Annual Performance Management Report – Alcohol and Drugs
North Ayrshire Council · 19 September 2024
Back to Integration Joint Board — 19 September 2024 and its agenda
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Integration Joint Board 19 September 2024 Subject : North Ayrshire HSCP & ADP Annual Performance Management Report – Alcohol and Drugs Purpose : To present the annual performance information in relation to the partnership’s Alcohol and Drug services. This report is for :- • Awareness Recommendation : IJB are asked to note the content of the report. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required √ 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms HSCP Health and Social Care Partnership ADP Alcohol and Drug Partnership 1. EXECUTIVE SUMMARY 1.1 To present the annual performance report for North Ayrshire Health and Social Care Partnership (HSCP) for the period April 2023 to March 2024. 2. BACKGROUND 2.1 This annual report (please refer to Appendix 1) provides detailed information related to all alcohol and drug related performance management targets, standards and outcomes. 3. PROPOSALS 3.1 IJB are asked to note performance in relation to :- • Access to Treatment Waiting Times; • Alcohol Brief Interventions; • Naloxone supply; • Drug Related Deaths; • Training delivery • Finance;
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3.2 Anticipated Outcomes Assurance regarding all key performance management information. 3.3 Measuring Impact All targets, standards and outcomes are monitored and evaluated with any learning implemented via quality improvement methodology. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources The Alcohol and Drug Partnership (ADP) works across agencies with a wide range of staff 4.3 Legal None 4.4 Equality/Socio-Economic Equality Impact Assessments are carried out where required. 4.5 Risk Risk assessments are completed as and when required – Low risk grading with regard to the information contained within this report. 4.6 Community Wealth Building Improvements will increase community confidence in partnership approaches and raise awareness of the impact of alcohol and drugs and the work of the ADP to reduce drug related deaths. 4.7 Key Priorities Actions and improvements link directly with Ministerial Priorities to support the delivery of local strategic and operational plans across statutory and partner services and support wider actions to prevent drug related deaths in line with the National Mission. 5. CONSULTATION Service users, families and staff from across a variety of services have contributed to the achievement of targets, standards and outcomes Caroline Cameron, Director Peter McArthur, Senior Manager, Alcohol & Drug Services 01294 317840, peter.mcarthur@aapct.scot.nhs.uk
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Appendices • Appendix 1 North Ayrshire HSCP & ADP, Performance Management Report Alcohol and Drug information (1st April 2023 to 31st March 2024)
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1 NORTH AYRSHIRE HEALTH & SOCIAL CARE PARTNERSHIP (H&SCP) and the Alcohol & Drug Partnership (ADP) Performance Management Report Alcohol and Drug information 1st April 2023 to 31st March 2024 Prepared by: Denise Brown NHS Prevention and Service Support Team Peter McArthur North Ayrshire Alcohol & Drug Services
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2 North Ayrshire – Access to Services – Waiting Times April 2023 – March 2024 Alcohol • 90% of clients will wait no longer than 3 weeks from referral to appropriate alcohol treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate alcohol treatment that supports their recovery Drug • 90% of clients will wait no longer than 3 weeks from referral to appropriate drug treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate drug treatment that supports their recovery Target achieved Q1 Q2 Q3 Q4 100% 96% 97% 100% Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved Q1 Q2 Q3 Q4 99% 96% 97% 100% Target achieved Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved
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3 ALCOHOL BRIEF INTERVENTIONS (ABI) Ayrshire and Arran wide information Annual report: April 2023 – March 2024 Annual target set by Scottish Government in priority settings (2023/24) – 3420 Total ABI delivery in priority settings (as at 31/03/2024) – 6398 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in wider settings (as at 31/03/2024) – 1210 SUBSTANCE USE TREATMENT TARGET The Scottish Government have created a new ‘Substance Use Treatment Target’ to increase the number of individuals being supported in treatment. North Ayrshire has been set a target to increase numbers in treatment from 882 individuals in April 2020 to 959 individuals by March 2024. Baseline from Scottish Government Quarterly reporting – North Ayrshire North 01/04/2020 882 Target by March 2024 - an increase of 77 North 01/04/2020 959 Interventions were put in place across our community alcohol and drug recovery services to support the achievement of this target. Please note the monthly information supplied is unpublished and has been collected from local prescribing systems to monitor progress, however, we await an initial verified nationally published report. Increase from Baseline figure by 247 at the end of March 2024. This exceeded the target set. Now awaiting a new nationally set target for 2024 onwards. Quarterly period Target Actual Apr-Jun 22 891 898 Jul-Sep 22 900 940 Oct-Dec 22 910 974 Jan-Mar 23 920 1011 Apr-Jun 23 930 1051 Jul-Sep 23 940 1080 Oct-Dec 23 950 1103 Jan-Mar 24 959 1129 Total 2 Year Increase Figure 77 247 Target achieved Target achieved
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7 AYRSHIRE AND ARRAN DRUG RELATED DEATHS INFORMATION Annual summary report: 1st April 2023 – 31st March 2024 National Records for Scotland - Drug Related Deaths Please find information in the link below around the definition of drug related deaths and what deaths are excluded from this definition: https://www.nrscotland.gov.uk/files/statistics/drug- related-deaths/drd2016/html/drug-related-deaths-2016-annex-a.html The link below details the full report which details statistics of drug-related deaths in 2022 and earlier years, broken down by age, sex, substances implicated in the death, underlying cause of death and NHS Board and Council: https://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland/2022 Published confirmed deaths (Extracted from National Records of Scotland Drug Related Deaths in Scotland, 2021) Number of deaths confirmed (most recent published information) East North South Total 2018 29 38 15 82 2019 41 41 26 108 2020 36 39 31 106 2021 38 39 23 100 2022 30 37 15 82 2023 – No confirmed published data as yet (however when reviewing local unpublished information, a further decrease is expected for North Ayrshire) Number of NADARS reviews conducted for individuals identified as potentially suffering a drug related death Number of these reviews which identified learning or recommendations Number of reports submitted by other services which identified learning or recommendations In the last year, local learning identified from reviews were: • NADARS review robustness of processes around GP notification of discharge from their service. • Where clients have not been seen and have to be re-appointed the plan of next steps should be documented clearly within clients notes • The Ayrshire Risk Assessment Framework (ARAF) used to assess a client’s mental health must be updated to reflect any significant change in a client’s circumstance on all occasions • Where Next of Kin information is available it is important to ensure their details are complete and up to date and recorded on the Care Partner system. 47 4 3 0
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8 PREVENTION AND SERVICE SUPPORT TEAM Annual summary report: 1st April 2023 – 31st March 2024 Alcohol & Drug training and education sessions Calendar courses with 739 participants Ad-hoc training courses with 1723 participants 110 89 Bitesize sessions with 79 participants 29 Training Delivery The team continue to provide a wide range of education and training initiatives which focus on improving awareness, competence and knowledge of those affected by alcohol and drug use, and those working in the field. Due to the COVID-19 pandemic the team introduced virtual training, this continues to be offered as well as face to face training. PSST currently issue upcoming training courses on a quarterly basis. What did our participants say? “I really enjoyed the variety of delivery slides/videos/breakout rooms” “Interactive. Trainers very knowledgeable and happy to answer any questions” “Thoroughly enjoyed today. Very informative and I particularly liked the interactive part of the presentation” "Learning about BBV which was new to me. Training was really useful and informative. Trainers were great" "I really enjoyed the training. Being new to this line of work it was very informative and will help me my job role" "I enjoyed learning about the types of drugs and the stats in this session. The trainers’ knowledge of the same provides me with confidence to carry out my role effectively” 46 sessions delivered within Ward 5 Attended 13 stalls/events Ad-hoc training and health information events by locality area 38% 30% 8% 24% East North South Pan-Ayrshire Alcohol Brief Interventions Annual target set by Scottish Government in priority settings (2023/24) – 3420 Total ABI delivery in priority settings (as at 31/03/2024) – 6398 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in priority settings (as at 31/03/2024) – 1210 Follow our social media pages to keep up to date with our activities in the Prevention and Service Support Team Prevention and Service Support Team – NHS Ayrshire and Arran @PSST_NHSaaa
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9 Ayrshire College Alcohol and Drug Liaison Officer 98 workshops were held with 1138 students 37 1-1 supports with students 6 staff supports 9 health events with an estimated 765 contacts 1 training session delivered for 12 information hub staff Naloxone 99 staff completed the Naloxone Learnpro Minimum of 57* lives saved in the community *lives saved across Ayrshire and Arran as reported on the Shared Addiction Management System (SAMS). Many saves go unsupported. 6 Train the trainer sessions delivered 39 Naloxone awareness sessions delivered 113 203 267 401 0 50 100 150 200 250 300 350 400 450 2020 2021 2022 2023 Naloxone supplied by PSST Service Support Service Support facilitate service development activity which supports the implementation and delivery of the quality improvement agenda for Alcohol and Drug Services which meets national, local and strategic objectives. 22 Audit and evaluation activity 8 Guidelines reviewed and updated Get our NHS Ayrshire and Arran Alcohol and Drug App Download the NHS Ayrshire & Arran app from your Apple or Android app store. Then search for Alcohol and Drugs. 32 Drug and Alcohol groups supported Support to implementation of MAT standards and reporting Development of NADARS Roles and responsibilities directory Gathering, collating and presenting client satisfaction and client stories ABI Heat Standard recording and reporting Support to START and RADAR service Support to local Adverse Incident review processes and reporting
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10 INFORMATION MANAGEMENT AND TECHNOLOGY (IM&T) Annual summary report: 1st April 2023 – 31st March 2024 The Information Management and Technology Team are responsible for the development, training and monitoring of the Shared Addiction Management System (SAMS) and the training and monitoring of Drug and Alcohol Information system (DAISy). These systems are used to record drug and alcohol information, which enables the team to provide national and local reports. SAMS updates 3 sections within SAMS were updated New MAT 9 Mental Health added to SAMS SAMS updated to use Active Directory Login New Substitute Prescribing Application went live Training, e-learning and support E-learning • Completion of a new Alcohol Detox module • New Substitute Prescribing read-only module released • Updated ABI module Training • 68 individuals received SAMS training • 34 individuals received DAISy training • 2 Naloxone training sessions delivered to new organisations Support Approximately 50 SAMS/ DAISy support calls per month IM&T are also responsible for the collation and reporting of Drug Related Deaths and the completion of the National Drug Death database. Drug related death reporting Reporting • Quarterly reports including ASPIRE report, (29 individual performance reports), Naloxone quarterly reports, Scottish Governance reports, ADP reports and local performance and planning reports • Development of reports and audits for MAT standards and submission of MAT 1 – 10 numerical data • Monthly reports including 10 current OST reports, MAT Target Report, SAMS Data Quality Reports and Psychological Therapy Waiting Times • Weekly DAISy quality data checks for Waiting Times, Assessments and Reviews for all Alcohol and Drug services • Monthly substitute prescribing audit • Drug related death report • Development of report for new residential rehab dataset • Approximately 10 – 15 ad hoc report requests per month
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11 IMPLEMENTATION OF MAT STANDARDS ACROSS NORTH AYRSHIRE Annual summary report 2023 - 24 In April 2021, the Scottish Government introduced 10 new Medication Assisted Treatment (MAT) Standards for implementation by Alcohol and Drug Services. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality1. , New approaches were required within North Ayrshire to support rapid access to MAT: • A local test of change was carried out to evaluate the new model of care to establish effectiveness prior to roll out • An Improvement Implementation Plan was implemented, evaluated & updated with regular progress reports submitted to the Scottish Government; • Quarterly updates on MAT developments were submitted to the national MAT support Team – MIST; • An explicit delivery plan was put in place for delivering trauma informed practice; • Guidelines and clinical & care pathways of support were put in place to ensure consistency and to support the staff to deliver the interventions. Results/outcomes (2023/24) • Improvement in the waiting time from referral to commencement of appropriate Opiate Substitution Therapy medication - 75% of individuals were offered a first MAT assessment on the same day as engagement with the service • 100% of individuals were supported to make an informed choice on MAT medication and the appropriate dose • 75% of notified high risk events to the multi-agency assessment team for assertive outreach were contacted on the same day • 85% of individuals were retained in service for more than 6 months • Over 90 individuals have shared care support with Primary Care • 100% of individuals received a mental health assessment • 100% of individuals were offered BBV testing, Harm Reduction interventions and a physical health assessment • Improvement in satisfaction and experience of clients. A RAGB self-assessment was completed and evidence (numerical, experiential and process information) was submitted to the MIST team for analysis and benchmarking. The table below highlights a very positive final RAGB score for the implementation of MAT standards 1 - 10 across North Ayrshire with improvement and progress across all 10 standards.
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12 RESIDENTIAL REHABILITATION EXPANSION Access to residential rehabilitation across Ayrshire and Arran – Ward 5, Woodland View. Ward 5 has 10 beds for residential care: Seamless pathways of support are in place with the local community team supporting individuals before, during and after their placement (extra support in place for NA residents e.g. in addition to ongoing NADARS support, everyone is also provided with daily follow up support from the P.E.A.R service for the first week following discharge). During 2023/24 Access to additional local residential rehabilitation - Harper House The NA H&SCP was instrumental in supporting Phoenix Futures, Scotland, to open ‘Harper House’ in November 2022. It is located in Saltcoats and is a Care Inspectorate registered service, funded by the Scottish Government – it offers specialist support for the ‘whole family to recover from the harms of problematic drug and alcohol use’. Their family- focused programme of interventions is ‘designed to benefit each member of the family and the family unit as a whole’. Referrals are accepted from across Scotland, with enhanced local access available for residents of North Ayrshire. These pathways continue to be improved with a local oversight group meeting regularly to support the identification and suitability of families. In 2023/24 NADARS supported 7 applications into Harper House with 5 starting the programme. The 2 families who were not suitable at that time have had continued involvement from community services as appropriate. Access to External Residential Rehabilitation (ERR) Individuals wishing to access external residential rehabilitation support can do so via NADARS who will support the development of a care plan, identify a residential rehabilitation provider, seek funding and then support individuals into, through and after their external residential rehabilitation placement. In 2023/24, 55 referrals were received for ERR. Following assessment, 22 individuals were suitable for ERR and funding was approved (33 individuals felt not ready or declined the ERR intervention at that time and were offered alternative community supports). • 21 individuals commenced ERR (with one individual declining admission at their start date) 5 5 Detoxification Rehabilitation 138 individuals (NA = 94) 74 individuals (NA =45) Detoxification support Rehabilitation support
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13 FINANCIAL INFORMATION ADP 23-24 Forecast Spend Ministerial Priorities Sum of Agreed Projects Community based treatment and recovery services for adults £1,122,568.30 Other £107,995.54 Other Projects £1,030.90 Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) £209,179.50 Alcohol and drug services specifically for children and young people £100,343.47 Recovery community initiatives £135,699.00 Services for Families affected by alcohol & Drug use £126,637.91 Additional National Mission uplift £218,035.22 MAT Standards £364,225.04 Residential Rehab £164,252.28 Whole family Approach framework £141,366.26 Residential Support £41,609.04 Grand Total £2,732,942.45 Community based treatment and recovery services for adults 41% Other 4% Other Projects 0% Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) 8%Alcohol and drug services specifically for children and young people 4% Recovery community initiatives 5% Services for Families affected by alcohol & Drug use 5% Additional National Mission uplift 8% MAT Standards 13% Residential Rehab 6% Whole family Approach framework 5% Residential Support 1% Community based treatment and recovery services for adults Other Other Projects Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) Alcohol and drug services specifically for children and young people Recovery community initiatives
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14 Additional funding streams Ministerial Priorities Sum of Agreed Projects Other Projects £ 1,030.90 Additional National Mission uplift £ 218,035.22 MAT Standards £ 364,225.04 Residential Rehab £ 164,252.28 Whole family Approach framework £ 141,366.26 Grand Total £ 888,909.70 The ADP has accumulated a reserve balance due to underspends in previous financial years. • Plans are in place to utilise the reserves and they are committed in future years. Other Projects 0% Additional National Mission uplift 25% MAT Standards 41% Residential Rehab 18% Whole family Approach framework 16% Other Projects Additional National Mission uplift MAT Standards Residential Rehab Whole family Approach framework