8 - Performance Information - Drug and Alcohol Services 2022-23
North Ayrshire Council · 7 November 2023
Back to Cabinet — 7 November 2023 and its agenda
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1 NORTH AYRSHIRE COUNCIL 7 November 2023 Cabinet Title: Performance Information – Drug and Alcohol Services - April 2022 to 31 March 2023 Purpose: To provide an update on the national and local drug and alcohol related targets and standards and performance in North Ayrshire. 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 During 2022-23 all the following national and local drug and alcohol related targets and standards were met: • Access to Treatment’ waiting times • Alcohol Brief Intervention delivery • Substance Use treatment • Naloxone delivery 1.2 Improvement actions were delivered in support of achieving new Medication Assisted Treatment Standards (MAT). North Ayrshire services devised and implemented a wide reaching MAT Improvement Plan which enabled the rollout and delivery of the MAT Standards across all localities. A new national benchmarking report was produced, which is currently being reviewed in order to identify further improvements. 1.3 National reports covering the year 2022 were published in relation to drug and alcohol related deaths. With regard to drug related deaths, there was a decrease in numbers across Scotland with a slight decrease in numbers for North Ayrshire. With regard to alcohol related deaths, there was an increase in numbers across Scotland with a decrease in numbers for North Ayrshire. Improvement actions were delivered in support of preventing both drug and alcohol related deaths.
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2 1.4 Improvement actions were also implemented to enable more individuals 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’ standards for 2022-23 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 2.3 ‘Substance Use’ treatment target As part of their ‘National Mission’ 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. 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).
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3 An improvement plan was created to promote the use of Naloxone and a local target was set for 2022-23 for local services to supply, as a minimum, 420 Naloxone 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-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 any areas for improvement. The North Ayrshire Alcohol and Drug Partnership allows partners to come together to implement actions aimed at preventing drug-related deaths. By adopting a wider public health approach, with local people, services and stakeholders, everyone can work together to tackle drug-related deaths. Each year the National Records of Scotland produce an annual report titled ‘Drug Related Deaths in Scotland 2022’. A similar report is produced yearly around 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 the last year the Scottish Government commissioned a new national service specifically designed to support vulnerable families with young children. This facility, Harper House, is situated in Saltcoats and offers support to families from across Scotland (with a local enhanced pathway of support available for more vulnerable families from North Ayrshire). The ADP has also receive funding in the last year to ensure pathways in place to support individuals to access longer term residential rehabilitation support across Scotland 2.7 Medication Assisted Treatment Standards As part of the ‘National Mission’ services have been tasked with delivering on new Medication Assisted Treatment (MAT) Standards for Scotland with the aim of improving access, choice and support for individuals.
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4 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. The 10 current standards are outlined below: • Standard 1: All people accessing services have the option to start MAT from the same day of presentation. • Standard 2: All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose. • Standard 3: All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. • Standard 4: All people are offered evidence based harm reduction at the point of MAT delivery • Standard 5: All people will receive support to remain in treatment for as long as requested. • Standard 6: 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 7: All people have the option of MAT shared with Primary Care. • Standard 8: All people have access to advocacy and support for housing, welfare and income needs. • Standard 9: All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery • Standard 10: All people receive trauma informed care. Following a successful test of change pilot across North Ayrshire, an Improvement Plan was agreed to assist in the delivery of the MAT standards with a specific focus during 2022-23 on MAT standards 1 to 5. 3. Proposals Performance Information 2022-23 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 Quarter 2 Quarter 3 Quarter 4 96% 98% 96% 96% • 100% of Clients will wait no longer than 6 weeks from referral to appropriate alcohol treatment that supports their recovery Quarter 1 Quarter 2 Quarter 3 Quarter 4 100% 100% 100% 100%
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5 Drugs • 90% of clients will wait no longer than 3 weeks from referral to appropriate drug treatment that supports their recovery Quarter 1 Quarter 2 Quarter 3 Quarter 4 94% 100% 100% 96% • 100% of Clients will wait no longer than 6 weeks from referral to appropriate drug treatment that supports their recovery 3.2 ‘Alcohol Brief Interventions’ standards for 2022/23 Quarter 1 Quarter 2 Quarter 3 Quarter 4 100% 100% 100% 100% All waiting times standards were met during 2022 to 2023: 3.3 ‘Substance Use’ treatment target North Ayrshire has been set a target to increase numbers in treatment from 882 individuals in April 2020 to 959 individuals by March 2024 .
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6 As of March 2023, the numbers in treatment exceed the 2024 target. Please note the monthly information supplied is unpublished and has been collected from local prescribing systems to monitor progress. We await a verified nationally published report. 3.4 ‘Naloxone’ supply Against a local target of supplying 420 Naloxone kits during 2022 to 2023 - 846 kits were supplied across North Ayrshire. 51 lives across Ayrshire and Arran were reported to be saved through the use of Naloxone during this period (31 in North Ayrshire). Many lives saved via the use of Naloxone go unreported . 3.5 Alcohol and drug related deaths The National Records of Scotland recently produced its annual report titled ‘Drug Related Deaths in Scotland 2022’. In 2022, there were 1,051 drug misuse deaths registered in Scotland. This was a decrease of 279 deaths compared with 2021. This is the lowest number of drug misuse deaths since 2017.
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7 The change between 2021 and 2022 is the largest year on year decrease on record. Despite this recent fall, drug misuse deaths are still much more common than they were in 2000. People in the most deprived areas of Scotland are almost 16 times as likely to die from drug misuse compared to people in the least deprived areas. The association of deprivation with drug misuse deaths is much greater than with other causes of death. Regrettably compared to other Local Authority areas, North Ayrshire recorded the 4th highest drug deaths in 2022. North Ayrshire is an area with high levels of poverty and people living in relative deprivation, with over 40% of people living in North Ayrshire living in areas considered to be among the most deprived in Scotland, The HSCP alongside wider system partners are dedicated to tackling the inequalities that many local people face. • For North Ayrshire, the number of drug related deaths in 2022 was 37 - a reduction of 2 from the previous year. The recent National Records of Scotland Alcohol Specific Deaths 2022 report illustrates a rise in deaths caused by alcohol. This is the highest level of alcohol related deaths in 14 years, with the figures showing that individuals in the poorest communities were more than four times as likely to die as those in the wealthiest areas. With regard to the Ayrshire & Arran Health Board area, there was a reduction from 91 deaths in 2021 to 86 in 2022 (one of 5 Health Board’s to illustrate a reduction). • North Ayrshire deaths reduced from 37 deaths in 2021 to 29 deaths in 2022 • East Ayrshire reduced from 30 to 28 deaths • South Ayrshire increased from 24 to 29 deaths North Ayrshire council were one of 12 council areas to illustrate a reduction. In the last 4 years, the number of deaths in North Ayrshire has reduced yearly from 50 deaths in 2019, to 44 deaths in 2020, to 37 deaths in 2021 to 29 deaths last year 3.6 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.
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8 Seamless pathways of support are in place with the local community alcohol and drug services to support 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). During 2022/23: Detoxification support Rehabilitation support Vulnerable families from North Ayrshire also have access to additional local residential rehabilitation support. The HSCP was instrumental in supporting Phoenix Futures, Scotland, to open ‘Harper House’ in November 2022. It is located in Saltcoats & 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 the first 4 months of opening 4 families from NA have benefited from this support. Another development in late 2022 has been focused on providing access to External Residential Rehabilitation with funding being made available by the ADP. Individuals wishing to access this support are now able to 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. By March 2022, four individuals had benefited from ERR. Funding was identified to appoint a ‘single point of contact’ who will lead on enabling individuals and families to access local and external residential support options. A key priority is to build on the pathways created during the last year to ensure more individuals and families are able to access this type of support.
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9 3.7 Medication Assisted Treatment Standards As part of the ‘National Mission’ services have been tasked with delivering on new Medication Assisted Treatment (MAT) Standards for Scotland with the aim of improving access, choice and support for individuals. An evaluation of an initial test of change pilot demonstrated that MAT delivery could be undertaken safely and with positive recovery outcomes. It was agreed to expand MAT availability during 2022-23 – to ensure MAT was available across all of North Ayrshire and Arran to prioritised groups due to vulnerability in relation to risk. An Improvement Implementation Plan, approved by Chief Executives, was implemented, evaluated & updated with regular progress reports submitted to the Scottish Government alongside quarterly update reports being sent to the national MAT support Team – ‘MIST’. • MAT availability was increased at Caley court to 3 days per week & ‘drop in’ access and then ultimately expanded to 5 days a week with extended hours. • Locations identified across NA Localities for MAT access closer to home – ultimately MAT is now available across all 6 NA Localities with immediate support available to all from Caley Court alongside ‘low threshold’ access in rural areas. • An explicit delivery plan was put in place for delivering trauma informed practice, LOPs, SOPs, guidelines & clinical & care pathways of support were all implemented. • National and local ADP funding was secured for additional staff which includes: Consultant Psychiatry, Additional prescribing capacity; Addiction Workers; Nursing staff; Support Workers; Recovery Development Workers (lived experience) Priorities for 2023/24 include: • Sustain MAT delivery across MAT Standards 1 to 5; • Identify key actions to implement MAT Standards 6 to 10 (once national reporting requirements are clarified); • Improve the gathering of experiential data for SG reporting and to identify further improvement actions • Create a clear vision, model and process to implement MAT Standard 7 (this relates specifically to primary care involvement in MAT delivery) Funding issue in relation to delivery of MAT Standard 7 With no additional funding being made available, and whilst awaiting outcomes of national and local funding discussions, the North Ayrshire Alcohol & Drug Partnership (ADP) allocated non-recurring funding of £89k a year to initiate, at pace, proposed developments in North Ayrshire. This funding will be used to
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10 employ additional specialist GP and Pharmacist prescribers and to initiate a test of change involving local pharmacies administering Buvidal (an OST medication). In April 2023, NHS Boards received a letter from the Scottish Government which identifies that funding for MAT 7 developments should be extracted from the funding already allocated through the Primary Medical Services funding for Enhanced Services. This creates an issue for services to unpick previous commitments which would enable shifting resource to meet the MAT 7 commitment that ‘All people have the option of MAT shared with Primary Care’. National and local discussions are ongoing to find a resolution. Rating of MAT initiation: 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 at the end of March 2023.
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11 4. Implications/Socio-economic Duty Financial 4.1 The ADP has been provided with some non-recurring funding to support access to external residential rehabilitation support. It is unknown if this funding will be sufficient to meet future demand. Funding will require to be identified to implement the MAT Standards in full especially in relation to MAT Standard 7 which will require the support of primary care colleagues. 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 work of the North Ayrshire ADP and delivery priorities of NADARS progresses and strengthens prevention. The necessary work through our ADP, HSCP, NHS Board and NAC and wider partners contributes to effective means of preventing drug-related deaths. Climate Change and Carbon 4.5 None Key Priorities 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
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12 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. Caroline Cameron Director - North Ayrshire Health and Social Care Partnership For further information please contact Peter McArthur, Senior Manager – Addiction Services, on 01294 317840. Background Papers 0
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Performance management report NORTH AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP & ADP April 2022 - March 2023 Prepared by Denise Brown Prevention and Service Support Team Alcohol and drug related information On target Achieved Not achieved
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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 Target by 2024 by Scottish Goverment 2022/2023 Financial Year Interventions are in place across our community alcohol and drug recovery services to support the achievement of this target by the due date of April 2024. 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.
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Ayrshire and Arran Drug related deaths information ANNUAL SUMMARY 1st April 2022- 31st March 2023 Published confirmed deaths (Extracted from National Records of Scotland Drug Related Deaths in Scotland, 2021) Number of deaths confirmed 2017 2018 2019 2020 24 29 41 36 25 38 41 39 12 15 26 31 61 82 108 106 EAST NORTH SOUTH TOTAL 2021 38 39 23 100 Number of NADARS reviews conducted for individuals identified as potentially suffering a drug related death 27 Number of these reviews which identified learning or recommendations 3 Number of reports submitted by other services which identified learning or recommendations 0 2022/23- no confirmed published information as yet 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 2021 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/files//statistics/drug-related-deaths/21/drug-related-deaths-21- report.pdf Review and update of Drug Notification Process Local Operating Procedure Effective record keeping Regularity of review and continuity of support when keyworker was not available In the last year, local learning identified from reviews were:
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MAT availability was increased at Caley court to 3 days per week & ‘drop in’ access - and then ultimately expanded to 5 days a week with extended hours. Locations identified across NA Localities for MAT access closer to home – ultimately MAT is now available across all 6 NA Localities with immediate support available to all from Caley Court alongside ‘low threshold’ access in rural areas. An explicit delivery plan was put in place for delivering trauma informed practise; LOPs, SOPs, guidelines & clinical & care pathways of support were put in place Consultant Psychiatry, Additional prescribing capacity; Addiction Workers; Nursing staff; Support Workers; Recovery Development Workers (lived experience) MAT 7 – Primary Care (GP & Pharmacy) involvement. Vision, model & process agreed. SG recently Ring Fenced funding for this. LES to be offered to GPs. In addition MAT availability to be expanded to include Prison and Police Custody. An Improvement Implementation Plan, approved by Chief Executives, was implemented, evaluated & updated with regular progress reports submitted to the Scottish Government alongside quarterly update reports being sent to the national MAT support Team – ‘MIST’. National and local ADP funding was secured for additional staff which includes: Priorities for 2023/24 include: 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. Implementation of MAT standards within North Ayrshire A pilot test of change evaluation was carried out within the Three Towns Area of North Ayrshire. By March 2022, results demonstrated that MAT delivery could be undertaken safely and with positive recovery outcomes throughout North Ayrshire. An evaluation of an initial test of change pilot demonstrated that MAT delivery could be undertaken safely and with positive recovery outcomes. It was agreed to expand MAT availability during 2022/23 – to ensure MAT was available across all of North Ayrshire and Arran to prioritised groups due to vulnerability in relation to risk.
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Access to residential rehabilitation across Ayrshire and Arran - Ward 5 Local residential rehabilitation support is provided in Ward 5, Woodland View to anyone who has an alcohol and/or drug problem and mental health issues. 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 PEAR service for the first week following discharge). During 2022/23: 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 & 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 the first 4 months of opening 4 families from NA have benefited from this support. 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 quarter 4, 4 indiviudals have been supported in to ERR. Residential Rehabilitation expansion Rehabilitation 55 Detoxification 143 individuals (NA=84) Detoxification support 67 individuals (NA=41) Rehabilitation support
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Financial information ADP 22-23 Forecast Spend
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Additional funding streams