Item 10 - Alcohol and Addiction Services
North Lanarkshire Council · 21 September 2022
Back to Health and Social Care Integration Joint Board — 21 September 2022 and its agenda
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REPORT Item No: 10 SUBJECT: North Lanarkshire ADP – Self-Assessment TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran, Strategic Lead for North Lanarkshire ADP DATE: 21st September 2022 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval x For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed X Endorsed
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3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note the content of the report; (2) Note the key actions to support the strategic direction of NLADP structures to deliver on the priorities in line with additional investment; (3) Note the additional investment and ring-fenced budget for each priority area; Medication Assisted Treatment (MAT) Standards Residential Rehab Assertive Outreach and Crisis support Harm reduction – including Naloxone provision Whole Family Approach and Family Inclusive Practice Lived and Living Experience (4) Approve NLADP Self-Assessment completion setting out the appropriate governance is in place to deliver the National Mission priorities and The Partnership Delivery Framework objectives. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on alcohol and drugs use issues locally. Members include agencies with an interest in providing treatment and intervention for people experiencing problem alcohol and drug use, and other key stakeholders. 5.2 The NLADP Strategic Lead has been working closely with strategic partners through the five ADP sub-groups (below) to develop key actions in keeping with national evidence, regional scoping work and learning from commissioned services including the voices of lived experience 1. Prevention, Early Intervention, & Education Yes No N/A
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2. Treatment, Care & Recovery 3. Whole Family Approach 4. Public Health Approach to Justice 5. Reducing Alcohol Harms Group 5.3 All thirty of Scotland ADPs are responsible for delivering on the National Mission Priorities. The aim of the National Mission is to improve and save the lives of people who use drugs and their loved ones. It will do this by: providing fast and appropriate access to treatment and support through all services improving frontline drugs services (including the third sector) ensuring services are in place and working together to react immediately for people who need support and maintain that support for as long as is needed increasing capacity in and use of residential rehabilitation implementing a more joined-up approach across policy and practice to address underlying issues. 5.4 A Self-Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. 5.5 The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. Strategic Planning follows a cycle of Assessing need Aligning resources Agreeing delivery plans and priorities Reporting and learning from outcomes 5.6 The self-assessment is designed to ensure key relationships are in place and that the local system is supporting the work of the ADP. The self-assessment should be agreed and signed off with the relevant Chief Officers and stakeholders 5.7 The self-assessment will set out where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: 1. Strategic planning 2. Financial arrangements 3. Quality improvement and Outcomes 4. Governance and Oversight 5. The relationship between the ADP and the Integration Authority
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6. CONCLUSIONS 6.1 The range of work to scope strengths and challenges in current arrangements, place the experience of people with lived experience and families at the centre of developments and engage with all stakeholders will significantly reshape the commissioning intentions, create a robust response to the challenge of preventable drug deaths in North Lanarkshire and inform the proposed Investment Plan. 6.2 The following actions have been taken to progress NLADP response locally (1) ADP Strategic Lead and support team have established the appropriate structures/representation required to support approval and delivery of the ADP strategy in keeping with national priorities (2) Rapid Review of treatment and care services undertaken (Feb – May 2022) setting out key recommendations, actions and priorities to inform NLADP investment and planning (3) Additional investment for 2022 aligned with new funding streams and allocated (4) Residential Rehab oversight and operational groups established to review/establish robust pathways and processes with spending arrangements in place - details published (5) Residential Rehab training sessions complete with further briefings taking place throughout Autumn (6) Pan-Lanarkshire arrangements in place for MAT standards. Oversight and governance group established in September 2022 to drive forward plans to realise target to implement by March 2024. (7) Proposals and commissioning priorities identified by each sub-group to allow NLADP to configure and commission the most appropriate services beyond 2023 (8) Workforce Development needs analysis launched to shape the learning and development programme required to realise the collective skills, knowledge and expertise required to deliver on our priorities (9) Additional funds allocated to support ongoing Test of Change initiatives, local stigma action fund and wellbeing support to tackle some of the root causes of problematic substance use in collaboration with VANL 6.3 The strategic vision and proposed subgroups will carry forward the programme of work to be led by NLADP until 2024. The proposed priorities and structures will support the ADP to report on ministerial priorities given the increased scrutiny that will come with the additional investment directly or indirectly via integrated authorities. 6.4 All actions and progress of the ADP to be recognised in the Self-Assessment setting out any work still to be done.
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7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This paper impacts on all of the national outcomes. 7.2 ASSOCIATED MEASURE(S) • Medication Assisted Treatment (MAT) standards – 1-5 implemented and embedded by March 2024 (6-10 beyond) • Residential rehab – assessment and access for anyone who chooses/where appropriate as part of their care and treatment. Each ADP/Health Board should now publish rehab pathways online setting out how people can access residential rehab. • Harm reduction – consistent approaches and increase workforce confidence/capacity to deliver HR. Includes Naloxone provision. • Assertive Outreach – ADPs should define their approach for increased support with commissioning for effective assertive outreach/crisis support expected in 2023. • Treatment Targets – increase engagement by 9% (113) by 2024 • Whole Family Approach – increase/widen Family Inclusive Practice (FIP) across all treatment and care settings • Recovery – Lived and Living Experience (LLE) involved in design, delivery and evaluation of services. LLE Panels to be established. • Mental Health – Complex needs are fully considered and met via trauma informed workforce • Stigma – tackled at local level • Human Rights – are at the heart of how substance use services and wider supports are designed and offered. NLADP Reporting requirements 2022 MAT standards benchmarking supplementary appendix 27th June – complete Residential rehab pathways processes publish – end of July 2022 – complete
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ADP Annual review 5th August – complete Treatment Target projections – 17th August – complete MAT standards Self-Assessment - 19th September 2022 - in progress Note: NLADP commissioned services are due to submit a 6-month performance and engagement report in October 2022 - service delivery reviews will take place shortly after. 7.3 FINANCIAL Nationally, a commitment has been made to rolling investment for the next 5 years. ADPs are expected to use any reserves in full in addition to the new investment having to account for any reserve or carry forward fund year on year. All funding will be multi-year with an expectation there will be flexibility in how this is utilised for maximum output/impact. Nationally • £5 million of this is to expand access to residential rehabilitation • £5 million to support the priorities of the National Mission • £3.5 million to implement the Whole Family Approach framework. North Lanarkshire Actual Budget Spend YTD Key Initiatives Residential Rehab £317,148 £4,934 Rehab team allocate this spend based on treatment choice & new pathway National Missions £317,148 £119,004 Acute Navigators/Advocacy/Positive support/IPS SAMH/Harm Reduction Whole Family approach £222,004 £40,000 Family plus/Creative faces/housing support Outreach £190,289 £59,278 VAW partnership/ABI/Arrest Referral MAT Standards £380, 578 0 MAT oversight Group will allocate this spend Lived & Living Experience £31,715 0 Post Approved
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CORE Funded Adult support Phoenix £294,204 £108,336 Children Barnardos £270,000 £99,455 Integrated Addiction Team £260,858 £86,953 Youth Bridges £66,246 £21,544 Prison Through care £39,000 £13,000 This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT As part of the updated oversight arrangements of the ADP, a new Risk Register will be formed which will feed through into the operational registers of the partnership and the strategic register of the IJB. 7.5 PEOPLE Regular stakeholder engagement will take place through the ADP subgroup structures with people with lived experience (including families) involved in shaping the decision around tackling alcohol and drug related harms. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 NLADP Strategy Appendix 2 NLADP Position paper on progress toward priorities Appendix 3 NLADP Rapid Review Appendix 4 Self-Assessment tool template CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact John Holleran on 01698 753651
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Appendix 1 NLADP Strategy North Lanarkshire ADP Strategy 2021 – 2024
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About this Strategy This strategy has been co-developed through ongoing engagement with a broad range of stakeholders including people with lived experience across North Lanarkshire. It was vitally important to the success of any improvements we are trying to influence that individual voices and experiences were included in this process. Our approach, coupled with the existing and emerging evidence base for tackling harms from problematic substance use offer a robust and ambitious way forward that will see us confidently lead the way in keeping people safe, well and thriving in North Lanarkshire. This document sets out some of the challenges we face and how we intend to move forward. We have set out the appropriate Alcohol and Drug Partnership structures that will be tasked with implementing change and supporting more people to find their own type of recovery. A detail delivery plan will follow to support specific actions and outputs for the ADP sub-groups. This strategy does not exist in isolation and is intended to link with other strategic plans focussed on identifying and protecting those at risk of harm from substance use. This includes but is not limited to: North Lanarkshire Children’s services plan Mental Health and Wellbeing Strategy Community Justice Improvement Plan Strategic Commissioning Plan VANL strategic plan North Lanarkshire Town Visions NL Housing Strategy & Rapid Rehousing Plan About North Lanarkshire ADP North Lanarkshire Alcohol and Drug Partnership (NLADP) was established in 2019 as a multi-agency strategic partnership focused on understanding and mitigating the impact of problematic alcohol and drug use in the local area. The purpose of the ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who used alcohol and drugs and those around them. The ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives. This includes the wider community and those who have lived experience (including families). Much of our work involves bringing people together to plan and improve services whilst setting out what needs to be put in place to support change and keep people safe and well. We do this by reviewing, monitoring and evaluating the impact of investments targeted towards reducing substance-related
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harm and improving health and wellbeing. Our Approach North Lanarkshire Alcohol and Drug Partnership has drawn on the successes, challenges and learning from previously funded initiatives to form this strategy. In addition, we commissioned targeted scoping work through Scottish Drugs Forum and Scottish Families Affected by Alcohol and Drugs to give us direct insight from individual and family experiences. These offered first-hand accounts of the needs, challenges and innovative ideas for change from those living in North Lanarkshire, including many who have been in contact with services for support with substance-related issues. We’ve also drawn from the invaluable wealth of experience, skills and local knowledge within our workforce and volunteers working across our communities. Policy Perspective In 2018, Rights Respect and Recovery 1and the Alcohol Framework2 were published setting out the Scottish Government’s commitment to reducing deaths from alcohol and drugs and tackling harms to individuals and those around them. For the first time there was direct recognition of the right to health for people who use alcohol and drugs and a focus on a wider approach moving beyond clinical services. This included a commitment to increasing harm reduction measures, tackling stigma, removing barriers to support, increasing community-based recovery opportunities, understanding the links to justice, tackling inequalities and offering direct support for the whole family. At the same time, in Scotland’s Public Health Priorities, the focus on reducing the use and harms from alcohol, tobacco and other drugs and a focus on good mental wellbeing were reinforced taking a public health approach to improve the nation’s health3. Since the publication of Rights, Respect and Recovery and Scotland’s public health priorities, further commitments have been made nationally, as part of the Drugs Deaths Task Force, to refine the response in keeping the most up-to-date evidence-base for what works to support change. This includes the new priorities set out in the Partnership Delivery Framework4, the National Mission Priorities5, Tackling Stigma6 and implementation of the Medication Assisted Treatment (MAT)7 Standards. This document recognises the cross-cutting commitments, outcomes and priorities in each publication and sets out the role of the ADP in realising the whole systems approach required to achieve these. 1 Rights, Re spect an d Reco very : Scotland’s strategy to impro v e health by preventing and reducing alcohol and drug use, harm and related deaths
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(www.gov.scot) 2 Alcohol Framework 2018 - gov.scot (www.gov.scot) 3 Scotland's public health priorities - gov.scot (www.gov.scot) 4 Alcohol and Drug Partnerships: delivery framework - gov.scot (www.gov.scot) 5 Drugs policy - update: statement by the First Minister - 20 January 2021 - gov.scot (www.gov.scot) 6 https://drugdeathstaskforce.scot/media/1111/stigma-strategy-for-ddtf-final-290720.pdf 7 medication-assisted-treatment-mat-standards-scotland-access-choice-support.pdf (www.gov.s
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Alcohol and Drug Use in North Lanarkshire Drugs North Lanarkshire has some of highest levels of alcohol and drug related deaths in Scotland with 94 people dying from drug-related causes in 2020. Of these, 68% were male and 32% Female. Further analysis of the data shows 62% of all deaths in North Lanarkshire occurred in the 35 – 54 age group with 25- 34 olds and 45 and over age range falling not far behind. Overall, 98% of DRDs were poly-drug deaths with 71% of deaths from drugs in 2020 having more than 5 substances named in the toxicology reports*1. This represents a significant challenge in understanding and responding to the needs of people who use drugs in North Lanarkshire. There were 2,812 drug related crimes in North Lanarkshire in 2019/20 [latest figure available]. This is a rate of 82.4 per 10,000 population share, this is contrasted to a rate of 64.6 across Scotland.
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Alcohol In 2020, 101 people died from alcohol-related causes in North Lanarkshire. Alcohol related hospital admissions were 3270 in 2019/20 [latest available figures]. There were 36,135 Alcohol related hospital admissions across Scotland. Age-sex standardised rate per 100,000 for North Lanarkshire in 2019/20 was 982.36 and 673.27 for Scotland. The age-standardised death rates for alcohol-specific deaths in the most deprived 20% of areas in Scotland has been consistently higher than the rest. The death rate in the most deprived areas is 4.3 times the rate in the least deprived areas in 2020 (41 deaths per 100,000 compared to 10). Since 2001 the death rate in the most deprived areas has remained the highest of all five SIMD quintiles although the gap has narrowed slightly. *1 Not from the full sample of 94 deaths as at the time of analysis we did not have the toxicology reports for all 94 deaths therefore this percentage is from the available data set (61 of 94 deaths) SIMD and DRD Across Scotland in 2020, 1339 drug-related deaths occurred. Seven hundred and seven (53%) were in SIMD quintile 1 and three hundred and sixteen were in quintile 2 (24%) therefore 77% in quintiles 1 and 2. This is most significant if we consider the population of North Lanarkshire where 59% (32% SIMD 1; 27% SIMD 2) of the population is in SIMD quintile 1 or 2*. The strong links between drug and alcohol related harms and poverty8, inequality and trauma are widely acknowledged. Deprivation has been linked as a significant factor9 in drug and alcohol problems developing. 8 Hard Edges Scotland | The Robertson Trust 9 Staying-Alive-in-Scotland-Digital.pdf (sdf.org.uk)
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What we see in North Lanarkshire is not unique and reflects a national picture where data trends are synonymous with the wider evidence base on substance- related harms10 . It is vital we have the most relevant data and evidence available to us to target the response needed to tackle the root causes of problematic substance in a holistic way. This includes using tried and tested approaches and targeting specialist responses across key localities. This will help to improve links to universal services and support the right investment in initiatives that can influence change and prevent deaths at the earliest opportunity. Support for Families In the Scottish Families report ‘Hidden in Plain Sight’ commissioned by NLADP in 2020, the vast majority of community survey respondents (9 in 10 people) felt their community had an issue with alcohol or drug use, with just 7% believing this not to be the case. Levels of support across communities were significantly below the level of prevalence, with just over 13% feeling their community was supportive of those living with drug or alcohol addiction, rising to 19% who felt their community was supportive of families affected. For both of these statements, just over a third did not express a view (remaining neutral) but even taking this into account this indicates: Very high levels of substance-related issues for communities (89%) Very low community support for people living with addiction (13%), or for their families (19%). A strong message from the study was families in North Lanarkshire were hidden in plain sight. ‘There are thousands of families affected by substance use in the area but a tiny number reaching support’. Yet there was a significant number of community ‘touchpoints’ where families were engaging providing key routes for awareness-raising and links to early support. These include schools, churches/ faith communities, financial/ advice services and workplaces. There was widespread recognition of the impact of stigma, shame and secrecy on families. This often prevents families coming forward for support. Tackling stigma is not just about the media and communities, but also about those closest to families (wider family, friends, workplaces). * See appendix 1 for fuller data10 Problem drug use in Scotland (parliament.uk)
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North Lanarkshire Alcohol & Drug Partnership Board ADP Chair NLADP Strategic Lead NLADP Administrator Clerical Officer Development Officer Development officer Information Research COVID19 Covid19 has had a significant impact on the lives of many people living in North Lanarkshire and the services that provide for them. In some cases, this may have led to an increase in drug and alcohol consumption and increased risk and harm within the home11 Drug services and prescribing arrangements were adapted with some innovative practice offering realistic solutions for fast access to treatment and support including; electronic prescribing, distanced check- ins with people who use services, wider Naloxone distribution and wider choices in OST (including Buvidal). These were options not previously possible or permitted due to legislation but now offer learning that should be considered in our plans moving forward. What currently exists in North Lanarkshire NLADP Support staff team is made up of a Strategic Lead, Development Officer x 2, Information and Research Officer, Administrator and Clerical Support. The ADP directly funds over 30 programmes and initiatives across North Lanarkshire aimed at reducing harms, providing recovery-focussed activities and improving lives. We still have much work to do to get it right and reach those in need of support who are still not known to our services. Moving forward we will place more focus on getting what people need, where they need it most whilst making it as easy as possible to access. Our vision A North Lanarkshire where individuals and families experience less harm from the effects of problematic alcohol and drug use. People are safer, healthier and treated with dignity to make informed choices around their own care and empowered to find their own type of recovery. 11 Changes in alcohol consumption in Scotland during the early stages of the COVID-19 pandemic: Descriptive analysis of repeat cross-sectional survey data (publichealthscotland.scot)
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The way forward Actions will be centred on improving quality, offering choice and creating more of the connections to keep people safe, well and thriving. Realising a North Lanarkshire where: 1. Fewer people develop problem drug and alcohol use 2. People access and benefit from effective, integrated person-centred support to achieve their own type of recovery 3. Children and families affected by alcohol and drug use will be safe, healthy, included and supported. 4. Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. 5. Less harm is caused by alcohol. NLADP Structure ADP Board Finance Sub Group Prevention Treatment ROSC Whole Family App/FIP Justice & Health Alcohol Harms
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10 | P a g e Final Draft 2021 JHolleran ADP Strategic Framework National Outcomes Prevention and Early Intervention Developing Recovery Oriented Systems of Care Getting it Right for Children, Young People and Families Public Health Approach & Justice An Alcohol Framework for North Lanarkshire Priority Area Fewer people develop problem alcohol & drug use. People access and benefit from effective, integrated person-centred support to achieve their recovery. Children and families affected by alcohol and drug use will be safe, healthy, included and supported. Vulnerable people are diverted from the justice system wherever possible, and those in the system are fully supported. A Scotland where less harm is caused by alcohol. Sub-Group Prevention, Early Intervention, & Education Treatment, Care & Recovery Development Whole Family Approach /Family Inclusive Practice Justice, Health and Care public health to improve links to community Reducing alcohol harm and improving treatment pathways Cross-cutting Objectives Embedding a Whole Systems Approach via Workforce development, collaboration & learning Partnership Work & Collaboration Lived experience, co- production & active participation. Ongoing evaluation, quality assurance and performance monitoring Communication, transparency & good governance are key Focus on the right to health, choice, fairness & equitable opportunities free from stigma
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Final Draft 2021 JHolleran Key Priorities & Actions 2021 – 2024 NLADP Strategic Lead and the support team will develop the structures and process required to deliver the programme of work set out including establishing the appropriate sub-groups tasked with leading the work. It is expected these groups will take a lead in informing the finance arrangements and facilitating wider stakeholder engagement. A delivery plan and commissioning strategy will be developed in the first six months with progress linked to the following priorities: 1. People have early access to support for problem substance use –early intervention strategies will be put in place to prevent problem use with support offered through a range of community-based responses. 2. NLADP will facilitate efforts to embed a Whole Systems Approach – including families and a broader range of stakeholders to reach those not already known to services. 3. Strengthen the links between physical/mental health & substance use taking a ‘No w ro ng doo r appro ach’ focussed around the needs of the individual and not solely focussed on the substance use or disorder/s. 4. Young people and families receive evidence based, effective education on substances, harm reduction and how to access help when problems develop. Through the provision of effective, evidence-based education both within and beyond school. 5. Workforce capability is increased through learning via a strategic workforce development plan including needs analysis to identifying gaps and opportunities to strengthen the workforce knowledge, skills and confidence to respond. Drawing on local experience, knowledge and assets to support quality Improvement and best value. 6. People are supported to make informed decisions about their own care through a range of treatment options including residential rehab for all those who will benefit. Including all those who want, and for whom it is deemed clinically appropriate, to access residential and/or community rehabilitation. 7. People are supported to remain in treatment for as long as requested – MAT standard 5, individuals are supported to remain in the treatment that is right for them, for as long as they want or need. 8. Improved early identification, assertive outreach & increased engagement (MAT standards – opiate/benzo with rapid access) so people at high risk are proactively identified and offered support – MAT standard 3 targeting at-risk groups. 9. Overdoses are prevented from becoming fatal – increasing provision of naloxone, strengthening proactive outreach for at-risk groups improving near fatal overdose pathways. 10. All people are offered evidence based harm reduction – MAT standard 4. Provision of harm reduction materials such as injecting equipment, BBV and wound care for those who need it. 11. People who use drugs have access to information about risks and harm reduction – in person, digital and via phone information on drugs and harm reduction including WAND, EIP and DBST.
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Final Draft 2021 JHolleran 12. More families are involved in the care and treatment of their loved ones with access to support in their own right – even where their loved one is not engaged with treatment. This includes choice and wider access to opportunities locally for adult family members, young adults as well as children and young people. 13. Effective pathways between justice and community services are established including prison through-care and diversion pathways. This will take account of housing, advocacy and connections to the community. 14. Less harm is caused by stigma for people who use alcohol and drugs and their families in North Lanarkshire. NLADP will lead on a local stigma plan recognising individuals, families and communities should have access to a range of opportunities to support improved well-being, resilience and reduced feelings of isolation caused by stigma. 15. NLADP will develop an alcohol specific framework recognising the impact alcohol has on individuals, families and communities implementing targeted interventions to reduce harm, change attitudes to alcohol consumption and improve health & wellbeing. 16. NLADP Drug-Deaths Prevention Action Plan is refined and linked with key outcome areas from DDTF priorities using evidence of based practice whilst targeting those most at risk.
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1 Appendix 2 NLADP Position Paper – June 2022 This paper sets out the key commitments and responsibilities of North Lanarkshire ADP and relevant integrated authorities in working towards the national mission objectives, MAT standards implementation and residential rehab progress as set out in Rights, Respect and Recovery and the partnership delivery framework. In addition, proposals and recommendations have been made to progress each of these areas in keeping with North Lanarkshire ADPs strategy. A national benchmarking report was issued on 23rd June showing progress made across Scotland on a RAG status basis. North Lanarkshire is in a good position to implement the MAT standards however, there is still a lot of work to do to fully embed the standards across all six localities. A supplementary overview, setting out further details and actions required to achieve all standards, will follow on 2nd August. This was submitted to PHS on 27th June. All services involved were asked by the ADP to review and submit comments ahead of the deadline. MAT Standards - current status in North Lanarkshire 1. Same day access - All people accessing services have the option to start MAT from the same day of presentation. RED Choice - All people are supported to make an informed choice on what medication to use for MAT and the appropriate dose AMBER Assertive outreach - All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. AMBER Harm Reduction - All people are offered evidence-based harm reduction at the point of MAT delivery. AMBER Retention All people will receive support to remain in treatment for as long as requested. RED Funding position North Lanarkshire received £380,578 for 2021/22 towards implementing MAT standards 1-5. A further £570,866 will be made available in 2022/23 to fully embed the MAT standards over the coming year. Chief Officers and Chief Executives have been asked to sign timed, specific and published Improvement Plans for implementing the standards – to include the delivery recommendations being made locally with MIST which are to be published by PHS on 2 August. Progress so far The proposed model for MAT standards is a Pan-Lanarkshire model based on an assertive outreach delivered via an ‘Urgent Care Response Team’ to be established. Progress on this is expected from August 2022 and will include the use of telehealth and mobile outreach facilities to increase same day access to treatment. The approach will need to ensure transparency, full oversight and accountability in the delivery and evaluation of the MAT standards. There is an expectation that ADPs will monitor and report on progress via a full evidence review, numerical data and experiential
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2 qualitative feedback. There will be ongoing support from the MIST team nationally though Public Health Scotland. MATIGTerms of ReferenceDraftJH072 The ADP has already approached all services involved to report back on progress towards implementing and embedding the standards by 8th July. A full report and evidence review of clinical governance arrangements will follow. This will be handed over to the Project Lead to take forward with the Service Manager when in post.
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3 NLADP is required to submit the following to the Scottish Government: MAT standard benchmarking supplementary appendix 27th June – complete Residential rehab pathways processes publish – end of June 2022 – complete ADP Annual review 5th August – complete Treatment Target projections – 17th August – complete MAT standards Self-Assessment - 19th September 2022 - in progress Drug and Alcohol Treatment Services- MAT standards 1-5 The recent ‘Rapid Review’ research commissioned by North Lanarkshire ADP acknowledges statutory services continue to work hard in supporting people who need drug and alcohol services. The unwavering commitment of staff across the sector has been well documented and widely acknowledged by individuals and those working in services at a consensus event on the 26th May. There is agreement that the current demand on services, coupled with challenges around premises, staff recruitment and retention have all lead to limited workforce capacity which remains significant. This has limited the ability of services to meet people’s needs consistently across all six localities in North Lanarkshire. Concerns exist around the current quality and consistency of care as well as ongoing support and development opportunities for the workforce. Recruitment is likely to become more of a challenge as investment increases across Scotland. It is understood it may become more difficult to find suitably qualified practitioners with the right skills, knowledge, capability and values required to deliver the MAT standards. Next steps Immediate approval and sign-off on recruitment for a MAT standards Project Lead and Service Manager who will work closely with the ADP support team and key stakeholders to co-ordinate the operational requirements for MAT standards to be implemented and fully embedded. A decision to be reached on where these posts will be hosted in the current system including; who will assume line management responsibilities and ongoing support and supervision arrangements for these post to minimise disruption and maximise progress. Is this quality and performance/service delivery or other? Agreement that a MAT standards monitoring group will be established to oversee implementation, review progress and respond appropriately to ensure all operational elements are achieved in North Lanarkshire. Agree how the monitoring group, ADP and other stakeholders will report on progress into existing structures moving forward? Facilitate improved collaboration, input and support from Community Addiction Pharmacy and Quality Improvement colleagues sharing data and improving intelligence around all test of change initiatives linked to the MAT standards.
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4 Next steps Investment and support is urgently required to stabilise existing services and ensure equitable access to treatment, care and support across all localities. Approval work to commence to identify clinically viable premises to deliver treatment and care services. The output from this work should set out what investment/approaches are needed to offer accessible and approachable treatment services that are fit for purpose. Approval and sign-off for a full review of treatment, care and support services should be initiated (alcohol, drugs and mental health. This is vital to understand current delivery capacity and any additional investment/reconfiguration of services required to meet local need in line with current demand. Staff recruitment and retention remains a significant challenge. Further consideration should now be given to how addiction services can incentivise those staying or coming to work in North Lanarkshire. This will help not only to build capacity but to build the capability needed to ensure we have the right skill set, values and commitment within our workforce. This is significant as we move closer to same day access via the Medication Assisted Treatment (MAT) standards. Workforce development needs should be fully reviewed via a training needs analysis to upskill and inform ongoing practice in keeping with national priorities, clinical guidelines and a rights-based approach including; • more frequent care and treatment reviews, • better access and choice in treatment and care services, • increasing family inclusive practice, • routine harm reduction screening at each point of contact. Consideration should be given to workforce wellbeing through protected time and wellbeing networks for staff working across localities to come together. Assertive Outreach & Crisis Support MAT Standards 1,3 & 4 The Lanarkshire Overdose Response Team (LORT) was established in September (2021) with 4 outreach staff and 1 coordinator. This is service is funded through the Drugs Death Task Force (DTTF) until February 2023. Following the model set up on Glasgow in 2019, a proposal to complement current provision and directly address key gaps and vulnerabilities were identified as: The absence of ‘out of hours’ provision; The absence of persistent and assertive ‘wrap-around’ care at point of crisis; The inconsistency of intervention and follow-up care after near fatal overdose. The Turning Point Scotland service provides a rapid response to near-fatal overdose (NFO) providing a short, focused period of support to each person and assertively engaging them with mainstream alcohol and other drug services. The team received and responded to a total of 113 referrals during the initial reporting period. These referrals came from a variety of different sources that the team had built pathways with
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5 in order for them to refer into the response with as much ease as possible, including a 24hr free phone number and a simple referral form which can be emailed direct to the team. The 113 referrals represent 92 individuals, with 76 of these having a single referral and 16 having 2 or more referrals. NLADP has recently approved funding for a dedicated worker to monitor and co-ordinate the overdose response approach. This post will be linked with the harm-reduction team and is a shared post with SL ADP. MAV Navigators – Assertive Outreach MAT standards 1,3 & 4 North Lanarkshire APD has approved continued funding for year 2022/23; to support the development of an assertive outreach model (navigator programme) to improve engagement of service users within the acute setting and onward referral to community based drug and alcohol support services. The service was extended in 2021 via the ADP board based on local needs and demand. Increased funding was required to cover both the major trauma centre at UHW and Monklands Hospital in North Lanarkshire. Navigators are uniquely placed within the ED to provide the earliest intervention, to be there at the time of crisis and also to be there at the time of reflection (the reachable moment) when that window of opportunity to plant the seeds of change is open. In 2021/22, the service within Wishaw ED has engaged with 127 individuals from North Lanarkshire (50F:76M) since July 2021(as well as a further 38 (24M:14F) seen between April to June 2021 who were seen under the previous joint funding arrangement). Of the 127 North Lanarkshire patients 74 (58%) patients actively and immediately engaged with the service and 20 (16%) were unable to engage immediately (usually due to intoxication or serious injury). 33 (26%) refused the offer of support. Treatment Targets Next steps Drawing on learning from the Turning Point interim report and Rapid Review further consideration should now be given to extending the operational hours of the ART services to meet the needs of individuals and families who need support in crisis. The sustainability of the overdose response team beyond February 2023 needs consideration. Will this be part of our core funded response and MAT standards or should this be commissioned separately by the NLADP moving forward? Will the MAV Navigators and additional capacity provided by Substance Misuse Liaison Nurse roles be extended and funded via core or continue to be funded via the ADP beyond 2023?
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6 In North Lanarkshire, a 9% (113 people) increase is expected by April 2023 across statutory drug treatment services. This approach is linked to the evidence-base that acknowledges those engaged in treatment are less likely to experience a fatal overdose. The update from the Scottish Government, March 2022, shows the current picture across Scotland based on CHI capture. At present, the CHI capture rate of those accessing Opiate Substitution Therapy (OST – Methadone/Buvidal or other) in North Lanarkshire sits at 55%. NLADP Strategic Lead has initiated discussions with Community Pharmacy colleagues to understand more with a view to improving CHI capture – more work is required to develop a strategy to meet this target. Alcohol treatment targets will follow in 2024. Harm Reduction – MAT standards 1-5 There is significant harm related to drug injecting related to blood borne viruses, bacterial infections, injection site wounds and overdose risk. Within existing NHS Addiction services these issues are often not picked up - as appropriate questions are not asked and assessments of injecting risk are not undertaken. The Medication Assisted Treatment Standard 4 highlights this and aims to integrate harm reduction with the delivery of OST. Next steps Support from SLT to communicate treatment target requirements and identify who is best placed to support NLADP to take this forward. Approval for a SLWG to be established to fully consider the targets and to develop a strategy with the ADP to meet the targets. To establish a closer relationship across the ADP with the Community Addiction Pharmacy service to support the wider workforce capability and what the current offer is of those accessing OST in the community including Buvidal.
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7 The WAND assessment consists of: • Wound care • Assessment of injecting risk • Naloxone • Dry Blood Spot Tests Residential Rehab – MAT standards 2 & 5 Improving access to residential rehabilitation as a treatment option is a key part of the National Mission to save and improve lives. The Government is clear that residential rehabilitation should be part of the full range of drug prevention and treatment services available to people in all local authority areas. The approach and commitment is set out here Work has been undertaken through the Lanarkshire residential rehab operational and oversight working groups. The group has set out clear pathways and processes for individuals seeking to explore residential rehab as part of their care and treatment planning. • North Lanarkshire residential rehab funding 2021/22 - £317,148 • North Lanarkshire residential rehab funding 2022/23 - £ 317,148 Next steps Support from SLT to communicate the requirements and identify who is best placed to take this work forward. Agreement to increase capacity for WAND consistently across all services and at each point of contact across North Lanarkshire Wider Naloxone provision should be explored with effective monitoring so that Naloxone is offered at each point of contact across North Lanarkshire including acute sites and CPS. Agreement that all practitioners and community members likely to come into contact with people who use drugs are encouraged (possibly via a local campaign) to undertake Naloxone training and have access to a kit. All health board and local authority premises should have a nominated Naloxone contact with a supply kit available to respond in the event of an emergency situation as with first aid, AED or other heath need that is routinely expected to be met.
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8 Independent advocacy Commissioned by the ADP, the independent advocacy service (Equal Say) continues to link with individuals via referral from statutory and voluntary sector colleagues. Work is underway to strengthen pathways and referral links across all alcohol and drug services (ART). This is particularly significant given the additional investment in Residential Rehab across Scotland, MAT standards and the right for individual and their families to be involved in the co- production, delivery and evaluation of substance use services. Whole Family Approach (WFA) and Family Support There is a commitment to meeting the needs of children and young people Lanarkshire-wide through stronger links and collaboration with community planning partners to achieve our shared objectives in preventing children and young people from developing drug, alcohol and mental health problems. Work should be carried out to scope and identify opportunities to link and share financial investments for prevention and early intervention (including diversionary activities). Currently, through Rights, Respect and Recovery and the national holistic whole family approach framework there is an expectation and right for families to be involved in the care and treatment of their loved ones (where appropriate) and a right for families to have support in their own right, even if their loved one is not in treatment. There is currently support available to families via Phoenix Futures, Barnardos and carers services but this is in no way comparable to the capacity and availability of support available via statutory and voluntary sector services for those needing treatment and care for drug and alcohol issues. Next steps A more consistent approach and understanding of the residential rehab process is now required. Training for all staff in treatment and community services will commence across Lanarkshire, led by the Scottish Recovery Consortium, to ensure staff working in services (statutory and voluntary sector) understand the approach, referral pathways and assessment criteria. NLADP will lead the work focussing on how residential rehab options and access are communicated to individuals and their families as part of a wider package of treatment and care options. All data and costs associated with Residential Rehab assessment and access will be shared with NLADP on a quarterly basis. This is needed to strengthen transparency, accountability and understanding of the true picture for those being referred, assessed and placed in residential rehab.
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9 Next Steps Lived and Living Experience Rights, Respect and Recovery sets out the right to health, choice and quality in care and treatment services. This includes participation from those with lived experience in the design delivery and evaluation of services. North Lanarkshire continues to make great progress in involving the views and experiences of those who have used or need access to drug and alcohol services in shaping the way forward. NLADP commission North Lanarkshire Recovery Community, Phoenix futures and Barnardo’s who all have lived and living experience representatives involved in shaping the design, delivery and evaluation of services. In addition, the ADP commissioned Scottish Drugs Forum to lead a third phase of peer research and the addiction worker training project. The rapid review also takes account on individual and families views. Work is ongoing via the ADP support team to establish lived experience panels to connect to Voluntary Action North Lanarkshire (VANL) and Community Solutions to strengthen participation and engagement of people with lived and living experience across all services. As part of the MAT standards readiness to implement, all lived experience reports have been reviewed and NLADP is well on track to deliver on our commitment here. More parity is required to rectify this and ensure the offer of family support via treatment and care services is increased significantly. The evidence tells us that family support can be a protective factor for those not engaged in services. We have limited data and intelligence to understand the levels of family involvement in care and treatment including; care planning and family support offered via statutory services. This needs to be reviewed and a plan put in place to increase family inclusive practice, this is a right and a need that remains largely unmet. Agreement for the WFA allocation from the Scottish Government to be used to increase capacity and engagement with families based on recommendations and actions from the WFA sub-group. Next steps Agree that lived and living experience voices are heard, valued and acknowledged by all stakeholders and practitioners delivering care and support services in North Lanarkshire. To seek recognition that it will take time with the right financial investment to make an impact and see progress being made here. The ADP has funding set aside/approval for a lived experience support worker to work with all commissioned services and partners to take this work forward.
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1 0 Governance, future decision making and reporting Approval for the work set out in this paper to be the focus of the ADP Treatment, Care and Recovery Sub-group delivery plan for the next 18 months. A suitable lead and Co-lead will be identified to take the group forward. Discuss and agree the most appropriate way forward to monitor progress and ensure oversight in relation to drug related deaths, MAT standards, National mission priorities. Where/how will the ADP report on these priorities and progress moving forward? Support a review of NLADP board/finance group membership to ensure appropriate influence, oversight and information sharing to the relevant accountable groups and forums. Set out who is best placed within North Lanarkshire to support decision making moving forward in line with the Public Protection Agenda. Consider how best to strengthen collaboration across/between Integrated Authorities, voluntary sector and Community Planning Partners in tackling the root causes of problematic substance use and shared interests in reducing substance-related deaths. Background & further information: Angela Constance MSP, Minister for Drugs Policy, gave a statement to Parliament on the progress toward the MAT standards. on 23rd June, 2022. https://www.parliament.scot/chamber-and-committees/official-report/what-was-said-in- parliament/meeting-of-parliament-23-06- 2022?meeting=13840&iob=125537#orscontributions_M1735E440P776C2417362 Angela Constance MSP, Minister for Drugs Policy, gave a statement to Parliament on Accountability for Delivering the National Mission to Reduce Drug Deaths and Improve Lives. 26th May, 2022. The speech is approximately 10 minutes long with 20 minutes for questions. The full statement is available to watch back: https://www.scottishparliament.tv/meeting/ministerial- statement-accountability-for-delivering-the-national-mission-to-reduce-drug-deaths-and- improve-lives-may-26-2022 Date Name and comment 27/06/22 John Holleran - NLADP 28/06/22 LK reviewed
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1 1 Appendix 3 RAPID REVIEW OF SUBSTANCE USE SERVICES IN NORTH LANARKSHIRE May 2022 Abstract This report presents findings from interviews with sixteen stakeholders and fourteen individuals, working in or have experience of substance use or substance use services in the area. This review set out to understand current provision, what is working well and what is not, and also what people want it to be. Briege Nugent and Ian Clark briegenugentresearch@gmail.com and ian@iconic-consulting.co.uk
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1 2 Contents Executive Summary .................................................................................................... i Background and Methods ......................................................................................... 1 The Current Situation ................................................................................................ 3 What is working well? ............................................................................................................ 3 What is not working well? .................................................................................................... 5 What drives partnership working? ................................................................................... 13 Groups not accessing support ......................................................................................... 14 Future Service Provision ......................................................................................... 15 What support do people want and need? ...................................................................... 15 ‘The ideal’ ................................................................................................................................ 16 Opportunities ......................................................................................................................... 18 Wider evidence of good practice ...................................................................................... 19 Conclusion and recommendations ........................................................................ 21 Case Studies ............................................................................................................ 25 Acknowledgement We would like to take this opportunity to thank the North Lanarkshire ADP – Treatment, Care and Recovery sub-group for commissioning this research, and especially thank all the stakeholders and individuals who were open, honest, gave their time and trusted that this process would help to lead to positive change.
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i Executive Summary North Lanarkshire Alcohol and Drug Partnership (ADP) Treatment, Care and Recovery sub-group commissioned a rapid review of services in North Lanarkshire to understand how substance misuse services work together. The review involved interviews with 16 professionals from across North Lanarkshire working in this field, and 14 individuals who have issues with alcohol and drug use and, their families. Interviews were undertaken in April and May 2022. The study also involved a workshop with over 30 stakeholders in late May to share and discuss emerging findings. What is working well? Stakeholders and individuals identified the following as issues that are working well in North Lanarkshire: The recovery community Services that are accessible via out of hours support and assertive outreach Phoenix Futures Advocacy Improvements in partnership working and communication across the ADP Some of the connections and digital support developed during the pandemic What is not working well? Consultees highlighted the following as issues that were not working well in North Lanarkshire: Access to addiction, and mental health, services can be challenging Statutory addiction services under-pressure Inadequate and unequal provision across areas Incompatible cultures and short-term funding inhibiting partnership working GP treatment choices and an information gap Lack of follow-up support The negative impact of the pandemic Stigma Barriers to engagement The following barriers to engagement were identified: Stigma and perceptions Lack of resources and inappropriate responses Professional attitudes: Lack of empathy and understanding Lack of information sharing between services Lack of exit plan for methadone use What drives partnership working? The key drivers of partnership working in North Lanarkshire were identified as: Good communication Taking a holistic approach Co-location of services
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ii Groups not accessing support Stakeholders identified the following as groups that were not accessing support: Those isolated and living on their own Those who have an addiction where there is not a medical intervention (as current provision focuses really on those who are using opiates) Young people aged 8-11 (as services are not available for this age group) LGBTQ+ Victims of domestic abuse Mothers People from ethnic minority backgrounds Elderly people What support do people want and need? Services need to be person-centred and holistic Services need to be responsive Services should be available out of hours and be able to provide assertive outreach Services should have a single shared assessment Prioritise prevention Elements of the ‘ideal’ future service Stakeholders and individuals proposed ‘ideal’ future service provision in North Lanarkshire should consist of the following: A one stop shop with wraparound care Responsive services with no waiting times Holistic services that take a whole family approach and address the root causes of addiction Providing out of hours and outreach support Accessible residential rehabilitation Follow-up service Connecting people into ‘something meaningful’ Individual recovery plans Opportunities Stakeholders suggested the following opportunities existed to enhance service provision in North Lanarkshire: Relating to provision: • Improve provision for those in crisis and families • Expansion of the recovery community • Digital connections Relating to cultural shifts: • Support for staff • Partnership working • Services to promote flexibility • Including the voices of people with living and lived experience in service design and delivery
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iii Recommendations The following recommendations are made by the report authors, based on the findings of their research with stakeholders and individuals in North Lanarkshire: Development of a ‘one stop shop’ bringing services or representatives of services to be co-located together, and where people who have substance misuse issues and their families can come and receive instant support, with a care plan developed. The development of a crisis service which is a hybrid between an addiction service and an emergency response. Services to move towards more provision that offers out of hours support and outreach. Quicker and easier access to mental health services, with addiction and mental health services working together, and this is already a priority in NLADP’s Strategy. Development of accessible rehabilitation and detox beds. Following good practice in Forth Valley to develop partnerships between housing, addictions and recovery. To commit to having no unplanned discharges. More recovery communities established across North Lanarkshire and specific recovery cafes set up for families and young people. Where possible people should be encouraged to take a lead role in provision and the NLADP create a specific strand of funding so local communities can take forward local initiatives. Development of family support in its own right, looking to services such as Scottish Families Affected by Alcohol and Drugs (SFAD). More long-term funding of projects in the third sector, to be able to attract quality staff, ensure continuity of care and development of strong partnerships. Staff in statutory and third sector services to create shadowing opportunities so that they share practice and work together to overcome challenges, rather than seeing this as a ‘them and us’ situation. Drawing on lived and living experience, working with third and statutory services, create a day programme for people. Substance use services in local areas to make connections with GPs, schools, local voluntary sector to open up avenues of communication and referral pathways. For the infrastructure to be improved, and for services also to be innovative, using community resources, and in this way also potentially addressing some of the barriers to stigma people are likely to have about having to visit ‘an office.’ Services to be trauma informed. NLADP remain committed to the development of the Stigma plan. A simple but effective strategy for promoting partnership working is ensuring email signatures include mobile phone numbers.
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1 Background and Methods North Lanarkshire Alcohol and Drug Partnership (ADP) Treatment, Care and Recovery sub-group commissioned a rapid review of services in North Lanarkshire to understand how substance misuse services work together. This research is part of a wider body of work and research being undertaken in North Lanarkshire to inform future planning of service provision. As this report will highlight, North Lanarkshire’s Strategy for 2021-2014 aligns with many of the key priorities and actions that will be recommended, but also adds new insights too. This research set out to bring together expertise from professionals, and from individuals with lived and living experience of substance misuse. The two main areas of enquiry were, firstly, to understand and hear directly from people ‘on the ground’ what current provision in North Lanarkshire is like, and secondly, what improvements or developments people would like to see to better meet the needs of people with substance misuse issues in North Lanarkshire. Methods and limitations This review involved interviews with 16 professionals from across North Lanarkshire working in this field, and through them, contact was made and discussions carried out with 14 individuals who have issues with alcohol and drug use, and their families. Eight were males and six were females. All were North Lanarkshire residents except two individuals who lived in South Lanarkshire but were engaging with support services in North Lanarkshire. Interviews ranged in length from 30 minutes to one hour 45 minutes. Two interviews were face-to-face and the rest were by telephone or video conferencing. The findings from both stakeholder and individuals’ interviews were brought together to establish key messages. These key messages were shared during an online workshop with 27 stakeholders who were invited to reflect on the findings and feedback further; their contributions are included in this report. This report is structured in three sections. Firstly presenting what participants described as the current situation in North Lanarkshire, secondly, what they said they would like future provision to look like and finally, the conclusions and recommendations formulated as a result. The main limitation for this piece of work has been time, and ideally even more stakeholders, individuals and families would have been interviewed. As it stands, there was only one family member interviewed and no young people directly although professionals who work with both these groups did contribute to the research. North Lanarkshire has already published the ‘Hidden in Plain Sight’ research which showed there are thousands of families affected by substance use but only a ‘tiny number’ reaching support. That research also drew attention to the stigma and shame felt, not just generally from the wider public, but even from within family circles. A particular strand of research is now being taken forward in North Lanarkshire to hear from families further and this report should be read as being complementary to those findings. The limited voice of young people was highlighted at the stakeholder workshop. There was a view that further research was required into the experiences and needs of young people from North Lanarkshire who have experience of substance misuse in their lives.
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2 As with any qualitative research, this work was reliant on people to open up and to be able to tell it like it is. Interviewees were not pushed for answers, but it would be fair to say that those who participated seemed to trust in the process and hoped that their testimonies would go some way to promoting positive change. They welcomed the opportunity to be heard and were encouraged by the idea that there was a sense of bravery about what provision could become. It was also clear from the interviews that across North Lanarkshire, those working across services are passionate, committed and driven to make positive change. All interviewees have been made anonymous.
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3 The Current Situation What is working well? * The recovery community Stakeholders and individuals reported that the recovery communities are doing exceptional work, helping people to connect to one another, creating genuine support networks, combatting isolation, and creating spaces where people feel understood and achieve a sense of belonging. The involvement of people with lived experience was seen as crucial as they were able to empathise and support people going through similar situations as their own. The availability of recovery cafes at different venues and times throughout the week was also important as it provided people with options and somewhere to go when they needed it. Two individuals described how when they had taken more of a lead role in these initiatives, that is when they felt most purposeful and had been at their most stable. “Last year and a half and I have got involved in community recovery. That is done more for me than all the other things the past 30 years. Firstly, it is addicts together. Speaking to someone who is not an addict, they never understand…You know everyone there is like you, under the same dark cloud as you. We are all trying to get a bit of sun...I found them on Zoom in the first year of the pandemic. There were meetings every day. There was different support out there for different folk.” (Sarah) “The recovery cafes are a godsend because they are all going through the same things… The people who work in them are brilliant because they are all recovering addicts so they know what you are going through”. (Shona) * Services that are accessible via out of hours support and assertive outreach Individuals and stakeholders felt that the best services, and which there are still so few, such as the Overdose Response Team and High Resource User Project, are able to be responsive to need, are ‘not 9-5’, proactive, and go to people, offering assertive outreach, rather than functioning on an appointment basis. One of the priorities in North Lanarkshire’s Strategy, reflecting the MAT standard 3 is the targeting of at-risk groups. One individual praised the support they were receiving from the Addiction Recovery Team (ART) highlighting how flexible and supportive they had been. This individual explained that their addiction worker picked him up once a month to go to a neighbouring town for a buvidal injection. The individual commented “They are great, couldnae ask any more of them” and they had no suggestions on additional services or how existing services could be improved.
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4 * Phoenix Futures Many stakeholders, individuals and the family member said that Phoenix Futures was a good service because of the holistic support they offer, and that they provide support to families in their own right. Consultees also highlighted the person-centred approach and compassionate way that workers supported service users. “Phoenix – they were good. If you could go and meet your worker – get acupuncture for an hour, do that, there is a wee art group.” (Alan) “They had said they offered family counselling… We met with the counsellor…it gave myself and sister a chance to say what we were feeling, be validated and get techniques to deal with it. We were thrust into this world… My role in the family is the fixer, because I know, I do and I fix… The counsellor is great with me, I am on edge that the relapse has happened. She said there is nothing I can do.” (Lorraine, family member) “I was with Phoenix Futures, that was amazing. Loved it there…My mentor… could understand me as she was a recovering addict, she knew what you were going through, she wasn’t a textbook worker. She had living experience and that makes a difference. I like them because they didn’t judge you. I was there a few times a week. They had SMART recovery group meetings when you’d go round the table and everybody tells you a little about their week. And an art class on a Friday was good cos it got you away from talking about addiction all the time. The place had a nice feel about it. And if you didn’t go for a week they’d phone you to see if you were alright. A lot of people don’t have family support so at least they’ve got that”. (Shona) * Advocacy The North Lanarkshire addiction advocacy service delivered by Equal Say was not known by all individuals, but those who had used it, reported that it had been invaluable. The opportunity to talk to someone impartial who was able to provide information, signpost, and tell people about their rights was very much welcomed by those who had used the service. “He’s (worker from Equal Say) really good. He did everything he could to get me back into the homeless unit because they were going to kick me out as I’d broken the drugs rules. He pointed me in the right direction for a few different things. He phones every wee while to make sure I’m alright.” (Shona) In addition, several people with lived experience who were unaware of the service, felt it could be helpful to people with substance misuse issues. Some suggested addiction services should do more to advocacy. * Improvements in partnership working and communication across the ADP It was felt by stakeholders that over the past year in particular, there had been an improvement in services working together and North Lanarkshire ADP had played an important part in facilitating this. The meetings now being held which give
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5 organisations a chance to share practice were especially welcomed. There were some specific examples given by stakeholders of good partnership working, for example, such as the Occupational Therapy doing joint assessments with the Addiction Recovery Team (ART), and the Individual Placement and Support Service (IPS). The Department of Work and Pensions (DWP) have also been working more closely with the recovery community and this brought to light people were missing appointments with their workcoach to make meetings, risking being sanctioned. The DWP can support people in their journey by providing ‘easements’, and this means they will not be sanctionned. At present the service are developing ‘single points of contact’ within each area, so they have a specific role for engaging with the recovery community and for example, can run outreach clinics at a recovery café to help individuals with issues relating to their benefits. * Some of the connections and digital support developed during the pandemic As well as being challenging the pandemic also led to some positive developments. Stakeholders and some individuals felt that physical delivery of methadone to those unable to get to chemists highlighted the extent of needs and legal barriers to the provision of naloxone had been lifted. Digital communication had also created new avenues for communication and opportunities. For example, the recovery community now offer digital sessions and reported that this widened participation from people in more rural areas. Moreover, innovative practice by the Harm Reduction Team, to link up professionals to provide digital consultations has reduced waiting times. What is not working well? 17. Access to addiction, and mental health, services can be challenging Individuals, a family member and stakeholders reported that access to addictions and mental health services was, sometimes, challenging. This can lead to people not accessing a service in the first place, voluntarily withdrawing, or choosing not to engage with a service at a later date. A number of specific challenges were raised which are summarised below. Individuals repeatedly said that services, particularly statutory services, could respond quicker and with greater understanding when people first ask for help. They explained that when they had asked for help, when they were at their worst, the processes put in place acted as serious barriers. The length of time it took to be able to see a worker was a particular concern, with some individuals reporting that they had been given appointments a number of weeks in the future, They felt that when they asked for help it should be immediate. The testimonies also further highlighted the lack of understanding individuals felt existed in services about the realities of addiction (stigma is discussed later in this section as a specific issue). “See when I was at my worst and I decided I needed help and phoning up the services, Integrated Addiction Services and your first appointment is a fortnight down the line. It’s not like the next day. When you need to speak to somebody, you get
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6 turned away. I went to the hospital with my mother and I was in my third day withdrawal and I was in a bad way, that doctor at Monklands Hospital told my mother to take me out on to the street and buy me heroin because there was nothing they could do. I wanted help. I wanted to go into hospital and I got turned away. We get judged, I did get judged. He asked what was the matter and the minute I told him it was a heroin addiction his whole attitude changed. My Mum was with me and she said to him if I wasn’t here I wouldn’t have believed it. In the early stages there’s just not much help there, there isn’t. I know they say you’ve got to make sure they need it but a lot of people are dying through it… in that fortnight (waiting for an appointment) you are going to use, you are going to do it to make yourself feel better. If they could give you an appointment the next day, people who could speak to you, you’d have more hope but you come out with no hope. I didn’t think I could get better because I didn’t have any hope because nobody actually sat and spoke to me and told me what could be done”. (Shona) A family member described trying to call addictions services but none of the advertised numbers on the internet were correct. They eventually relied on a friend working in a different area to get them the right contact information. Another individual recalled her own challenges accessing support after she had engaged and her experience resulted in her saying she ‘hated’ the local addiction team. She explained: “They wanted me to travel to X, with no money, in the snow all the way to pick up a prescription… and they know I’ve got a heavy, major fear of the outside because of what I’ve been through… I thought nah, fuck you… it wasnae happening. So I thought I’ll get through it… my partner, he supported me”. (Leanne) Access to mental health services was also a challenge for some people with both mental health and addiction issues. One stakeholder said that they have never had so many people request to be sectioned as they recognised this was the only way they would get the support they needed and wanted. This finding was echoed by individuals and a family member who said that when they called NHS24 for help, they were informed that they would only get someone to come out to them if they were suicidal. Several consultees referred to the need for people with addiction issues to be clean/sober for a period of time before they could access mental health services. They added that this could be very challenging for some people who used drugs/alcohol as a means of self-medication for mental health issues. A particular area of concern and which is likely to affect the majority of people using substances, is when they also have mental health issues. In these cases, and a finding which is not new, is that people are passed from mental health services to substance use services and round again, because it is argued they have to be stable to get access to mental health services, and this ‘hamster wheel’ as one stakeholder called it, means people are essentially without support. “The links into mental health – that stopping someone if they are using drugs and vice versa, they don’t get a service. I happened to get someone who I was able to
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7 get into treatment within three days, but that was me being stubborn and his sister also being stubborn and persistent.” (Stakeholder 6) 18. Statutory addiction services are under-pressure Individuals and some stakeholders suggested that statutory addiction services do not generally have time to engage meaningfully with individuals. As a result, consultees felt, these services are symptom led rather than dealing with underlying causes of substance use. Staff have substantial caseloads and were viewed as ‘firefighting’. For example, several individuals stated that they only saw their addiction worker for a short period of time once a month; they also reported that workers regularly moved on making it difficult to build trust and continuity. Although there were exceptions reported in one area, with a stakeholder and a couple of individuals stating they had fortnightly, sometimes weekly hour-long appointment with their community addiction worker, this was not the experience of any of the other individuals interviewed from across North Lanarkshire. The ART team highlighted that problems with staff recruitment and retention resulted in high caseloads, and accommodation issues added to the pressured environment. It should be noted that statutory addiction service have met the targets set by the Scottish Government throughout covid and this is despite with depleted staffing levels. Generally, other stakeholders understood the pressures the team was operating under. Individuals felt that it was when they were really able to speak to someone, to understand the underlying reasons why they took substances that real change was able to happen, highlighting that meaningful engagement is imperative. In North Lanarkshire’s Strategy, what is referred to as the ‘No wrong door approach’, this promotes the need to focus not only on the substance use or disorder but all the needs people may have. A third sector representative observed that statutory services “don't have time to dig deep into the myriad of peoples’ problems” and this was instead felt to be left to the third sector to do the ‘heavy lifting’, leading to staff burnout. The rise in cost of living and the support people needed to deal with poverty was also highlighted as something statutory services do not have the time to deal with. Individuals also said that statutory workers did not let them know of the different options available to them in the community, and instead there was an emphasis only on prescribing methadone, medicalising what was recognised to be a psychosocial problem. “I think the problem is that no one is really speaking to you about why you are drinking or taking drugs. You don't have that time. I was going to get my script and there are 12 people in there at a time and they are all waiting to be seen by 3 or 4 workers, and so you feel like you are taking up peoples’ time. You can also hear what people are saying, so you don’t have privacy. You are also seeing different people all the time, so you don’t build that relationship with the worker… I have had lots of different addictions workers and it has got to the point where I don’t know who I am going to see when I go in there.” (Kate)
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8 “I think is my 10th or 11th addiction worker. It’s hard because you only see them for about 10 minutes about once a month or something. A lot of the time they just want to keep you on a script. I went to them in April to ask about the rehab and was told there was no funding and they asked if I wanted to up my methadone rather than come off it…The addiction workers don’t know what you are going through and they don’t have the time to sit and get to know you…Addiction services don’t offer you things. So unless you know about it. It is only when you go to the recovery cafes that you hear about these things and you think why didn’t my addiction worker mention it. They’re happy to up your methadone though, it’s crazy.. Also use other things other than medication. They want to medicate everything. It’s only now I know that’s not the answer because I was addicted to painkillers for years. It’s not the answer. You need to sort out the problem before you can medicate it. ” (Shona) “I have a drugs worker but you see her once a month and I don’t really get any help. They ask how things are going – I can see that the worker I have is stressed out of her mind and so I am thinking – right get out the door. So I think that needs to change, there should be more of her. You can feel the stress that they are going through, you don't want to take up any of their time.” (Peter) As a result of the lack of meaningful engagement, fewer connections are occurring to mental health provision or access to counselling - which can help people to open up and begin to understand and address underlying causes. “I have a sickly feeling he will be on buvidal for the rest of his life. We are not addressing any of the issues.” (Lorraine, family member) “They need to sit down one-on-one with people and get into their story why, and exactly what help they need. Listen to the patient, not what they have read in a book. They can’t relate to how I have lived. They don’t come from our areas. They come from nice affluent areas, mortgages and they come down here and it is different. I don't think I have ever had a meaningful conversation with my drugs counsellor. I probably could speak to them, but they don't have that experience. The biggest thing for me is that they can’t relate to how I have lived.” (Mark) 19. Inadequate and unequal provision across areas Consultees highlighted a number of issues regarding service provision which they felt was either inadequate or unequal across North Lanarkshire. There was a strong agreement that crisis support in North Lanarkshire was inadequate. In situations where services can only offer appointments a number of weeks in the future, as reported above, stakeholders and individuals felt there was no service where people in crisis could be seen at short notice. Some individuals and stakeholders mentioned the Crisis Centre in Glasgow as being good practice. Stakeholders and individuals also highlighted the lack of residential rehabilitation options and hospital detox beds. Most of the individuals with lived experience had not been offered residential rehab and had no expectation of it being a treatment option; they were aware that finances was the reason.
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9 “False economy at the moment. Guy in his early 40s continually relapsing in hospital for 10 days, back out with no support to a sparsely furnished flat in the middle of a scheme, relapse, re-admitted to hospital, until eventually he died – at no point was he offered residential rehab.” (Stakeholder 7) “No. The addiction services gave me a stable prescription. They never helped. They never suggested a detox, rehab, nothing.” (Sarah) A number of individuals and stakeholders reported that the recovery pathways were unclear and this was regarded as a significant issue. Several individuals stated they did not know what support and treatment was planned and, significantly, what the milestones would be that triggered the next step in their journey for example, progressing from a methadone prescription in the community to residential rehab. They stated they would welcome an individual recovery plan that clearly set out the support and treatment they would be following. Similarly, several stakeholders felt there was no clear treatment and support pathway which set out how services in North Lanarkshire would support people in different situations. This meant they were unable to provide clarity to individuals they were working with. “When people turn up at statutory services they need to be given a plan, knowing what is expected of them, so they know the steps they need to take to get there”. (Stakeholder 7) One particular area of concern was the limited support for people when they leave prison. In North Lanarkshire’s Strategy this is a particular group highlighted as requiring support and needing a partnership approach, taking account of housing, advocacy and connections to the community. Interviewees observed the importance of family support and felt that at present this is an area which needs to be addressed in North Lanarkshire. One stakeholder suggested that having a recovery café specifically for family members and having a local Scottish Families Affected by Drugs and Alcohol, to offer face to face support would be beneficial. One of the key priorities in North Lanarkshire’s Strategy is the development of support for families in their own right. It transpired that in different areas there are particular issues relating to the poor infrastructure inhibiting engagement. In Bellshill in it was reported by both stakeholders and individuals that the current buildings for addictions support are inadequate, with no waiting area and people having to ‘hang around’ outside feeling especially stigmatised as a result. At the stakeholder workshop it was raised that the Wishaw ART team had to temporarily operate out of Motherwell because of accommodation issues, which meant service users could be faced with three different modes of public transport to make appointments. In rural areas, in particular, stakeholders felt more should be done to provide people access to support. Individuals and stakeholders also reported that in some areas there is a lack of access to buvidal.
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10 It was also reported that generally across services there is a problem with recruitment and retention of ‘good’ staff. It was felt that this can add affect the support available to people with substance misuse problems across North Lanarkshire. 20. Incompatible cultures and short-term funding inhibiting partnership working Stakeholders reported that as yet, there is a lack of integration and information sharing between statutory services and the third sector. It was also reported that some staff from statutory services had displayed a level of ‘professional snobbery’ in their interactions with staff from the third sector. There was a view that short term funding and competition could inhibit partnership working between third sector organisations. It was also reflected that short term funding restricts the extent to which services can recruit high quality staff. 21. GP treatment choices and an information gap Three individuals reported that GP prescription of opiate-based painkillers had led to a heroin addiction either when the prescription ended or when they self-medicated by taking heroin as well as their painkillers. These individuals felt the ten-minute time limited appointment was not long enough and their addiction may not have developed if the GPs had taken a different approach. For example, one of these individuals who had experienced childhood trauma was prescribed co-codamol as a teenager when she enquired about counselling, and was prescribed dihydrocodeine in her 20s, when she had another traumatic experience. Some individuals and stakeholders suggested that some GPs did not know what support people could access for addiction and mental health problems. Individuals reported they had found this information through engagement with the recovery community or when they had hit crisis point. “I didn't know where to ask for help. My cheese had slid off my cracker. I had gone into fits outside and taken into hospital. I think if there had been one person I could have spoken to, if I had been able to say, I wouldn't have got so extreme… I think even a leaflet through the door so people know what support is there. Rather than Domino’s pizza leaflet.” (Peter) 22. Lack of follow-up support Individuals described points in their life when they had relapsed soon after getting stable through support such as rehab or a Drug Treatment Testing Order (DTTO). They explained that the lack of follow-up support once these interventions had ended had been a key factor in their relapse. As highlighted earlier, people leaving prison also reported a lack of follow-up support.
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11 23. The negative impact of the pandemic Partnership working between statutory and third sector services that had begun to take place in one area stopped as a result of the pandemic and was said to have not started again. Over this time, contact was lost by statutory services with people. By May 2022, face-to-face contact by statutory services was reported to still not be happening to the extent it had, prior to the pandemic. Individuals reflected on the staff shortages and subsequent lack of continuity of service, and stakeholders noted the rise in referrals, with the impact on staff stress levels. 24. Stigma Individuals and stakeholders reported that people working in some services, especially statutory services, could make people feel stigmatised, and there was much work to be done to challenge stigma. “When I was in hospital having caused this injury through using drugs, half the nurses looked at me as a drug user, and half as a patient. Most of the young nurses treated me like a drug user, it was the older ones that were better, they didn’t have the experience.” (Alan) A few individuals opened up about the realities of living in poverty and that the areas they lived in were rife with drugs and people felt stigmatised more generally. “There are three big high rise flats down the road and everyone calls them ‘Heroin Heights’, they put everyone who is in the same situation in the same places.” (Kate) In North Lanarkshire’s Strategy there is a commitment for the NLADP to lead on a local stigma plan. Barriers to engagement 1. Stigma and perceptions Stigma felt from the wider public and professionals is a significant barrier to people engaging with help. Individuals reported even feeling stigmatised by the chemist they went to, when picking up their prescription. “You can’t talk to anyone who looks down on you. The Chemist look down on you. They make you wait. Some of them are awkward. They don’t need to look down on you. Why are they working with people they don’t like?” (Neil) Stakeholders reflected that many people with an addiction have experienced systematic failures over their lifetime and distrust services, and overcoming this is a significant barrier. “Some people think what’s the point. You have an addictions issue and an addiction workers and they ask you to keep a diary, what’s that all about. It seems quite passive – here’s a leaflet, here’s a website. There’s a feeling of self-loathing scum. People need to be grabbed by a community like the recovery community who can
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12 say you’re not scum, I was like you and look at me, and I’ll come on the journey with you.” (Stakeholder 7) 2. Lack of resources and inappropriate responses Many participants, both stakeholders and individuals reported that at present people ask for help and the response is not timely, with waiting times a particular barrier, preventing people from engaging. The lack of provision for mental health support was also identified. “When people make that decision they need help that day. They don’t need a referral for a fortnight’s time. We need walk-in clinics that are staffed by prescribers. Somebody who can say to them that day this is what the plan is, they leave with an NHS prescription, and they are asked to come back again tomorrow to maintain support. Something to get through the night. To be grabbed at that point.” (Stakeholder 6) “The initial referral, you need to wait three weeks before you see a drugs counsellor. Within those three weeks, they insist on you giving a dirty sample. If I said to them, I have gone through cold turkey, but they can’t start you on treatment unless you are giving in a dirty sample…Access to psychiatrist. I have been waiting a year.” (Mark) As already mentioned, mental health services and addiction services not being integrated meant that some people were in a situation without any support. Stakeholders reflected that where a medical intervention for substance use was not clear, gaps arose, and this was also echoed by individuals. “All the services seem to be focussed on opiates. People don’t want to go there if they’ve got a problem with cocaine, alcohol, diazepam – don’t want to go in as its seen as the junkies place.” (Leanne) In addition, stakeholders and individuals felt services operating on a mainly 9-5 Monday to Friday, appointment-only basis were inhibiting levels of engagement. 3. Professional attitudes: Lack of empathy and understanding Stakeholder and individuals observed that the current model of working of discharging people who miss a number of appointments, fails to recognise the realities of the challenges people face and the practical barriers that are likely to also exist. A number of barriers were highlighted including public transport links, distance, finance, family/relationship issues, ongoing substance misuse, mental health, and the support that was likely to be provided during the appointment. Consultees suggested a more flexible approach with assertive outreach was required. One stakeholder suggested that people who were missing appointments should be the focus of intensive proactive support – the opposite of the current situation when they are likely to be discharged from services.
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13 4. Lack of information sharing between services Third sector services felt that at present statutory services generally do not share information in a way that would enable wider access to support for individuals and this needs to change. 5. Lack of exit plan for methadone use Individuals reflected on being put on methadone on a long-term basis without an exit plan and viewed this as replacing one addiction for another. What drives partnership working? 1. Good communication Stakeholders welcome the partnership meetings now being convened by the ADP. Stakeholders also spoke about the success of different partnerships developed, between the third sector, and also some examples of the statutory and third sector working together too. “Same goals and working together and the opposite of that is services getting precious.” (Stakeholder 3) 2. Taking a holistic approach Stakeholders reported that the best partnership working was when services worked with whole person and family, understood the complexity of the issues, the extent of the support needed and prioritised building relationships with the person around this, ‘being human’. An example of good practice was discussed whereby the Simon Community Housing First Team are working closely with addiction services, doing outreach and helping people sustain their tenancies and connect to relevant services. “In the statutory services there needs to be more of a shake up, what they see as their role, the old school speak about how they approach their job and there is a lot of burn out. There isn’t role validation, is what I am doing right? There is also a fear of change too. Are statutory services welcoming to people? MAT standards, same day access to treatment, we don’t even have that for assessment! If someone wants help, they want help, you want to help them then. We send people away and then they have to come back, and then back again.” (Stakeholder 6) “I had been in rehab for six months, years ago and it was good, but I was back drinking more or less as soon as I got out as I was back in the same area and same problems, nothing had changed…I do think if I had got the help that I am getting now, to be able to talk about the things that happened to me, the abuse when I was younger I might not have handled things the way I did… I remember last time getting the taxi (after the detox) to take me straight to the shops and I bought drink. No one
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14 is looking at the reasons why you are drinking. You are left to the same things that you left, the only difference is now you can get drunk faster. The area I was living in, everyone was taking drugs… I have numbed my feelings all these years and now when I stopped they are all coming back. There is always a reason why people drink the way they drink. I feel like I have been born again as I am having to learn all about my feelings again. ” (Kate) 3. Co-location of services Although rare, a few stakeholder said that when services are co-located together it makes partnership working easier and promotes ongoing communication. The example of statutory sector addiction and housing staff sharing office space in Motherwell was highlighted as an example. Groups not accessing support The following are the key groups that stakeholders felt were not accessing support: ● Those isolated and living on their own ● Those who have an addiction where there is not a medical intervention (as current provision focuses really on those who are using opiates) ● Young people aged 8-11 (as services are not available for this age group) ● LGBTQ+ ● Victims of domestic abuse ● Mothers ● People from ethnic minority backgrounds ● Elderly people Raising awareness of what is available to people who are not in supported accommodation and not connected with services was felt to be key, and some noted that the GP could be a ‘way in’ for this group. It was felt that for people who are LGBT+, mothers and people from ethnic minority backgrounds, they face additional layers of stigma which makes seeking help especially challenging. It was felt by most that it is important therefore for substance use services to try to reach these groups building links in the community. “I think women with young kids are definitely more unlikely to be able to engage, so the fear of losing their kids, and that has been an ongoing issue. It is about letting people know that it is ok to ask for help. We need to raise awareness of that.” (Stakeholder 5) One stakeholder however also raised that at present, services are not giving those who are coming to services, good support, and therefore trying to engage with those ‘missing’ would not be a good use of time, as resources are already stretched.
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15 Future Service Provision What support do people want and need? 1. Services need to be person-centred and holistic Individuals and stakeholders emphasised the importance of people having a choice and being informed about the options available to them, and services designed around needs and wants, for example to be age and gender specific. Good practice was identified when it was felt that services took a holistic approach, to link in with partners, supporting people to make links to help that was meaningful to their whole lives, working towards positive mental, physical and social health. 2. Services need to be responsive A key message across groups was that people need to get support quickly, and they described the need for a crisis service which was a hybrid between an addiction service and an emergency response. Interviewees felt this service should be an accessible walk-in service that provided immediate support for people seeking assistance with a substance misuse issue, including overnight accommodation if required. They also felt the service should fully support people to access the most appropriate substance misuse service in the days following their initial presentation. 3. Services should be available out of hours and be able to provide assertive outreach At present it was felt that generally services are designed for service providers and not for the people the service is for. Taking account of the needs identified, good practice was felt to be when services provided both assertive outreach and out of hours support. The interim report of the Overdose Response Team (Evans et al. 2022), which operates in the area of North Lanarkshire, highlights the benefits of this type of provision. “The worker gave me a list of numbers but I prefer one to one and have not phoned anyone… I think having people come to you, so I had the workers come to me when I was out of hospital and it really helped.” (Kate) 4. Services should have a single shared assessment Statutory service providers reported that the referral systems and bureaucracy involved mean that staff are having to spend a lot of time between different systems to gather information and link people in appropriately, and a single shared assessment across services would work better. 5. Prioritise prevention One stakeholder observed that addiction is inextricably linked to poverty and inequalities and one of the best ways of addressing this is to offer universal services to young people by way of breakfast clubs, free meals and afterschool care that are
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16 preventative in nature. They recognised this was a ‘brave’ move in terms of future commissioning, but also felt that the current system including a focus on people who are using opiates is not working. ‘The ideal’ Stakeholders and individuals were asked what the ideal provision would look like. Some felt that service provision should be completely overhauled and to get ‘the ideal’ it is a case of starting again. “What we need to do is not tinker and look at workforce planning and job roles. We need to start again to fundamentally change how things are done”.(Stakeholder 7) 1. A one stop shop with wraparound care The majority of consultees wanted North Lanarkshire to have a ‘one stop shop’. A physical building with staff who are trauma informed, that individuals could self-refer into at any time, that offered a range of support options. Staff from a variety of services would have time to meaningfully engage, and practical help could be provided to help people make links to the support they needed and wanted, and they would be provided with aftercare. “I think people need a personal worker, so they can phone people day to day, appointments, things like that, take them out for something to eat.” (Leanne) Essentially the vision is that people could get crisis management support and a forward plan would be developed, taking account of people’s needs, wants and capabilities. 2. Services are responsive and there are no waiting times Echoing earlier findings, stakeholders and individuals wanted services to be responsive and, ideally, there would be no waiting times. “Services need to be set-up so they can rapidly respond when folk make that decision.. Timing is so important – striking while the iron’s hot. Someone might be ready to do it one week but the next week they are back using again. If you had the service set-up with a rapid response with a multi-disciplinary team that they should be able to help someone enough within that week when they are open to help for them to think it’s not worth going back to their old life. Someone leaving detox may only have a small window of clarity but if they are going straight back to a homeless unit with an appointment in three weeks’ time to speak to an addictions worker, they are likely to slip and the moment has passed. Find it difficult when people are at that stage. Temptation there when they are being offered street valium for a fiver.” (Stakeholder 7) “I think it takes too long to the time people ask for help to when they get it. When people are chapping the door for help, they want it now, they don’t want it in a
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17 month. When they go to an addictions worker, they want that help. You can’t go to A and E even. It is time people have not got…I have went for help before, I chapped the door, and then they are away. I am on the bender. I went to the addictions team in X to ask for help, they took all my details, by the time I went for urine tests and they finally got back to me, I was on a binge. I think I really wanted the help and I don’t think I would have had those other years if they had given it to me then.” (Neil) 3. Services are holistic, taking a whole family approach and addressing the root causes of addiction As already discussed, consultees felt that the best approaches took a holistic view, listened, learned and responded to what people and their families wanted and needed, providing or connecting people to appropriate practical and emotional support, and taking time to help address the root causes of addiction. 4. Providing out of hours and outreach support A common theme was the need for out of hours and outreach support. “Going to people, out of hours. There are people who can’t get out as much. I feel that they would respond more towards their recovery, if they had that ability to sit in their own house, make the person a tea and coffee, instead of hard chairs and made to rush. You are in your own home. There needs to be a thing of time.” (Alan) The Overdose Response Team and Harm Reduction Team were identified as providing excellent support and ‘bending over backwards’ to help people get the support they want and need. 5. Accessible residential rehabilitation Stakeholders and individuals felt that in North Lanarkshire there was much need for accessible residential rehabilitation, actively promoted and not limited by funding. “I asked for rehab three years ago and still waiting. I ask every fortnight about getting into rehab…we don’t have a rehab in North Lanarkshire. For the last 18 months, every other person on Zoom from Glasgow has been in and out of rehab. We have been told there are 3 beds available in North Lanarkshire, you would need to be really lucky to be one of the three. Where does our worth start?” (Sarah) 6. Follow-up service Individuals and stakeholders also felt follow-up provision was required. This would ensure people are supported by a ‘checking in’ service when they are at home . 7. Connecting people into ‘something meaningful’ One of the key findings in this report is the importance of the recovery community to supporting people to make connections with others, engage in meaningful programmes, support and groupwork. Two individuals spoke about when they were
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18 at their most stable they had taken more of a leading role in the recovery community and it was felt by all, that supporting people to have a sense of purpose and linking into their communities was the ideal. Many individuals spoke about the benefits of the recovery community and of being able to access groups in the community. “These groupwork sessions, art or computer course, little things, acupuncture, meditation, open up something like that…you have no friends when you stop using. Most people who are in recovery, they don’t have a place to go and meet people who are focused on the same thing as them. Get to know more people. Play games, be social. We were experienced in recovery ourselves, see other people. There are not these places about. It is expensive to travel to these other places.. Part of my problem was the isolation and then I had this recovery café, you made friends. ” (Alan) “So the café that I go to, it has opened an allotment. So different days they do different things. There are five different cafes on from Motherwell, sometimes you can get lifts.” (Sarah) One stakeholder described a Community Day Programme that had existed in North Lanarkshire years ago, that provided health information, groupwork and provided people with structure. There was support for something similar to be re-introduced. 8. Individual recovery plan Individuals and stakeholders reported that every person should have their own individual recovery plan. The plan would set out a tailored treatment and support plan including clear milestones that triggered progression to the next stage of the plan. Opportunities Stakeholders were asked where they felt the opportunities were in North Lanarkshire and what change they would like to see happen. The key messages: Relating to provision: 1. Improve provision for those in crisis and families The need to address the lack of crisis services and support for families currently available was a particular focus. 2. Expansion of the recovery community The value of the recovery cafes was clear and it was hoped that they would exist in all areas throughout North Lanarkshire, and there would be specific provision for families too. 3. Digital connections One stakeholder discussed the opportunities that digital connections open up and are yet to be fully utilised.
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19 Relating to cultural shifts: 4. Support for staff At present it was felt that staff, particularly in statutory services are overworked and had become reductive in their practice, so having adequate support and development for staff is needed. Another stakeholder said the one thing they would like to change is that staff are ‘nice’ and have compassion for people. In North Lanarkshire’s Strategy one of the key priorities focuses on the need to develop the workforce. 5. Partnership working Across sectors the benefits of working in partnership are clear and there was a commitment for this to happen more. It was suggested that services offer opportunities to staff across sectors to shadow one another, and in doing so understand their working practices, challenges faced and ideally arrive at solutions together to address them. Stakeholders and individuals alike noted the important role GPs could play in helping people to link into service provision and the need for more information raising. Individuals felt that the responsibility for service provision design and delivery needed to involve statutory, third sector and people with lived experience, and that it was only by working together that real change is possible. 6. Services to promote flexibility It was felt that closing down the cases of people who have not made appointments needs to change and instead barriers to engagement needed to be decreased as much as possible. 7. Including the voices of people with living and lived experience in service design and delivery It was raised by one stakeholder that there is much value in having people who are still using substances included in decision making, and this should be treated as one form of evidence, so that decisions are informed by as many stakeholders and evidence as possible. Wider evidence of good practice The following were ideas given by stakeholders of initiatives that could be tried, drawing from the wider evidence base: ● Rehabilitation services run by people who are in recovery and offering a day programme. ● In Forth Valley there is a paid member of staff from the recovery community who works with the Housing First team there, to support people with any practical and/or emotional needs they may have, as well as actively linking them in with the recovery community, reducing isolation. ● To have people with lived experience paid as experts to inform every aspect of provision. ● Better pathways for rehabilitation, taking the holistic approach to involve the recovery community and family, to understand the best time for this person and the support they require.
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20 ● Injecting rooms and being able to test drugs. ● Therapeutic communities. ● Have no unplanned discharges like Norway. ● Legalise and regulate the supply of drugs.
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Conclusion and recommendations This conclusion draws together the key messages from across the different questions. There was a lot of synergy between what stakeholders and individuals with substance misuse problems said in terms of what the current provision is and what people want for the future. Significantly, there was also a collective commitment and desire to make this happen. There was a sense that this could be a key moment in time when real change for the better began. What is working well? Interviews recognised the backdrop of poverty, backgrounds of trauma, abuse and long-standing issues people faced as being the underlying reasons why individuals had issues with substance use. The services felt to be working well therefore viewed people holistically, often doing outreach, offering out of hours support, taking time to really listen to and understand people, promoting their rights, and worked hard to link people into support they wanted and needed, particularly mental health provision. They also provided or linked people in so they could avail of whole family support, understanding the ripple effect substance use has. The importance of human connection and meaningful engagement, relationships built over time and trust was further emphasised by interviewees’ recognition of the good work carried out by services such as Phoenix Futures, the Overdose Response Team, Equal Say and the recovery communities. Many wanted this outstanding work by these organisations to be expanded further. What is not working well? Lack of resources The responses to what is not working well could be divided into resource and cultural issues. In terms of resources and provision, it was felt that crisis support, accessible rehabilitation options, detox beds, the length of waiting times for treatment and support for families was inadequate. Stakeholders and individuals were concerned about the rise in the cost of living and reflected that deprived areas are already badly affected by drugs. It was reported that the extent to which people with mental health issues are requesting to be sectioned so they can get support has never been seen to this level before. The lack of support for people leaving prison was also noted. Cultural barriers Issues relating to cultural barriers were that addiction and mental health services are sometimes not easy to access, not responsive and people who have a dual diagnosis can fall between mental health and addiction services. Although, there were exceptions reported, stakeholders and all individuals felt that at present, statutory addiction services are overwhelmed and do not have time to meaningfully engage with individuals. All felt that this model meant culturally the focus was on the symptoms rather than addressing the underlying causes of addiction, and essentially medicalising what is a psychosocial problem. There was a perceived cultural divide between statutory services and the third sector, while short-term funding could inhibit partnership working between third sector organisations. A few individuals felt their addiction could have been avoided if they had received better support from their GP and it was also suggested that GPs could play a more proactive role in linking people in to treatment or community support options. Individuals praised the support they
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had received from completing a DTTO and within rehab, but the lack of follow-up support meant that this was not able to be sustained. At the time of writing, statutory services are still not seeing people face-to-face to the extent they had prior to the pandemic. Culturally, the stigma around substance use is a significant barrier and as well as the general public, both individuals and stakeholders, felt this also came from professionals who worked in the field. Barriers to engagement Stigma about addiction was felt to be the main barrier to people asking for help and that when they do, services are not always responsive, with lengthy waiting times for a first appointment. Interviewees reflected on the inflexibility of the current model of working, which tends to be 9-5 Monday to Friday and appointment based. Further, if people do not attend a number of appointments they tend to be discharged by services which underlines the lack of empathy and understanding within the current system. Limited information sharing between services was also noted as a barrier to people connecting to appropriate support. Finally, individuals revealed that a barrier to engagement is the concern of going on methadone long-term without an exit plan, and this is essentially linked again to people not having meaningful engagement with workers. Partnership working Good partnership working was felt to be when services are working together towards the same goals, have good communication and when services worked with the whole person and their family, echoing the move towards this being viewed as the ideal way to support people. Co-location of services was also observed as promoting links, for example in Motherwell between housing and health services. Groups not accessing support There were particular groups identified and felt to currently not be accessing support, namely, those living on their own, those not taking opiates, young people, LGBT+, victims of domestic abuse, mothers, people from ethnic minority backgrounds and those who are elderly. GPs were mentioned as a potential ‘way in’ for these groups but also the need to widen partnerships even further. Future service provision Most interviewees emphasised the importance of person-centred and holistic support, giving individuals and their families options and choice, finding out what support they want and need, creating a single shared assessment and connecting them to services and clear treatment plans as quickly as possible. Services would also ideally be designed around persons’ needs, offering out of hours provision, assertive outreach and accessible residential rehabilitation. Effectively what people want is to have a ‘one stop shop’ with wrap-around care provided, connecting people also into ‘something meaningful’ in their communities, with the recovery community viewed as playing a vital supporting role, for example by running a day programme. Stakeholders were asked about what they felt the opportunities were in terms of change. As well as those already discussed relating to the need for more provision, expansion of the recovery community and digital connections, the need for cultural shifts were discussed. It was said that staff need to be supported and would benefit
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from shadowing and sharing practice across organisations, to understand more and support one another to overcome current challenges. Services needed to be more flexible, taking account of the people they are supporting, and including the voices of those with lived and living experience going forward. It was also felt that digital connections which worked well during the pandemic could continue to support people into the future. Wider evidence Drawing on wider evidence, interviewees also suggested better links between housing, addiction and recovery; involving the family and recovery community in treatment plans; having a commitment to have no unplanned discharges; creating injecting rooms; developing therapeutic communities and, finally, legalising and regulating the supply of drugs. Recommendations 1. Development of a ‘one stop shop’ bringing services or representatives of services to be co-located together, and where people who have substance misuse issues and their families can come and receive instant support, with a care plan developed. 2. The development of a crisis service which is a hybrid between an addiction service and an emergency response. 3. Services to move towards more provision that offers out of hours support and outreach. 4. Quicker and easier access to mental health services, with addiction and mental health services working together, and this is already a priority in NLADP’s Strategy. 5. Development of accessible rehabilitation and detox beds. 6. Following good practice in Forth Valley to develop partnerships between housing, addictions and recovery. 7. To commit to having no unplanned discharges. 8. More recovery communities established across North Lanarkshire and specific recovery cafes set up for families and young people. Where possible people should be encouraged to take a lead role in provision and the NLADP create a specific strand of funding so local communities can take forward local initiatives. 9. Development of family support in its own right, looking to services such as Scottish Families Affected by Alcohol and Drugs (SFAD). 10. More long-term funding of projects in the third sector, to be able to attract quality staff, ensure continuity of care and development of strong partnerships. 11. Staff in statutory and third sector services to create shadowing opportunities so that they share practice and work together to overcome challenges, rather than seeing this as a ‘them and us’ situation. 12. Drawing on lived and living experience, working with third and statutory services, create a day programme for people. 13. Substance use services in local areas to make connections with GPs, schools, the local voluntary sector to open up avenues of communication and referral pathways.
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14. For the infrastructure to be improved, and for services also to be innovative, using community resources, and in this way also potentially addressing some of the barriers to stigma people are likely to have about having to visit ‘an office.’ 15. Services to be trauma informed. 16. NLADP remains committed to the development of the Stigma plan. 17. A simple but effective strategy for promoting partnership working is ensuring email signatures include mobile phone numbers.
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Case Studies Rab: Alcohol addiction, lack of aftercare in the past but in recovery with vital support from Phoenix Futures and AA Rab drank heavily all his life from a young age and this was the culture he had grown up in, to the point that he drank, not for enjoyment but to get through the day. He had ‘always’ been a ‘secret drinker’, and would go to the pub, but described that it was when he got home that is when he really started to drink, and yet always made his work the next day. He described losing friends because they had helped him too many times over the years, with debts or just even getting himself ready, when he would go on spells of not washing or looking after himself. He had been to hospital many times before for a detox, but was ‘straight out’ and back drinking. Just before lockdown he had was suicidal and called Phoenix Futures who sent the police around to his house and he was taken into a psychiatric ward. He realised if he didn’t stop drinking he would die. Over the past two years he has been engaging with Phoenix and the worker, who has lived experience and feels this has been a real turning point for him. He does not remember being offered support like this before and said that aftercare in the past had been ‘non-existent’. He tried AA in the past and had rejected it, but now attends local meetings. He explained ‘you go there with your bag of shit, put it down and leave it there.’ He says attending the meetings helps him to keep his head clear and he said, ‘I get a wee cuddle off people’. Other services he feels have been excellent were the housing officer that helped him with his debt. He was given support also by a mental health charity but felt that their time frame of working with him for 12 weeks only was not realistic. Rab has stayed sober and feels that one of the reasons is that he is the main carer for an elderly aunt, which is ‘all consuming’ and has given him ‘a real sense of purpose’. Rab felt the main thing missing from services at the moment is communication, with people not having read your file and feeling like you have to explain yourself all the time. His GP also refused to give him medication to deal with withdrawals from alcohol. Rab has found support from the psychologist to be really useful and felt for the first time he was learning about his emotions. The doctor at the hospital also said he could call anytime and he has found this person really helpful too. Rab felt that he had to be suicidal to really get help and felt this should not be the case.
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Shona: Prescription drug addiction led to longstanding illicit drug use, in recovery with support from the recovery community and various services When she was 16, Shona was prescribed co-codamol and diazepam by her GP after enquiring about counselling to help address childhood abuse. For a number of years, Shona continued to take the drugs to “block things”; she was also self- harming. In her 20s Shona was raped. By then she was also taking dihydrocodeine. On an occasion when she could not get the tablets an acquaintance told her dihydrocodeine was heroin in a tablet so she started using heroin. She became addicted to heroin and also started using street valium and crack cocaine. Her addiction continued with sporadic attempts to get clean. On one occasion she had “a major relapse and ended up in hospital” when a doctor told her Mum there was nothing they could do and her best option was to buy Shona heroin. After her relapse, Shona ended up back in hospital with an abscess. At that point she said, “I was done, I was exhausted and I got put on to methadone”. She has not used illegal drugs for two months and said she was “feeling brilliant, feeling really good”. Shona regularly attends recovery cafes throughout North Lanarkshire as well as CA meetings. She described the recovery cafes as a “godsend” adding that “it keeps you busy and gives you something to look forward to; there’s a lot of boredom otherwise”. She has previously been supported by Phoenix Futures and described them as “amazing” but “fell away from it and relapsed again” during lockdown. Shona also has experience of the Addiction Recovery Team. She described having 10 or 11 addiction workers and felt that none of them had the time to support her and focus on the traumatic events which had led to her substance misuse. In the past she had asked about rehab but was told there was no funding and, she reported, her worker asked if she wanted to up her methadone dose. Shona felt her GP had missed numerous opportunities to recognise her dependency on prescription drugs and subsequent use of illegal drugs. Shona was identified by the High Resource User Project as a frequent A&E attender. She has been supported by this project and by the Homes First service. She was very complimentary about both services. Shona has also been supported by Equal Say’s addictions advocacy service which helped greatly when she was at risk of being homeless after leaving hospital. Equal Say’s involvement stemmed from Shona’s mum who was told about the service by SFAD. Shona described her mum’s help as invaluable, “she’s been great, she’s my rock, so she is”. Shona’s mum has continued to engage with SFAD including Zoom calls and added “they’ve been really good for her; they’ve given her an understanding of what it’s like to be an addict”. Shona suggested that, to improve, services needed to “make a point of seeing people more often, and for longer, offer the services that are available other than medication (like counselling) as they want to medicate everything”. Shona also suggested it would be ideal if there was more funding for rehab places.
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Appendix 4 ANNEX A IMPROVING GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS WITHIN ALCOHOL AND DRUG PARTNERSHIPS: SELF ASSESSMENT TOOL Alcohol and Drug Partnerships Partnership Delivery Framework Self Assessment Tool
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June 2022 Introduction to the Self Assessment Tool This Self Assessment Tool has been developed to support Alcohol and Drug Partnerships to deliver the Partnership Delivery Framework, Rights Respect and Recovery and the National Mission to Reduce Drug Deaths and Improve Lives. The Scottish Government and COSLA coproduced the Partnership Delivery Framework for Alcohol and Drug Partnerships which was published in 2019. It sets out the expectations for the role of Alcohol and Drug Partnerships (ADPs The purpose of the self-assessment The purpose of the self-assessment is to give local ADPs a tool to engage and discuss opportunities and barriers to delivery. Strategic Planning follows a cycle of Assessing need Aligning resources Agreeing delivery plans and priorities Reporting and learning from outcomes ADPs are strategic planning partnerships that set out plans to delivery national and local priorities. To effectively deliver these priorities ADPs undertake strategic planning, formulate delivery plans and report outcomes. They do this on a partnership basis
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that aims to be inclusive and transparent with representation from stakeholders affected by alcohol and drug harms. Increasingly alcohol and drug harms are seen as a “whole system” issue and not just the realm of specialist drug and alcohol services. ADPs are not Statutory Public Bodies, i.e. they are not “organisations” and therefore rely on the Integration Authority for financial governance and ratification of investment as well as performance oversight. Community Planning Partnerships hold the overall responsibility for population level outcomes set out in the National Outcomes Framework for Scotland and therefore provide ADPs with an overarching forum for reporting achievement of outcomes. Local areas will also have other strategic partnerships which are required in statute such as Children Service Boards, Community Justice Partnerships etc and it is important to ensure that there are strong links between ADPs and these partnerships. The self-assessment is designed to help local stakeholders ensure that these key relationships are in place and that the local system is supporting the work of the ADP and vice versa. The self-assessment should be agreed and signed off with the relevant Chief Officers and stakeholders. The Scottish Government use of the Self Assessment reports As stated, the self-assessment tool is for local stakeholders to ensure that they are creating the right conditions and operating environments for ADPs to function effectively. The Scottish Government will have oversight of the self-assessment reports and the information will be used to help develop programmes of support for local areas when required and will help facilitate peer discussions with ADPs about best practice and achievements. Where an ADP signals it would like further discussion or support in responding to local barriers, this will initially be provided through discussion with the ADP Liaison leads within the ADP Support Team in the Scottish Government. External Validation ADPs are asked to assess their own ability to deliver against the Quality Standards and highlight any issues. At a future point the Scottish Government will seek to validate the self-assessment through a third-party organisation such as the Care Inspectorate or Health Improvement Scotland. On that basis, ADPs should complete the self-assessment from the perspective of “if an external person reviewed our approach would they find the same evidence we are presenting?” How to complete the Self Assessment Tool
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The self-assessment should tell a story about where the local ADP and relevant partners are in relation to the Partnership Delivery Framework: Strategic planning Financial arrangements Quality improvement and Outcomes Governance and Oversight The relationship between the ADP and the Integration Authority A representative national working group agreed the following five standards in relation to the Partnership Delivery Framework. The five quality standards are: Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan Structure of the Self Assessment Tool The Self Assessment Tool should be completed in conjunction with the Self Assessment Criteria (Appendix 1 page 25-34). The criteria outline the minimum supporting evidence required to demonstrate the ADP is delivering and working in line with the Partnership Delivery Framework.
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The first part of the Self Assessment asks ADPs to assess themselves against the Self Assessment Criteria and to map themselves again the Criteria using the definitions Maintain, Explore, Develop outlined in the table below. Definition Maintain We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. To meet this definition the ADP needs to be confident that it has policies and practice in place. ADP member’s and senior stakeholders support this statement. The ADP has feedback processes in place and is confident that an external process could independently gather similar feedback locally. The ADP is confident in maintaining this standard as core practice. Explore We currently partly demonstrate this standard and may need further development The ADP feels it has some evidence to support the standard but isn’t confident it is consistently maintained. The ADP and stakeholders feel there is room for improvement on some elements of the standard. Develop We do not fully demonstrate this standard currently and need to develop / discuss this further. The ADP is not confident it is achieving the standard. Further work is required to generate support for improvement or progress The self-assessment then asks the ADP to demonstrate their assessment with narrative in line with the headings of: * How effective is the ADP in respect of this area? * How do you know this? * How will you do it and by when?
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For each of the elements described above, please outline in no more than 250 each what you need to maintain, improve or do differently and provide a timeframe for these to be implemented. Please be open and honest in your response and consider the self-assessment in collaboration with relevant stakeholders, including local communities, children, young people and families. This will provide opportunities to: 25. review what progress has been made and what development and learning has happened 26. provide assurance about the quality of delivery 27. highlight areas of good practice for sharing 28. highlight areas for improvement and levels of priority Those completing the self-assessment are encouraged to use information from different sources to triangulate evidence of the quality of service delivery. The completed Self Assessment should focus on outcomes rather than activities. This could include a description of the impact of changes or improvement activities on the delivery or information on how potential impact is being monitored.
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The Self Assessment Tool ADP area: Please use the box below to highlight relevant contextual and background information about the ADP including: -Population data for context -Outlining Governance and accountability arrangements (particularly in relation to ADP, Community Planning Partnership, Integration Joint Boards and Chief Officer Groups) -Links to other local statutory plans/partnerships (and how they link to local delivery) e.g. what links / role does the ADP have in relation to delivery of outcomes against their Local Outcome Improvement Plan / Children’s Services Plan
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Section 1: Strategic Planning Maintain Explore Develop We are confident that we are demonstrating this standard; we have evidence to support this, including stakeholder confirmation and need to maintain this focus overtime. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 1.1 Transparency and Effectiveness 1.2 Inclusion 1.3 Planning Cycle 1.4 Needs Assessment 1.5 Whole System Approach 1.6 Resources and Delivery 1.7 Outcomes Quality Standard 1: The ADP has a Strategic Plan for delivery of identified outcomes
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Q. How effective is your approach to Quality Standard 1? 1.1 Transparency and Effectiveness 1.2 Inclusion 1.3 Planning Cycle 1.4 Needs Assessment
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1.5 Whole System Approach 1.6 Resources and Delivery 1.7 Outcomes Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when?
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Any further comments?
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Section 2: Financial Governance Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 2.1 Investment 2.2 Governance 2.3 Accountability 2.4 Reporting 2.5 Financial Planning Quality Standard 2: The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of its Strategic Plan
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Q. How effective is your approach to Quality Standard 2? 2.1 Investment 2.2 Governance 2.4 Accountability 2.5 Reporting
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2.6 Financial Planning Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when? Any further comments?
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Section 3: Quality Improvement Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 3.1 Methodology 3.2 Reporting 3.3 Sustainability Quality Standard 3: The ADP can demonstrate Quality Improvement in delivery of outcomes
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Q. How effective is your approach to Quality Standard 3? 3.1 Methodology 3.2 Reporting 3.3 Sustainability Q. How do you know this? Q. What do you want to maintain, improve or change?
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Any further comments?
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Section 4: Governance and Oversight Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 4.1 Oversight 4.2 Governance 4.3 Risk Management 4.4 Accountability Quality Standard 4: The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan
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Q. How effective is your approach to Quality Standard 4? 4.1 Oversight 4.2 Governance 4.3 Risk Management 4.4 Accountability
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Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when? Any further comments?
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Section 5: The relationship between the ADP and the Integration Authority Maintain Explore Develop We are confident that we are demonstrating this standard. We have evidence to support this, including stakeholder confirmation and need to maintain this focus over time. We currently partly demonstrate this standard and may need further development. We do not fully demonstrate this standard currently and need to develop / discuss this further. 5.1 Alignment and Governance Quality Standard 5: The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan
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Q. How effective is your approach to Quality Standard 5? 5.1 Alignment and Governance Q. How do you know this? Q. What do you want to maintain, improve or change, how will you do it and by when? Any further comments?
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This Self-Assessment of Partnership Delivery Framework is agreed and ratified by: Senior System Stakeholders ADP Lived Experience Stakeholder/s / Representative Chair of the Alcohol and Drug Partnership Chair of the Community Planning Partnership The Chief Executive of the Local Authority The Chief Executive of the NHS Board Director of Public Health The Chair of the Integration Joint Board The Chair of the Chief Officers Group Divisional Commander for Police Scotland Chief Executive of Third Sector Interface The Chief Officer of the Health and Social Care Partnership
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APPENDIX 1 Self Assessment Criteria
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1 Quality Standard 1 : The ADP has a Strategic Plan for delivery of identified outcomes which ensures adequate alignment with other aligned strategic plans 1.1 Transparency and Effectiveness The strategic plan is agreed by the ADP The strategic plan is published and publically available The ADP can demonstrate effective strategic linkage with other local partnership groups and local communities The ADP can demonstrate examples of improvement activities and positive outcomes for the local population The ADP can demonstrate evidence that Strategic Planning is safe, effective, compassionate and person-centred 1.2 Inclusion The ADP can describe how they engage with local communities The ADP can demonstrate how any potential barriers to involvement or engagement are removed The ADP strategic planning is inclusive of people affected by drug and alcohol harms and their family members, those who use services, those who deliver services, and the local population The ADP embeds equality impact assessment processes to understand the diverse needs of local populations and uses this information to inform pathways and provision in its strategic planning and ensure human rights are met
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The ADP Strategy effectively aligns to other statutory plans / priorities on delivery in support to families in crisis or at risk of being in crisis as a result of drug / alcohol use (e.g. Child Protection, Adult Protection) 1.3 Planning Cycle The ADP can demonstrate that it delivers in line with a strategic cycle for planning which includes: needs assessment, delivery, commissioning, review and reporting of outcomes / progress ADP Strategic Planning is based on population health approaches and includes primary, secondary and tertiary prevention 1.4 Needs Assessment The ADP has a local assessment of the needs of people who use alcohol / drugs led by NHS Public Health and involving partners 1.5 Whole System Approach The ADP can demonstrate that their strategic planning is based on national and local priorities, is evidence based and aligns with delivery of local supports and services The ADP has representatives of: Health and Social Care Partnership: mental health, primary care, adult services Specialist drug / alcohol services Health (e.g. emergency department, relevant acute wards, health improvement / public health)
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Children’s services Police Justice services Housing / accommodation / homelessness services Employment services Community Lived experience Education Third Sector Interface The ADP can demonstrate that other local planning partnerships and services incorporate and complement ADP activity to reduce alcohol and drug harms 1.6 Resources and Delivery The ADP has an annual delivery plan agreed by member organisations that details resources aligned in support of delivery, including the following: direct resource, local financial investments and “in kind” resources. It details cross-system prioritisation and responsibilities within, for example, Health and Social Care Partnerships, Children’s Services Planning Partnerships, Community Justice Partnerships and Community Planning Partnerships to be deployed to implement the Annual Delivery Plan and the outcomes to be achieved
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1.7 Outcomes The ADP uses the outcomes and priority actions set out in Rights, Respect and Recovery and the Alcohol Framework 2018: Preventing Harm and the National Mission Outcomes Framework The ADP outcomes are measureable and reportable The ADP routinely reports on progress against strategic outcomes 2 Quality Standard 2 : The ADP can demonstrate public money is used to maximum benefit to deliver measurable outcomes for the local population in delivery of the Strategic Plans 2.1 Investment The ADP is able to demonstrate that investment in the delivery of outcomes comes from a range of sources, including the Local Authority, Health Board and the Integration Authority, as well as outside of the public sector The ADP can demonstrate investment is in line with Scottish Government priorities The ADP can demonstrate that investment is based on evidence of effectiveness and outcomes The ADP can demonstrate ability to disinvest based on evidence of effectiveness and outcomes and in line with changing priorities articulated though formal needs assessment
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2.2 Governance The ADP has clear policies and procedures for aligning resources for investment with strategic planning The ADP seeks authorisation for investment from the Integration Authority and local scheme of delegation The ADP has a clear policy agreed with members and the Integration Authority on the treatment of underspends / overspends The ADP can demonstrate effective and transparent governance arrangements are in place The ADP can relate investments in third sector and public sector to performance and outcomes 2.3 Accountability The ADP and the Integration Authority can demonstrate all funding allocated to NHS Boards for onward delegation to ADPs is available to the ADP The ADP has full accountability for the totality of funding allocated for drugs / alcohol from its NHS Board and Local Authority 2.4 Reporting The Health and Social Care Partnership Chief Finance Officer is a member (or formally represented) on the ADP There is regular routine financial reporting to the ADP on the total spend on alcohol and drug services The ADP and Integration Authority provide an quarterly and annual financial report to the Scottish Government The ADP reports to local governance structures on investments
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2.5 Financial Planning The ADP strategy includes investment to increase activity over time in relation to prevention and early intervention aligned with other such preventative spend across local partners / partnerships 3 Quality Standard 3 : The ADP can demonstrate quality improvement in delivery of outcomes 3.1 Methodology The ADP has or uses an underpinning quality improvement methodology ADP staff and members are supported to use improvement methodologies through training and other workforce development activities 3.2 Reporting The ADP can demonstrate examples of where improvement methods have had a positive impact The ADP can demonstrate links with outcome reporting, needs assessment and financial investment / disinvestment
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3.3 Sustainability The ADP can demonstrate how achieved improvements are embedded and sustained The ADP benchmarks performance with other areas (e.g. other ADPs, other partnership groups) 4 Quality Standard 4 : The ADP can demonstrate appropriate Governance and Oversight in delivery of the Strategic Plan 4.1 Oversight ADP Members can demonstrate effective oversight arrangements are in place to deliver the local strategy The ADP can demonstrate processes to ensure oversight, coordination and alignment of ADP activity with other relevant local partnerships and strategies 4.2 Governance The ADP has published the roles and remit for members setting out how decisions are made, issues and disputes are resolved, conflicts of interest are managed There is a organogram that sets out the relationship of the ADP with the Integration Authority, with other planning boards (e.g. Children’s Partnership and the Community Justice partnership), and with areas of statutory responsibility (e.g. Child Protection and Adult Protection)
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The ADP can demonstrate how they know governance structures provide appropriate assurance of safe, effective, compassionate and person-centred delivery There are process in place for the ADP Chair to escalate and progress discussions with local partners / responsible officers when a priority is not being delivered and a process in place to ensure ADP contribution to aligned plans is being progressed The ADP strategic plan forms part of the overall Community Planning Partnership (CPP) offer, is ratified via CPPs, and aligns with the priorities of other key statutory plans 4.3 Risk Management There is a clear process for identifying and managing risk in relation to delivery of national and local priorities There are clear controls in place to reduce impact of identified risks The ADP can demonstrate how failure is reported, analysed and learning facilitated 4.4 Accountability The ADP can describe clear accountability to appropriate Chief Officer(s) responsible for the delivery of relevant policy, system or targets The ADP can demonstrate clear articulation of the relationship with senior accountable officers, and specifically, the relationship between the ADP and Public Protection that sit with the local Chief Officers Group and can demonstrates that
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processes are in place to ensure learning from drug deaths and responsibility for reducing substance use mortality and harm 5 Quality Standard 5 : The work of the Integration Authority and the ADP is aligned and the Integration Authority is able to provide Directions to partners in support of the ADP Strategic Plan The ADP has a clear policy on taking investment plans and business cases to the Integration Authority Joint Board for ratification The ADP provides performance and financial reporting to enable support the development of the Integration Authority’s Annual Performance Report The ADP regularly reports to the Integration Authority on performance The work of the ADP is reflected in the objectives of the Integration Authority Strategic Plan Governance and oversight arrangements for ADP business are supported by the Integration Authority Adult treatment services are delivered in line with ADP strategy The ADP and the Integration Authority have a clear policy on how decisions and directions are managed for services out- with the scope of the Integration Authority (e.g. children’s services, police, housing will be issued)
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The Integration Authority ensures governance arrangements support the deployment of resources at pace to support the Mission