Essex Drug & Alcohol Partnership

Essex Drug & Alcohol Partnership Systems Change Pilot Project Plan Systems Change Pilot Project Manager: Dan Hales Dan.hales@essex.gov.uk June 2009

Introduction Essex Drug Action Partnership has been successful in bidding against 150 areas nationally to successfully achieve Drug Systems Change Pilot status. One of seven successful pilots, which will last for two years, the pilot will provide more flexibility to explore innovative approaches to tackling drug misuse. Since 2001, there has been an expansion in drug treatment services in England to help protect communities as well as individual drug users and their families from the harm problem drug use causes. The pilots have been launched to test new approaches to drug treatment and the broader social support needs of drug users both in the community and in prisons, including the ongoing care of drug-using offenders leaving prison. Successes learnt from the pilots will help inform the future direction of drug funding and service delivery nationally. This new approach stems from the 2008 Drug Strategy, Drugs: protecting families and communities. The strategy outlines the need for end to end management of drug users including more effective use of funding to have a sharper focus on achieving positive outcomes for drug users, their families and their communities. 1

Executive Summary For Essex DAP, the pilot will be guided towards two main outcomes, increasing independent living and reducing the harm caused by drugs misuse. Independent living allows service users to exit the treatment and / or criminal justice systems, gain skills, housing and employment and become fully independent. Reducing the harm caused by drugs misuse gauges reductions in crime, re-offending, community safety, personal health and social functioning and perceptions of safety. This plan will look to move EDAP towards a joint commissioning model which moves away from using KPI s as success criteria, and moves towards commissioning against outcomes which are more specific to individual areas and needs within the county. EDAP will look to commission for whole families as opposed to solely individual service users and will connect with aftercare and reintegration agencies to deliver end to end case management and outcomes. Agencies will be commissioned to provide benefits regarding not only service user but also community impact, ensuring that delivery impacts on and is felt by the local communities as a whole. Within the initial pilot plan and bid there are specific elements such as end to end criminal justice case management. However, as Essex DAP have opted for a complete systems change rather than solely specific elements, an added element to the first stage of the pilot will be to build a strategic assessment of gaps, blockages and future modelling. This will be constructed in line with current assessments such as the JSNA, DAAT Needs Assessment and CDRP Strategic Assessments, but will go further in focussing on and identifying substance misuse related areas. Not only will this deliver more specific tangibles for change management and delivery on an ongoing basis, but is also hoped to be one of the tangible products that is delivered by the pilot. This will also ensure that key areas are analysed sufficiently so as not to lose the opportunity to pilot new and innovative areas during the lifetime of the pilot and beyond. EDAP is clear that it will use the Systems Change Pilot to push the boundaries of drug misuse strategy as far as possible in the County. Independent Living and Reducing Harm Caused by Drugs Misuse are over arching outcomes which will be measured and underpinned by linked targets already in place within Essex primarily LAA and current EDAP targets. Aligned with this are organisational benefits around efficiency of finance and decision making. 2

Areas of Improvement EDAP's pilot is directed towards delivering the following increases in target areas. Clearly, all targets regarding individuals will have an effect on communities targets and similarly for organisational, but for the purpose of the pilot they are separated in order to measure distinctly. Individuals / Independent Living 1. A higher proportion of drug users, especially problematic drug users, recovering from their dependency and reintegrating into the community 2. Reduction in reoffending as a result of better services and improved reintegration support 3. An increase in the number of drug users accessing and retaining secure housing 4. An increase in the number of drug service users accessing and continuing to participate in employability schemes 5. An increase in those service users obtaining and retaining paid, licit employment, with associated reduction in welfare benefit claimants 6. An increase in service users tracked through the change system, who move from referral to positive completion of treatment, with housing and/or employment 7. Better care and safeguarding of service users, their carers and families including dependent children, through improved arrangements for data sharing Communities / Harm caused by drugs misuse Reduction in the negative consequences of drug misuse for the community Reduction in drug related crime as a result of better coordinated services An increase in DRR completions Organisational / Efficiencies A saving in administration, bureaucracy and decision making lead times through the reduction in number of processes, groups and meetings required to commission and performance manage services An increase in services and service outcomes without an increase in funding, through improved coordination A reduction in administration costs of the system and reduction in lead time to decision making, quantified in staff hours. Outlined below the planning tables are two outcome hierarchies, the first for independent living and the second for reduction in the harm caused by drugs misuse. The centre of the panels look at the ideal pathway for an example of a problematic drug user and the issues and systems that they will face and need to move through. On the left hand side of the panels are the outcome elements which need to be achieved as a result of a positive pathway. Two main areas to be investigated further are Sustained Independence and Return to Treatment in the first panel, and how the IOM and localities system needs to be designed within the second panel. Risk Register Essex County Council uses JCAD as a risk register for all areas of business. This system will be used to monitor risks as they arise and these, along with risk mitigation plans, will be added to this action plan on an ongoing basis. 3

Strategic Planning Table Work Area Lead 09/10 Q1 Q4 10/11 Q1 Q4 1) Governance SCP Review Pilot Review Pilot Review Pilot PM progress progress progress 2) Data Sharing / Strategic Assessment SCP PM Begin Strategic Assessment Process 3) DIP JCM Risk / Benefit analysis and recommendat ions 4) PPO Testing JCM Recommissionin g timetable 5) DRR s EDAAT CJS Lead 6) Prison Treatment 7) Prison Treatment JCM JCM Use current data from Probation / service provider to outline gaps Recommissionin g timetable Prison Partnership Form Steering Implement new EDAP Governance Structures Present FAFFOR* report to Steering Agree F&F s F&F s agreed Pooling of PPO Testing funding Redesign DRR process in line with DIP and IOM F&F s agreed F&F s agreed Integrate commission Service User Retender completed Present Strategic Assessment report to Steering Link in with localities strategic assessment systems Timetable commission structure Commence recommendat ions agreed by Steering Integrate commission Review Pilot progress Review membership / role Review gaps, blockages and needs with regional / central groups Strategic Assessment used for 10/11 treatment planning Implement Outcome tracking Review baselines & targets Review of PPO testing Recommissionin g timetable Continue ongoing Strategic Assessment Review progress Agree Exit Strategy Improved Partnership Review Pilot progress Coordinatio n on Review Pilot progress Agree published report Implement Exit Strategy Review effects of info sharing and strategic assessment freedoms 4

Cont Board of CARATs funding 8) Employability Job Centre Plus lead joins JCG 9) Community Well Being 10) Young people and Transition Arrangements SCP PM 11) Housing SCP PM 12) Accomm odation Related Support Include Young People in Strategic Assessment Link with EHOG Board F&F s agreed Map current system F&F s agreed Deliver findings report to Steering Appoint Housing posts, TTS and SCP 13) Comms Collate PAS and other survey information for County of IDTS funding Implement wraparound tracking for drug users Begin implementati on of reccomendati ons Complete Housing mapping project F&F s agreed Align Supporting People and DAT Planning Agree and initiate SCP Comms plan, including target measures, groups and measures Involvement in the Connected Care projects Align YP and Adults commissionin g plans Risk / Benefit analysis Complete mapping Carry out service user involvement comms and consultation (providing retender timetable adhered to) Move towards aligning planning Review mapping project and agree recommendat ions Carry out provider involvement comms and consultation (providing retender timetable adhered to) arrangement s covering resettlement services and information sharing Hidden Harm fidings implementati on Implement findings Review against baselines release of high risk / high profile drug dependent prisoners Review Progress Review Progress Ensure all lessons learnt published and communicated * FAFFOR = Facts, Analysis, Findings, Futures, Options for action, Recommendations, designed as interim report for Steering to present current issues and decide further strategic direction. 5

Detailed Action Plan Tables Outcome 1 Increase Independent Living LAA target Increase the % of vulnerable people living independently. In this case, vulnerable people indicates problematic drug users Target 1.1 A higher proportion of drug users, especially problematic drug users, recovering from their dependency and reintegrating into the community 09/10 baseline X% increase Target 1.2 A reduction in reoffending as a result of better services and improved reintegration support 09/10 baseline X% decrease Target 1.3 An increase in the number of drug users accessing and retaining secure housing 09/10 baseline X% increase Target 1.4 Target 1.5 Target 1.6 Target 1.7 Local Target An increase in the number of drug service users accessing and continuing to participate in employability schemes An increase in those service users obtaining and retaining paid, licit employment, with associated reduction in welfare benefit claimants An increase in service users tracked through the change system, who move from referral to positive completion of treatment, with housing and/or employment Better care and safeguarding of service users, their carers and families including dependent children, through improved arrangements for data sharing Increase TOPS reporting to National Standard Level (as EDAP Treatment Plan) 09/10 baseline X% increase 09/10 baseline X% increase 09/10 baseline X% increase 09/10 baseline X% increase Area Milestones / RAG Lead Timescale Linked Outcome / LAAs Retendering of F&F 5, 6, 7 & 9 Target 1.1, 1.2, DIP services in agreed 1.6 order to create end to end CJS Risk / benefit DAAT CJS Lead All Independent case management analysis and Living and intervention review team, from police All Reducing harm custody to prison Set Adult JCM caused by drugs and beyond. commissioning timetable Plan Link DAAT Strategy CJS Plan Treatment plan Risks Implement commissioning timetable Adult JCM 6

Implement Outcome Star and tracking DAAT Performance Manager Q1 10/11 Set baselines and new financial year targets DAAT Performance Manager Q1 10/11 Prison Treatment Review progress F&F 1, 2, 3, 7 and 9 agreed 10/11 Target 1.1, 1.2, 1.6 Integrate CARAT commissioning All Independent Living Integrate IDTS commissioning All Reducing harm caused by drugs Set commissioning timetables Adult JCM Implement Outcome Star and tracking DAAT Performance Manager Set baselines and new financial year targets DAAT Performance Manager Q1 10/11 Review progress group Q1 10/11 Employability F&F 13 agreed Map current system with Jobcentre and local suppliers Implement ongoing tracking / Jobcentre Plus Coordinator / Jobcentre Plus Coordinator Q1 10/11 Target 1.1, 1.4, 1.5 Reducing use of benefits Reducing offending Economic 7

system independence Review progress Q4 10/11 Increase in skills Young People & Transition Arrangements F&F 7 & 9 Finalise transitions report, include data in Strategic Assessment Agree recommendations Transitions Consultant Target 1.1, 1.7 Reduction in youth crime ASB perceptions Local crime targets Begin implementation Economic independence Risk / benefit analysis of aligned planning with adults Q4 Increase in skills Reducing drugs use Review progress, agree alignment of planning Q4 Family functioning Hidden Harm Finalise Hidden Harm Report Hidden Harm Consultant 10/11 Safeguarding Agree recommendations 10/11 Begin implementation 10/11 Housing Appoint Housing Coordinator Complete mapping exercise F&F 10 agreed Housing Coordinator Q4 Target 1.1, 1.3 Reducing offending Reducing drugs use Agree Q1 10/11 Family functioning 8

recommendations from mapping Hidden Harm Implement recommendations from mapping 10/11 Sustained independence Accommodation related support Review progress Align Supporting People and DAAT Commissioning Complete mapping exercise Agree recommendations from mapping Adult JCM Housing Coordinator Q4 10/11 Q4 Q1 10/11 Target 1.1, 1.3 Reducing offending Reducing drugs use Reducing use of benefits Implement recommendations from mapping 10/11 Family functioning Hidden Harm Review progress Progress Q4 10/11 Sustained independence 9

Outcome 2 Reduce harm to communities caused by drugs misuse Target 2.1 Reduction in the negative consequences of drug misuse for the community 09/10 baseline X% increase Target 2.2 Reduction in drug related crime as a result of better coordinated services 09/10 baseline X% increase Target 2.3 Increase in DRR completions X% increase Area Milestones / RAG Lead Timescales Linked Outcome / LAAs DRR F&F 5, 6 and 7 Target 2.1, 2.2, agreed 2.3 Plan Link Risks As CJS Action Plan EDAT CJS Lead All Reducing harm caused by drugs Review current provision EDAT CJS Lead Recommendations for change EDAT CJS Lead PPO Testing F&F 5, 6, 7 and 9 agreed Target 2.1, 2.1, 2.3 Community Well Being Communications As CJS Action Plan F&F 4 agreed Involvement in Connected Care projects in Pitsea and Jaywick Agree SCP Comms plan, including target measures, groups and measures EDAT CJS Lead Adult JCM Q4 All Reducing harm caused by drugs Physical Health Mental Health Feeling safe Review progress against plan Annual 10

Regular, quarterly updates to DAAT Manager, with decision to use for publicity. Identify surveys and information to assist communications targeting and messages Ensure Service User and provider information disseminated Quarterly 11

Outcome 3 Target 3.1 Target 3.2 Target 3.3 Organisational Efficiencies A saving in administration, bureaucracy and decision making lead times through the reduction in number of processes, groups and meetings required to commission and performance manage services An increase in services and service outcomes without an increase in funding, through improved coordination A reduction in administration costs of the system and reduction in lead time to decision making, quantified in staff hours Area Milestones - RAG Lead Timescale Linked Outcome / LAAs Governance Review current Target 3.1, 3.1, governance 3.3 structure Form SCP Steering All Plan Link Risks Retender Service User Involvement Recommend revised governance structure, including service user and provider involvement F&F 8, 9, 11, 14 & 15 agreed Implement governance structure Review Targets Agree Exit Strategy Implement Exit Strategy DAAT Manager Q4 Q4 10/11 Q4 10/11 12

Strategic Assessment Finalise definition of SCP targets and indicators EDAT Info Officer Target 3.2 All FAFFOR Report agreed Present main report, linked to localities Strategic Assessments EDAT Info Officer F&F 12 agreed Q4 Review gaps, blockages and needs with regional / central groups Strategic Assessment used for 10/11 treatment planning Q4 Continue ongoing Strategic Assessment EDAT Info Officer Q1 10/11 Review effects of info sharing and strategic assessment freedoms Q4 10/11 13

Outcome Hierarchy In order to move the treatment system forward, as well as widening and lengthening what is the current treatment system to include JobCentre Plus and other agencies, it is essential that Essex DAP look to commission via outcomes as oppose to solely outputs. Currently, the performance management framework for Drug Action Teams across the country is based around output performance, for example waiting times, and Key Performance Indicators are used as proxies for success criteria. An example of this is the effective treatment target. Numbers of individuals who stay in treatment for more than 12 weeks is used as a proxy for numbers of individuals who leave the treatment system as a planned discharge. Essex DAP want to move past proxy indicators, and even past planned discharged numbers, to commission services to increase outcome areas for individuals. For example, instead of % of individuals staying in treatment more than 12 weeks, Essex DAP will commission services to reduce the offending, drug misuse and increase family functioning of those referred to treatment. TOPS will be integral in achieving the measurement of this, and Essex DAP is in the enviable position of being one of the most successful areas on the country for TOPS submissions. Clearly, outputs are still important in order to gauge throughput, conversion and % rates of success for commissioning. The element of success criteria for commissioned services will become a balance between outcome and throughput achievement. It is worth noting at this point that an element of the conditions of the Systems Change Pilot is that all current National Treatment Agency dictated targets will continue to be met throughout the pilot. Filter funnel systems will be used to gauge throughput, with outcomes measurements alongside to ensure quality and behavioural change is achieved. An example of this is shown below with the first Outcome Hierarchy diagram. Numbers (throughput) will be gleaned from the pathway shown at the centre of the diagram, with attrition and conversion rates added as required. Along the left side of the diagram are the draft proposed outcome elements that will be seen as success criteria for those moving through the system. Example: Outputs Outcomes 100 people seen with waiting times Stabilisation 85 retained in treatment for over 12 weeks Reducing Drugs Use / Reducing Offending 60 access ETE services Increase in Skills 40 gain employment NEET to EET 30 positive discharges (from entire system, not solely current treatment) Economic Independence / Reduced Return to Treatment Essex DAP will be commissioning services to increase outcomes for individuals within their system as well as outcomes for surrounding communities. Therefore, the second diagram shows how the above principle can be applied to commission services to work with and for the communities that they serve outside of solely problematic drug users referred to them for treatment. 14

Outcome hierarchy Mortality Rate Independent Living LAA, % of vulnerable people living independently Economic independence Positive discharges Overall employment Housing move on Reducing use of Benefits Retentions (whole scheme) NEET to EET Sustained independence Increase in Skills Increase in levels 2/3/4 qualifications LAA Housing Access to ETE Opportunities Adult volunteering Accommodation Support Return to treatment Reducing Offending Mental Health Physical Health Carer support Access to Aftercare / Through care BBV s Stopping Smoking Alcohol Related Hospital Admissions Family functioning / Hidden Harm Family based interventions Primary / Mental Health Care Reducing drugs use Stabilisation Treatment Quality (MoC Compliance) Service User Involvement Drug Treatment / MoC Substance Misuse by YP LAA (include transitions) Waiting times / Access to treatment 15

Reducing Harm of Drugs Feeling Safe Safer County Hidden harm Safeguarding Reduction in NEET Reducing SAC Reduction in no of victims Reduction in Youth Crime Clean Streets ASB Perceptions - LAA Local crime targets LCJB / Cracked trials etc Reduction of Offending (Probation supervision) Community re-integration Prison Release Community treatment Prison treatment Breach DRR s Remand Court processing speed PSR s Arrest Referral IOM PPO Enviro-Crime Localities Safer Essex / SCP Board Commissioning / Tasking DAAT Strategic Assessment Repeat DV LAA Arrest JSNA incl treatment / YP Pre CAF / Merlin CDRP Strategic Assessment E-Oasys Re-offending Availabilities Arrest data Disorder S. 60 data 16

Freedoms and Flexibilities Requests 1. Movement of responsibility for IDTS and CARAT commissioning to EDAP 2. Budgetary movement of IDTS and CARAT funding to EDAP 3. Aligning of related commissioning with EDAP joint commissioning IDTS, CARAT, PPO Testing, DIP 4. Total funding for substance misuse for Mental Health Trusts. Trusts are commissioned by EDAP from the pooled treatment budget, but also have substance misuse funding directly from the NHS Trusts in the area. These two budget areas are currently separate and would benefit from being pooled. 5. DRR target flexibilities 6. DRR / DIP Case Management guidance 7. Review of all related targets within performance management framework 8. Outcome based commissioning using filter funnels regarding individual and locality based impact measurement 9. Relaxation of specific grant conditions for budgets which become pooled 10. Housing benefit adjustment for move on 11. End of financial year planning 12. Changes to Needs Assessment to allow Strategic Assessment to take precedence, with annual refresh 13. Jobcentre plus scheme extension 14. Use of Outcome Star to support TOP s, baseline target setting and measurements 15. Review of guidance and criteria for vulnerable people, and how this relates to substance misusers 17

Steering Terms of Reference Purpose and Key Activities 1. To lead, direct and drive forward the Systems Change Pilot, on behalf of EDAP and Safer Essex Board 2. To convene as the focal point for strategic direction for substance misuse in the County and :- a. To take the strategic lead and own the 3 key strands of the Drug and Alcohol Agenda i.e Prevention, Treatment, Enforcement and to ensure that these areas of work are reflected within the EDAP Strategic Plan and the Essex-wide partnership locality working b. To ensure that all substance misuse issues are included in annual Needs / Strategic Assessment and firmly linked with JSNA / ENIMS c. To recommend to the Safer Essex Board the annual EDAP Delivery and Treatment Plans d. Oversee appropriate EDAP budget and performance monitoring e. To report into the Safer Essex Board 3. To act as an effective co-ordinating body, ensuring that there is a strong voice for district level priorities and interests on other partnerships such as the Local Criminal Justice Board and Local Strategic Partnerships. 4. To consider and recommend priorities for community engagement and other related issues for LAA2. 5. To monitor performance for all county level substance misuse priorities 6. To lead on the agreed strategic objectives and consider progress against these objectives 7. To take a strategic overview of resources including financial and recommend allocation of these resources for projects and services that fulfil identified strategic needs 8. To be responsible for, lead and direct sub-groups, including Adult Joint Commissioning Board, to ensure strategic direction, value for money and public value are achieved Arrangements and Chairing of Meetings 1. The Chair of the partnership group shall be appointed for one year and shall be selected from and by the Safer Essex Board 2. Administration for the group will be provided by Essex County Council EDAT Team Initial Membership Chair - Director of Public Health 5 x PCT Directors of Commissioning Essex Police Superintendent Essex Probation Lead Essex County Council Directors of Commissioning (Adults and Schools, Children and Families) Chair, Essex Housing Officers Regional Lead, JobCentre Plus National Treatment Agency, Eastern Regional Manager GO East Mike Ward Director of Offender Management First meeting will discuss Terms of Reference, governance, action plan and membership and further direct each area. EDAAT Team Advisors DAAT Strategic Manager, Systems Change Pilot Manager, Adult Joint Commissioning Manager, Young Peoples Commissioning Manager 18

Policy Analyst Role Seconded to team as initial part of pilot In order to optimise use of the strategic assessment, Essex DAP aim to include policy analysis as part of the interrogation of data, local and national research and current policies. The strategic assessment will be run using National Intelligence Model principles, and will be based within the Essex Drug Action Team. This role affords the unique opportunity to review local and national policy, combined with an evidence based assessment of needs and data, and recommend new policy direction that will put Essex at the heart of substance misuse policy by informing national policy. Using Public Value concept as a basis, the policy analysis role will ensure that the gaps analysis and data being provided by the team is measured and analysed against existing policy and local survey data, to direct local drugs partnership policy in line with residents value and political direction. The role will require an individual who will: Work on their own initiative to contact and link with local, regional and central policy makers and researchers Robustly test strategic assessment hypotheses against policy Collate and challenge current policy Ensure that this new strategic assessment process is recorded and published Present findings and any new policy directions to strategic and political departments Have excellent negotiation and communication skills, both written and verbal Work on cross cutting themes with multiple organisations and departments The role will fit in line with the timescale and milestones for the strategic assessment, and will be for three months from the 1 st of July. Primary milestones: By end of July: Collate, summarise and challenge relevant policy at local, regional and national level Make contact with appropriate policy makers in relevant areas, especially local LAA leads Understand and inform strategic assessment process Understand substance misuse performance management framework By end of August: Link findings with local survey and research data In tandem with data team, recommend new performance management framework and gaps analysis and cost benefit analysis Create horizon scanning documentation of local, regional and national future issues with implications for substance misuse Present initial findings to local, regional and national stakeholders, esp policy makers By end of September: Write and publish full description of strategic assessment management process, including data used, analytical products employed, learning from process and summary of policy findings and recommendations 19

Current Governance Structure County CYSP Safer Essex Partnership Board Change Pilot Steering Young People s JCG Adult JCG Prison Partnership Board 20

Proposed Governance Structure Safer Essex P/ship County CYPSP Essex H&WB CDNE Systems Change Pilot Steering Board / EDAP Adult & YP Joint Commissioning Boards Communities Treatment Harm Reduction Shared Care Alcohol CJS / Availabilities Data Expert Task & Finish s Communications 21