Medication Assisted Treatment - Annual Report
North Ayrshire Council · 19 September 2024
Back to Integration Joint Board — 19 September 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
Integration Joint Board 19 September 2024 Subject : North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report Purpose : To present the annual report in relation to the continued implementation of the Medication Assisted Treatment Standards. 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 Medication Assisted Treatment MAT HSCP Health and Social Care Partnership ADP Alcohol and Drug Partnership 1. EXECUTIVE SUMMARY 1.1 To present the 2023 to 2024 annual report regarding the continued implementation of the Medication Assisted Treatment (MAT) Standards. 2. BACKGROUND 2.1 This annual report (please refer to Appendix 1) provides detailed information relating to implementation of the MAT Standards, achievements, outcomes and priorities for the year ahead. 3. PROPOSALS 3.1 IJB are asked to note information in relation to :- • Effects of change; • Intervention Outcomes; • Client experience; • Developments and future priorities;
Page 2
• Benchmarking and RAG ratings; • Improvements and progress 3.2 Anticipated Outcomes Assurance regarding positive progress in the delivery of MAT Standards across all 10 Standards. 3.3 Measuring Impact All targets, standards and outcomes are monitored and evaluated with any learning implemented via quality improvement methodology. More detailed outcomes and positive impact measures are evidenced via regular reporting to the Scottish Government. 4. IMPLICATIONS 4.1 Financial There is a risk of being unable to sustain implementation of MAT Standard 7 (Primary Care) unless recurring funding can be identified (currently the ADP has provided non- recurring funding to implement a new model of care which will be evaluated over the next 2 years). 4.2 Human Resources The implementation of the MAT Standards involves a wide range of staff across a variety of partner organisations 4.3 Legal None 4.4 Equality/Socio-Economic Equality Impact Assessments are carried out where required. 4.5 Risk Risk assessments are completed. There is a Low risk grading with regard to full implementation of 9 of the 10 Standards. There is a Medium risk grading with regard to the full implementation of MAT Standard 7 (Primary Care) due to the absence of recurring funding. 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 & HSCP to reduce drug related deaths.
Page 3
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 MAT delivery. Caroline Cameron, Director Peter McArthur, Senior Manager, Alcohol & Drug Services. 01294 317840, peter.mcarthur@aapct.scot.nhs.uk Appendices • Appendix 1 Medication Assisted Treatment – Annual Report
Page 4
IMPLEMENTING MEDICATION ASSISTED TREATMENT (MAT) NORTH AYRSHIRE DRUG AND ALCOHOL RECOVERY SERVICE (NADARS) Reporting period: 1st April 2023 - 31st March 2024 Quality issue: In 2022, there were 1,051 drug related deaths registered in Scotland, 279 deaths fewer than 2021. Although this is the lowest number of deaths since 2017, there were 3.7 times as many deaths in 2022 compared with 2000. Ayrshire and Arran continues to have the second highest death rate at 28.1per 100,000 population. Evidence suggests quick access to treatment is crucial and being in treatment can be a protective factor for majority of individuals. The Scottish Drug Deaths Taskforce (SDDTF) has prioritised the introduction of the MAT standards to help reduce the number of drug related deaths. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality. Aim: To have no barriers to accessing treatment and care that supports an individual’s recovery. This project focussed specifically on improving access to appropriate Medication Assisted Treatment (MAT) within the North Ayrshire Drug & Alcohol Recovery Service (NADARS) in order to prevent deaths, reduce harms and promote recovery opportunities. Effects of change during 202324: • Improvement in the waiting time from point of referral to commencement of appropriate Opiate Substitution Therapy (OST) medication - average time from assessment to prescribed medication 0 days. • Increased choice in OST medications • Improvement in satisfaction and experience of clients. • All individuals received a mental health assessment and support as required. • All individuals were offered Blood Borne Virus (BBV) testing, Harm Reduction interventions, physical health assessment and referred on for further support where required. • All individuals had the opportunity to access Recovery Development Worker's with lived experience to provide person centred recovery support. • All individuals had the opportunity of family involvement. • All individuals were offered housing, advocacy support and were referred for social care support where appropriate. Tests of change: Cycle 1: Implement and Test the MAT clinic pathway on a Monday and a Thursday in one locality (Three Towns). Cycle 2: Secure funding to recruit staff to support the implementation of the full model. Cycle 3: Refine project charter to facilitate full model Cycle 4: Expand service to 5 days per week across 6 localities of North Ayrshire (NA). (Test of change is complete and now working towards sustaining full model during 2024/25) 0 1 2 3 4 5 Average number of days referral to prescription 0 1 2 3 4 5 6 7 8 9 10 Average number of days from assessment to prescription Median = 3 days Median = 0 days
Page 5
IMPLEMENTING MEDICATION ASSISTED TREATMENT 565 REFERRALS BY GENDER FEMALES MALES 188 377 (33%) (67%) REFERRALS BY GENDER & AGE GROUP 0 50 100 150 200 0 - 24 25 - 34 35 - 44 45 - 54 55+ COMMENCED SAME DAY/NEXT DAY (where clinically safe and appropriate) 97% of clients commenced MAT on same day or next day from assessment INTERVENTIONS OFFERED AT POINT OF MAT DELIVERY 100% of clients were offered Mental Health Support and Harm Reduction interventions BBV testing, IEP and Sexual Health 350 individuals chose this pathway of MAT related support. The reasons given for not commencing the pathway were: • clients went to prison • not ready to commence MAT but continued to receive support from the wider service NALOXONE AND OVERDOSE AWARENESS 100% 72%* of clients were of clients were supplied offered Naloxone with Naloxone or already had a kit *The remaining 28% declined* CLIENT SATISFACTION Of clients rated their initial waiting time either “excellent” or “very good” 79% 81% Of clients rated the communication from NADARS either “excellent” or “very good” Of clients who were able to commence medication at their initial appointment stated that there were no delays in getting their prescription 95% 95% Of clients felt that they were given sufficient information to make an informed choice on their treatment options 95% Of clients felt that the NADARS worker explained all the care and treatment options in a way that they understood 81% Of clients rated the overall service either “excellent” or “very good” OPIOID SUBSTITUTION THERAPY (OST) MEDICATIONS PRESCRIBED FOLLOWING ASSESSMENT 63% 32% 5% Methadone Espranor/ Buvidal Suboxone This evidences increased patient choice of OST
Page 6
IMPLEMENTING MEDICATION ASSISTED TREATMENT Developments during 2023/24: • Quarterly reports have been submitted to the Scottish Government evidencing progression across each of the 10 standards from the previous year. • An explicit delivery plan was put in place for delivering trauma informed practice • LOPs, SOPs, guidelines and clinical & care pathways of support were reviewed & updated • MAT availability was increased at Caley court and expanded to 5 days per week. MAT is now available across all 6 localities with immediate support available to all from Caley Court alongside remote (low threshold) access in more rural areas including the islands. • Over 90 individuals currently have ‘shared care’ support with Primary Care colleagues. • A workforce training plan is in place to ensure all staff offering MAT & OST can provide the core harm reduction services at the same time and place as MAT delivery • A robust 7 wide reaching experiential process was implemented by the NA ADP, to capture, analyse and utilise feedback from clients, families and staff to inform service improvement • Appropriate recording information systems were updated to collect and analyse data • In the absence of additional national being able to be accessed, the NA ADP committed non-recurring funding to implement initial MAT 7 (Primary Care) developments at pace. • A new staff guidance document was approved for implementation to provide an ‘interface protocol’ as to how secondary care mental health services & alcohol & drug services can better support individuals with co-occurring mental health and alcohol and/or drug use. Priorities for 2024/25 • Sustained implementation of all 10 MAT standards • Following formal submission of experiential data, we will conduct a local analysis to identify themes for further improvement. • Based on national feedback/approval we will update the NA MAT 7 model & explore options to secure additional funding to deliver, in full by next year, a revised NA implementation plan • Work underway, with all ADP partners, to scope out requirements and system change to support MAT delivery for individuals using Stimulants and Benzodiazepines; • Engage with service users, families and staff to evaluate and learn from the recently implemented MAT 9 related multi-agency ‘operational interface protocol’ to better support individuals presenting with co-occurring mental health and alcohol and/or drug use • For MAT 6&10 a key development/priority is to continue to increase access to psychological interventions and therapies through staff training and ongoing support. INFORMATION AND FEEDBACK 565 referrals were received between 1st April 2023 and 31st March 2024 350 clients commenced MAT support (the others declined service, required preparatory support or disengaged from service) 97% of clients commenced MAT on the same day or next day from assessment (where clinically appropriate and safe) 99% of clients commenced MAT within 1 week Reasons for timescales over 7 days include initial non- attendance with follow up in place Detailed numerical data on referrals, timescales, interventions etc was submitted to MIST in April 2024, which is now being analysed to identify good practice and learning.
Page 7
IMPLEMENTING MEDICATION ASSISTED TREATMENT EXPERIENTIAL FEEDBACK • To gather feedback and data in a consistent and impartial way, the ADP adopted a multidisciplinary approach by identifying a mixture of service staff and individuals with Lived & Living Experience (LLE) to gather experiential feedback from service users, families/carers of people on MAT, and staff delivering the service. • Individuals identified to carry out the interviews attended a 3-session training course delivered by MIST (national MAT Implementation Support Team). • A mixed methods approach was applied to gather data e.g. 1-1 interviews, smaller engagement events. • The ADP Support Team collated, analysed, and themed the data for submission to MIST (with full involvement of the Experiential Engagement Team and people with LLE). The feedback received was mainly positive and demonstrates the ease of access, increased choice of medications and no barriers to the overall support received. “Everything got dealt with at my initial appointment. Services are totally different now in comparison to years ago so there is nothing I could suggest that would've made it better” “I definitely felt involved in my options. I mind the lassie discussed all available options I could choose from and I think it was Espranor she recommended for me, due to it having a blocker effect, so if I used on top of it there would be no effects. I decided to go for methadone though and my choice was respected.” MIST BENCHMARKING 2024 – SCORING TRACKER Over the last year there has been improvement and progress across all 10 standards