ITEM 10 MAT Standards March25
North Lanarkshire Council · 25 February 2025
Back to IJB Performance, Finance and Audit Committee — 25 February 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 IJB Reporting Template REPORT Item No: 10 SUBJECT: MAT Standards TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy Head of Planning, Performance and Quality Assurance Author(s) of Report John Holleran – Strategic Lead, North Lanarkshire ADP DATE: 19 March 2025 1. PURPOSE OF REPORT This paper sets out the progress made towards implementing the Medication Assisted treatment (MAT) standards in North Lanarkshire for 2024. The current position for each standard is set out below with an updated status on each standard required for national reporting in April 2025. This paper is coming to the IJB PFA for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note the content of the report; (2) Acknowledge the significant progress made towards delivering the Medication Assisted Treatment Standards (MAT) throughout 2024. (3) Note the current status of MAT Standards implementation and the position for this year’s national benchmarking report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Scottish Government initiated the Medication Assisted Treatment (MAT) Standards in 2021 with the expectation of MAT being fully implemented by 2024. 5.2 North Lanarkshire ADP and relevant integrated authorities are required to work towards the national drug mission objectives which includes the delivery of the MAT Standards. 5.3 A national benchmarking report was published by Public Health Scotland in July 2024, showing progress made across Scotland on a RAG status basis. Lanarkshire was in a good position to implement the MAT standards with more work still required to fully embed standards 6-10 across all localities. 5.4 This paper sets out the progress made in more detail and highlights the position for North Lanarkshire, based on evidence due to be submitted to Public Health Scotland, for the 2025 benchmarking report. 5.5 North Lanarkshire RAG Benchmarking position 2024: MAT 1 = Green MAT 2 = Green MAT 3 = Green MAT 4 = Green MAT 5 = Green MAT 6 & 10 = Amber MAT 7 = Provisionally Amber Yes ☐ No ☐ N/A ☐
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3 MAT 9 = Amber 5.6 In order to meet green status there is a requirement to provide numerical data, evidence standard operating procedures (SOPs) in place, and report on experiential feedback gathered through interviews with those in services, practitioners and families. 5.7 National progress on MAT Implementation – Published July 2024
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4 5.8 A Pan-Lanarkshire oversight group met quarterly in 2024 with a north delivery group meeting monthly to monitor and progress the MAT standards delivery plan. 5.9 This group was Chaired by the Head of Health and includes representatives from the MAT delivery team from Public Health Scotland. – Throughout 2024, NLADP was required to report to the Scottish Government on MAT standards progress on a monthly basis. – A Project Lead is in place to oversee all MAT deliverables supporting a range of operational improvement measures with drug and alcohol treatment services. – Key MAT leads were identified to maintain progress on each standard. – A peer support worker was recruited to support the experiential elements of the MAT standards delivery. – North Lanarkshire received positive feedback from PHS and the Scottish Government on the significant improvements and progress made between 2023 and 2024.
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5 5.10 MAT 1. All people accessing services have the option to start MAT from the same day of presentation. Standard met – Green. ‒ The Urgent Care Response Team launched in March 2023. This was initially supported by 3 Advance Nurse Practitioner’s (ANPs) with 2 further posts in North as part of a Pan-Lanarkshire approach. ‒ In total, 515 referrals were made for MAT in North Lanarkshire via the Urgent Response Team from April 2023 – March 2024 and since April 2024 – Dec 2024 122 people have been supported. ‒ From Sept - December 2024, 86% of people referred for MAT were assessed within 24 hours, the target is to reach 75% of referrals prescribed OST within in 24 hours. ‒ A decision was reached in January 2024 to move to a North specific approach linking the local Addiction Recovery Teams (ART); to enhance capacity and improve access for those requiring same day access to MAT. ‒ 1 ANP is currently in place for the response team (from July 2024) and being supported with Community Prescribing Service (CPS) to deliver same day prescribing. ‒ The current ANP structure needs reviewed with addiction services in 2025 to ensure any risk to service continuity can be mitigated. 5.11 MAT 2. All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose. Standard met - Green. – Standardised approach in place setting out a range of choices can be offered to individuals across all services - SOPs/guidelines in place. – Leaflet/promotional content improved for individuals accessing treatment, setting out all medication options available. – NHSL continues to grow the focus on choice with more people moving to longer lasting OST including Buvidal. – Updated prescribing guidelines finished in 2024. – Currently, 1207 people access OST/OAT in North Lanarkshire.
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6 5.12 MAT 3 & 5 are now linked. All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. All people will receive support to remain in treatment for as long as requested. Standards 3 –Green. – A local near-fatal overdose response system is in place. This system links with the Scottish Ambulance Service, tier 2 support services including the active recovery community. – The Crisis Outreach Team was commissioned via the North ADP to provide Overdose response, assertive outreach capacity and crisis support (linked to housing service as part of the rapid rehousing transition plan). – Since the service became operational (December 2023), 293 people have been reached across all 3 elements of the combined service operated by Turning Point Scotland (TPS). – NHSL Harm Reduction Team screened 232 Near Fatal Overdoses in 23/24 and have screened 122 so far in 24/25. – MAT 5 data sets are now complete and in place with final snap shot data collections tested. – Exit planning – supported/unsupported discharge data still required for review and improvement plan is in place. 5.13 MAT 4. All people are offered evidence-based harm reduction at the point of MAT delivery. Standard Implemented – Green. - All locations now offering core harm-reduction measures (take-home naloxone and overdose awareness, injection equipment provision and blood-borne virus testing) at follow up MAT appointments. - ART started recording Harm Reduction Interventions July 23, 2464 were recorded between July 23 and Mar 24.
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7 - Since April 24 till Dec 24, 3454 harm reduction interventions have been recorded. - This includes, BBV testing, naloxone offered/taken up, sexual & reproductive health screening. - Harm reduction kits are supplied to all ART sites with Injecting Equipment Provision/Wound care/Dry Blood Spot Testing - staff guides within to ensure consistency all across teams. - Experiential data gathered suggests people have access to harm- reduction interventions and there is widespread awareness of naloxone. 5.14 MAT 6 & 10 are now linked. The system that provides MAT is psychologically informed (tier 1); routinely delivers evidence-based low-intensity psychosocial interventions (tier 2); and supports individuals to grow social networks. Standard in progress – Amber. – A multi-agency steering group is in place and a training plan is being rolled out in conjunction with the development of appropriate training resources for all frontline staff. – Some constraints exist due to release time for staff to complete training linked to this standard, this is limiting the roll out of the workforce development plan. – T1 workforce training, 83% complete with staff, T2 workforce training at 97% and by 31st March 2024 we will be at 100%. The target for MAT benchmarking for PHS is 50%. – Reflective practice sessions now available to all staff, 2 sessions have taken place and been evaluated by participants and facilitators. T2 groups are being piloted in 2 localities, with learning being shared at the North MAT 6&10 meetings. – There are now 4 Turas hosted modules available to expedite the delivery of the training plan. 5.15 MAT 7. All people have the option of MAT shared with primary care. Provisionally amber – NHS Lanarkshire took a strategic decision over 15 years ago to centralise provision of MAT in a GP-run Community Prescribing Service to ensure equity of access. – These arrangements have worked well and are funded from FHS budget (£0.55m in 2022/23). In addition, a MAT dispensing and pharmaceutical care service is funded via community pharmacy (£2.016m) alongside a needle exchange scheme (£0.05m). – Following discussions with the GP subgroup, there is a strong preference to retain a special interest GP approach as there is neither the capacity nor skillset within most practices to reverse our approach. – Prescribing within community pharmacy may be an option but will require further maturity and development – A task and finish group has been created to guide MAT 7 compliance within our existing infrastructure, focussing on a range of options to review and improve the offer to meet MAT 7
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8 – Medical Director has met with MAT Joint Chairs and locality service managers North and South to discuss the approach moving forward 5.16 MAT 8. All people have access to independent advocacy and support for housing, welfare and income needs. Standard met – Green. – Review carried out across all services with key actions, recommendations required to standardise referral pathways, baseline data and reporting arrangements to evidence MAT 8. – Commissioned advocacy services are in place in North Lanarkshire via ADP funding and clear pathways now exist across treatment and care services. – New combined service commissioned via NLC procurement with all MAT requirements included. 5.17 MAT 9 is linked to MAT1. All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. Standard in progress – Amber - A steering group was established in 2024 with joint working between mental health and addiction services (including commissioned services) is in place. - Joint review board now reviewing all aspects of MAT 9 work. - Mapping exercise being carried out and linked to the Mental Health and Substance Use (MHSU) protocol published by HIS in 2024. - Work underway to identify gaps across services with a staff questionnaire being drafted and issued to all MHSU staff. - All people accessing MAT are screened for co-occurring MHSU needs – 122 in total, in 2024. - There is a delivery plan for this standard in place and more wide-spread and routine screening for Mental health concerns now takes place across all key services. - Robust experiential evidence submitted to demonstrate progress is being made in this standard. Experiential Engagement 5.18 In 2023-24 North Lanarkshire’s experiential programme was robust, coordinated and met all of MIST/SG’s criteria. The expectation for 2024-25 is to develop a sustainable model for continued service user, family /loved ones and staff’s feedback. 5.19 This system has been developed and is being piloted and the findings will be part of the 2024/25 submission of evidence. 6. CONCLUSIONS
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9 North Lanarkshire is on track to meet all MAT standards with the exception of MAT 7, which his provisional at Amber. This is due to constraints linked to delivery of MAT across Primary Care. North Lanarkshire is not unique in this. MAT 7 limitations have been acknowledged by the Scottish Government and Public Health Scotland as a national barrier with the majority of ADP areas unable to fully deliver on this standard, hybrid approaches are in place in many Board areas. A great deal of work has gone into achieving the standards across the whole system, this has been acknowledged by Public Health Scotland and the Scottish Government. North Lanarkshire is in a much stronger position to offer MAT as proposed with further improvement work in place to improve the quality and consistency of MAT standards delivery across all localities. The appropriate measures and plans are now in place to drive forward the additional improvements required to fully embed all standards across all localities in 2025. 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 ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL
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10 MAT standards Annual budget for 2024/25 is £570,866, of which £142,446 has been spent (as of month 9). This has been allocated to the fixed-term posts set out above and delivery of MAT standards 1-10, in keeping with the current delivery model. The majority of MAT standards funding is tied to posts with reserves in place to support further mental health and substance use protocol resourcing and stabilisation services in 2025. Additional Injecting Equipment Provision and Naloxone costs have now been linked to this budget for 2024 as well as equipment and supplies for the day to day running of the Urgent Care Response team. This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION 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 Yes ☒ No ☐ N/A ☐
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11 ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. Yes ☐ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
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12 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following;
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13 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
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