2013-16 Service Specification September 6Th V9

2013-16 Service Specification September 6th v9

Cornwall & Isles of Scilly
Community Alcohol & Drug Service Specification
Adults 2013-2016
Reducing Harm, Promoting Recovery
A Drug and Alcohol treatment system that:
1. is simple for people to access;
2. has a clear range of pathways, options and choices that are easy for people to navigate;
3. is delivered through co-ordinated partnership working,
and
4. achieves positive outcomes by supporting recovery and community integration for service users, children, families and local communities.
Service Specification No.
Service / Provision of Community Adult Drug and Alcohol Recovery and Treatment Service
Commissioner Lead
Provider Lead
Period / April 2013-March 2016
Date of Review / March 2014

Purpose

NHS Cornwall (CIOSPCT) is tendering an outcome focused, recovery oriented, community alcohol and drug treatment system (the Service) on behalf of the CIOS Drug and Alcohol Action Team (CIOSDAAT) partnership. The DAAT commissioning functions are currently based within NHS Cornwall and will be transferring to Cornwall Council in April 2013. This service specification has been developed with key stakeholders of the partnership. The drug and alcohol tender process provides the opportunity to establish a fully integrated and comprehensive, recovery-orientated system in CIOS; ensuring value for money and the delivery of continuous improvements in recovery outcomes and harm reduction. This is in line with national strategies and other policy directives.
The provider will submit a service design that will deliver outcomes for 2013/14 and beyond and will provide monthly performance management information of the highest quality that demonstrates progress towards achievement of these outcomes.
Local commissioners want to procure a system model which is sensitive to the different needs of Service Users in CIOS. The service should deliver evidence based interventions that are recovery focused for both drug and alcohol users, and which take into consideration the transfer of care between the community and prisons as well as effective transition between Young People’s and Adult Treatment services.
The commissioner requires a service which places service users at its core and embeds a culture of active and inventive methods of service user involvement which permeates service delivery. The service will embody an ethos of ambition for individual success and demonstrate a proactive approach and entrepreneurship in developing opportunities for individual success and sustainable recovery.
This specification will be reviewed regularly and may need to be amended dependant on changes in national policy, identification of changing local need, change in best practice and changes to financial allocations. The provider must be prepared to enter into negotiations with the commissioner if such changes are required and allow for variation of this specification as a result.
Unforeseen situations may emerge which have not been planned for or included within the service specification and the provider may need to work beyond the remit of this specification to ensure that a service users’ health needs are fully met. These incidences should be reported to the commissioner to inform future service specification development.

1. Strategic Context:

1.1 National Context
1.1.1 The national Drugs Strategy 2010[1] has two overarching aims with regard to treatment:
·  Reduce illicit and other harmful drug use, and
·  Increase the numbers recovering from dependence.
The strategy describes the elements of recovery:
‘Recovery involves three overarching principles – wellbeing, citizenship, and freedom from dependence. It is an individual, person-centred journey, as opposed to an end state, and one that will mean different things to different people. We must therefore, put the individual at the heart of any recovery system and commission a range of services at the local level to provide tailored packages of care and support. This means that local services must take account of the diverse needs of their community when commissioning services’
‘One of the best predictors of recovery being sustained is an individual’s ‘recovery capital’ – the resources necessary to start, and sustain recovery from drug and alcohol dependence. These are:
·  Social capital - the resource a person has from their relationships (e.g. family, partners, children, friends and peers). This includes both support received, and commitment and obligations resulting from relationships;
·  Physical capital - such as money and a safe place to live;
·  Human capital – skills, mental and physical health, and a job; and
·  Cultural capital –values, beliefs and attitudes held by the individual.
In order to deliver recovery-oriented services, there is an acknowledgment that links with housing, employment and family services must be firmly established and integrated into overall treatment services and that supportive relationships with families, carers and social networks must be promoted’.
The strategy includes working with alcohol dependence and also covers new plans for monitoring the performance of drug treatment services.
1.1.2 Recovery Orientated Drug treatment- an interim report (NTA 2011) [2]
The report by John Strang, chair of the Expert Group formed “to provide guidance to the drug treatment services on the proper use of medications to aid recovery and on how to care for those in need of effective and evidence-based drug treatment is more fully orientated to optimise recovery.”
1.1.3 Medications in Recovery. Re-orientating drug dependence treatment NTA (2012)[3]
Provides a framework for meeting the ambition of the Drug Strategy 2010 to help more heroin users to recover and break free of dependence.
1.1.4 The national Alcohol Strategy 2012[4] adds the following aims:
§  A change in behaviour so that people think it is not acceptable to drink in ways that could cause harm to themselves or others;
·  A reduction in the amount of alcohol-fuelled violent crime;
·  A reduction in the number of adults drinking above the NHS guidelines;
·  A reduction in the number of people “binge drinking”;
·  A reduction in the number of alcohol-related deaths; and
·  A sustained reduction in both the numbers of 11-15 year olds drinking alcohol and the amounts consumed.
1.1.6 The Drug Interventions Programme (DIP) is a key part of the government's strategy for tackling drugs and reducing crime which seeks to facilitate access to help at any point in the criminal justice system. This has been extended to allow the inclusion of alcohol and drugs other than Class A.
1.1.7 Integrated Offender Management (IOM) the TurnAround project is the overarching framework that allows local and partner agencies to come together to ensure that the offenders, whose crimes cause the most damage and harm locally, are managed in a coordinated way.
1.1.8 The Troubled Families Programme
In 2011, the governement unveiled plans for a Troubled Families proramme[5] for families with ‘serious problems’ including parents not working, mental ill health and children not in school, and causing crime and anti-social behaviour. In March 2012 the DCLG’s announced The Troubled Families programme: Financial framework for the payment-by-results scheme for local authorities.
1.1.6 National Outcomes – Public Health Outcome Framework
CIOS DAAT has responsibility for delivering against the following 3 national outcomes locally:
“Successful completion of drug and alcohol treatment”
Public Health Domain 2.15 / “Reducing Alcohol-related admissions to hospital”
Public Health Domain 2.18 / “Identifying people entering prison with substance dependence issues who are previously not known to community treatment and engaging them in treatment”
Public Health Domain 2.16
CIOS DAAT also contributes to the delivery of :
1.8 Securing employment for those with a long term health condition
1.11 Reducing domestic abuse
1.13 Reducing re-offending
1.15 Reducing statutory homelessness
2.8 Improving the emotional wellbeing of looked after children
2.10 Reducing hospital admissions as a result of self-harm
2.23 Self-reported wellbeing
4.3 Reducing Mortality from causes considered preventable
4.8 Reducing mortality from communicable diseases
4.6 Mortality from liver disease
4.10 Preventing suicide
4.11 Reducing emergency re-admissions within 30 days of discharge from hospital
1.2. Local context:
1.2.1 Alcohol
The three objectives of the Cornwall and Isles of Scilly alcohol strategy are to:
1)  Enable people to make informed choices about alcohol.
2)  Increase services to reduce harm caused by alcohol.
3)  Create partnerships to reduce alcohol’s impact on the community.
·  Of the total 441,000 population aged 16 and over in Cornwall, 102,000 are drinking above the recommended safe levels (just under a quarter), according to public health estimates. In addition, an estimated 66,500 are 'binge drinkers’.
·  1,428 adults engaged in structured treatment in 2009/10 for alcohol as their primary problem substance, 9% of the estimated number of dependent drinkers in Cornwall.
1.2.2 Local Context – Drugs
·  The latest figures estimate that there are between 2,100 and 2,500 opiate and / or crack users (OCUs) in Cornwall and the Isles of Scilly, with a mid-point estimate of 2,285.
·  The estimated unmet need (people requiring treatment but not in contact with services) is between 550 and 1,300 people.[6]
·  Drug users in Cornwall are more likely than the national average to also have a problem with alcohol.
·  Two thirds of parents in treatment have children living with them.
·  The rate at which people are discharged from treatment is lower than average and around a fifth of people in treatment have been in for 4 years or longer.
·  Drug use is a risk factor for a third of offenders on the Probation caseload.
·  Across a range of performance indicators, in 2009/10 Cornwall did not compare favourably with the South West for getting offenders into treatment. Once in treatment, however, we are successful on the whole at retaining them and successful in diverting them away from crime.
1.2.3 Cornwall Works for Families
Cornwall Works with Families is part of DWP’s European Social Fund Convergence programme to get members of workless families working together to get closer to the labour market and back into work.
1.2.4 Troubled Families
Alcohol and drug problems are key risk factors in families with complex multiple problems and vulnerabilities.
Based upon local needs assessments, the Cornwall Troubled Families Strategy Group has selected problem drinking and drug taking as one of their local indicators to be added to the national indicators for eligibility to the programme.
1.2.5 Service Users and stakeholders
CIOS DAAT undertakes an annual consultation with service users, providers, clinicians and other stakeholders as part of its needs assessment and review processes. Over the past two years, this has focussed upon how recovery oriented the local treatment system is. This process identified the following priorities for improvement:
o  A clearer vision of recovery and understanding of what this means by service providers
o  Continue to Improve Access to Treatment to attract and proactively engage people in treatment earlier, including increasing self referrals. To include clearer information about what is available and how to access
o  Delivering recovery and progress within treatment, increasing the range of services available, through more flexible responses to individual needs. Recovery to be made more visible to people immediately upon entry. To include:
- Improved care co-ordination
- Daily availability of services and interventions to support recovery
- Post treatment recovery support
- Service user involvement in planning , developing and reviewing services
- Access to housing to support recovery
1.2.6 The Wellbeing, Early Intervention and Prevention Strategy[7] is one of a series of three strategies that set out Adult Care and Support’s commissioning intentions for the next three years.The commissioning intentions identified in the Strategy include:
·  Embedding Changing Lives principles pioneered by the voluntary and community sector in Cornwall. These include:
·  Developing services based on evidence of multiple outcomes and shared impact
·  Not layering solutions but working to connect local services and people together
·  Mainstreaming prevention throughout
·  Safeguarding included in procurement, contracting and monitoring
·  Co-producing services with the people that use and provide services
·  Good quality services that are innovative, outcomes focused and responsive to local need
·  Supporting individuals to live in their own homes in the community
The strategy provides the context for supported accommodation commissioned services for young people and people with complex needs.
1.2.7 Transition
Local transition policies seek to ensure that young people aged 18 & over with drug and/or alcohol problems who continue to need treatment are transferred smoothly to services for adults. Good transitional arrangements will ensure that treatments are provided consistently, with no loss of effectiveness, and that risks to the young person are minimised.

2. Scope:

2.1 Aims of service
2.1.1 Aims
The aims of the adult drug and alcohol treatment system are for drug and alcohol users to achieve long term abstinence from their substance of dependency and to reduce the harms associated with any other alcohol and drug use.
The aims of the adult drug and alcohol treatment system are in accordance with local Prevention Strategy ‘Changing Lives’ principles that organisations should work towards to help with reducing health inequalities, tackling social exclusion, and improving community cohesion.
2.2 Objectives
2.2.1 Increase the numbers of people accessing effective treatment year on year
Particularly young adults and offenders– and to facilitate earlier engagement. People entering treatment in Cornwall have historically been likely to be older than the national average and are likely to stay in treatment longer.
2.2.2 Increasing numbers who
a) successfully complete treatment and
b) then do not re present for at least 1 year
2.2.3 Improving outcomes for individuals, their children, families and local communities.
2.2.4 Demonstrate that the service is designed and continuously improved via effective consultations with service users, their families and other stakeholders.
2.3 Values and beliefs – Service Essentials
·  Everyone has capacity to change and take control over their own lives.
·  Behavioural change requires concerted effort and focus. It requires a range of internal and external resources to initiate and maintain.
·  Services are ambitious for service users and for families and support them to realise their hopes and aspirations
·  The service takes full responsibility for proactively engaging service users and families
·  Service users are actively involved in developing and achieving their recovery care plans
·  Services users are supported in any step they can take, however, small, towards their own health and wellbeing (low threshold services and harm reduction)
·  Service users are actively encouraged to support each other and increase the support they have through self help and mutual aid groups
·  The service integrates learning from history (harm reduction and recovery), best evidence, and experience in order to innovate. This is a learning contract which seeks to develop new ways of working to improve outcomes as well as demonstrates the incorporation of best practice.
·  The best outcomes will only be achieved through service users, providers and commissioners working in partnership with each other and partner organisations in an integrated way to deliver pathways to physical and mental health, housing and social support, employment, education and training opportunities.
·  Safeguarding children and vulnerable adults are integral.
·  An excellent service depends upon excellent customer care, attaining the trust and respect of service users, families and carers and other agencies involved.
·  A well trained & supported workforce will impact positively on client recovery as an inspiring recovery oriented workforce.
·  Training and supporting non-specialist, generic services reduces the stigmatisation of problem drinkers and drug takers and promotes their recovery through raising the awareness and ability of partner agencies
2.4  Service Outcomes
In commissioning local services, the key service outcomes for services users are:
1.  Freedom from dependence on drugs or alcohol
2.  Improvement in mental and physical health and wellbeing and reducing drug and alcohol related deaths
3.  Prevention of blood borne viruses
4.  A reduction in crime and re-offending
5.  Sustained employment
6.  The ability to access and sustain suitable accommodation
7.  Improved relationships with family members, partners and friends
8.  Improved capacity to be an effective caring parent
Equality and human rights are integral to each of these 8 areas, with implications for equitable service delivery and improved access, encompassing gender, sexual orientation, disability, age, isolation, vulnerability, ethnicity, religion and beliefs.

3. Service description and Pathways for a Recovery Oriented System