MIDDLESBROUGH COUNCIL

Report Title:Drugs and Alcohol Service review and procurement

Executive Member for Public Health: Cllr Michael Thompson

Director: Kevin Parkes, Executive Director, Economic Development and Communities

Date: 3 November 2015

PURPOSE OF THE REPORT

  1. This paper outlines the future plans for the review and procurement of Drugs and Alcohol services in Middlesbrough.
SUMMARY OF RECOMMENDATIONS
  1. It is recommended for the Executive to:
  2. approve the plans to review and procure a drugs and alcohol rehabilitation and recovery service to be in place for 1st October 2016; and
  3. delegate the development and approval of the service specification, procurement documentation and evaluation of the tenders to the Executive member for Public Health supported by the Director of Public Health.

IF THIS IS A KEY DECISION WHICH KEY DECISION TEST APPLIES?

It is over the financial threshold (£150,000) / 
It has a significant impact on 2 or more wards / 
Non Key

DECISION IMPLEMENTATION DEADLINE

  1. For the purposes of the scrutiny call in procedure this report is

Non-urgent / 
Urgent report

BACKGROUND AND EXTERNAL CONSULTATION

  1. Drugs and alcohol have a significant impact on individuals, families and communities. The impacts range from health, social care, safeguarding adults and children, crime, anti-social behaviour, domestic violence, sickness and absence from work. Substance misuse can be both a cause and consequence of a range of health and social issues for the individual, families and communities.
  1. The national annual cost to society of alcohol-related harm is estimated to be £21bn. In Middlesbrough alcohol related harm is estimated to cost £68m of which £29m is crime and licensing, £17m cost to workplace, £16m to the NHS and £8m on social services.
  2. Drug treatment prevents an estimated 4.9m crimes, nationally, every year saving nearly £1bn in costs to the public, businesses, criminal justice and the NHS. For every £1 spent on drug treatment saves £2.50 in costs to NHS and reduced crime.
  1. Tackling drugs and alcohol requires a collaborative and multi-agency approach to:
  1. reducing supply, availability and strengthening enforcement activity;
  2. prevention and early intervention;
  3. treatment , rehabilitation and recovery
  1. The Local Alcohol Profiles for England (LAPE) illustrate the extent to which alcohol related harm and preventable deaths differs across the country. Middlesbrough has some of the worst indicators related to alcohol health harms. Whilst there has been significant progress on a number of indicators especially alcohol related admissions and crimes, more work needs to be done to reduce the gap between the local, regional and national comparators.
  1. Middlesbrough has high levels of estimated drug misuse amongst the population. The Middlesbrough JSNA highlights the local levels of opiate and crack use as being higher than the national and regional averages with a pattern that mirrors patterns of social deprivation across the town. There is national and local evidence of an older cohort of heroin and crack drug users who have been in the treatment system for a number of years and continue to present with complex health and social care issues.
  1. Structured drug treatment has tended toward meeting the needs of what was formerly termed the problematic drug using group, Class A drug users and in particular opiate and crack users. This group has been seen to be at higher risk of causing harm both to themselves and society.
  1. The local number of people going through treatment and recovery services are high for heroin and alcohol, whilst cocaine and cannabis users are under-represented in the services. Whilst there is a reported increase in the misuse ofprescription medication, ’over the counter’ drugs and novel psychoactive substances (NPS) - legal highs, this is not represented in new presentations to treatment.
  1. Middlesbrough has a lower percentage of clients who successfully complete drug treatment and do not re-present in services within 6 months. For opiate clients, this was 6.6% in June 2015, compared to 7.4% nationally. Successful completions for non-opiates is34.8% compared to 39.2% nationally.Since August 2014, opiates successful completions and representations for non-opiates have increased steadily to be more in line with national rates.

  1. Middlesbrough has a higher proportion of adults accessing drugs and alcohol services more likely to have children living with them. In 2014/15, the number of people entering/in treatment who have children was1,310, with 720 of them indicating that they currently have children living with them. This has a significant impact on the number of children and young people who are subject to safeguarding procedures.

Reducing supply, availability and enforcement activity

  1. Middlesbrough was one of 20 local authority areas to participate in the Home Office led Local Alcohol Action Areas (LAAA) programme. The programme had the following aims:
  1. to reduce alcohol-related crime and disorder;
  2. to reduce alcohol-related health harms; and
  3. underpinning both of these aims will be work to promote growth by establishing diverse and vibrant night-time economies
  1. Through the LAAA programme a safety map has been developed which combines data on alcohol related harm from health, police and safeguarding. The map also identifies density and proximity of off licenses and the average price per unit for the cheapest alcohol being sold. This work will inform the review of the Licensing policy and the review of the alcohol strategy currently underway.
  1. The programme also identified areas for improving the night time economy and diversifying the local offer. Work is underway utilising the Purple Flag framework, an accredited standard for the night time economy, to improve the local offer. The Purple Flag is a recognised standard in itself which, if achieved in Middlesbrough, would provide a foundation to refresh the public’s perception of Middlesbrough’s night time economy. It also provides a foundation for the sustainability and continuation of the priority work areas identified through the LAAA.
  1. There is need for a similar coordinated programme to be developed to tackle drug related issues. Currently, there is limited information and intelligence sharing on drug supply and drug markets between the different agencies resulting in the efforts to disrupt drug supply not being joined up. Cleveland Police have identified this is one of the priority areas and work is now underway to establish develop and strengthen the local arrangements.
  1. The local aim is to create an environment where the vast majority of people who have never taken drugs continue to resist any pressures to do so and to make it easier for those that do to stop. Public Health and the Police are working together to develop actions aimed at young people with targeted actions for those most at risk of using drugs, particularly NPS, cocaine and cannabis.

Prevention and early intervention for drugs and alcohol

  1. Prevention and early intervention is an important component of the local service delivery. A number of awareness raising campaigns have been carried out, led by the public health team and their partner organisations/services with examples including:
  1. regional and local campaigns with Balance NE such as Alcohol Awareness Week, Dry January, Foetal Alcohol Spectrum Disorder;
  2. Middlesbrough Recovering Together (MRT) employing a community development worker to provide in-reach into local communities, raise awareness of substance issues, promote services and engage people;
  3. The Recovery service holds quarterly events in the Town Hall Crypt to celebrate Volunteer and Peer Mentor qualifications, promote good news stories and show the positive side of treatment and recovery; The service recently organiseda recovery walk through the town centre to provide a more visible celebration of local recovery;
  1. There has been significant progress with regard to early intervention over the last three years, with many initiatives resulting in positive impacts, including:
  2. Naloxone programme – preventing opioid-related deaths from overdose by providing take-home naloxone kits and training to high-risk clients;
  3. Fulcrum GP alcohol pathway – early identification, screening and brief intervention delivered within GP practices across Middlesbrough by substance misuse professionals. This has resulted over 2,000 patients being screened in the waiting room of their own GP practice with the majority not having had any previous contact with substance services;
  4. Hospital Intervention and Liaison Team (HILT) – based within James Cook University Hospital (JCUH), preventing multiple re-admissions for substance-related issues, screens patients and A&E attendances, refers into community services, has a detoxification pathway to ensure continuity of treatment and delivers training to JCUH staff to raise awareness of substance issues;
  5. The Middlesbrough Recovering Together (MRT) drugs and alcohol service delivers substance misuse awareness, identification and brief advice training to a wide variety of staff from a range of organisations;
  6. Needle exchange provision across the town, delivered centrally from the Town Hall and from ten pharmacies serving communities where misuse is most prevalent, which helps to reduce the harm related to intravenous drug use (e.g. blood borne viruses, dropping used needles, access to specialist advice);
  7. Senior practitioners integrated into 0-19/family services to ensure substance misuse early intervention provision and prevention of cases being escalated into safeguarding.

Drugs and alcohol treatment and recovery services

Children and young people

  1. The children and young people’s substance misuse service is currently delivered by Platform (provided by DISC) deliver the young persons’. The service delivers advice, information and low-level interventions with clinical provision delivered through Middlesbrough Recovering Together. The service is commissioned by the Council’s Risk and resilience team (in Well-being care and Learning)and has a total contract value of £214,892 per annum (funded by a combination of public health grant and the early interventions grant). The current contract runs until 30th September 2016.
  1. The current treatment model for young people’s substance misuse in Middlesbrough was established in 2007. The service has four distinct roles:
  2. to provide dedicated support for schools, academies and colleges to enable teachers and lecturers to deliver good quality substance misuse education
  3. to support and enable universal and targeted children’s services to respond to substance misuse, through the early help agenda, thereby keeping young people at the lowest tier of treatment possible;
  4. to provide an accessible service where Children and Young People and their Families can make contact with the service directly, and can access general advice, support and where necessary, receive low level interventions or accept the young person into specialist substance misuse treatment, including an outreach service through a seconded youth worker;
  1. to provide specialist substance misuse treatment for young people and their families, including a dedicated service for young people involved in the youth justice system. This includes all 5 modalities of treatment outlined by Public Health England (Formerly the NTA)[1], pharmacological treatment;
  2. although the service is primarily commissioned as a substance misuse service, the overarching approach is for strong links with other risk taking behaviour prevention programmes and services, in particular: Teenage Pregnancy / Sexual Health, smoking and crime and disorder.
  1. The service review will explore the options for delivery of children and young people’s substance misuse and recommend the most effective approach to achieving outcomes.

Adult drugs and alcohol service

  1. The Middlesbrough Recovering Together (MRT) drugs and alcohol service brings together the commissioned drugs and alcohol services and programmes for adults.These services are commissioned by the Council’s public health team contracted until 30 September 2016. The current budget for the substance misuseis £5,320,282.
  1. The services are delivered by the following providers: Fulcrum Medical Practice, Lifeline, Thirteen Care & Support and Hope North East. The MRT services are currently delivered from a number of sites across the town. These include the Fulcrum Medical practice, Hope North East premises and community hubs, Lifeline premises on Park Road North, Forbes Buildings for the community gym and the Town Hall.
  1. MRT has the following three components;
  1. Medical support (Fulcrum) – this is a multi-disciplinary, specialist service covering opiate substitute prescribing, alcohol (specialist) prescribing, specialist in-reach clinics into GP practices, inpatient and community detoxification programmes, residential rehabilitation programmes, relapse prevention, general medical services and specialist/high-level psychosocial interventions.
  2. Recovery support (Thirteen Care & Support and Hope North East) – this covers a telephone service to support people to maintain their service engagement/abstinence, volunteering, peer mentoring, therapeutic groups, recovery activities and programmes, dedicated Citizen’s Advice Bureau provision, employment and housing support to reintegrate clients back into communities. This also includes the use of existing community hubs and local pharmacies in order to offer services closer to home across the town.
  3. Treatment support (Lifeline) – this covers a range of interventions to support individuals with substance misuse issues towards recovery, including single assessment and referral process, psychosocial interventions for counselling, supporting behaviour change, care coordination for complex clients and harm minimisation (needle exchange, screening and immunisations for blood borne infections, support for performance and image enhancing drugs).

Transforming drugs and alcohol services in Middlesbrough

  1. Public Health England (PHE) has recently published guidance for commissioning drugs and alcohol services which includes examples of best practice. Benchmarking against other comparable local authority areas will also be carried out to identify key areas for improvement. These resources together with the findings from the service review will be used to inform the transformation of the drug and alcohol local services.
  1. Transforming drugs and alcohol services is one of the strategic priorities for the Council’ public health team. This transformation seeks to prevent and reduce the drugs and alcohol related harm, improve outcomes for individuals, families, neighbourhoods and communities, whilst delivering cost efficiencies and maximising value for money. As part of this programme, the Council is currently carrying out a review of the current service model for drugs and alcohol recovery to achieve a cost effective recovery oriented service.
  1. The service review will evaluate the effectiveness of the current model of service delivery and will engage with service users and communities. The service review will also seek views from a range of key partners and stakeholders and will adopt a co-production commissioning approach to service redesign and transformation to achieve a high quality, cost effective, efficient, sustainable and integrated drugs and alcohol recovery service. To date a number of key themes have been identified such as;
  1. The numbers of clients who either remain static on substitute prescribing treatment or re-present to services within six months remains high;
  2. Further work is required to understand why clients drop out of treatment and have repeated unsuccessful treatment journeys;
  3. There are a high number of children living with substance misusing parents which the current model does not address their needs effectively or in joint working with wider council services and programmes;
  4. Transition for young people into and adult drugs and alcohol services is not effectively coordinated;
  5. Despite the reported changes in the substance misuse patterns legal highs/novel psychoactive substances, prescription and over the counter drugs, this is not represented in the numbers coming into the treatment and recovery services.
  1. The new service will be characterised by:
  1. prevention and early intervention for the individual, families and communities at the forefront;
  2. focus on outcomes and utilising evidence based and innovative approaches;
  3. high quality, integrated and comprehensive recovery pathway based on an understanding of local needs and adaptive to changing and emerging trends in substance misuse and associated social issues (e.g. housing, employment, anti-social behaviour and crime);
  4. support for individuals to break the cycle of dependency and reliance on services with the aim of increasing the number of people achieving recovery;
  5. coordinated and integrated ‘whole family’ approach in supporting and safeguarding children, young people, families and communities affected by alcohol and drugs.
  6. Having a key role in multi-agency action on tackling supply, reducing availability, reducing related crime and related harm.

The procurement timeline

  1. The existing contract for the drugs and alcohol service will end on 30th September 2016.The Council expects the formal tender process to commence in January 2016 and a procurement plan will be developed in line with the procurement rules and to reflect the type and complexity of the contract.
  1. A project board is being established to oversee the service review and the procurement process. This team will have representation from Public Health England, local public health team, Police, NHS commissioners, NHS clinicians, local safeguarding team, service user representatives, finance, procurement and legal.

OPTION APPRAISAL/RISK ASSESSMENT

  1. A detailed project plan, risk register and communications plan for the review and procurement will be developed and monitored by the project board.

FINANCIAL, LEGAL AND WARD IMPLICATIONS

Financial

  1. Middlesbrough Council currently spends £5,320,282 on drugs and alcohol services and programmes funded from the public health grant.The table below summarises the key programme areas:

Service, programme or activity / Cost (000)
MRT recovery service: Thirteen Group Recovery service (elements sub-contracted to Hope NE) / £798,934
MRT treatment/psychosocial service - Lifeline* / £1,209,994
MRT Pharmacological service (for drugs) – Fulcrum Medical practice / £650,000
Treatment-related costs - drugs and dispensing, needle exchange, drug testing, detox / £1,434,196
Hospital Intervention and Liaison Team (HILT) / £158,673
Whole family service - jointly commissioned service/approach with Stronger families / £155,220
Carers support / £34,000
SECOS project / £50,000
Platform YP service and transitions pathway / £190,036
Prevention and early intervention initiatives / £541,335
Partnership contributions (Balance, Galvanise Project) / £97,894
Overall total / £5,320,282

*elements sub-contracted to Fulcrum