ITEM 12 Drug related deaths in North Lanarkshire and ADP Self-Assessment
North Lanarkshire Council · 18 October 2023
Back to IJB Performance, Finance and Audit Committee — 18 October 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 REPORT Item No:12 SUBJECT: North Lanarkshire ADP – Drug Related Deaths TO: IJB Performance, Finance & Audit Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 18th October 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTES TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to: (1) Note the content of the report; (2) Acknowledge the content of the National Record of Scotland (NRS) Drug Related Deaths in North Lanarkshire report, setting out the detail of the confirmed drug related health data from 2022, published by NRS in July 2023. (3) Recognise that there are a range of current arrangements in place to reduce harms. (4) Recognise a more detailed report on the impact of commissioned services and progress will follow in March 2024. This will include a financial overview of spend and forecast arrangements.
Page 2
2 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The National Record of Scotland (NRS) Drug Related Deaths was published in July 2023, this report highlights the information specific to North Lanarkshire. 5.2 A summary paper is presented at Appendix 1 providing more detail to the summarized information noted below. 5.3 There were Sixty-five Drug Related Deaths in North Lanarkshire in 2022, down nineteen percent (15 deaths) on 2021. This reduction is the third fall in three successive years. (Highest number of deaths 95 in 2019) though figures remain high. The figures represent the fifth highest number of Drug Related Deaths on record. 5.4 The five-year average rate for North Lanarkshire is very similar to that seen nationally across the reporting period. 5.5 Drug related deaths are more prevalent in males than females in North Lanarkshire in 2022. 5.6 Opiates/opioids were the most common group of drugs implicated in DRD in north Lanarkshire in 2022. 5.7 Four of the six localities in North Lanarkshire had a reduction in DRD in 2022 compared to the previous year. o Airdrie Locality had largest reduction in DRD in 2022 compared to the previous year with ten less reported deaths. The only Locality with an increase in DRD (+5) in 2022 was Motherwell Locality. 5.8 Over seventy percent (71%) of DRD in North Lanarkshire in 2022 had two or more substances implicated in the cause of death. 5.9 Alcohol was implicated in almost double the proportion (20%) of DRD in North Lanarkshire in 2022 compared to Scotland as a whole (11%). 5.10 The NLADP support team worked closely with key partners through the five ADP sub-groups (below) to develop key actions in keeping with national evidence- base, regional scoping work and learning from commissioned services to target the right responses to reduce harms. 5.11The following ADP sub-groups oversee and support decision making on local investments linked to delivering the National Mission priorities. (1) Prevention, Early Intervention, & Education (2) Treatment, Care & Recovery (3) Whole Family Approach (4) Public Health Approach to Justice
Page 3
3 (5) Reducing Alcohol Harms Group (pan – Lanarkshire) (6) Drug Death Prevention Group (pan – Lanarkshire) 5.12 The work led by the NLADP will continue to engage wider stakeholders in analysing the impact of current services, supports and models of intervention, as well as consider the priorities and design into the future. A stakeholder conference in November 2023 will bring together people with lived and living experience, frontline practitioners, managers and strategic leads to reflect on local and national performance. Outcomes from this event will be incorporated into a fuller report to committee in March 2024. 6. CONCLUSIONS 6.1 Deaths from drugs in 2022 reduced, as did the numbers across Scotland. The numbers for North Lanarkshire remain high. 6.2 Poly-substance use is an ongoing concern, including alcohol prevalence in confirmed deaths from drugs. More work is required to understand the right approach needed for North Lanarkshire. This will be explore thought the Drug Death Review processes in place and the Reducing Alcohol Harms group. 6.3 NLADP now has the appropriate processes and measures in place to offer assurances that everything possible, to reduce harms and deaths from substances, is being considered. This is set out in the ADP Annual Survey. 6.4 NLADP increased investments across key priority areas for the past 3 years and is working closely with key stakeholders to review data and local intelligence to target the most appropriate interventions in areas of concern. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒
Page 4
4 7.2 ASSOCIATED MEASURE(S) Drug Death prevention - The Pan-Lanarkshire Drug Death Prevention group (DDPG), a function of North and South ADP’s has been in place since 2019. The work of the group is guided by an action plan aligned to the national approach set out in Staying Alive and the Drug Deaths Task Force Changing lives report. NHSL, Director of Public Health will take on the Role of Chair for the DDPG strategic group from December 2023. North and South ADPs share a Drug Deaths Information Officer post providing a supporting role in gathering data any information relating to suspected drug related deaths. This allows the wider partnership to identify trends and patterns to target the right responses required to reduce deaths and harms from drugs. Quarterly reports are produces and shared by the groups. The drug trends monitoring group is a quarterly meeting attended by police/ADP stakeholders and is Chaired Public Health colleagues. The purpose of this group is to identify and share relevant information appropriately to inform and safe lives. This group is linked to Public Health Scotland’s RADAR alerts system to ensure our local response is well informed and efficient. A seminar to examine the challenges in relation to drug-related deaths and suicides has been scheduled for 4th October, on behalf of the Public Protection Chief Officers Groups (PPCOGs) for North and South Lanarkshire. PPCOGs have a responsibility to ensure suicide prevention and drug related deaths are a priority. The seminar will ensure all are cited on the local issues and that the responses both individually and collectively are effective. • Medication Assisted Treatment (MAT) standards – 1-5 implemented and embedded by March 2024 (6-10 beyond). Work continues to fully embed all standards by March 2025. A dedicated North working group meets monthly to guide this work with links to a Pan-Lanarkshire oversight group. • Residential rehab – assessment and access is now offered to anyone who chooses/where appropriate to access rehab, as part of their care and treatment. NLADP published the rehab pathways online in 2023, setting out how people can access rehab. There has been an increase in referrals and placements following training being delivered to frontline staff in 2023. • Harm reduction and Assertive Outreach – A new crisis response team has been commissioned via NLADP, in collaboration with housing and treatment service colleagues. The new service will deliver vital support to reach people in crisis sooner and will connect people to support following a near fatal overdose. A steering group has been established to lead this work to ensure we offer a consistent approach and make the most of the increased workforce capacity to deliver Harm Reduction measures. This includes Naloxone provision, Blood-Bourne Virus testing and wound care.
Page 5
5 • Whole Family Approach – integrated authorities are tasked with increasing and widening Family Inclusive Practice (FIP) across all treatment and care settings. NLADP commissioned a new family support service, independent of treatment services, to meet the needs of families. Workforce training is underway with frontline staff to improve family involvement in treatment and care planning, where appropriate. This is being led by Scottish Families Affected by Alcohol and Drugs who developed the national framework. • Lived and Living Experience (LLE) and those in recovery are involved in design, delivery and evaluation of services. LLE Panels are to be established with a dedicated post within the ADP support team out to advert to lead this work. NLADP has a very strong focus on listening to LLE via ADP commissioned services, there are visible and active Recovery Communities and Tier 2 treatment services operating across all six localities in the North. – LLE involvement in ADP recruitment and commissioning processes – LLE Representation embedded across all ADP sub-group structures – NLADP is establishing lived experience panels by March 2024. Young people’s voices are included in the planning, delivery and evaluation of services with NLADP commissioning services to support young people to engage in this process. – Peer-awareness and education initiatives recommissioned with youth lived- experience panels to be established. Healthcare Improvement Scotland have been leading a review of mental health and substance use support (North) this includes lived and living experience. Final recommendations and actions for consideration to be reported in October 2023. 7.3 FINANCIAL NLADP has increased investment across the sector, targeting the most appropriate and evidence-based interventions to deliver on the Nation Mission Priorities. This is intended to reduce harms and prevent deaths with spending decisions made via the ADP sub-groups with approval by the ADP Board and finance groups. The year-end position for NLADP spending is set out below: 2020/21 Year end £2,410,584 2021/22 Year end £2,290,611 2022/23 Year end £4,219,447 2023/24 Spend forecast £4,988,194 This paper has been reviewed by Finance: Yes ☐ No ☐ N/A ☒
Page 6
6 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes □ Provide stakeholders with information on how to get involved □ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings □ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff □ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒
Page 7
7 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 National Record of Scotland (NRS) Drug Related Deaths in North Lanarkshire report, 2023. This report sets out a more detailed breakdown of NRS data for confirmed Drug Related Death in North Lanarkshire for 2022. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; John Holleran on 01698 753651 john.holleran@lanarkshire.scot.nhs.uk
Page 8
8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
Page 9
[Type here] [Type here] [Type here] Appendix 1 P a g e NATIONAL RECORDS OF SCOTLAND (NRS) REPORTED DRUG RELATED DEATHS (DRD) IN NORTH LANARKSHIRE IN 2022 A NORTH LANARKSHIRE FOCUSSED SUMMARY OF THE NRS DATA AND PUBLICATION North Lanarkshire Alcohol and Drug Partnership 28 August 2023
Page 10
1 | P a g e Summary ...................................................................................................................................................................................... 2 Headlines ................................................................................................................................................................................. 3 Sex ............................................................................................................................................................................................. 3 Age ............................................................................................................................................................................................ 4 Deprivation ............................................................................................................................................................................. 5 Geography ................................................................................................................................................................................... 6 Substances .................................................................................................................................................................................... 7 Opiates or Opioids .......................................................................................................................................................................... 8 Benzodiazepines ...................................................................................................................................................................... 9 Other substances ................................................................................................................................................................... 10 Annotation ..................................................................................................................................................................................... 11 CONTENTS
Page 11
2 | P a g e THERE WERE SIXTY FIVE DRUG RELATED DEATHS IN NORTH LANARKSHIRE IN 2022. This is fifteen less than 2021 and the third successive year showing a reduction. Deaths are still high however with almost thirty more deaths in North Lanarkshire in 2022 compared to ten years ago. DRUG RELATED DEATHS ARE MORE PREVELENT IN MALES THAN FEMALES IN NORTH LANARKSHIRE IN 2022. In North Lanarkshire in 2022 there were one and a half times more DRD reported for males than females. Whilst this is a considerable difference and both male and female DRD have shown a decrease from 2021 the proportional fall is much more marked in males. Ten years ago, in 2012, there were over four and a half more DRD reported for males in North Lanarkshire than females. OPIATES/ OPIODS ARE THE MOST COMMON GROUP OF DRUGS IMPLICATED IN DRD IN NORTH LANARKSHIRE IN 2022. Whilst Opiates/Opioids are the most common drug implicated in DRD in North Lanarkshire, in 2022, the proportion is considerably less than that reported nationally (82% Scotland, 74% North Lanarkshire). The most commonly implicated Opiate/Opioid for DRD in 2022 in North Lanarkshire differs from what is seen nationally with Heroin/ Morphine being the most commonly implicated in North Lanarkshire and Methadone the most commonly implicated nationally. SUMMARY
Page 12
3 | P a g e Drug Related Deaths in North Lanarkshire remain high but have fallen in three successive years. • Sixty five Drug Related Deaths in North Lanarkshire in 2022. • Down nineteen percent (15 deaths) on 2021. • Third fall in three successive years. (Highest number of deaths 95 in 2019). • Fifth highest number of Drug Related Deaths on record. • Five year average rate very similar to that seen nationally across the reporting period. HEADLINES
Page 13
3 | P a g e Reduction in deaths over six times greater in males than females. There were one and a half times the number of drug related deaths for males (39, 60%) compared to females (26, 40%) in 2022. The gap has narrowed, for the second consecutive year, with one point nine times the number of drug related deaths for males (52, 65%) compared to females (28, 35%) in 2021. Reduction in deaths over six times greater in males (13 less deaths) than females (2 less deaths). SEX
Page 14
4 | P a g e Thirty eight percent of DRD in 2022 in North Lanarkshire occurred within the thirty five to forty four age group. The age profile in North Lanarkshire is broadly similar to the national profile for 2018-2022 averages per 100,000 population deaths. Deaths per 100,000 population in the 25-34 age group in North Lanarkshire is considerably higher than what is seen nationally for 2018-2022 averages (41.3 North Lanarkshire, 27.9 Scotland). In 2022 the age group with the largest proportion of deaths was the 35-44 age group (38%) followed by the 45-54 (32%) age group. This differs from 2021 where the this was reversed i.e. most deaths in 45-54 age group followed by 35-44 age group. AGE
Page 15
5 | P a g e More than half (58%) of the DRD reported in 2022 in North Lanarkshire were for individuals living in the most deprived area (Scottish Index of Multiple Deprivation (SIMD) quintile 1). Almost ninety percent (86%) of DRD in North Lanarkshire in 2022 were for individuals in the two most deprived areas (SIMD 1 and 2). In North Lanarkshire in 2022 there were ten percent more (86%) DRD in the two most deprived areas compared to Scotland as a whole (76%). Less than four percent of DRD in North Lanarkshire in 2022 were for individuals in the two least deprived areas (SIMD 4 and 5). DEPRIVATION
Page 16
6 | P a g e All localities in North Lanarkshire had five or more DRD in 2022. Four of the six localities in North Lanarkshire had a reduction in DRD in 2022 compared to the previous year. Airdrie Locality had largest reduction in DRD in 2022 compared to the previous year with ten less reported deaths. The only Locality with an increase in DRD (+5) in 2022 was Motherwell Locality. GEOGRAPHY
Page 17
7 | P a g e Opiates/Opioids are the most common drug implicated in DRD in 2022 in North Lanarkshire. Whilst Opiates/Opioids are the most common drug implicated in DRD in North Lanarkshire in 2022 the proportion is considerably less than that reported nationally (82% Scotland, 74% North Lanarkshire). A similar relationship can be seen for benzodiazepines and Gabapentin and/or Pregabalin (Benzodiazepines 57% Scotland, 49% North Lanarkshire, Gabapentin and/or Pregabalin 35% Scotland, 28% North Lanarkshire). Alcohol was implicated in a considerably larger proportion of DRD in 2022 in North Lanarkshire compared to Scotland (20% North Lanarkshire, 11% Scotland). Over seventy percent (71%) of DRD in North Lanarkshire in 2022 had two or more substances implicated in the cause of death. SUBSTANCES
Page 18
8 | P a g e Methadone was implicated in almost half the proportion of DRD in North Lanarkshire (23%) compared to Scotland (45%) in 2022. Buprenorphine was implicated in more than double the proportion of DRD in North Lanarkshire (14%) compared to Scotland (6%) in 2022. Every DRD in North Lanarkshire in 2022 where Buprenorphine has been implicated was a poly drug death; on average there were 4 drugs implicated in every DRD where Buprenorphine was implicated. In North Lanarkshire in 2022 the most commonly implicated Opiate/ Opioid for DRD was Heroin/ Morphine (40%). This differs from Scotland were Methadone was the most commonly implicated Opiate/ Opioid (45%); Methadone was implicated in twenty-three percent of DRD in North Lanarkshire. OPIATES OR OPIOIDS
Page 19
9 | P a g e With the exception of Etizolam all categories of Benzodiazepines are implicated in a smaller proportion of DRD in North Lanarkshire in 2022 than across Scotland. Any "Prescribable" benzodiazepine were implicated in half (9%) the proportion of DRD in North Lanarkshire in 2022 compared to Scotland as a whole (18%). Diazepam was implicated in five times the proportion (15%) of DRD in 2022 across Scotland compared to North Lanarkshire (3%). BENZODIAZEPINES
Page 20
10 | P a g e Alcohol was implicated in almost double the proportion (20%) of DRD in North Lanarkshire in 2022 compared to Scotland as a whole (11%). Cocaine was implicated in more than one in three (35%) of DRD in North Lanarkshire in 2022, which is identical to the proportion across Scotland. In 2021 Cocaine was implicated in twenty-seven percent of DRD in North Lanarkshire. Although this (35% reported in 2022) is a proportional increase of seven percent it equates to just one more DRD were Cocaine was implicated in 2022 (23 deaths) compared to 2021 (22 deaths). Gabapentin and/or Pregabalin was less commonly implicated (7% less) for DRD in 2022 in North Lanarkshire (28%) compared to Scotland as a whole (35%). OTHER SUBSTANCES
Page 21
11 | P a g e Pages 3 and 4 1) Populations for 2022 are not available at the time of publication so 2021 populations are used to calculate rates for 2022. Page 4 2) Some age groups have been aggregated to protect anonymity. Pages 7,8, 9 and 10 1) More than one drug may be reported per death. These are mentions of each drug, and will not add up to give total deaths. ANNOTATION
Page 22
12