IJB Report - Drug Alcohol Related Deaths Dec 2022
North Ayrshire Council · 15 December 2022
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Integration Joint Board 15 December 2022 Subject : Update Report on Prevention Actions for Drug and Alcohol Related Deaths Purpose : An update report presented for Information and Discussion Recommendation : IJB to note the content and assertive improvement actions contained within the report Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MAT Medication Assisted Treatment ADP Alcohol and Drug Partnership 1. EXECUTIVE SUMMARY 1.1 Drug related Deaths Across Scotland during 2020, 1,330 people died from drug related causes. There were nine less deaths in 2021 than in the previous year1. The decrease is not statistically significant. This figure remains at over twice the figure reported in 2014 (n=614), and more than three times the rate recorded in England and Wales in 2021 (25 v. 8.4 per 100,000 population: age-standardised rates2), 22.9/100,0003. Data reported for 2021 indicates a marginal, not statistically significant shift in death events across HSCP geographies with the previous five-year rate of 27.2/100,000. These rates translate to 100 deaths among people from the Ayrshire & Arran Health Board area: 75 men and 25 women, with 39 deaths in North Ayrshire, 38 in East Ayrshire and 23 in South Ayrshire4. 1 Drug-related Deaths in Scotland 2021: https://www.nrscotland.gov.uk/files/statistics/drug-related-deaths/21/drug- related-deaths-21-report.pdf 2 Deaths related to Drug Poisoning in England and Wales, 2021: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugp oisoninginenglandandwales/2021registrations 3 Drug-related Deaths in Scotland 2021: https://www.nrscotland.gov.uk/files/statistics/drug-related-deaths/21/drug- related-deaths-21-report.pdf 4 Drug-related Deaths in Scotland 2021: https://www.nrscotland.gov.uk/files/statistics/drug-related-deaths/21/drug- related-deaths-21-report.pdf
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Critically these deaths are preventable and represent a considerable human cost for individuals, families, and communities. There has been slower progress than expected in reducing drug deaths across Scotland which requires an expectation of change at pace across systems and services from the Scottish Government. Alcohol related Deaths Information extracted from the National Records for Scotland - Alcohol-specific deaths 2021 report: • There were 1,245 alcohol-specific deaths in Scotland in 2021, an increase of 5% (55 deaths) on 2020. • After adjusting for age, the alcohol-specific mortality rate was higher than the Scottish average in Greater Glasgow and Clyde and in Lanarkshire (at health board level). • Alcohol-specific deaths were 5.6 times as likely in the most deprived areas of Scotland compared to the least deprived areas. Alcohol related deaths* – Health Board level Year Scotland NHS Ayrshire and Arran 2017 1,120 70 2018 1,136 79 2019 1,020 108 2020 1,190 87 2021 1,245 91 *Deaths which are known to be direct consequences of alcohol misuse, registered in Scotland 1.2 The IJB is asked to note the evident challenges in preventing drug and alcohol related deaths and to acknowledge the extensive range of related work being undertaken across the health and social care system by the Alcohol and Drug Partnerships (ADPs) and HSCP clinical and social care teams to evidence an impact on incidents of drug and alcohol related deaths in North Ayrshire. 2. BACKGROUND 2.1 Drug Death Task Force Every drug-related death is a loss and a personal tragedy for partners, children, families, and friends with impacts that reverberate to the wider community and service providers. The Minister for Public Health, Sport and Wellbeing released a public
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statement in July 2019 noting that the rising number of drug-related deaths in Scotland represented a public health emergency and announced the establishment of the Drug Death Taskforce to enable the delivery of Scotland’s alcohol and drug strategy: “Rights, Respect, and Recovery. The primary role of the Taskforce was to co-ordinate and drive action to improve the health outcomes for people who use drugs, reducing the risk of harm and death. The Drug Death Taskforce concluded its work programme in July 2022 with a summary report: ‘Changing Lives’, submitted to the Scottish Government. The report concludes that ‘to bring about transformational change, much greater resource and a strong commitment to increasing system capacity are needed’. The aim of the national mission is save and improve lives through: • Fast and appropriate access to treatment and support through all services. • Improved frontline drugs services (including third sector). • Services in place and working together to react immediately and maintain support for as long as needed. • Increased capacity in and use of residential rehabilitation. • More joined-up approach across policies to address underlying issues - such as poverty, debt, and addiction including measures to address suicide. The Scottish Government will fund the Scottish Recovery Network as part of the initial three-year action plan. This will boost community peer-support groups to allow people to discuss their feelings and drive down suicide. 3. PROPOSALS 3.1 Drug and Alcohol related death data North Ayrshire Drug related death information Published confirmed deaths (Extracted from National Records of Scotland Drug Related Deaths (DRD) in Scotland, 2021) North Ayrshire Year Number of DRD’s 2018 38 2019 41 2020 39 2021 39 Alcohol-specific death rate 2017-2021: At council area in the last five years, Inverclyde, Glasgow City, West Dunbartonshire, North Lanarkshire, Dundee City, Renfrewshire, and North Ayrshire all had alcohol
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specific death rates higher than the Scottish average. Some other areas also had rates higher than the Scottish average but had large confidence intervals which make it hard to tell whether there was a true difference. Drug and alcohol related death prevention – North Ayrshire ADP and NADARS prevention activities include: • Continued roll out and expansion of the Medication Assisted Treatment (MAT) standards. • The implementation of a new MAT Improvement Implementation Plan and submission to the Scottish Government of a North Ayrshire MAT progress report. • Increased support to individuals following a Non-Fatal Overdose. • Increased promotion and supply of Naloxone. • Steering Group meetings arranged to focus on improvement actions to ensure that there is increased support for individuals with ‘co-existing mental health and drug and/or alcohol use. • The roll-out of a new Alcohol and Drug Liaison Service across Ayrshire and Arran. • Compliance with all Alcohol and Drug ‘Access to Treatment’ waiting times standards. • Continued promotion and availability of drug and alcohol related training • Promotion and delivery of Alcohol Brief Interventions (ABI) across priority and non-priority settings whilst continuing to meet the ABI national standards • New pathway and processes formally approved by the North Ayrshire ADP to support individuals into, during and after external Residential Rehabilitation placements • Support to Phoenix Futures in the launch and delivery of the new residential rehabilitation facility ‘Harper House’, in North Ayrshire to support families affected by drug and alcohol use (official opened in November 2022) North Ayrshire Drug and alcohol related deaths reviews In North Ayrshire, the North Ayrshire Drug and Alcohol Recovery Service (NADARS) reviews every death where an individual was known to service (or recently discharged). The aim of all reviews is to reflect on areas of good practise but also to share any learning or improvements. Any identified points of good practise or improvement areas are shared with the North Ayrshire Drug Death Prevention Group (an ADP sub group) for further consideration of shared improvement actions. Since not all services across North Ayrshire conduct a review of each death (and some individuals were also not in contact with statutory services) – the local review process has been enhanced to encourage every Agency (who had been involved in supporting
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an individual) to conduct, as a minimum, their own service review and share any learning: The North Ayrshire Drug Death Prevention Group (which is a multi-agency group) has recently updated its ‘Preventing Drug Related Deaths – Action Plan’. The identified actions are being implemented and will then be reviewed and evaluated. Alcohol and Drug related Performance Management Information will be included in a further full year report covering the period April 2022 to March 2023 will be submitted to the IJB in 2023 and will include updated alcohol and drug related death information and information around specific drugs implicated in DRDs. 3.2 Anticipated Outcomes Reduction in drug and alcohol related deaths in Ayrshire and Arran. 3.3 Measuring Impact There is a significant programme of national and local performance monitoring linked to ADP strategic priority plans and the Medication Assisted Treatment delivery standards service response. 4. IMPLICATIONS 4.1 Financial The Drug Death Taskforce concluded its work programme in July 2022 with a summary report: ‘Changing Lives’, submitted to the Scottish Government. The report concludes that ‘to bring about transformational change, much greater resource and a strong commitment to increasing system capacity are needed’. There has been additional SG ADP investment allocated during 2021/22, including development of the national Harper house Family support service based in North Ayrshire. There continue to be evident risks however in relation to management of ADP reserves in the context of national budgetary pressures. 4.2 Human Resources Workforce development and planning across the whole system in response to national and local strategy priorities and plans. 4.3 Legal None. 4.4 Equality/Socio-Economic The majority of people at risk of drug and alcohol related deaths are among the most marginalised and disadvantaged in our population. Many of those people experience
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significant disadvantage of opportunity and poorer health outcomes. The work of the North Ayrshire ADP and delivery priorities of NADARS progresses and strengthens prevention. The necessary work through ADP, HSCP and the NHS Board contributes to effective means of preventing drug-related deaths. 4.5 Risk The strategic whole systems approach is critical to the success of the national mission to reduce drug and alcohol related deaths with a whole public health population outcome driven approach across the whole of government and society to address risk. It is important that there is coherence moving forward to all the new strategic developments in mental health and wellbeing at both a national and local level to ensure successful targeted, whole system, population, and cross governmental delivery. Investment in continued workforce planning, capacity and development is critical to maintain planning commitments. 4.6 Community Wealth Building The ADP and statutory services continue to develop employability opportunities and peer support and recovery focused roles embedded within workforce plans for people with lived experience. 4.7 Key Priorities The report notes key priorities and actions aligned to national strategy and local strategic plans. 5. CONSULTATION This report notes the significant collaboration and engagement underway both nationally and locally across the health and social care system to prevent drug and alcohol related deaths. Caroline Cameron, Director Thelma Bowers, Head of Service, Mental Health, tbowers@north-ayrshire.gov.uk Appendices • None