Sunderland Partnership Performance Report

Sunderland Partnership JCG Performance Report – March 2012 Update

1Numbers in Effective Treatment (12 weeks or more) at October 2011

• PDU = 800 (77%)
• Non PDU = 240 (23%)
• All Drug Users = 1040 (100%)

• North East PDUrate = 83%
• National PDU rate= 85%

Mitigating Actions

All treatment providers attended a two day workshop focusing on three areas including access, co-ordination and discharge functions. To increase access into treatment the following actions have been put in place.

Access

• Data cleansing exercise has taken place with Counted 4 and Lifeline to rectify issues with drug episodes
• The 0800 number and assessment function absorbed within Counted 4 to reduce hand-offs
• A client consultation will be carried out from beginning of April and last for four weeks to identify any barriers to accessing treatment including: opening hours, location of services and for those that have previously been in treatment why they have disengaged in the past
• A ‘Warm Welcome’ service consisting of peer mentor telephone support service to be established to keep clients motivated to access treatment and reduce drop out rates
• A DNA protocol has been developed so that a whole systems approach is taken to re-engage those that drop out of treatment
• The ‘Sick and Tired campaign’ will be re-launched to assertively target hidden populations
• Lifeline introducing challenge to all accessing needle exchange to engage effectively in treatment
• A women’s only service will be held in Connected Recovery every Thursday afternoon with crèche facilities available to engage women with children.

2Drug Treatment Successful Completions - Rolling Year

(Please see appendix A for an example of the 3 possible different performance measures)

Opiates - Sunderlandat rolling year to January 2012 for Opiates shows 65 successful completions against the baseline of 62. This equates to +3 or +5% above target.

(The cluster D average to December is +8% and the national average +12%)

Non opiates- shows 88 successful completions againstthe baseline of 138, this equates to - 50 or -36% below target. The national average is +2%.

[1]All drug users- shows 153 successful completions againstthe baseline of 200, this equates to -47 or -24% below baseline. The national average is +7%.

The treatment system still needs to get more clients into the system and successfully completing treatment;although opiateshasseen the first rise above baseline since April, non opiate users haveseen a significant reduction; this is an area for sustained improvement. All drug users show a slight improvement in January, reversing the declining trend evident since April.

Mitigating Circumstances

Although there is an enormous ongoing effort to improve performance rates within Sunderland, The baseline set at April 2011 was set against a then PDU rate of: 920 and an all drugs rate of: 1396 measured at year end to March 2011, this compared to the current rolling year PDU and all drugs rate at rolling year end to January 2012: (830 and 1117 respectively) implies that Sunderland is going to be challenged in relation to the set baseline until the effective numbers in treatment can be successfully increased and sustained.

In real terms, Sunderland is currently working with 90 (10%) fewer PDU and 279 (20%) fewer all drugs users than at the time the April 2011 baseline was set, and the lower proportionate rate for all drug users may explain the more challenging baseline for this group.

3Drug Treatment Successful Completions and Exits – Year to Date

3.1Successful CompletionsYTD

Successful completions for all drugs exiting treatment YTD to January 2012 for Sunderland was measured at 132 or 43% thisis generally in line with both the regional and national averages at 45% and 47.6% respectively.

The opiatessuccessful completions figure at January 2012was 55 or 36% this is also in line with both regional and national averages at 34.2% and 37.2% respectively.

3.2Treatment Exits by Exit Reason, Year to Date - April 2011 to January 2012

Treatment exits YTD to January2012 forSunderland and national figures does not show any significant differences, although the two most noticeable differences are:

• The drop out rate for Sunderland is around 4.5% higher than nationally

• The treatment completed(drug free) rate is around 4.5% lower.

Mitigating Actions:

Co-ordination

• The Care Navigation Meetings will be revised to scrutinise all new referrals entering the system so that multi agency care plans can be put in place. This also enables care packages to be revised to support re-presenters with more intensive interventions.
• There has been increased capacity within the social work team to allow wider implantation of Care Navigation work
• A case tracking co-ordinator function extended to include the whole system to monitor treatment outcomes to reduce unplanned discharges. All agencies have committed to using Micase to make this tracking and co-ordination an easier process
• Weekly reporting underway to ensure a clear ongoing picture of completions against monthly target (12 monthly)
• Cohorts identified for targeted work including intensive file audits and multi agency care packages

4Re-presentation Rates (within 6 months of completing treatment)

Year to December 2011

(Completions: Jan to June 2011 with 6 month re-presentation window:July to Dec 2011)

During 2011 there were 26% of opiateclients who successfully completed treatment during Jan to June who re-presented to treatment during July to Dec; this is slightly higher than the national average at 21%.

Discharge

• A ‘Transfer of Care’ protocol and pathway has been developed, this will enable three way meetings to take place to ensure that a client has engaged into a service before being discharged from the transferring service
• Post discharge TOPS will be carried out to allow services to intervene at the earliest convenience if any clients are at risk of re-lapse
• Contract of main provider being varied to include financial penalty for failing to successfully discharge enough clients against trajectory
• Treatment Effectiveness Meetings will be held monthly to monitor progress
• Refresher training from NEPHO to be organised for admin staff and managers

5Treatment Outcome Profiles (TOP)

5.1Compliance: Q3 20011-12

Sunderland is generally performing well with TOP reports and continues to achieve the 80%+compliance level to receive quarterly reports for Start/Review and Start/Exit TOP’s.

5.2 Reduced drug use, housing and employment outcomes

5.3TOP Exceptions

IOM had 34 new treatment starts during Q3 but only 27 had a start TOP completed within the +/- 2 week time frame (79%).

C4 had 38 clients start in the period (who were in treatment for at least 6 months) but only 30 had a review TOP completed within the 5-26 week time frame, this has lowered the start/reviews compliance rate.

C4 had 2clients successfully exiting treatment who did not have a TOP completed within the +/- 2 week time frame, and IOM and NECA Washington each had 1 client successfully exiting treatment and not completing an Exit TOP within the time frame.

6Criminal Justice Clients

6.1 DIP referrals during Q3

There were only 19 clients triaged and starting a modality from the 30 new referrals from DIP during Q3. (Leaving 11 clients potentially lost to the treatment system)

Although this is an improvement over Q2 when only 45% (27 from 60 clients) were triaged and started a modality, (and better than national performance currently at 57%) there is room for improvement around new DIP referrals into treatment to ensure clients do not drop out of the system.

6.2 Criminal Justice (CJ) Successful Completions

From all CJ clients in treatment: 253 (rolling year to end of Q3 Dec-11) 14% or 35 (opiates=10, non opiates=25) have successfully completed treatment; this is in line with the national average at Q3 of 14%, howeveris a slight fall for Sunderland from Q2 when 17% successfully completed treatment.

6.4 CJ Re-presentations

During the first 6 months of 2011 there were 25 CJ clients (opiate=6, non opiate=19) successfully completing treatment;of these, 4 (opiate=1 and non opiate=3) re-presented to treatment during the following 6 month period: July to Dec 2011 a 16% CJ re-presentation rate. (North East CJ re-presentations rate = 18%, National = 15%)

6.5 CARAT

CARAT to CJIT transfers and pickups for referrals made during Q3

During Q3 theSunderland pick up rate for CARAT to CJIT transfers is significantly below both the national and north east averagesand requires some considerable improvement.

• Pathways have been improved to reduce drop out rates for those leaving prison. Turning Point provides all providers daily with information of remands and short sentences so they can continue to engage those in prison

• DISC staff are working into the prescribing agency to enhance engagement and target those dropping out from IOM pathways

• Friday prison leavers are accommodated via multi agency Saturday clinics

7Alcohol

7.1 Numbers in Treatment

The figures below show the number of alcohol clients currently in treatment, and the ‘Year to Date’ figures for those in treatment.

At Jan2012the number of clients in treatment was: 480, the Year to date figure was: 866

New presentations into treatment average around 60 per month.

Discharges also average around 60 per month.

7.2Waiting Times

Waiting times for first intervention for alcohol during Q3 was 97% - for 3 weeks and under.

7.3Treatment System Exits (YTD)

Year to date (to Q3) there has been 178 planned exits (54%)

7.4Alcohol Related Hospital Attendances

The table above shows analysis of the activity relating to the Top 30 most frequent attenders at City Hospital Sunderland. Following a general rise during the year to a peak in August, (93 attendances) the following months show a general decline and exhibit some reduced activity.

• 6 Month period: (March-11 to Aug-11 = 466 attendances)
• 6 Month period: (Sept-11 to Feb-12 = 443 attendances)

Stephen G Potts

March 2012

Appendix A:

The Three Different Performance Measures for Drug Successful Completions

(Uses All Drugs as an Example)

• Measure 1)Numerical difference from baseline (Growth in successful completions)

e.g.Baseline = 200 (set from the performance during April 2010 to March 2011)

Performance at rolling year to: Jan 2012 = 153 successful completions

Measure 1 is therefore: -47

(This measure does not take into account changing numbers in treatment after the snapshot taken at the April baseline)

April 2011 Baseline = 200

-47 (-24%)

Jan 12 Performance = 153

• Measure 2) Percentage difference from baseline (% Growth in successful completions)

e.g.Baseline = 200 (set from the performance during April 2010 to March 2011)

Performance at rolling year to: Jan 2012 = 153 successful completions

Measure 2 is therefore: -24%

(This measure does not take into account changing numbers in treatment after the snapshot taken at the April baseline)

• Measure 3) Successful completions as a proportion of all in treatment (rolling year numbers in treatment)

e.g. Baseline = 14.3% (this was set from the performance during April 2010 to March 2011 and was calculated with 1396 numbers in treatment and 200 successful completions at baseline which is a 14.3% successful completion rate)

Performance at Jan 2012 = 13.7%

Numbers in treatment Feb 11 to Jan 12 = 1117 (rolling year)

Successful completions = 153 (13.7% of 1117)

Therefore Measure 3is: 14.3% – 13.7% = -0.6

(This measure takes into account changing numbers in treatment after the snapshot taken at the April baseline)

Measures 1 and 2 are important because they directly influence a proportion of the money paid to Sunderland from the PTB. (20%)

Measure 3 is important as it is an indication as to how well Sunderland is performing with changing client numbers currently within the treatment system.

1

[1] ‘All drug users’ does not take into account cluster averages as the calculations for clustering are based primarily around opiate users and their treatments.