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Agenda item

Alcohol and Drug Abuse - Update

Minutes:

Charlotte Ashton, Deputy Director, Public Health L.B. Islington/Camden, was present for discussion of this item and outlined the report.  Georgia Brown, Chair of Islington Clients and Drug Abuse and Alcohol services, Lisa Luhman, Substance Misuse Commissioning Manager, Islington/Camden Public Health, Peter Kane, Divisional Director, Camden and Islington NHS Foundation Trust, and Liz McGrath, Clinical Director, Camden and Islington Substance Misuse service, Camden and Islington NHS Foundation Trust were also present            

 

During discussion of the report the following main points were made –

 

·         Islington experiences some of the greatest levels of substance misuse related harm in London. Substance misuse has significant detrimental impacts on health services, crime and community safety, and is important contributor to adult and children’s social care needs, as well as having wider economic, employment and societal impacts

·         Better Lives, Islington’s adult drug and alcohol recovery services, has been operational since April 2018, following a major redesign and transformation programme. The vision and operating model for the new service, aligns closely with the Council’s Corporate Plan, and specifically the development of integrated, place-based working in localities focused on tackling the deeper social challenges, which prevent residents from fulfilling their potential, and improving outcomes for themselves, and their families

·         The new integrated contract and service model represents a very significant move away from previous ways of working, and service provision. As a consequence, public health commissioners acknowledged that, owing to significant mobilisation and change processes, that the provider needed to implement, in order to establish this new service, performance was likely to be impacted in the first year of the contract delivery

·         Prevalence information – new estimates of the number of crack and/or opiate users were published in 2018, and give an indication of the number of people in a Local Authority area, who are in need of specialist treatment, as well as a measure of unmet need, (based on the proportion of those estimated to be in need), who are not currently in treatment. The Home Office estimated that in 2010/11 the cost of illicit drug use in the UK was £10.7 billion per year

·         Research has shown that for every £1 invested in drug treatment, there is a £2.50 benefit to society. There were 203,808 people engaged in treatment in 2015/16, and if these people were not in treatment, they may have cost the NHS over £1billion. It is estimated that structured treatment prevented 4.9 million crimes in 2010/11

·         Health risk factors for drug misuse include - family history of addiction, socio-economic deprivation, homelessness, unemployment.  Men are more likely to use illegal drugs, and poor mental health is linked to drug misuse, and vice versa, and there are strong links between health inequalities, and drug use, however the picture is a complex one

·         Feedback from service users – mystery shopping has found that users feel that the services that are available are helpful. The service user forums have developed some positive initiatives, however there is mixed engagement across the three main service sites – Grays Inn Road, Seven Sisters Road and King Henry’s Walk

·         Better Lives – the new adult Islington Drug and Alcohol service started on 1 April 2018. Camden and Islington Foundation Trust are the lead provider, working in partnership with Westminster Drugs Project, and Humankind (formerly Blenheim CDP). There were significant logistical challenges in the first 6 months of operation. There has been positive feedback from partners about the proactive, and flexible engagement, of staff from Better Lives, and a pilot project has been instituted, based in GP practices, to work with people who are being prescribed benzodiazepines, and opioids, who are showing signs of dependence. Since November 2018, Better Lives has offered a new structured day programme at King Henry’s Walk, and more targeted group sessions are being offered across all sites. There has been a renewed focus on reducing drug related deaths, and there has been raised awareness of drug and alcohol harm, and how to support people that are using substances

·         Better Lives has developed its partnership working, with housing/supported housing providers, and there is improved joint working to support service users. There has been a continuation, and support, of street outreach activity, in partnership with St.Mungo’s outreach team. In addition, support is being provided for people in poor health, and the service is adapting to the changing needs of service users, and specifically those service users who have increasing health risks and needs

·         Themed feedback – the Better Lives Family Service is a therapeutic service for children, young people and adults, whose lives are affected by someone else’s drug or alcohol use. In year 1, the family service received 80 referrals, and in Q1 and 2 of 2019/20, there have been 49 referrals, and this is expected to continue to increase. There is a range of support available, including group sessions, and shortened interventions, in order to meet needs. More recently, the Family Service has made links with the Young Carers Group, to hear from young carers as to what they feel would help them in understanding what their parents/guardians are experiencing

·         Performance – Islington’s new contract and service model Better Lives, represents a significant move away from previous ways of working. Owing to the significant service mobilisation effort, and change processes that the provider needed to implement, in order to establish the new service, the performance in the first year of the contract dropped. However, in Q1 2019/20 improvements in performance are evident, and the number of people in effective treatment has risen, together with treatment successful completions

·         Further progress includes – abstinence rates for all four substance categories are within, or exceed, expected ranges. Better Lives has also been focusing on developing their partnerships with a number of key services, and providers

·         Service user reported outcomes – Seven well-being related i statements were developed with Better Lives service users, and service users rate themselves at the start of treatment, and at each 3 monthly review. Service user reported outcomes are an important guide for joint care planning, and are a self-defined, and valid way, of measuring progress

·         Key challenges and priorities for the year ahead – in the next 12 months, commissioners will support Better Lives, to increase the number of people accessing, and engaging, with the service, and continue to improve performance across all key performance indicators. In addition, work to continue to develop effective partnerships with key services, and providers, is taking place, to further develop and identify opportunities for co-production, continue to tackle drug related deaths by ensuring Naloxene is offered widely to those using drugs, and their friends/family, and also to support service users to access appropriate health care services  

·         Reference was made to the fact that at King Henry’s Walk there is provision for a number of schemes that catered for specific needs. Footfall is increasing at the Seven Sisters Road site, however this is challenging, due to the drug problems in the Finsbury Park area

·         Contact is being made with BAME groups, and specific training is being provided

·         It was noted that Quarter 2 performance has shown a further improvement in the service

·         Reference was made to the fact that the provider has undertaken a great deal of training, and that this is continuous

·         There is still work to be done with young people who are involved in drug supply, and this is an area where partnership working needs to take place. There is also the need to also to work in conjunction with adult services. There are often a number of factors involved in dealing with substance misuse, such as housing, health, employment, and youth services, and there needs to be a co-ordinated approach. There is also a need for more work to be carried out with the criminal justice system

·         It was noted that there is no wait time in order to access services at present

·         Outreach staff are being trained to disseminate information in the community, and people often refer themselves to the service, as a result of contact with other service users

·         It was noted that work is taking place with the Refugee Forum, and BAME groups, and there is a need to access services in the community at different locations, and this is additionally being looked at

·         Members were informed that often users presented with multiple substance misuse issues, and the issues are often complex ones

 

RESOLVED:                              

 

(a)  That the report be noted, together with the progress in developing the new service, and improving outcomes for Islington residents affected by substance misuse

(b)  That when the update is presented to the Committee in 12 months, comparative performance figures be included for other similar Local Authorities

(c)   That Members be informed of awareness training that Members can access, if they wish to do so

 

 

 

The Chair thanked Charlotte Ashton, Lisa Luhman, Peter Kane, Georgia   Brown, and Liz McGrath for attending

Supporting documents: