ITEM 8 Medical Assisted Treatment (MAT)
North Lanarkshire Council · 27 March 2024
Back to Health and Social Care Integration Joint Board — 27 March 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 8 SUBJECT: Medical Assisted Treatment (MAT) Standards TO: Integration Joint Board Committee Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 27 March 2024 1. PURPOSE OF REPORT This paper sets out the progress made towards implementing the Medication Assisted treatment (MAT) standards in North Lanarkshire for 2023. The current position for each standard is set out below with an updated status on each standard required for national reporting in April 2024. This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note the content of the report; (2) Acknowledge the significant progress made towards delivering the Medication Assisted Treatment Standards (MAT) throughout 2023. (3) Note the current status of MAT Standards implementation and the position for this year’s national benchmarking report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Scottish Government initiated the Medication Assisted Treatment (MAT) Standards in 2021 with the expectation of MAT being fully implemented by 2024. North Lanarkshire ADP and relevant integrated authorities are required to work towards the national drug mission objectives which includes the delivery of the MAT Standards. A national benchmarking report was published by Public Health Scotland on 23rd June, 2023 showing progress made across Scotland on a RAG status basis. Lanarkshire was in a good position to implement the MAT standards with more work required to fully embed the 10 standards across all localities. North Lanarkshire RAG Benchmarking position 2023: MAT 1 = Amber MAT 2 = Green MAT 3 = Amber MAT 4 = Amber MAT 5 = Amber This paper sets out the progress made in more detail and highlights the position for North Lanarkshire, based on evidence due to be submitted to Public Health Scotland, for the 2024 benchmarking report. In order to meet green status there’s a requirement to provide numerical data, evidence standard operating procedures (SOPs) in place, and report on experiential feedback gathered through interviews with those in services, practitioners and families Yes ☐ No ☒ N/A ☐
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3 National progress on MAT Implementation as of 1st April 2023 5.2 A Pan-Lanarkshire oversight group meets quarterly with a north delivery group meeting monthly to monitor and progress the MAT standards delivery plan. This group Chaired by the Head of Health and includes reps from the MAT delivery team from Public Health Scotland. The ADP is required to report on progress to the Scottish Government on a monthly basis. – A Project Lead was recruited in May 2023 to oversee all MAT deliverables over the next 2 years. – Operational MAT leads were identified to maintain progress on each standard. – A peer support worker was recruited to support the experiential elements of the MAT standards delivery. – All experiential evidence is gathered by fully trained peers from the Recovery Community to engage with those in contact with services. 5.3 MAT 1. All people accessing services have the option to start MAT from the same day of presentation. Standard met – Expected Green. ‒ The Urgent Care Response Team launched in March 2023. This was initially supported by 3 Advance Nurse Practitioner’s (ANPs) with 2 further posts in North as part of a Pan-Lanarkshire approach. ‒ In total, 390 referrals were made for MAT in North Lanarkshire via the Urgent Response Team from April 2023. ‒ In December 2023, 81% of people referred for MAT were assessed within 24 hours, the target is to reach 75% of referrals within in 24 hours. ‒ A decision was reached in January 2024 to move to a North specific approach linking the local Addiction Recovery Teams (ART); to
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4 enhance capacity and improve access for those requiring same day access to MAT. MAT 2. All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose. Standard met – Expected Green. – Standardised approach in place setting out choice offered to individuals across all services - SOPs/guidelines in place. – Leaflet/promotional content developed for individuals accessing treatment, setting out all choices. – NHSL continues to grow the focus on choice with the ongoing expansion of clinics offering different treatment options. MAT 3 & 5 are now linked. All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. All people will receive support to remain in treatment for as long as requested. Standards 3 – Provisionally Green. – A local near-fatal overdose response system is in place. This system links with the Scottish Ambulance Service, tier 2 support services including the active recovery community. – The Crisis Outreach Team was commissioned via the North ADP to provide Overdose response, assertive outreach capacity and crisis support (linked to housing service as part of the rapid rehousing transition plan). – Since the service became operational (December 2023), 170 people have been reached across all 3 elements of the combined service operated by Turning Point Scotland (TPS). – NHSL Harm reduction team works closely with TPS and the Scottish Ambulance Service to ensure suspected overdose patients are linked to the response team within 72 hours (standard requirement). – MAT 5 data sets are now complete and in place with final snap shot data collections tested. – Exit planning – supported/unsupported discharge data still required for review and improvement plan is in place. MAT 4. All people are offered evidence-based harm reduction at the point of MAT delivery. Standard Implemented – Provisionally Green. - All locations now offering three core harm-reduction measures (take- home naloxone and overdose awareness, injection equipment provision and blood-borne virus testing) at follow up MAT appointments. - Harm reduction kits provided to all sites with Injecting Equipment Provision/Wound care/Dry Blood Spot Testing - staff guides within to ensure consistency all across teams.
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5 - Experiential data gathered suggests people have access to harm- reduction interventions and there is widespread awareness of naloxone. MAT 6 & 10 are now linked. The system that provides MAT is psychologically informed (tier 1); routinely delivers evidence-based low-intensity psychosocial interventions (tier 2); and supports individuals to grow social networks. Standard in progress – Amber. – A Pan-Lanarkshire multi-agency steering group is in place and a training plan is being rolled out in conjunction with the development of appropriate training resources for all frontline staff. – A trauma walk through was delivered by Addiction Psychology Service (APS) for the North Addiction Recovery Teams (ART) to highlight improvements for the patient experience. – Some constraints exist due to release time for staff to complete training linked to this standard, this is limiting the roll out of the workforce development plan. – There are now 4 Turas hosted modules available to expedite the delivery of the training plan. MAT 7. All people have the option of MAT shared with primary care. Standard Not Implemented – Red. – NHS Lanarkshire took a strategic decision over 15 years ago to centralise provision of MAT in a GP-run Community Prescribing Service to ensure equity of access. – These arrangements have worked well and are funded from FHS budget (£0.55m in 2022/23). In addition, a MAT dispensing and pharmaceutical care service is funded via community pharmacy (£2.016m) alongside a needle exchange scheme (£0.05m). – Following discussions with the GP subgroup, there is a strong preference to retain a special interest GP approach as there is neither the capacity nor skillset within most practices to reverse our approach. – Prescribing within community pharmacy may be an option but will require further maturity and development – A task and finish group has been created to guide MAT 7 compliance within our existing infrastructure, focussing on a range of options to review and improve the offer to meet MAT 7 – Medical Director has met with MAT Joint Chairs and locality service managers North and South to discuss the approach moving forward MAT 8. All people have access to independent advocacy and support for housing, welfare and income needs. Standard met – Green. – Review carried out across all services with key actions, recommendations required to standardise referral pathways, baseline data and reporting arrangements to evidence MAT 8.
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6 – Commissioned advocacy services are in place in North Lanarkshire via ADP funding and clear pathways now exist across treatment and care services. MAT 9 is linked to MAT1. All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. Standard in progress – Provisionally Amber - A steering group was established and joint working between mental health and addiction services (including commissioned services) is in place. - A Pan-Lanarkshire forum was established to develop a protocol outlining the expectations for the holistic, joined up care of people with a co- occurring mental health condition and problem substance use. - There is a delivery plan for this standard in place and more wide-spread and routine screening for Mental health concerns now takes place across all key services. 6. CONCLUSIONS North Lanarkshire is on track to meet all MAT standards with the exception of MAT 7. This is due to constraints linked to delivery of MAT across Primary Care. North Lanarkshire is not unique in this. MAT 7 limitation have been acknowledged by the Scottish Government and Public Health Scotland as a national barrier with the majority of ADP areas unable to deliver on this standard. A great deal of work has gone into achieving the standards across the whole system, this has been acknowledged by Public Health Scotland and the Scottish Government. North Lanarkshire is in a much stronger position than this time last year. The appropriate measures are now in place to drive forward the additional improvements required to fully embed all standards across all localities in 2024. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐
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7 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL MAT standards Annual budget £309,606, of which £268,036 has been allocated to the fixed-term posts set out above and delivery of MAT standards 1-10, in keeping with the current delivery model. The majority of MAT standards funding is tied to posts as set out above. Additional Injecting Equipment Provision and Naloxone costs have now been linked to this budget for 2024 as well as equipment and supplies for the day to day running of the Urgent Care Response team. This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Yes ☐ No ☒ N/A ☒
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8 Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: Yes ☐ No ☐ N/A ☒
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9 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. None. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Morag Dendy DendyM@northlan.gov.uk Yes / Date added ☐ No ☐ N/A ☐
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10 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed