerset, injecting is common among drug users and 75% of people entering treatment each year report that they were currently injecting or had injected in the past. 3.5. In comparison to drugs, there is an estimated 87,000 people aged 16 to 64 in Somerset that has an alcohol use disorder. Further national prevalence rates suggest that 3.6% of the population aged 16 64 could be categorised as severely and moderately dependent drinkers. 3.6. An estimated 15% of the adult Somerset population regularly binge drink. Although levels of harmful and hazardous drinking are estimated to be lower across Somerset than the South West average, around 19% of Somerset adults drink at harmful levels (between 22 and 50 units a week for men, and 15 and 35 units for women) and a further 4% at levels considered hazardous (50 units a week for men, 35 units a week for women). 3.7. Over the past five years, Somerset has seen an upward trend in hospital admission rates for alcohol related conditions. Between April 2002 and March 2007, 17% (4469) of alcohol related hospital admissions in Somerset were the 2 of 5
result of mental and behavioural disorders due to alcohol, a further 16% (4200) were the result of falls or injuries. 3.8. This is a snapshot of the issues related to drug & alcohol and work is ongoing within the DAAT to ensure our understanding of the demand for drug & alcohol treatment services is up to date. 4. SOMERSET DRUG & ALCOHOL ACTION TEAM WHAT IS IT? 4.1. Somerset Drug & Alcohol Action Team (DAAT) is a strategic partnership of organisations which is responsible for implementing the national drug and alcohol strategies at a local Somerset level. 4.2. Core organisational membership consists of: Somerset Primary Care Trust Somerset County Council (Community and Children & Young People s Directorates) Avon & Somerset Constabulary Avon & Somerset Probation Sedgemoor District Council (on behalf of the five District Councils). Additionally, senior representatives from the two treatment providers in Somerset also sit on the DAAT. The DAAT is currently chaired by Jan Hull Deputy Chief Executive of the PCT, with Miriam Maddison Corporate Director Community Directorate of SCC as DAAT Vice Chair. 4.3. A key function of the DAAT is to commission responses to meet the needs of Somerset s population. There are three subgroups to the DAAT: adult treatment, children and young people and communities. Each undertakes a broad range of development work and/or commission s specific services to respond to local needs. All groups are responsible for drug & alcohol issues within their area of work. Partner organisations pool their resources including funding to commission services in Somerset to ensure the most efficient use of the resources available in the county. In 2008/09 the value of all commissioned services through the DAAT amounts to 5.8 million. It is made up of central government funding streams and contributions from DAAT partner organisations. 5. DRUG & ALCOHOL TREATMENT SERVICE PROVISION 5.1. In Somerset, the DAAT commissions two services to provide drug and alcohol treatment: On the Level (part of Somerset Partnership NHS Foundation Trust) provides a service for young people aged 17 years and under Turning Point provides a service for adults aged 18 years and over. 3 of 5
5.2. Adult Treatment The drug and alcohol treatment system for adults has changed significantly in the last year with the introduction of a new model from 1 st April 2008. The DAAT undertook extensive consultation in 2006 with a wide range of stakeholders including service users and carers, to develop the specification for a new approach to the provision of drug & alcohol treatment in Somerset for adults. A central part of this was bringing together, within a single organisation, the whole range of treatment options that had previously been delivered by three services. The integrated under one roof model, aims to make better use of the existing resources, extend the range of treatment options available in Somerset for both drug and alcohol misusers and meet the performance requirements attached to central government funding and our local ambitions. In 2007/08 the DAAT undertook a competitive tendering exercise led through Somerset County Council to award the contract for this new service from 1 st April 2008. Service users and carers were key partners to the award of contract for example one of the panels interviewing bidders was made up of a mix of 15 service users and carers from across the county with a variety of experiences of drug and alcohol misuse treatment. The contract was awarded in December 2007 to Turning Point (a large national voluntary sector organisation) and began service delivery on the 1 st April 2008. 5.3. The Turning Point service has now been operating for over 10 months and the benefits of the new model are clearly being realised. These include: a) Increased access to treatment by allowing self-referral to all tier 2 and tier 3 treatment interventions and extending the service opening times. At the end of December 2008, Turning Points caseload was 1390 individuals accessing help for their drug and/or alcohol misuse. The following table shows the number of people accessing each tier of service some access more than one tier. Tier of service Drugs Alcohol Tier 2 (e.g. needle exchange, harm reduction) 603 215 Tier 3 (e.g. substitute prescribing, community detox, group programme) 4 of 5 885 97 Tier 4 (e.g. residential or inpatient) 12 1 b) Reducing assessment for a client as the new service uses a single assessment process. c) Improved access to needle exchange by ensuring this is available from all team offices during all opening times. d) Improved access to testing for and vaccination of blood borne viruses by having these interventions provided in-house as part of the standard package of care. e) Improved access to specialist prescribing by reconfiguring the way prescribing doctor time is utilised and having more clinic time available. f) Establishing a pan-somerset comprehensive group work programme to meet all the stages of a service user s recovery from stabilisation groups through to
a 2 hour per day Intensive Group Work programme. g) Ongoing development of joint work with primary care services GPs and pharmacists who now work alongside and as part of, the new integrated service. h) Improving the use of staff time by moving towards a core generic skill base, whilst utilising practitioners like nurses to undertake specific tasks related to their professional training. i) Developing services for carers, family and friends affected by someone s drug & alcohol misuse to ensure that these people regardless of whether their loved one is treatment has access to services in their right. j) Developing services for alcohol misusers k) Formalised Link Worker posts to improve care & referral pathways with Housing, Midwifery, Social Care, Criminal Justice services, Mental Health Services and Carers and Family support. 5.4. The benefits for the DAAT are being realised through: a) More efficient use of resources b) More sustainable attainment of national key performance indicators c) Access to anonymised data concerning key performance indicators from a single database of client information d) A simpler more streamlined service structure in which to invest or adapt according to changes in political or local emphasis. 5.5. There is also a separate contract with Turning Point to provide the Community Access Programme which aims to support people who are receiving treatment for their drug and alcohol problems to access education, training and employment, sports and leisure activities, daily living and social skills training. The programme is intended to complement, but not replicate, interventions provided by other services and organisations and is based on the premise that by delivering a range of interventions to enable substance misuers to move through and on from the specialist treatment system, they can successfully reintegrate into local communities. 5.6. Young People s treatment Somerset DAAT and Somerset Children and Young People s Partnership (SCYPP) work together to prevent the onset of substance misuse in young people, and to provide services to minimise harm and provide treatment for those who reach that stage of need. On the Level is the name of the young people s specialist drug and alcohol service and works with young people aged 17 and under. They work closely with Turning Point to ensure that for younger people access the service that can best meet their needs. They also work closely with the wider range of children & young people services including the new targeted substance misuse service which provides early intervention for vulnerable young people. 5 of 5