250120 ARS Board Audit Scotland - Alcohol and Drugs Services - FINAL 2
Renfrewshire Council · 20 January 2025
Back to Audit, Risk and Scrutiny Board — 20 January 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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___________________________________________________________________ To: Audit, Risk and Scrutiny Board On: 20 January 2025 ___________________________________________________________________ Report by: Chief Executive ___________________________________________________________________ Heading: Audit Scotland Report - Alcohol and Drugs Services ___________________________________________________________________ 1. Summary 1.1 In October 2024 Audit Scotland published a report on ‘Alcohol and Drug Services’, looking at how effectively Scotland’s alcohol and drug services are delivering the Scottish Government’s strategies. The audit considers: • how well are current leadership and accountability arrangements supporting the effective delivery of the Scottish Government’s drug and alcohol strategies? • how responsive are drug and alcohol services to the needs of people using services, and is this evidenced in outcomes and performance data? • how effective are the funding arrangements for drug and alcohol services for achieving objectives in national strategies, and what is the balance of investment across different types of services? 1.2 This paper summarises the report, and provides an overview of activity in Renfrewshire to mitigate the risk of alcohol and drug-related harms. 1.3 Elected Members are asked to note that updates in relation to local recovery related activities are reported through updates provided on Fairer Renfrewshire and the HSCP to the Leadership Board, with the Fairer Renfrewshire sub-committee hearing a more detailed update on local statistics and activities at its meeting on 13 November 2024. Detailed presentations on alcohol and drug related harm are also provided at least annually to the Member Officer Group and Chief Officer Group. ___________________________________________________________________ 2. Recommendations 2.1 It is recommended that members of the Audit, Risk and Scrutiny Board: • Note the content of this paper
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3. Background 3.1 Audit Scotland have published a number of briefings on alcohol and drug services, in 2009, 2019, and 2022. Key findings from the 2022 briefing included: concerns around leadership from the Scottish Government on this issue; a perceived lack of transparency over how much is invested in alcohol and drug services, the sources of funding, and where that funding is directed to; and, a conclusion that there was a need for an integrated plan that sets out how investment in evidence-based strategies and interventions can improve outcomes. 3.2 In undertaking the 2024 audit, the fieldwork focused on three Alcohol and Drug Partnership (ADP) areas, to better understand local challenges and pressures: Clackmannanshire and Stirling; Glasgow City; and, North Ayrshire. Auditors also engaged with a range of stakeholders, including national organisations across the public and third sector. The scope of the audit does not include the justice system’s approaches to preventing drug harm through the supply of drugs. 4. Key Messages from Report 4.1 The report provides data on the numbers of people dying in Scotland relating to alcohol and drug use, over the period 1999 – 2023, which continue to be high compared with other parts of the UK and Europe. The report notes that this is despite its assessment of improved national leadership, and increased investment in alcohol and drug services. 4.2 Scottish Government progress to address previous Audit Scotland recommendations is noted, including increasing residential rehabilitation capacity, and implementing treatment standards. However, the report highlights that progress relating to putting in place key national strategies into practice, such as implementing a workforce plan, and alcohol marketing reform, is viewed as being slow. The paper asserts that alcohol consumption is a deep-seated part of Scottish culture, and that the Scottish Government’s focus on drug harm through the National Mission shifts the balance of attention from tackling alcohol harm. 4.3 The report recognises that alcohol and drug services are complex and are delivered by a wide range of partners. It notes that ADPs have limited powers to influence change and direct funding, and that accountability requires to be clearer across partnerships, including how partners contribute towards improving outcomes. With most funding directed at specialist services treating people at crisis point, it is highlighted that investment in prevention is limited. Auditors believe that better information to inform service planning and funding prioritisation is required. 4.4 Funding for tackling alcohol and drug harm has more than doubled over the last ten years, and there has been increased funding through the National Mission. However, the paper notes that ADPs have experienced a decrease in real terms funding due to inflationary pressures, and that short term funding makes it difficult to plan and deliver long term, and invest in prevention. It is highlighted that the Scottish Government has not yet undertaken evaluation to determine costs and effectiveness
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of alcohol and drugs services, and the importance of directing available funding in the most effective way, particularly given the uncertainty around how services will be sustained after the National Mission ends in 2026. 4.5 The paper notes that the provision of person-centred services is mixed, and that not everyone can access the services they need, or is aware of their rights. The barriers noted to accessing support include stigma, limited access to services in rural areas, high eligibility criteria, and long waiting times. It is also noted that those already facing disadvantage experience additional barriers to accessing support, and there is more to do to tailor services to individual needs. 4.6 The immense strain on the alcohol and drug workforce is highlighted as a concern, with staff often feeling undervalued and at risk of burnout, and lacking job security. The report notes the Scottish Government workforce plan to address this, but believes urgent action is required to address these challenges, as well as better joined up working and data sharing between partners, and further involving those with lived and living experience. 5. Recommendations from Report 5.1 The report notes recommendations for the Scottish Government to undertake by mid- 2025, as well as recommendations for ADPs, Integration Authorities, and key partners. These are summarised below: Scottish Government Recommendations, by mid-2025 • Work with key stakeholders to identify and agree actions to increase focus and funding for tackling alcohol-related harm, while continuing to tackle drug-related harm. • Develop a transition plan for the ongoing funding and sustainability of alcohol and drug services after the National Mission ends in 2026. • Clarify accountability of alcohol and drug service providers and other statutory service providers that are collectively responsible for improving outcomes for people facing alcohol and drug harm. • Set out ambitious but realistic timescales for delivering key national supporting strategies and work collaboratively with stakeholders to put in place robust monitoring and transparent reporting on progress. • Identify ways of developing more preventative approaches to tackling Scotland’s long history of alcohol and drug problems, to target people at risk of harm before problems with substance use develop. ADPs, Integration Authorities, and Key Partners – Recommendations • Work together, along with people with lived and living experience, taking a person-centred, rights-based approach to identifying joint solutions for addressing the barriers that people face in accessing services.
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6. 6.1 6.2 6.3 6.4 Renfrewshire Context The below provides a summary of the work taking place across Renfrewshire to mitigate the risk of drug and alcohol related harms, including an overview of the data in Renfrewshire relating to drug-related and alcohol-specific deaths in 2023, as well as current actions supported by partners in the Renfrewshire ADP. Further detail was recently provided as part of an update to the Fairer Renfrewshire Sub-Committee on 13 November 2024, relating to data available and activity currently being progressed and planned across Renfrewshire. Drug-Related Deaths 2023 The National Records for Scotland published Drug-Related Deaths in Scotland in 2023 in August 2024. The figures showed that 44 people in Renfrewshire lost their lives in 2023 with drug use as a factor. This is a 13% increase on the previous year. Opioids remain the most common type of substance implicated, and men continue to be more likely than women to have a drug-related death, although in Renfrewshire there was an increase in female drug related deaths compared with 2022. This is in line with national trends, as is the rising average age of those dying from a drug- related death. Alcohol-Specific Deaths 2023 The National Records for Scotland published Alcohol-Specific Deaths 2023, in September 2024. In Renfrewshire, 52 people died as a direct result from alcohol use in 2023, an increase of 24% from 2022. As with drug-related deaths, the average age of those dying from an alcohol-specific cause is increasing, and men are significantly more affected. Those living in the most deprived areas are also more likely to be affected. Renfrewshire Council and Renfrewshire HSCP Services and Projects The below provides a summary of a number of current services, activities, programmes, and projects delivered by the Council and HSCP : • The Alcohol and Drugs Change Programme was developed to progress the response to the recommendations of the Renfrewshire Alcohol and Drugs Commission on a partnership basis, with the Council agreeing to allocate funding to support a range of projects, aiming to pilot new ways of working across the community planning partnership, with the opportunity to use this learning to transform the way in which people receive support across Renfrewshire. As well as providing supplementary funding to a number of projects, the Programme has supported projects, including: o MyLA (MyLife Ahead) – This housing-led project provides holistic support for families/individuals affected by alcohol and drugs, and who may be in danger of losing their home. o Safeguarding Vulnerable Young People Partnership Programme – Schools – this project provides targeted support in a Renfrewshire school,
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for pupils experiencing significant challenges, and are identified as at risk of missing out on education. o Alcohol and Substance Awareness Resources – Children’s Services, in partnership with I Am Me Scotland, have developed a digital, interactive and progressive curricular programme in substance use for early years to senior phase, aligned to the principles of Curriculum for Excellence, and reflecting the context of alcohol and drug use within Renfrewshire. In September 2023, the programme won the COSLA Excellence Award in the Tackling Inequalities and Improving Health and Wellbeing category and in December 2023 was the winner of a Scottish Public Service Award - The Campbell Christie Public Service Reform. o Trauma Informed and Responsive Renfrewshire – this programme initially arose from the recommendations of the Renfrewshire Alcohol and Drugs Commission, but widened in scope to have a broader focus on reducing inequalities arising from experience of trauma. The programme aligns with the national work on trauma as set out in the National Trauma Transformation Programme. o Stigma/Language Matters – Resources for the workforce have been co- developed with people with lived experience of alcohol and drug stigma, and I Am Me Scotland, with the aim of improving the understanding, awareness, and confidence of the workforce in relation to stigmatising language, and the impact of stigma on individuals and communities, in particular in relation to alcohol and drugs. It is anticipated that these will form part of a wider programme of work, launching in spring 2025. • The Alcohol and Drugs Change Programme is in its final phase, with an evaluation process being progressed to inform future recommendations in relation to service funding/developments. • RADAR works with young people aged 12-20 who have issues with alcohol or drugs, or other substances. It aims to help young people make safe choices through individualised flexible support as well as group work. • The Alcohol and Drug Recovery Service (ADRS) continues to provide a range of care and treatment options for people affected by alcohol and drug use. This includes harm reduction interventions, detoxification and protective medications, support for social issues, psychological therapy, support for family members, access to the CIRCLE Recovery Hub and access to residential rehabilitation. • The Acute Addiction Liaison Service continues to work with colleagues in the Royal Alexandra Hospital. The service will assess the nature and degree of alcohol and drug use experienced by patients admitted to hospital. • CIRCLE supports people in their recovery from both Alcohol, Drugs and Mental Health. It has strongly developed links and pathways with the HSCP core Mental Health and Alcohol and Drug Recovery Service, as well as key partners across Renfrewshire. CIRCLE currently facilitates a wide range of support-focused groups. This is inclusive of holistic, therapeutic and mutual aid/peer groups, to support individuals to further develop a range of skills that will aid them in their
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recovery, and further build confidence and learning techniques to support recovery from addiction-related and/or mental health issues. • The Harm Reduction Response Team (HaRRT) is a mobile assertive outreach service which has been developed to deliver a harm reduction service to individuals who are not in contact with treatment and care services. The key aim of the service is to reduce the risk of overdose and other drug related harms, and provide timely care and support. • RAMH FIRST Crisis drug and alcohol specific service component was launched in April 2022 as a test of change project, and is now embedded in service delivery. • The Renfrewshire Family Support Service offers support to families impacted by alcohol and drugs. The service also continues to facilitate the Bereavement Support Group which helps people to process their grief after losing loved ones due to substances. 6.5 Third Sector Delivery In addition to the provision from the public sector, there are a wide range of third sector organisations in Renfrewshire providing support to those impacted by alcohol and drug harms. These include, but are not limited to: • RCA Trust – a local charity focused on community-based prevention and treatment and offering group work, advice, education, Alcohol Brief Interventions, counselling and providing supported accommodation in Renfrewshire for those who have been homeless or are at risk of homelessness due to their alcohol use; • Kairos Women+ - a community-led women’s space for all women and non-binary people in Renfrewshire offering a range of supports and services including a peer-led recovery support group; • Street Connect – a Scotland-wide charity offering drop-in services and one-to-one support in Paisley; • Barnardo’s Family Support Recovery Service - offering support for family members affected by another’s alcohol or drug use; • Kickin’ On – a peer support group supporting those with mental health challenges as well as harm from alcohol and drugs, and focused on exercise and talking therapies; • Youth Inspired - a multi-disciplinary team working with young people aged 11-25 including workshops, therapeutic recovery and tailored support for young people using drugs and/or alcohol. The ADP website provides has more information on available support, including from national organisations. 6.6 Multi-agency Working Partners work in collaboration across Renfrewshire to tackle harm from drugs and alcohol, including through: • Renfrewshire Alcohol and Drug Partnership
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• The Renfrewshire Drug Deaths Prevention Group • The Drug Death Review Group • The Alcohol Harms Group • The promotion and supply of Naloxone, alongside training for anyone who would like to carry a kit 6.7 Lived Experience The Renfrewshire Lived Experience Forum (LEF) brings together people with lived or living experience of alcohol or drug use, including loved ones affected. The purpose of the group is to give members the opportunity to share their views and experiences to help inform the work of Renfrewshire Alcohol Drug Partnership and in turn improve services in Renfrewshire. The Forum is currently developing a Stigma Action Plan In response to feedback from people with lived experience, a number of trauma informed improvements are being progressed within ADRS at Back Sneddon Street. These are being delivered by a working group which includes input from psychology colleagues and CIRCLE Recovery Hub. 6.8 Additional Resources Renfrewshire ADP recruited an Alcohol Deaths Prevention Lead Officer post for a period of 12 months and will focus on carrying out an audit of alcohol specific deaths which occurred in Renfrewshire. This will identify any trends or risk factors that could point towards areas of focus for harm reduction. In conjunction with the ADP, Renfrewshire Health and Social Care Partnership has recently recruited a Health Improvement Lead and Health Improvement Practitioner with a dedicated capacity for alcohol and drugs. 7. Next Steps 7.1 Partners continue to work together to mitigate the risk of drug and alcohol-related harms in Renfrewshire. Below is a number of activities and actions that will be progressed throughout 2025, including: • ADP Needs Assessment, which will inform the refresh of the ADP Strategy. • Volunteers within CIRCLE have been supporting the growth of the service, including starting Recovery Cafes in other Renfrewshire areas. • A Non-Fatal Overdose Audit conducted by the ADP between October 2022 and September 2023 to be shared with partners. • Work to develop a series of Naloxone videos to educate the wider community about Naloxone, as well as a Harm Reduction campaign aiming to promote service provision available from ADRS and key harm reduction messages will take place. • Workforce development activities such as training for staffing groups on the Impact of Parental Substance Use, a resource developed by the Drug Death Prevention Group outlining risk factors and harm reduction messages, as well as
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resources relating to alcohol and drug stigma and how this impacts individuals, families and communities. • A joint pilot is being established between ADRS and Liver nurses from Royal Alexandra Hospital. The pilot will aim to deliver essential fibro scanning of the liver in a community setting where the person is familiar with, to increase detection of early liver disease/fibrosis in people drinking alcohol harmfully. • The ADP Support Team will continue to develop improved data around those at risk of alcohol and drug related harms, including quarterly reports, a thematic review, and an audit of alcohol-specific deaths to inform service developments and local provision. • A working group is currently being established to investigate and address women-specific issues. • Continue the roll out of Trauma Informed training to staffing groups. • Roll out of resources to support the workforce to think about stigma and its impact on individuals and communities, as part of a wider strategic campaign. ___________________________________________________________________ Implications of the Report 1. Financial – None 2. HR & Organisational Development – None 3. Community/Council Planning – None 4. Legal - None 5. Property/Assets – None 6. Information Technology – None 7. Equality & Human Rights – None – an equality impact assessment is not required for this report as it is a summary of a national report, with an overview of relevant activity in Renfrewshire, for noting only. 8. Health & Safety – None 9. Procurement– None 10. Risk – None 11. Privacy Impact – None 12. Climate Risk – None. 13. Children’s Rights – None. 14. Cosla Policy Position – None _______________________________________________________