Performance Information Update - Drug and Alcohol Services 2023-24
North Ayrshire Council · 1 October 2024
Back to Cabinet — 1 October 2024 and its agenda
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1 NORTH AYRSHIRE COUNCIL 1 October 2024 Cabinet Title: Performance Information and Update – Drug and Alcohol Services – 2023/24 Purpose: To provide an update on the national and local drug and alcohol related targets and standards and performance in North Ayrshire. To provide information of the ongoing successful implementation of the Medication Assisted Treatment Standards. To provide assurance to Members of the performance, actions and service developments being progressed to address the significant challenges for our communities. Recommendation: To note the update on performance and improvement actions contained within the report. 1. Executive Summary 1.1 Detailed progress reports for Drug and Alcohol Services in North Ayrshire are included within: Appendix 1 – North Ayrshire Performance Management Report Alcohol and Drug Services 2023-24 Appendix 2 - Medication Assisted Treatment Progress Report 2023-24 1.2 During 2023-24 all the following national and local drug and alcohol related targets and standards were met in North Ayrshire: • ‘Access to Treatment’ waiting times • Medication Assisted Treatment (MAT) ‘access to MAT’ waiting times • Alcohol Brief Intervention delivery • Substance Use treatment • Naloxone delivery
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2 1.3 Improvement actions were delivered in support of implementing the Medication Assisted Treatment Standards (MAT). North Ayrshire services implemented a wide reaching MAT Improvement Plan which enabled the rollout and delivery of the MAT Standards across all localities. The most recent (2024) national benchmarking report has highlighted continued improvement in North Ayrshire across all 10 MAT Standards. A MAT 7 (primary care focused) model of service delivery has been developed, peer reviewed and is currently being implemented. Further improvement actions have been identified through extensive experiential and data gathering and will be implemented in the year ahead. 1.4 National reports covering the year 2023 were published recently in relation to drug and alcohol related deaths. With regard to drug related deaths, sadly there was a 12% increase in numbers across Scotland with a slight decrease in numbers for North Ayrshire. With regard to alcohol related deaths, there was an increase of one death across Scotland with an increase of one death in North Ayrshire. Further local improvement actions have been identified and are being implemented in support of preventing drug and alcohol related deaths. 1.5 More individuals have been supported to access residential rehabilitation support across North Ayrshire and Scotland wide. 2. Background 2.1 ‘Access to treatment’ waiting times standards In order to promote the importance of individuals being able to access local support timeously, a national standard is in place for individuals seeing help for both for alcohol and drug related issues: • 90% of all clients referred to services will wait no longer than 3 weeks from referral to appropriate alcohol treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate alcohol treatment that supports their recovery The same standard and measurements are also in place for individuals seeking support for their drug use 2.2 ‘Alcohol Brief Interventions’ (ABI) standards for 2023-24 In order to promote the importance of engaging with individuals to reflect on their alcohol use and consider possible change, a national standard is in place to ensure opportunistic discussions can take place across a variety of settings. The ‘Priority’ settings are primary care, A&E and ante-natal. The ‘wider’ settings include partnership and local authority and 3rd sector services. • Target number of ABI’s to be delivered across Ayrshire and Arran within ‘priority’ settings – 3,419 • Target number of ABI’s to be delivered across Ayrshire and Arran within ‘wider’ settings – 855
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3 2.3 ‘Substance Use’ treatment target As part of the ‘National Mission’ the Scottish Government created a ‘Substance Use Treatment Target’ to increase the number of individuals being supported in treatment. North Ayrshire was set a target to increase numbers in treatment from 882 individuals in April 2020 to 959 individuals by March 2024. 2.4 ‘Naloxone’ supply One of the key initiatives to prevent drug related deaths is to supply and promote the use of ‘Naloxone’ (which is an opiate antidote which can temporarily reverse the effects of an opiate overdose, providing more time for an ambulance to be called and treatment to be administered). An improvement plan was created to promote the use of Naloxone and a local target was set for 2023-24 for services to supply, as a minimum, 460 kits. 2.5 Alcohol and drug related deaths Central to the ‘National Mission’ is the requirement to prevent alcohol and drug related deaths. Each and every drug and alcohol related death is a tragedy for those involved and of great concern to all. Services have implemented a range of actions to prevent such deaths whilst also wishing to learn as much as possible about the circumstances around each death and work closely with partners to identify issues and areas for improvement. The North Ayrshire Alcohol and Drug Partnership (ADP) enables partners to come together to implement actions aimed at preventing drug and alcohol related deaths. By adopting a wider public health and human rights based approach and working with local people, services and stakeholders, everyone can work together to prevent these deaths. Each year the National Records of Scotland produce annual reports on drug and alcohol related deaths. 2.6 Residential Rehabilitation Another key element of the ‘National Mission’ is to increase access to residential rehabilitation support. For residents of Ayrshire and Arran, Ward 5, Woodland View, is available for hospital based detoxification support, shorter term rehabilitation support and also offers a day attendance programme. In addition, vulnerable families with young children can be supported to access Harper House in Saltcoats (who offer support to families from across Scotland - with a local enhanced pathway of support available for more vulnerable families from North Ayrshire. The ADP has continued to receive funding to ensure pathways are in place to support individuals to access longer term external residential rehabilitation support across Scotland
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4 2.7 Medication Assisted Treatment Standards As part of the ‘National Mission’ services have been tasked with delivering on 10 Medication Assisted Treatment (MAT) Standards with the aim of improving access, choice and support for individuals. The term MAT is used to refer to the use of medication such as opioids, together with any psychological and social support, in the treatment and care of people who experience problems with their drug use. Over the last year, across North Ayrshire, there has been sustained improvement and progress across all 10 standards. 3. Proposals Performance Information 2023-24 3.1 ‘Access to treatment’ waiting times standards Alcohol • 90% of clients will wait no longer than 3 weeks from referral to appropriate alcohol treatment that supports their recovery Quarter 1 data Quarter 2 Quarter 3 Quarter 4 96% 100% 97% 100% • 100% of Clients will wait no longer than 6 weeks from referral to appropriate alcohol treatment that supports their recovery Quarter 1 data Quarter 2 Quarter 3 Quarter 4 100% 100% 100% 100% Drugs • 90% of clients will wait no longer than 3 weeks from referral to appropriate drug treatment that supports their recovery Quarter 1 data Quarter 2 Quarter 3 Quarter 4 96% 99% 97% 100% • 100% of clients will wait no longer than 6 weeks from referral to appropriate drug treatment that supports their recovery Quarter 1 data Quarter 2 Quarter 3 Quarter 4 100% 100% 100% 100% All waiting times standards were met during 2023 to 2024: 3.2 ‘Alcohol Brief Interventions’ standards for 2023/24 Annual Target set by Scottish Government in priority settings (2023/24) – 3,420 Total ABI delivery in priority settings (as at 31/03/2024) – 6,398 Target achieved
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5 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in wider settings (as at 31/03/2024) – 1,210 3.3 ‘Substance Use’ treatment target North Ayrshire was set a target by the Scottish Government to increase the number of individuals in treatment from 882 individuals in April 2020 to 959 individuals by March 2024. Against a target of 77, there was an increase of 247 individuals receiving treatment, which significantly exceeded the target set. We are now awaiting a new nationally set target for 2024 onwards. 3.4 ‘Naloxone’ supply Against a local target of supplying 460 Naloxone kits during 2023 to 2024 – 679 kits were supplied across North Ayrshire. 57 lives across Ayrshire and Arran were reported to be saved through the use of Naloxone during this period (23 in North Ayrshire). 3.5 Drug related deaths The National Records of Scotland recently produced its annual report titled ‘Drug Related Deaths (DRD) in Scotland 2023’. In 2023, there were 1,172 DRD deaths registered in Scotland. This was an increase of 121 deaths compared with 2022 (an increase of 12%). Scotland continues to have the highest rates of any European country, with 90 per cent of these deaths classified as ‘accidental poisoning’. These deaths are a tragedy for individuals, families and communities across Scotland and are avoidable and preventable. People in the most deprived areas of Scotland are over 15 times more likely to die from a DRD compared to people in the least deprived areas, with males being twice as likely to die as females. Ayrshire and Arran Health Board saw a slight increase of DRDs last year, from 82 deaths in 2022 to 83 deaths in 2023. In North Ayrshire, we saw a slight decrease from 37 deaths in 2022 to 36 in 2023. East Ayrshire saw a slight increase from 30 deaths in 2022 to 31 in 2023, and South Ayrshire saw a slight increase from 15 deaths to 16. North Ayrshire Drug Related Death figures for the past five years are as follows: 2019 – Total number of deaths: 41 2020 – Total number of deaths: 39 2021 – Total number of deaths: 39 2022 – Total number of deaths: 37 Target achieved
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6 2023 – Total number of deaths: 36 While we again welcome this slight reduction in the number of deaths in North Ayrshire, there is no room for complacency. Behind each drug death was a human being who was loved and is missed by their families and friends. 3.6 Alcohol Specific Deaths Sadly, 1,277 people across Scotland died from an Alcohol Specific Death (ASD) in 2023 - an increase of one death from 2022. This is the highest level of deaths in 15 years – with the figures showing that individuals in the poorest communities were more than 4.5 times as likely to die as those in the wealthiest areas. Male deaths continue to account for around two thirds of all deaths. These deaths are preventable and are a tragedy for individuals, families and communities across Scotland. In North Ayrshire, we saw a slight increase from 29 deaths in 2022 to 30 in 2023. North Ayrshire Drug Related Death figures for the past five years are as follows: 2019 – Total number of deaths: 50 2020 – Total number of deaths: 44 2021 – Total number of deaths: 37 2022 – Total number of deaths: 29 2023 – Total number of deaths: 30 We will refresh our actions to reduce the number of deaths in North Ayrshire with an increased focus to reduce alcohol related harms similar to prioritising improvement actions to reduce drug related deaths. 3.7 Residential Rehabilitation Another key element of the ‘National Mission’ is to increase access to residential rehabilitation support. Local hospital based support is provided in Ward 5, Woodland View, Irvine to anyone who has an alcohol and/or drug problem and mental health issues. Ward 5 has 10 beds for residential care – offering local access to residential, detoxification, rehabilitation and day attendance support. Seamless pathways of support are in place with local community alcohol and drug services supporting individuals before, during and after their placement (extra support in place for NA residents e.g. in addition to ongoing NADARS support, everyone is also provided with daily follow up support from the local Turning Point, Scotland, service for the first week following discharge).
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7 During 2023/24: 138 individuals received detoxification support – 94 from North Ayrshire 74 individuals received rehabilitation support – 45 from North Ayrshire Access to additional local residential rehabilitation - Harper House The NA H&SCP was instrumental in supporting Phoenix Futures, Scotland, to open ‘Harper House’ in November 2022 which offers specialist support for the ‘whole family to recover from the harms of problematic drug and alcohol use’. In 2023/24 NADARS supported 7 applications into Harper House with 5 starting the programme. Access to External Residential Rehabilitation (ERR) Individuals wishing to access external residential rehabilitation support can do so via NADARS who will support the development of a care plan, identify a residential rehabilitation provider, seek funding and then support individuals into, through and after their ERR placement. In 2023/24, NADARS received 55 referrals for consideration of ERR. Following assessment, 22 individuals were suitable for ERR and funding was approved (33 individuals felt not ready or declined the ERR intervention at that time and were offered alternative community supports). No application has been declined due to financial considerations 21 individuals commenced ERR (with one individual declining admission at their start date) 3.8 Medication Assisted Treatment Standards In 2021, the Scottish Government introduced 10 Medication Assisted Treatment (MAT) Standards for implementation. Evidence suggests that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality. New approaches were required within North Ayrshire to support rapid access to MAT: A local test of change was carried out to evaluate the new model of care to establish effectiveness prior to roll out An Improvement Implementation Plan was implemented, evaluated & updated with progress reports submitted to the Scottish Government; Quarterly updates on MAT developments were submitted to the national MAT support Team – MIST; An explicit plan was put in place for delivering trauma informed practice; Guidelines and clinical & care pathways of support were put in place to ensure consistency and to support the staff to deliver the interventions.
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8 Results/outcomes (2023-24): • Improvement in the waiting time from referral to commencement of appropriate Opiate Substitution Therapy medication - 75% of individuals were offered a first MAT assessment on the same day as engagement with the service • 100% of individuals were supported to make an informed choice on MAT medication and the appropriate dose • 75% of notified high risk events to the multi-agency assessment team for assertive outreach were contacted on the same day • 85% of individuals were retained in service for more than 6 months • Over 90 individuals have shared care support with Primary Care • 100% of individuals received a mental health assessment • 100% of individuals were offered BBV testing, Harm Reduction interventions and a physical health assessment • Improvement in satisfaction and experience of clients. A RAGB self-assessment was completed and evidence (numerical, experiential and process information) was submitted to the MIST team for analysis and benchmarking. The table below highlights a very positive final RAGB score for the implementation of MAT standards 1 - 10 across North Ayrshire with improvement and progress across all 10 standards. Funding sustainability issue in relation to delivery of MAT Standard 7 (primary care) MAT Standard 7 relates to essential primary care involvement in order to meet the MAT 7 commitment that ‘All people have the option of MAT shared with Primary Care’. In North Ayrshire a MAT 7 delivery model was identified, peer reviewed and agreed. In 2023, NHS Boards received a letter from the Scottish Government which identified that funding for MAT 7 related developments should be extracted from the funding already allocated through the Primary Medical Services funding for
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9 Enhanced Services. This creates an issue for NHS Boards to unpick previous commitments which would enable a shifting of resource. To date there has been no funding re-allocated by NHS Ayrshire & Arran to support MAT 7 developments. With no additional funding being made available, the North Ayrshire ADP allocated non-recurring funding of £89,000 to initiate, at pace, proposed developments in North Ayrshire. Following national discussion and peer review the North Ayrshire MAT 7 delivery model was further refined and agreed resulting in the ADP then increasing their funding commitment to £116,936 a year for a further two years to provide time to review and evaluate the model. This non-recurring funding has been used to employ additional specialist GP and Pharmacist prescribers and to initiate a test of change involving local pharmacies administering Buvidal (an OST medication). 4. Implications/Socio-economic Duty Financial 4.1 The performance report provides an overview of the funding allocated and directed by the ADP to deliver on this critical mission. There remain financial risks including recurring funding which will require to be identified to ensure sustained implementation of all 10 MAT Standards and MAT Standard 7 in particular and the prescribing budget in the HSCP remains under pressure due to the positive promotion of choice of medication. Human Resources 4.2 None Legal 4.3 None Equality/Socio-economic 4.4 The majority of people at risk of drug and alcohol related deaths are among the most marginalised and disadvantaged in our population. Many of those people experience significant disadvantage of opportunity and poorer health outcomes. The programmes of work delivered via our ADP, HSCP, NHS Board, NAC and wider partners contributes to reducing inequalities and in the prevention of drug and alcohol related deaths through public health and human rights based approaches. Climate Change and Carbon 4.5 None Key Priorities
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10 4.6 The information contained within this report and the improvement actions that have been implemented have a positive contribution to play in support of one of the Councils key themes: • Wellbeing (we will address health inequalities, promote children and young people’s wellbeing and enable community wellbeing) Community Wealth Building 4.7 None 5. Consultation 5.1 This report notes the significant collaboration and engagement underway both nationally and locally across the health and social care system to prevent alcohol and drug related deaths and to ensure that all standards and targets are met. The report has been presented to the ADP and also the Integration Joint Board. Caroline Cameron Director - North Ayrshire Health and Social Care Partnership For further information please contact: Peter McArthur, Senior Manager – Alcohol and Drug Services, on 07770730916. Background Papers 2
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1 NORTH AYRSHIRE HEALTH & SOCIAL CARE PARTNERSHIP (H&SCP) and the Alcohol & Drug Partnership (ADP) Performance Management Report Alcohol and Drug information 1st April 2023 to 31st March 2024 Prepared by: Denise Brown NHS Prevention and Service Support Team Peter McArthur North Ayrshire Alcohol & Drug Services
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2 North Ayrshire – Access to Services – Waiting Times April 2023 – March 2024 Alcohol • 90% of clients will wait no longer than 3 weeks from referral to appropriate alcohol treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate alcohol treatment that supports their recovery Drug • 90% of clients will wait no longer than 3 weeks from referral to appropriate drug treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate drug treatment that supports their recovery Target achieved Q1 Q2 Q3 Q4 100% 96% 97% 100% Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved Q1 Q2 Q3 Q4 99% 96% 97% 100% Target achieved Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved
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3 ALCOHOL BRIEF INTERVENTIONS (ABI) Ayrshire and Arran wide information Annual report: April 2023 – March 2024 Annual target set by Scottish Government in priority settings (2023/24) – 3420 Total ABI delivery in priority settings (as at 31/03/2024) – 6398 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in wider settings (as at 31/03/2024) – 1210 SUBSTANCE USE TREATMENT TARGET The Scottish Government have created a new ‘Substance Use Treatment Target’ to increase the number of individuals being supported in treatment. North Ayrshire has been set a target to increase numbers in treatment from 882 individuals in April 2020 to 959 individuals by March 2024. Baseline from Scottish Government Quarterly reporting – North Ayrshire North 01/04/2020 882 Target by March 2024 - an increase of 77 North 01/04/2020 959 Interventions were put in place across our community alcohol and drug recovery services to support the achievement of this target. Please note the monthly information supplied is unpublished and has been collected from local prescribing systems to monitor progress, however, we await an initial verified nationally published report. Increase from Baseline figure by 247 at the end of March 2024. This exceeded the target set. Now awaiting a new nationally set target for 2024 onwards. Quarterly period Target Actual Apr-Jun 22 891 898 Jul-Sep 22 900 940 Oct-Dec 22 910 974 Jan-Mar 23 920 1011 Apr-Jun 23 930 1051 Jul-Sep 23 940 1080 Oct-Dec 23 950 1103 Jan-Mar 24 959 1129 Total 2 Year Increase Figure 77 247 Target achieved Target achieved
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7 AYRSHIRE AND ARRAN DRUG RELATED DEATHS INFORMATION Annual summary report: 1st April 2023 – 31st March 2024 National Records for Scotland - Drug Related Deaths Please find information in the link below around the definition of drug related deaths and what deaths are excluded from this definition: https://www.nrscotland.gov.uk/files/statistics/drug- related-deaths/drd2016/html/drug-related-deaths-2016-annex-a.html The link below details the full report which details statistics of drug-related deaths in 2022 and earlier years, broken down by age, sex, substances implicated in the death, underlying cause of death and NHS Board and Council: https://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland/2022 Published confirmed deaths (Extracted from National Records of Scotland Drug Related Deaths in Scotland, 2021) Number of deaths confirmed (most recent published information) East North South Total 2018 29 38 15 82 2019 41 41 26 108 2020 36 39 31 106 2021 38 39 23 100 2022 30 37 15 82 2023 – No confirmed published data as yet (however when reviewing local unpublished information, a further decrease is expected for North Ayrshire) Number of NADARS reviews conducted for individuals identified as potentially suffering a drug related death Number of these reviews which identified learning or recommendations Number of reports submitted by other services which identified learning or recommendations In the last year, local learning identified from reviews were: • NADARS review robustness of processes around GP notification of discharge from their service. • Where clients have not been seen and have to be re-appointed the plan of next steps should be documented clearly within clients notes • The Ayrshire Risk Assessment Framework (ARAF) used to assess a client’s mental health must be updated to reflect any significant change in a client’s circumstance on all occasions • Where Next of Kin information is available it is important to ensure their details are complete and up to date and recorded on the Care Partner system. 47 4 3 0
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8 PREVENTION AND SERVICE SUPPORT TEAM Annual summary report: 1st April 2023 – 31st March 2024 Alcohol & Drug training and education sessions Calendar courses with 739 participants Ad-hoc training courses with 1723 participants 110 89 Bitesize sessions with 79 participants 29 Training Delivery The team continue to provide a wide range of education and training initiatives which focus on improving awareness, competence and knowledge of those affected by alcohol and drug use, and those working in the field. Due to the COVID-19 pandemic the team introduced virtual training, this continues to be offered as well as face to face training. PSST currently issue upcoming training courses on a quarterly basis. What did our participants say? “I really enjoyed the variety of delivery slides/videos/breakout rooms” “Interactive. Trainers very knowledgeable and happy to answer any questions” “Thoroughly enjoyed today. Very informative and I particularly liked the interactive part of the presentation” "Learning about BBV which was new to me. Training was really useful and informative. Trainers were great" "I really enjoyed the training. Being new to this line of work it was very informative and will help me my job role" "I enjoyed learning about the types of drugs and the stats in this session. The trainers’ knowledge of the same provides me with confidence to carry out my role effectively” 46 sessions delivered within Ward 5 Attended 13 stalls/events Ad-hoc training and health information events by locality area 38% 30% 8% 24% East North South Pan-Ayrshire Alcohol Brief Interventions Annual target set by Scottish Government in priority settings (2023/24) – 3420 Total ABI delivery in priority settings (as at 31/03/2024) – 6398 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in priority settings (as at 31/03/2024) – 1210 Follow our social media pages to keep up to date with our activities in the Prevention and Service Support Team Prevention and Service Support Team – NHS Ayrshire and Arran @PSST_NHSaaa
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9 Ayrshire College Alcohol and Drug Liaison Officer 98 workshops were held with 1138 students 37 1-1 supports with students 6 staff supports 9 health events with an estimated 765 contacts 1 training session delivered for 12 information hub staff Naloxone 99 staff completed the Naloxone Learnpro Minimum of 57* lives saved in the community *lives saved across Ayrshire and Arran as reported on the Shared Addiction Management System (SAMS). Many saves go unsupported. 6 Train the trainer sessions delivered 39 Naloxone awareness sessions delivered 113 203 267 401 0 50 100 150 200 250 300 350 400 450 2020 2021 2022 2023 Naloxone supplied by PSST Service Support Service Support facilitate service development activity which supports the implementation and delivery of the quality improvement agenda for Alcohol and Drug Services which meets national, local and strategic objectives. 22 Audit and evaluation activity 8 Guidelines reviewed and updated Get our NHS Ayrshire and Arran Alcohol and Drug App Download the NHS Ayrshire & Arran app from your Apple or Android app store. Then search for Alcohol and Drugs. 32 Drug and Alcohol groups supported Support to implementation of MAT standards and reporting Development of NADARS Roles and responsibilities directory Gathering, collating and presenting client satisfaction and client stories ABI Heat Standard recording and reporting Support to START and RADAR service Support to local Adverse Incident review processes and reporting
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10 INFORMATION MANAGEMENT AND TECHNOLOGY (IM&T) Annual summary report: 1st April 2023 – 31st March 2024 The Information Management and Technology Team are responsible for the development, training and monitoring of the Shared Addiction Management System (SAMS) and the training and monitoring of Drug and Alcohol Information system (DAISy). These systems are used to record drug and alcohol information, which enables the team to provide national and local reports. SAMS updates 3 sections within SAMS were updated New MAT 9 Mental Health added to SAMS SAMS updated to use Active Directory Login New Substitute Prescribing Application went live Training, e-learning and support E-learning • Completion of a new Alcohol Detox module • New Substitute Prescribing read-only module released • Updated ABI module Training • 68 individuals received SAMS training • 34 individuals received DAISy training • 2 Naloxone training sessions delivered to new organisations Support Approximately 50 SAMS/ DAISy support calls per month IM&T are also responsible for the collation and reporting of Drug Related Deaths and the completion of the National Drug Death database. Drug related death reporting Reporting • Quarterly reports including ASPIRE report, (29 individual performance reports), Naloxone quarterly reports, Scottish Governance reports, ADP reports and local performance and planning reports • Development of reports and audits for MAT standards and submission of MAT 1 – 10 numerical data • Monthly reports including 10 current OST reports, MAT Target Report, SAMS Data Quality Reports and Psychological Therapy Waiting Times • Weekly DAISy quality data checks for Waiting Times, Assessments and Reviews for all Alcohol and Drug services • Monthly substitute prescribing audit • Drug related death report • Development of report for new residential rehab dataset • Approximately 10 – 15 ad hoc report requests per month
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11 IMPLEMENTATION OF MAT STANDARDS ACROSS NORTH AYRSHIRE Annual summary report 2023 - 24 In April 2021, the Scottish Government introduced 10 new Medication Assisted Treatment (MAT) Standards for implementation by Alcohol and Drug Services. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality1. , New approaches were required within North Ayrshire to support rapid access to MAT: • A local test of change was carried out to evaluate the new model of care to establish effectiveness prior to roll out • An Improvement Implementation Plan was implemented, evaluated & updated with regular progress reports submitted to the Scottish Government; • Quarterly updates on MAT developments were submitted to the national MAT support Team – MIST; • An explicit delivery plan was put in place for delivering trauma informed practice; • Guidelines and clinical & care pathways of support were put in place to ensure consistency and to support the staff to deliver the interventions. Results/outcomes (2023/24) • Improvement in the waiting time from referral to commencement of appropriate Opiate Substitution Therapy medication - 75% of individuals were offered a first MAT assessment on the same day as engagement with the service • 100% of individuals were supported to make an informed choice on MAT medication and the appropriate dose • 75% of notified high risk events to the multi-agency assessment team for assertive outreach were contacted on the same day • 85% of individuals were retained in service for more than 6 months • Over 90 individuals have shared care support with Primary Care • 100% of individuals received a mental health assessment • 100% of individuals were offered BBV testing, Harm Reduction interventions and a physical health assessment • Improvement in satisfaction and experience of clients. A RAGB self-assessment was completed and evidence (numerical, experiential and process information) was submitted to the MIST team for analysis and benchmarking. The table below highlights a very positive final RAGB score for the implementation of MAT standards 1 - 10 across North Ayrshire with improvement and progress across all 10 standards.
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12 RESIDENTIAL REHABILITATION EXPANSION Access to residential rehabilitation across Ayrshire and Arran – Ward 5, Woodland View. Ward 5 has 10 beds for residential care: Seamless pathways of support are in place with the local community team supporting individuals before, during and after their placement (extra support in place for NA residents e.g. in addition to ongoing NADARS support, everyone is also provided with daily follow up support from the P.E.A.R service for the first week following discharge). During 2023/24 Access to additional local residential rehabilitation - Harper House The NA H&SCP was instrumental in supporting Phoenix Futures, Scotland, to open ‘Harper House’ in November 2022. It is located in Saltcoats and is a Care Inspectorate registered service, funded by the Scottish Government – it offers specialist support for the ‘whole family to recover from the harms of problematic drug and alcohol use’. Their family- focused programme of interventions is ‘designed to benefit each member of the family and the family unit as a whole’. Referrals are accepted from across Scotland, with enhanced local access available for residents of North Ayrshire. These pathways continue to be improved with a local oversight group meeting regularly to support the identification and suitability of families. In 2023/24 NADARS supported 7 applications into Harper House with 5 starting the programme. The 2 families who were not suitable at that time have had continued involvement from community services as appropriate. Access to External Residential Rehabilitation (ERR) Individuals wishing to access external residential rehabilitation support can do so via NADARS who will support the development of a care plan, identify a residential rehabilitation provider, seek funding and then support individuals into, through and after their external residential rehabilitation placement. In 2023/24, 55 referrals were received for ERR. Following assessment, 22 individuals were suitable for ERR and funding was approved (33 individuals felt not ready or declined the ERR intervention at that time and were offered alternative community supports). • 21 individuals commenced ERR (with one individual declining admission at their start date) 5 5 Detoxification Rehabilitation 138 individuals (NA = 94) 74 individuals (NA =45) Detoxification support Rehabilitation support
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13 FINANCIAL INFORMATION ADP 23-24 Forecast Spend Ministerial Priorities Sum of Agreed Projects Community based treatment and recovery services for adults £1,122,568.30 Other £107,995.54 Other Projects £1,030.90 Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) £209,179.50 Alcohol and drug services specifically for children and young people £100,343.47 Recovery community initiatives £135,699.00 Services for Families affected by alcohol & Drug use £126,637.91 Additional National Mission uplift £218,035.22 MAT Standards £364,225.04 Residential Rehab £164,252.28 Whole family Approach framework £141,366.26 Residential Support £41,609.04 Grand Total £2,732,942.45 Community based treatment and recovery services for adults 41% Other 4% Other Projects 0% Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) 8%Alcohol and drug services specifically for children and young people 4% Recovery community initiatives 5% Services for Families affected by alcohol & Drug use 5% Additional National Mission uplift 8% MAT Standards 13% Residential Rehab 6% Whole family Approach framework 5% Residential Support 1% Community based treatment and recovery services for adults Other Other Projects Prevention including educational inputs, licensing objectives, Alcohol Brief Interventions) Alcohol and drug services specifically for children and young people Recovery community initiatives
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14 Additional funding streams Ministerial Priorities Sum of Agreed Projects Other Projects £ 1,030.90 Additional National Mission uplift £ 218,035.22 MAT Standards £ 364,225.04 Residential Rehab £ 164,252.28 Whole family Approach framework £ 141,366.26 Grand Total £ 888,909.70 The ADP has accumulated a reserve balance due to underspends in previous financial years. • Plans are in place to utilise the reserves and they are committed in future years. Other Projects 0% Additional National Mission uplift 25% MAT Standards 41% Residential Rehab 18% Whole family Approach framework 16% Other Projects Additional National Mission uplift MAT Standards Residential Rehab Whole family Approach framework
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IMPLEMENTING MEDICATION ASSISTED TREATMENT (MAT) NORTH AYRSHIRE DRUG AND ALCOHOL RECOVERY SERVICE (NADARS) Reporting period: 1st April 2023 - 31st March 2024 Quality issue: In 2022, there were 1,051 drug related deaths registered in Scotland, 279 deaths fewer than 2021. Although this is the lowest number of deaths since 2017, there were 3.7 times as many deaths in 2022 compared with 2000. Ayrshire and Arran continues to have the second highest death rate at 28.1per 100,000 population. Evidence suggests quick access to treatment is crucial and being in treatment can be a protective factor for majority of individuals. The Scottish Drug Deaths Taskforce (SDDTF) has prioritised the introduction of the MAT standards to help reduce the number of drug related deaths. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality. Aim: To have no barriers to accessing treatment and care that supports an individual’s recovery. This project focussed specifically on improving access to appropriate Medication Assisted Treatment (MAT) within the North Ayrshire Drug & Alcohol Recovery Service (NADARS) in order to prevent deaths, reduce harms and promote recovery opportunities. Effects of change during 202324: • Improvement in the waiting time from point of referral to commencement of appropriate Opiate Substitution Therapy (OST) medication - average time from assessment to prescribed medication 0 days. • Increased choice in OST medications • Improvement in satisfaction and experience of clients. • All individuals received a mental health assessment and support as required. • All individuals were offered Blood Borne Virus (BBV) testing, Harm Reduction interventions, physical health assessment and referred on for further support where required. • All individuals had the opportunity to access Recovery Development Worker's with lived experience to provide person centred recovery support. • All individuals had the opportunity of family involvement. • All individuals were offered housing, advocacy support and were referred for social care support where appropriate. Tests of change: Cycle 1: Implement and Test the MAT clinic pathway on a Monday and a Thursday in one locality (Three Towns). Cycle 2: Secure funding to recruit staff to support the implementation of the full model. Cycle 3: Refine project charter to facilitate full model Cycle 4: Expand service to 5 days per week across 6 localities of North Ayrshire (NA). (Test of change is complete and now working towards sustaining full model during 2024/25) 0 1 2 3 4 5 Average number of days referral to prescription 0 1 2 3 4 5 6 7 8 9 10 Average number of days from assessment to prescription Median = 3 days Median = 0 days
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IMPLEMENTING MEDICATION ASSISTED TREATMENT 565 REFERRALS BY GENDER FEMALES MALES 188 377 (33%) (67%) REFERRALS BY GENDER & AGE GROUP 0 50 100 150 200 0 - 24 25 - 34 35 - 44 45 - 54 55+ COMMENCED SAME DAY/NEXT DAY (where clinically safe and appropriate) 97% of clients commenced MAT on same day or next day from assessment INTERVENTIONS OFFERED AT POINT OF MAT DELIVERY 100% of clients were offered Mental Health Support and Harm Reduction interventions BBV testing, IEP and Sexual Health 350 individuals chose this pathway of MAT related support. The reasons given for not commencing the pathway were: • clients went to prison • not ready to commence MAT but continued to receive support from the wider service NALOXONE AND OVERDOSE AWARENESS 100% 72%* of clients were of clients were supplied offered Naloxone with Naloxone or already had a kit *The remaining 28% declined* CLIENT SATISFACTION Of clients rated their initial waiting time either “excellent” or “very good” 79% 81% Of clients rated the communication from NADARS either “excellent” or “very good” Of clients who were able to commence medication at their initial appointment stated that there were no delays in getting their prescription 95% 95% Of clients felt that they were given sufficient information to make an informed choice on their treatment options 95% Of clients felt that the NADARS worker explained all the care and treatment options in a way that they understood 81% Of clients rated the overall service either “excellent” or “very good” OPIOID SUBSTITUTION THERAPY (OST) MEDICATIONS PRESCRIBED FOLLOWING ASSESSMENT 63% 32% 5% Methadone Espranor/ Buvidal Suboxone This evidences increased patient choice of OST
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IMPLEMENTING MEDICATION ASSISTED TREATMENT Developments during 2023/24: • Quarterly reports have been submitted to the Scottish Government evidencing progression across each of the 10 standards from the previous year. • An explicit delivery plan was put in place for delivering trauma informed practice • LOPs, SOPs, guidelines and clinical & care pathways of support were reviewed & updated • MAT availability was increased at Caley court and expanded to 5 days per week. MAT is now available across all 6 localities with immediate support available to all from Caley Court alongside remote (low threshold) access in more rural areas including the islands. • Over 90 individuals currently have ‘shared care’ support with Primary Care colleagues. • A workforce training plan is in place to ensure all staff offering MAT & OST can provide the core harm reduction services at the same time and place as MAT delivery • A robust 7 wide reaching experiential process was implemented by the NA ADP, to capture, analyse and utilise feedback from clients, families and staff to inform service improvement • Appropriate recording information systems were updated to collect and analyse data • In the absence of additional national being able to be accessed, the NA ADP committed non-recurring funding to implement initial MAT 7 (Primary Care) developments at pace. • A new staff guidance document was approved for implementation to provide an ‘interface protocol’ as to how secondary care mental health services & alcohol & drug services can better support individuals with co-occurring mental health and alcohol and/or drug use. Priorities for 2024/25 • Sustained implementation of all 10 MAT standards • Following formal submission of experiential data, we will conduct a local analysis to identify themes for further improvement. • Based on national feedback/approval we will update the NA MAT 7 model & explore options to secure additional funding to deliver, in full by next year, a revised NA implementation plan • Work underway, with all ADP partners, to scope out requirements and system change to support MAT delivery for individuals using Stimulants and Benzodiazepines; • Engage with service users, families and staff to evaluate and learn from the recently implemented MAT 9 related multi-agency ‘operational interface protocol’ to better support individuals presenting with co-occurring mental health and alcohol and/or drug use • For MAT 6&10 a key development/priority is to continue to increase access to psychological interventions and therapies through staff training and ongoing support. INFORMATION AND FEEDBACK 565 referrals were received between 1st April 2023 and 31st March 2024 350 clients commenced MAT support (the others declined service, required preparatory support or disengaged from service) 97% of clients commenced MAT on the same day or next day from assessment (where clinically appropriate and safe) 99% of clients commenced MAT within 1 week Reasons for timescales over 7 days include initial non- attendance with follow up in place Detailed numerical data on referrals, timescales, interventions etc was submitted to MIST in April 2024, which is now being analysed to identify good practice and learning.
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IMPLEMENTING MEDICATION ASSISTED TREATMENT EXPERIENTIAL FEEDBACK • To gather feedback and data in a consistent and impartial way, the ADP adopted a multidisciplinary approach by identifying a mixture of service staff and individuals with Lived & Living Experience (LLE) to gather experiential feedback from service users, families/carers of people on MAT, and staff delivering the service. • Individuals identified to carry out the interviews attended a 3-session training course delivered by MIST (national MAT Implementation Support Team). • A mixed methods approach was applied to gather data e.g. 1-1 interviews, smaller engagement events. • The ADP Support Team collated, analysed, and themed the data for submission to MIST (with full involvement of the Experiential Engagement Team and people with LLE). The feedback received was mainly positive and demonstrates the ease of access, increased choice of medications and no barriers to the overall support received. “Everything got dealt with at my initial appointment. Services are totally different now in comparison to years ago so there is nothing I could suggest that would've made it better” “I definitely felt involved in my options. I mind the lassie discussed all available options I could choose from and I think it was Espranor she recommended for me, due to it having a blocker effect, so if I used on top of it there would be no effects. I decided to go for methadone though and my choice was respected.” MIST BENCHMARKING 2024 – SCORING TRACKER Over the last year there has been improvement and progress across all 10 standards