Community Impact Assessment Form
For a summary of this Community Impact Assessment, click here
Title of Community Impact Assessment (CIA): Drug and Alcohol Recovery Strategy
Directorate: Environment and Community Safety
Date of assessment: Jan 2013
Names and roles of people carrying out the community impact assessment. (Please identify Lead Officer):
Mark Knight– DAAT Joint Commissioning Manager (Lead Officer)
Andrew Macdonald – DAAT Alcohol Co-ordinator and Public Health Development Officer
Section A – What are you impact assessing?
(Indicate with an “x” which applies):A decision to review or change a service
A strategy
A policy or procedure
A function, service or project
X
Are you impact assessing something that is?:New
Existing
Being reviewed
Being reviewed as a result of budget constraints
X
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Describe the area you are impact assessing and, where appropriate, the changes you are proposing?
We are impact assessing the changes that are being made to Salford’s Drug and Alcohol Strategy towards a recovery model.
The main changes that are being proposed are:

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






To increase the numbers of people in Salford who are being provided with a drug and alcohol service from a narrow focus to a
whole population approach
To engage with the whole population via a communications strategy and the development of appropriate brief interventions
To target high risk and complex individuals
Greater emphasis on alcohol
To target people who drop out of treatment via an assertive outreach approach
Greater emphasis on a continuing care model, recovery management, after-care and community support
Greater emphasis on mutual aid and recovery communities
Greater emphasis on recovery housing
Provision of personalised budgets
A Community Impact Assessment (CIA) was undertaken on Salford’s Drug and Alcohol Strategy in March 2011. This was amended in
April 2013. We are now making a further amendment in light of our intention to procure a recovery treatment system utilizing a Lead
Provider Model as detailed in Section B below.
This latest version (November 2013) should be read in conjunction with the original CIA (March 2011).
Section B – Is a Community Impact Assessment required (Screening)?
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Consider what you are impact assessing and mark “x” for all the statement(s) below which apply
Service or policy that people use or which apply to people (this could include staff)
Discretion is exercised or there is potential for people to experience different outcomes. For example,
planning applications and whether applications are approved or not
Concerns at local, regional or national level of discrimination/inequalities
Major change, such as closure, reduction, removal or transfer
Community, regeneration and planning strategies, organisational or directorate partnership
strategies/plans
Employment policy – where discretion is not exercised
Employment policy – where discretion is exercised. For example, recruitment or disciplinary process
X
If none of the areas above apply to your proposals, you will not be required to undertake a full CIA. Please summarise below why a full
CIA is not required and send this form to your directorate equality link officer. If you have identified one or more of the above areas, you
should conduct a full CIA and complete this form.
Approval has already been given for a redesigned drug and alcohol treatment and recovery system in Salford that is compliant with local
and national strategies. It was envisaged that this would be procured via a series of tenders for individual parts of the redesigned
system. We now propose to adopt a Lead Provider Model that would see the system tendered as a whole. The procurement and
service delivery benefits of this model are outlined below.
Taking the treatment system to the market as a whole avoids the complexity of several time consuming tenders and means that
commissioners can instead focus on specifying an outcomes based system firmly grounded on assessment of need. Similarly, posttender the commissioners do not have to spend time with several providers ensuring the necessary arrangements are in place for the
system to operate effectively since the Lead Provider ensures there is one set of system wide policies covering issues relating to
equality, safeguarding, client transfers, referral criteria and information sharing.
The model thus allows for diversity of provision whilst avoiding several of the problems that treatment systems with multiple providers
have historically faced. Provision is no longer duplicated between providers competing to deliver similar types of services. Since they
are not in competition with each other, providers have no interest in retaining clients unnecessarily but instead refer them as appropriate
for each individual recovery journey.
The model lends itself not only to economies of scale and the integration of drug and alcohol services but also to better integration with
other services in the fields of housing, employment, education, training and family support that are essential to promoting recovery and
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reintegration.
The model will facilitate commissioners spending less time on the detail of delivery and allow more time to focus on strategic work and
outcomes based commissioning. We also believe that this model will foster innovation by allowing providers greater freedom to focus on
specified outcomes.
Our review of regional outcomes evidences that the four most improved performances for successful completion of opiate users over the
last 12 months are in partnership areas where a Lead Provider model has been introduced.
Equality Areas
Indicate with an “x” which equality areas are likely to be affected, positively or negatively, by the proposals
Age
X
Religion and/or belief
X
Disability
X
Sexual Identity
X
Gender (including pregnancy and maternity)
X
People on a low income (socio-economic inequality)
X
Gender reassignment
X
Other (please state below) (For example carers, ex
offenders)
Race
X
Homelessness
X
Families
X
Stage of recovery
X
If any of the equality areas above have been identified as being likely to be affected by the proposals, you will be required to undertake a
CIA. You will need only to consider those areas which you have indicated are likely to be affected by the proposals
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Section C – Monitoring information
C1 Do you currently monitor by the
following protected characteristics or
equality areas?
Age
Yes (Y) or
No (N)
Disability
Y
Gender (including pregnancy and
maternity)
Y
Gender Reassignment
N
Race
Y
Religion and/or belief
Y
Sexual Identity
Y
People on a low income
(socio-economic inequality)
N
If no, please explain why and / or detail in the action plan at Section E how
you will prioritise the gathering of this equality monitoring data.
Y
To be included in data collection requirements in new specifications
Partial data available. Action: to make a data request for all registered
service users earning over 18K a year
Other (please state) (For example
carers, ex offenders)
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Section C (continued) – Consultation
C2 Are you intending to carry out consultation on your proposals?
Yes
If “no”, please explain your reason(s) why
If “yes”, please give details of your consultation exercise and results below
From January to March 2012, Salford DAAT undertook a series of stakeholder, public and service user consultations as part of the
consultation phase of the re-specification of the drug and alcohol treatment system. Below is a summary of the key findings that
emerged from this work:
Provider Briefing Event
Took place on 19 January 2012, attended by 68 people from a range of agencies.
The main points raised by participants were:
 The need to develop peer recovery focused support including recovery champions and peer based assertive outreach
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The development of a visible and accessible recovery community
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Greater integration and co-ordination across the system with a single point of entry and effective and integrated information
systems

Community development and links between the services and the community
Development of employment related activity, linking into the local business economy

Fast entry and re-entry to prevent people disengaging and dropping out

Focus on families including the most vulnerable young people, adult carers, parents in recovery and identifying families and
parents who are not in treatment
Need to develop accessible opening times, evening and weekends, drop-in sessions

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Need for women specific services, especially women leaving prison


Recovery to be integrated into the model, as a guiding principle not as a service at the end of the model
Need to have more detail within pathways and methods of achieving outcomes.
All of the responses from the exercise were input into a database and used to create the word image below (the size of the word
represents the number of times the word was mentioned):
Service User Consultations
Eccles – 27th February 2012
The main points raised were:
 Lack of after-care support once finished treatment and the need for support to continue when people are in recovery

The need for recovery mentoring
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The need for help with methadone reductions
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Mona Street – 28th February 2012
The main points raised were:
 The need for services in the evenings and at weekend and in local areas
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The need for provision for women i.e. residential rehabilitation and mental health provision
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Greater involvement in the community including voluntary work, recovery talks in local community, schools, churches

Experience of stigma
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The need for relapse prevention and residential support for people who relapse
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Support for families i.e. childcare, weekend provision
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Support tailored to the person
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Not enough groups i.e. need to be longer, more confidence / self esteem related, more peer led
Little Hulton – 12th March 2012
The main points raised were:
 The need for more aftercare and changing social circles
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Social isolation and lack of provision in Little Hulton i.e. youth clubs, recovery activities
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The need for more support for women i.e. residential rehabilitation

The need for more publicity about personal budgets
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The need for more support for families i.e. childcare, support and information for children, keeping families together

Importance of support from key-worker, having continuity of care, phone calls to remind of appointments and follow up calls

Drugs education in local schools and in community

Transport issues

More ex users working in services
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Public Consultation
Eccles Gateway – 5th March 2012
 Alcohol was recognised as a key issue with particular points made about home drinking, social acceptability, accessibility
 The need of for a social life for people who abstain from drugs and alcohol
 Women’s needs were recognised, in particular the need for childcare
 Support for the separation of prescribing from co-ordination, brief interventions and outreach
 Workforce issues were raised with the need to ensure the right people are doing the right jobs and to avoid the loss of talent, skill
and existing expertise during the re-organisation process
 The need for strategic coordination of resources was highlighted
Also DAAT representatives attended the Ordsall and Langworthy Community Committee and held public events in Broughton and
Pendleton.
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Section C (continued) – Analysis
C3 What information has been analysed
to inform the content of this CIA? What
were the findings?
Please include details of, for example,
service or employee monitoring
information, consultation findings, any
national or local research, customer
feedback, inspection reports, and any
other information which will inform your
CIA.
This Equality Impact Assessment has been informed by the sources below. The findings are
referenced throughout Section D. The information has been gathered from existing sources.
Advisory Council on the Misuse of Drugs (2003) ‘Hidden Harm: Responding to the Needs of
Children of Problem Drug Users’
Alcohol Concern (2012) The State of the Nation
Alterman, AI, Erdlen, DL, Laporte, DL and Erdlen, FR (1982) ‘Effects of Illicit Drug
Use in an Inpatient Psychiatric Setting’, Addictive Behaviors, Vol. 7, pp 231242
Best, D, Rome, A, Hanning, K, White, W, Gossop, M, Taylor, A, Perkins, A. (2010)
‘Research For Recovery: A Review of the Drugs Evidence Base’. Scottish Government
Social Research.
Please specify whether this was existing
information or was specifically in relation
to this equality analysis and CIA process Barbee, JG, Clark, PD, Crapanzano, MS, Heintz GC and Kehoe CE (1989) ‘Alcohol
and Substance Abuse among Schizophrenic Patients presenting to an
Emergency Psychiatric Service’, Journal of Nervous Mental Disorders, Vol.
177, pp 400-407
Becker, J. and Duffy, C. (2002), ‘Women drug users and drugs service provision: servicelevel responses to engagement and retention’, DPAS Briefing Paper 17, UK Home Office,
London.
Department of Health (DOH) (2004) Alcohol Needs Assessment Research Project
Eliason, M.J., Hughs, T., (2004) Treatment Counselor’s Attitudes About Lesbian, Gay,
Bisexual and Transgendered Clients: Urban vs Rural Settings, Substance Use & Misuse,
39:4, 625-644.
Fountain, J, Bashford, J, Winters, M and Patel, K (2003) Black and minority ethnic
communities in England: A review of the literature on drug use and related
service provision, London: National Treatment Agency for Substance Misuse
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and the Centre for Ethnicity and Health
Fiorentine, R.; Anglin, M.D.; Gil-Rivas, V.; and Taylor, E. Drug treatment: Explaining the
gender paradox. Substance Use & Misuse 32:653– 678, 1997.
Grant, BF, Stinson, FS, Dawson, DA, Chou, SP, Dufour, MC, Compton, W et al.
(2004) ‘Prevalence and Co-occurence of Substance Use Disorders and
Independent Mood and Anxiety Disorders: Results from the National
Epidemiologic Survey on Alcohol and Related Conditions’, Archives of
General Psychiatry, Vol. 61, pp807-816
HM Government ‘Drug Strategy 2010 Reducing Demand, Restricting Supply, Building
Recovery: Supporting People to Live A Drug Free Life’
Marmot, M. (2010) 'Fair Society Healthy Lives'. The Marmot Review
http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmotreview/fair-society-healthy-lives-full-report
Mueser, KT, Bellack, AS and Blanchard, JJ (1992) ‘Comorbidity of Schizophrenia
and Substance Abuse: Implications for Treatment’, Journal of Consulting and
Clinical Psychology, Vol. 60, pp845-856
Najavits LM, Weiss RD, Liese BS. Journal of Substance Abuse Treat. ‘Group cognitivebehavioral therapy for women with PTSD and substance use disorder’ 1996 JanFeb;13(1):13-22.
NHS Salford Alcohol Equity Audit (2012)
Reiger, DA, Farmer, ME, Rae, DS, Locke, BZ, Keith, SJ, Judd, LL et al. (1990)
‘Comorbitity of Mental Disorders with Alcohol and Other Drug Abuse: Results
from the Epidemiologic Catchment Area (ECA) Study’, Journal of the
American Medical Association, Vol. 264, pp2511-2518
Rome, A, Morrison, A, Duff, L, Martin, J and Russell, P (2002) Integrated Care for
Drug Users: Principles and Practice, Edinburgh: Scottish Executive
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Royal College of Psychiatrists (2008) ‘Alcohol and Older People’, Royal College of
Psychiatrists’ Public Education Editorial Board.
Salford DAAT Alcohol Strategy 2008 – 2011 Equality Impact Assessment
Salford DAAT Community Impact Assessment 2011
Salford DAAT Drug and Alcohol Business Case 2013 – 2018 (Draft)
Scottish Government Review Best et al (2010) ‘Research For Recovery: A Review of the
Drugs Evidence Base’
Shaikh, Zaibby and Nez, Farah (2000) A cultural cocktail: Asian women and alcohol misuse
(Hounslow: EACH)
Stark, E. and Flitcraft, A. (1996) op.cit.; Maryland Department of Health, Journal of American
Medical Association 2001, quoted in Lewis, Gwynneth, Drife, James, et al. (2001) Why
mothers die 1997-1999: Report from the Confidential Enquiries into Maternal Deaths in the
United Kingdom (London: RCOG Press).
Tiet, QQ and Mausbach, B (2007) ‘Treatments for Patients with Dual Diagnosis: A
Review’ Alcoholism: Clinical and Experimental Research, Vol. 31, No. 4(Apr),
pp513-536
William L. White (2008) ‘Recovery Management and Recovery Oriented Systems of Care:
Scientific Rationale and Promising Practices’, Pittsburgh.
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Section D – Potential impacts and how these will be addressed
Could your proposals have a
Yes (Y)
differential impact relating to age
equality
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
Are your proposals
discriminatory on the grounds of
age?
Will people within certain age
ranges not be getting the
outcome they need?
Will people within certain age
ranges be disadvantaged as a
result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
N
Older People
Evidence tells us that alcohol use among older people can be problematic (Royal
College of Psychiatrists 2008). As people get older they become more sensitive to
the effects of alcohol. About a third of older people with drinking problems develop
them for the first time in later life. Bereavement, physical ill-health, difficulty getting
around and social isolation can lead to boredom and depression, which in turn
could lead to drinking.
Will the proposals mean that
people within certain age ranges
will experience positive
outcomes?
Highlight any positive impacts
Y
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
N
N
Action:
 This is being addressed in the strategy by prioritising the needs of older
people.
Children and Young People
The National Drugs Strategy aims to:
Ensure schools deliver evidence based alcohol harm prevention
Ensure future ‘alcoholics’ and problem drug users are targeted and intervention
occurs much earlier and more effectively
Use ‘markers’ in the system to target future problem users e.g. when young
people come to the attention of the authorities
Stay in touch with young people, families and adults in treatment over time to
ensure recovery
Evidence suggests that alcohol use among young people in Salford is a priority.
In 2009/10 Salford‘s young population of drinkers have the highest rate of alcohol
specific admissions (125.5 per 100,000) in Greater Manchester (GM) and are
significantly greater than the North West (102.8) and England rates, ranking the
tenth worst area nationally. Salford is only one of three authorities in GM that has
seen an actual increase in admissions since 2003/04. This demonstrates an
increasing concern regarding hazardous and harmful drinking and the subsequent
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issues it can have leading into adulthood.
The National Institute for Clinical Excellence (NICE) recommends Children’s and
Adults’ commissioners jointly commission specialist services for young people to
the age of 25 or 30 because the pattern and culture of drinking, and social
circumstances of this group, are often different to those of older adults. Children
and young people are less likely to have alcohol dependence than adults but
hazardous drinking behaviours such as binge drink are more common. The
guideline highlights the need to develop integrated alcohol (and drug) services for
children and young people.
There is widespread evidence that certain groups of young people face increased
risks of developing substance misuse problems. These include those who are
truanting or excluded from school, looked after children, young offenders and those
at risk of involvement in crime and anti-social behaviour, those with mental ill
health, or those whose parents misuse drugs or alcohol.
Following Salford DAAT’s Under 25s review, drug and alcohol has been included
within the integrated children’s services strategy. The priority will be to target
children and young people who are most at risk of developing drug and alcohol
problems.
Action: To ensure that recovery is included in the development of the integrated
commissioning approach in children’s services
Children of Adults with Drug / Alcohol Problems
Hidden Harm, the Advisory Council on the Misuse of Drugs Major report, estimated
in 2003 that there were between 250,000 and 350,000 children of problem drug
users in England. The evidence indicates that children of problematic drug users
are vulnerable to addiction and emotional, behavioural, physical and educational
problems.
Action: This is being addressed by the commissioning of the ‘In Focus’ project
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Section D (continued) – Potential impacts and how these will be addressed
Could your proposals have a
differential impact relating to
disability equality
Yes (Y)
Are your proposals
discriminatory on the grounds of
disability?
Will people with disabilities not
be getting the outcome they
need?
Will people with disabilities be
disadvantaged as a result of
your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
people with disabilities will
experience positive outcomes?
Highlight any positive impacts
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relation
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
No
Mental Health
The prevalence rates for substance-related disorders among patients with
mental health problems are between 33% and 66% for those diagnosed with
lifetime schizophrenia disorder (Alterman et al, 1982; Barbee et al, 1989; Mueser et
al, 1992; Tiet & Mausbach, 2007). Reiger et al (1990) reported that over 56% of
people with any lifetime bipolar disorder have been diagnosed with a substance
abuse problem. For many, recovery may be a long term goal or a path not
followed, therefore the recovery strategy recognises that long term palliative care
will be required for people with severe and enduring mental health needs.
No
No
Yes
Low level mental health problems e.g. anxiety, depression are common among
people with drug and alcohol problems. Grant et al (2004) found that around 60%
of clients seeking treatment for drug misuse suffer from a co-morbid mood
disorder, with 42% diagnosed with an anxiety disorder.
A common problem for people with concurrent substance misuse and mental
health problems is the barrier to accessing mental health services while they are
still using substances.
Actions:
 Development of clear pathways between mental health and drug and
alcohol services
 Creating a specific lot for people with severe and enduring mental health
problems within the specification which will provide ongoing palliative care
appropriate to needs.
 Development of protocols relating to information sharing and informed
consent
Physical Health
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The risks of drinking to excess are well established. Long term alcohol abuse can
lead to numerous health problems, including liver and kidney disease, acute and
chronic pancreatitis, heart disease, high blood pressure, depression, stroke, foetal
alcohol syndrome and several cancers (Alcohol Concern 2012).
The strategy will prioritise people with disabilities and long term ill health, ensuring
that they have access to case management and a level of care appropriate to their
needs. Provider agencies will be expected to work in accordance with disability
legislation.
Action: Physical disability and ill health will be included in the prioritising criteria in
the recovery system.
Sensory and Visual Impairment
It is important to ensure that communication by/with council staff is available using
a wide range of options. In addition it is important that council staff working in this
department are trained to recognise communication needs, including deaf
awareness and sign language support.
Action: Sensory and visual impairment issues to be included in service
specifications
Section D (continued) – Potential impacts and how these will be addressed
Could your proposals have a
differential impact relating to
gender equality (this includes
pregnancy and maternity)
Are your proposals
discriminatory on the grounds of
gender?
Yes (Y)
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
No
Salford’s profile for women in drug / alcohol treatment is above the national
average. NDTMS data 2011/12 shows that in Salford 29% of the drug treatment
population is female. In the same period the national figure was 27%.
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Will men or women, boys or girls
not be getting the outcome they
need?
Will men or women, boys or girls
be disadvantaged as a result of
your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
men or women, boys or girls will
experience positive outcomes?
Highlight any positive impacts
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
No
No
Yes
Heavy drinking by women increased by almost a third in the decade up to 2008
(Smoking and Drinking amongst adults, 2008, ONS 2010). Women have a range
of specific needs relating to alcohol including understanding their different physical
capacity to deal with intoxication, sexual health, pregnancy issues, teenage
pregnancy, domestic violence, needs of children for alcohol education, fears of
women with children who are dependent or harmful drinkers that Social Services
will take their children away, sex workers and poly drug use. Salford females
recorded the highest rate of alcohol specific deaths in Greater Manchester for
2007/09 (15.6 per 100,000) and ranked second worst nationally behind Blackpool.
This was significantly greater than the female alcohol specific mortality rates for
both North West (9.9) and England (6.1) and a 78% increase from 2003/05
records.
It is estimated that between 55% and 99% of women with dual diagnosis have
experienced some form of trauma (Najavits, Weiss and Liese 1996). This could be
related to domestic violence, sexual abuse, emotional abuse as a child, incest,
stillbirth or the death of a child (Becker and Duffy, 2002). Women drug users often
identified recurrent mental health problems such as depression, low self-esteem,
self-mutilation, suicide attempts and eating disorders (Fiorentine et al 1997; Becker
and Duffy, 2002).
The consultations have highlighted the lack of residential rehabilitation provision for
women; and have consistently highlighted the barriers faced by parents
(particularly women) with children in accessing treatment and recovery services.
Actions:
 Increasing access for women and provision of a wider range of services
 Social marketing targeting women including foetal alcohol syndrome and pre
natal care
 Specialist residential provision for women to be included in the respecification
 Childcare to be included in the remit of personalised budgets.
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Section D (continued) – Potential impacts and how these will be addressed
Could your proposals have a differential
impact relating to equality for people
planning, undergoing or who have
undergone gender reassignment?
Are your proposals discriminatory for
people planning, undergoing or who
have undergone gender reassignment?
Will people planning, undergoing or who
have undergone gender reassignment
not be getting the outcome they need?
Will people planning, undergoing or who
have undergone gender reassignment
be disadvantaged as a result of your
proposals?
If the impact is negative, how will it be
reduced or eliminated?
Yes (Y)
Will the proposals mean that people
planning, undergoing or who have
undergone gender reassignment will
experience positive outcomes?
Highlight any positive impacts
Yes
Are the proposals likely to impact on
community cohesion?
Is there potential to enhance
relationships between people who share
a protected characteristic and those who
do not?
Identify areas where there is potential to
foster good relations
No (N)
Explain impact(s) and what evidence or data exists to support your
analysis?
No
It is common for people who have undergone gender re-assignment to
experience issues in relation to drugs and alcohol (Eliason and Hughs
2004). Issues can be linked to stigma/harassment/discrimination,
confusion around sexual orientation or gender identity, loss of family and
community support, non-acceptance of themselves leading to low self
esteem, depression, anxiety and feelings of guilt and paranoia.
No
No
The current number of people who have undergone gender re-assignment
within Salford’s drug and alcohol treatment system is not known.
The principle that service users have the right to choose treatment
appropriate to their own personal identity needs to be central to the
Recovery specifications
Actions
 Partner agencies will be required to collect data relating to gender
reassignment and this will be a requirement in the new
specifications.
 People who have undergone gender-reassignment will be prioritised
within the new system.
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Section D (continued) – Potential impacts and how these will be addressed
Could your proposals have a
differential impact relating to
race equality
Are your proposals
discriminatory on the grounds of
race?
Will people within certain racial
groups not be getting the
outcome they need?
Will people within certain racial
groups be disadvantaged as a
result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Yes (Y)
Will the proposals mean that
people within certain racial
groups will experience positive
outcomes?
Highlight any positive impacts
Y
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Rome et al (2002) states that Black and Minority Ethnic (BME) drug users have
traditionally been reluctant to access existing services. Issues faced by BME
communities include language and communication issues and conflicts resulting
from cultural issues and practices. Issues experienced by new immigrants,
refugees and asylum seekers include different cultural practices and attitudes
which may conflict with UK laws and health initiatives. Also there may be issues
with mental health problems including trauma; and legal issues relating to
immigration status.
N
N
Actions:
 Address the communication needs of service users by the provision of
appropriate publicity, translation and interpretation support / services
 There is an expectation that providers will ensure that they have bi-lingual
staff in their workforce and provide suitably trained volunteers from local
communities. This be a requirement of new specifications.
 Being a member of a BME group will lead to being prioritised within the new
system.
 Outreach and communication strategy needs to outline how to reach people
from BME communities
Section D (continued) – Potential impacts and how these will be addressed
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Could your proposals have a
Yes (Y)
differential impact relating to
religion or belief equality
Are your proposals
discriminatory on the grounds of
religion or belief?
Will people of certain religions or
who have particular beliefs not
be getting the outcome they
need?
Will people of certain religions or
who have particular beliefs be
disadvantaged as a result of
your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
people of certain religions or
who have particular beliefs will
experience positive outcomes?
Highlight any positive impacts
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Salford Drug and Alcohol Action Team recognises that beliefs about alcohol and
drug use within certain religions can act as a barrier to people acknowledging that
they have a problem, speaking about it and seeking help. The strategy needs to
consider sensitively how to connect with people through outreach work, through
community contact and family work.
N
N
Actions: Outreach and communication strategy needs to outline how to reach
people whose drug / alcohol use conflicts with religious beliefs
Y
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
Section D (continued) – Potential impacts and how these will be addressed
20
Could your proposals have a
differential impact relating to
sexual identity equality
Are your proposals
discriminatory on the grounds of
sexual identity?
Will gay, lesbian and/or bisexual people not be getting the
outcome they need?
Will gay, lesbian and/or bisexual people be disadvantaged
as a result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
gay, lesbian and/or bi-sexual
people will experience positive
outcomes?
Highlight any positive impacts
Yes (Y)
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
N
Research into the drug / alcohol and sexual identity is limited. Eliason and Hughs
(2004) report that Lesbian, Gay, Bisexual & Transgender (LGBT) people use licit
and illicit drugs for a variety of reasons. This can be related to:
 stress associated with coming out
 stigma/harassment/discrimination
 confusion around sexual orientation or gender identity
 the role of gay bars as a major (and sometime only) social outlet
 greater likelihood of loss of family and community support
 non-acceptance of themselves or internalised homophobia: leading to low
self esteem, depression, anxiety and feelings of guilt and paranoia.
N
N
Actions required:
 Communication and outreach strategy needs to identify and engage with
gay, lesbian and/or bi-sexual people
 People from LGBT communities to be prioritised within the new recovery
system
Y
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
Section D (continued) – Potential impacts and how these will be addressed
Could your proposals have a
Yes (Y)
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
21
differential impact on socio
economic equality (people on a
low income)?
Are your proposals
discriminatory on the grounds of
socio economic inequality?
Will people on a low income not
be getting the outcome they
need?
Will people on a low income be
disadvantaged as a result of
your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
people on a low income will
experience positive outcomes?
Highlight any positive impacts
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
N
N
N
Y
The links between social deprivation and greater health inequalities that result in
much poorer health outcomes is well documented, most recently by Marmot 2010.
NHS Salford have identified that the areas of greatest health inequalities have the
greatest levels of alcohol related harm and access to alcohol.
A lack of community assets and social support is greatest in the most deprived
areas and individuals who are socially isolated are between two and five times
more likely than those who have strong social ties to die prematurely.
Understanding how to tackle social isolation in areas of deprivation is essential to
reduce future consequences such as alcohol-related mortality (NHS Salford 2012).
The recovery strategy takes an asset based community development approach
which aims to strengthen resources in local communities, targeting the most
deprived communities. Moreover, the development of communities of people who
are in recovery is required in order to strengthen the support available within local
communities (White 2008).
Actions:
 An asset based community development approach and the development of
recovery communities are central in the recovery strategy
 The personalisation project uses a deprivation index assessment to help the
panel to assess and prioritise applications
22
Section D (continued) – Potential impacts and how these will be addressed
Could your proposals have a
Yes (Y)
differential impact relating to any
other equality groups, for
example, carers, ex offenders?
Are your proposals
discriminatory in relation to any
other groups?
Will people within any other
groups not be getting the
outcome they need?
Will people within any other
groups be disadvantaged as a
result of your proposals?
If the impact is negative, how
will it be reduced or eliminated?
Will the proposals mean that
people within any other groups
will experience positive
outcomes?
Highlight any positive impacts
Are the proposals likely to
impact on community cohesion?
Is there potential to enhance
relationships between people
who share a protected
characteristic and those who do
not?
Identify areas where there is
potential to foster good relations
No (N)
Explain impact(s) and what evidence or data exists to support your analysis?
Alcohol
One of the major changes within the new recovery strategy is the integration
between alcohol and drug treatment. At least a third of the population of Salford
has or may develop an alcohol problem. Alcohol related hospital admissions in
Salford are 2nd highest in England. Alcohol related mortality is higher in Salford
than the North West and England. Levels of alcohol consumption in Salford, like
many urban areas in the North West, are significantly higher than the national
average. Synthetic estimates (NWPHO 2010) suggest that of the Salford
Population of 216,000 27% are binge drinkers (58,320), 23% are at increasing risk
(49,680) and 8% are at higher risk of harm (17,200) (DOH 2004).
There is an unknown and potentially unlimited demand for alcohol treatment and
recovery services. In order to address this, a system of exclusions, targeting and
prioritising of resources needs to be developed. This needs to take account of
factors such as the severity of the drug / alcohol problem, the complexity of a
person’s circumstances and their recovery assets. The operation of exclusions
could potentially impact on particular groups of people, therefore the understanding
of “complexity” needs to be mindful of diversity issues. For example an asylum
seeker who drinks comparatively lower levels of alcohol and is experiencing post
traumatic stress along with legal and other issues would have higher complexity
ratings therefore trigger a higher level of care.
Action required: System of prioritising to take account of diversity issues
Families / carers
The impact of substance use on families and carers is well documented and can
affect people physically, psychologically, spiritually, socially and financially. Carers
and affected family members are recognised in a wide range of legislative and
policy guidance, most recently in the National Drug Strategy 2010. In Salford,
23
families and carers will incorporated into the integrated commissioning approach
within Children’s Services.
Action:
 Young people, families and carers will be part of an integrated
commissioning approach in children’s services. This will need to be linked
to the recovery strategy.
 Strategy to be developed for young people, families and carers
Domestic Violence
Many women use substances as a response to and a way of dealing with abuse
and many women who access drug and alcohol services will have current or past
experience of domestic violence. Women experiencing domestic violence are up to
fifteen times more likely to misuse alcohol and nine times more likely to misuse
other drugs than women generally (Stark & Flitcraft). 40% of Asian women who
seek treatment for alcohol misuse are experiencing domestic violence (Shaikh et al
2000).
Issues include:
 Some women are introduced to substances by their abusive partners as a
way of increasing control over them
 When a woman's partner is also her supplier, it will be particularly difficult for
her to end the relationship
 When a woman seeks support, information or treatment for her substance
misuse, her partner may become even more abusive, or may actively
prevent or discourage her attendance at a substance misuse service
 Women whose partners misuse substances may minimise or excuse their
violence on those grounds; it is important to emphasis that even if substance
use ceases, the violence and abuse usually continues
 Women with problematic substance use who also experience domestic
violence are particularly likely to feel isolated and doubly stigmatised. They
may find it even harder than other women to report or even to name their
experience as domestic violence; and when they do, are in a particularly
vulnerable position, and may be unable to access any suitable sources of
support.
24
Action: Domestic violence to trigger priority status within the recovery system
Stage of recovery
The recovery strategy aims to increase the number of people recovering from drug
and alcohol problems. Recovery is a contested concept and has 3 main groupings
abstinent, moderated and medicated (White 2008). There are concerns that the
allocation of resources could favour one type of recovery e.g. abstinent. In order to
address this, the allocation of resources and service benefits / incentives needs to
be impartial and clearly linked to protocols for Fair Access to Care.
Action: Strategy and specifications to comply with Fair Access to Care
requirements
People who are Homeless
Salford DAAT and Supporting People have taken a strategic decision to jointly
commission housing support services for people with drug and alcohol needs, with
Salford DAAT being the lead. Central to this will be the provision of wet (for people
who are still drinking) and dry (abstinent) housing.
The risks of the strategy are that it may put an overwhelming demand on Salford’s
services and act as a draw for homeless people from surrounding areas. In order
to address this, an exclusion/ prioritising system will be required based on the
principle of being able to provide evidence of a connection / history with Salford.
Actions:
 Joint commissioning of drug and alcohol housing projects
 Provision of wet and dry housing support
 Development of a system of prioritisation for accessing Salford’s housing
projects
25
Section E – Action Plan and review
Detail in the plan below, actions that you have identified in your CIA, which will eliminate discrimination, advance equality of opportunity
and/or foster good relations.
If you are unable to eliminate or reduce negative impact on any of the equality areas, you should explain why
Impact (positive or
negative) identified
Proposed action
Person(s)
responsible
To ensure providers are
signed up to Salford
Council’s diversity and
equality policies,
including sensory and
visual impairment
Diversity and equality to
be central to
specifications
Andrew
MacDonald
To ensure that providers
have effective diversity
and equality monitoring
systems in place,
including gender reassignment
Potential exclusion of
diverse groups
Mark Knight
Potential providers to
demonstrate
understanding of the
council’s diversity and
equality policies
To be included in the
specifications for the
new contracts
To develop a system of
prioritising that accounts
for older people, mental
health, physical
disability, sensory /
visual impairment and ill
health, sexual identity
and gender re-
Where will action
Target date
be monitored? (e.g.,
Directorate
Business Plan,
Service Plan,
Equality Action
Plan)
Directorate business July 2013
plan and
performance
framework
Required outcome
To be included in the
specifications
Written plans and
presentations
Andrew
MacDonald
July 2013
To produce data as
agreed with DAAT
commissioners
Mark Knight
Directorate business
plan and
performance
framework
Andrew
MacDonald
Directorate business
plan
July 2013
Protocols and
specifications
Mark Knight
26
To ensure language
needs are met i.e.
translation, interpreting
Engaging with people
from diverse groups
where stigma is present
e.g. BME communities /
religious groups, LGBT
community
Uphold human rights in
relation to information
sharing.
Specialist residential
rehabilitation project for
women
Childcare
Links between recovery
strategy and young
people’s commissioning
Families, including
carers, parents and
young people
Domestic violence
assignment, race /
ethnicity / religion,
To specify providers
responsibilities in all
contracts
Nicky Tandy
Directorate business
plan
Done
To be included in all
contracts
Communications and
assertive outreach
strategy to include how
diversity issues will be
addressed
Andrew
MacDonald
Directorate business
plan
July 2013
Specifications
Development of
protocols relating to
information sharing and
informed consent
Andrew
MacDonald
Directorate business
plan
July 2013
Written protocols
To be included in the
specifications
Andrew
MacDonald
Directorate business
plan
July 2013
To set up a project
Directorate business
plan
Done
Budgets awarded
Directorate business
plan
August 2014
Linkage between
integrated children’s
services and
recovery system
Directorate business
plan
Sept 2012
Produce strategy
Directorate business
July 2013
To be included in the
Childcare to be included
in the criteria for
personalisation
Mark Knight
Mark Knight
Mark Knight
Mark Knight
Andrew
MacDonald
Mark Knight
To ensure that recovery
is included in the
development of the
integrated
commissioning approach
in children’s services
Strategy to be
Patrick
developed for young
McSweeney
people, families and
carers
Domestic violence to
Andrew
27
Children of problem drug
and alcohol users
Severe and enduring
Mental health problems
Accessing mental health
support / counselling
Ensure allocation of
resources is in line with
Fair Access to Care
(FACSs) policies
To meet the housing
needs of people with drug
and alcohol problems
trigger priority status
within the recovery
system
To commission the ‘In
Focus’ Project
MacDonald
Specifications to include
provision of palliative
care for people with
severe and enduring
mental health problems
dual diagnosis
Andrew
MacDonald
Mark Knight
Judd Skelton
To develop pathways
between drug and
alcohol and mental
health services
FACs to be included in
all specifications
Deprivation index in
personalisation project
Integrated
commissioning between
Supporting People and
DAAT
plan
Mark Knight
Mark Knight
specifications
Directorate business
plan
Done
Directorate business
plan
July 2013
To continue to
provide the service
according to need
Specification
Pathway
documentation
Andrew
MacDonald
Directorate business
plan
July 2013
Inclusion in all
specifications
Directorate business
plan
July 2013
Provide a range of
residential provision
Directorate business
plan
July 2013
Inclusion in
specifications
Mark Knight
Andrew
MacDonald
Mark Knight
To develop wet and dry
housing provision
Health inequalities:
social isolation
particularly in areas of
To include a system of
prioritisation for housing
specifications
Targeted asset based
community development
to be included in the
Andrew
MacDonald
28
deprivation
specification
Mark Knight
Could making the changes in any of the above areas have a negative effect on other groups? Explain why and what you will do about
this.
Review
Your CIA should be reviewed at least every three years, less if it has a significant impact on people.
Please enter the date your CIA will be reviewed: November 2015. You should review progress on your CIA action plan annually.
29
Section F – Summary of your CIA
As your CIA will be published on the council’s website and accessible to the general public, a summary of your CIA is required. Please
provide a summary of your CIA in the box below.
Summary of Community Impact Assessment
How did you approach the CIA and what did you find?
Review of literature and relevant documentation. A working group was formed to impact assess the changes to Salford’s Drug and
Alcohol Strategy.
What are the main areas requiring further attention?
 To ensure providers are signed up to Salford Council’s diversity and equality policies.
 To ensure that providers have effective diversity and equality monitoring systems in place, including gender re-assignment
 Potential exclusion of diverse groups
 To ensure language needs are met i.e. translation, interpreting
 Engaging with people from diverse groups where stigma is present e.g. BME communities / religious groups, LGBT community
 Uphold human rights in relation to information sharing.
 Lack of specialist residential rehabilitation project for women
 Links between recovery strategy and young people’s commissioning
 Families, carers and young people
 Childcare
 Children of problem drug and alcohol users
 Carers and families
 Severe and enduring mental health problems and dual diagnosis
 Accessing mental health support / counselling
 Ensure allocation of resources is in line with Fair Access to Care (FACSs) policies
 To meet the housing needs of people with drug and alcohol problems
 Health inequalities: social isolation particularly in areas of deprivation
 Domestic violence
Summary of recommendations for improvement
30
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


















Diversity and equality to be central to specifications and potential providers to demonstrate understanding of the council’s
diversity and equality policies
Equality monitoring to be included in the specifications for the new contracts
To develop a system of prioritising that accounts for older people, mental health, physical disability, sensory/visual impairment
and ill health, sexual identity and gender re-assignment, race / ethnicity / religion
To specify providers responsibilities for the provision of translation and interpretation in all contracts
Communications and assertive outreach strategy to include how diversity issues will be addressed
Development of protocols relating to information sharing and informed consent
Specialist residential rehabilitation project for women to be included in the specifications
To include families and carers and recovery in the development of the integrated commissioning approach in children’s services
Strategy to be developed for young people, families and carers
To support the commissioning of the ‘In Focus’ Project
Childcare to be included in the criteria for personalisation
Specifications to include provision of palliative care for people with severe and enduring mental health problems dual diagnosis
To develop pathways between drug and alcohol and mental health / counselling services
Fair Access to Care to be included in all specifications
Deprivation index included in the personalisation project
Integrated commissioning between Supporting People and DAAT
To develop wet and dry housing provision
To include a system of prioritisation for housing specifications
Asset Based Community Development to be included in the specifications
Domestic violence to trigger priority status within the recovery system
31
Section G – Next Steps
Quality Assurance
When you have completed your CIA, you should send it to your directorate Equality Link Officer who will arrange for it to be quality
assured. Your CIA will be returned to you if further work is required. It is important that your CIA is robust and of good quality as it may
be challenged
“Sign off” within your directorate
Your directorate Equality Link Officer will then arrange for your CIA to be “signed off” within your directorate (see below). Your directorate
Equality Lead Officer or other senior manager within your directorate should “sign off” your CIA (below).
Name
Signature
Date
Senior Manager
Nigel E Preston
4th November 2013
Lead CIA Officer
Mark Reeves
4th November 2013
Publishing
When your CIA has been signed off within your directorate, your directorate Equality Link Officer will send it to Elaine Barber in the
Equalities and Cohesion Team for publishing on the council’s website.
Monitoring
Your directorate Equality Link Officer will also send your CIA to your directorate Performance Officer where the actions identified within
your CIA will be entered into Covalent, the council’s performance management monitoring software so that progress can be monitored
as appropriate.
Feedback from the Equality Advocates (April 2013 amendments):
32
What
Section C
Comment
Should the word 'over' be replaced with
'under'?
p24 - alcohol
Reference to 'diversity issues' should be
replaced with 'ethnicity issues' for better
relevance.
Suggest emphasis should be on Salford
people providing evidence of a connection /
history with Salford or an immediate
neighbouring authority. Participants should
have the flexibility to go to a immediate
neighbouring authority as they may have
complex personal reasons why they do not
want to go to a specific LA, such as to avoid
the 'wrong crowd' or unwanted attention in
that area.
The document also makes no reference to
disability issues experienced by deaf
people, and there is no reference to
minicoms, or email access. It is particularly
an issue that deaf people often find it more
difficult to get out of a spiral of 'no hope' due
to isolation and communication difficulties.
They are perhaps more vulnerable to
alcohol and drug problems as a result of
this. Although it is recognised that people
experiencing alcohol and drug problems
may well not have the money for a minicom
or computer it is nevertheless important to
ensure that communication by/with council
staff is available using a wide range of
options. In addition it is important that
council staff working in this department are
trained to recognise communication needs,
including deaf awareness and sign
p25 – people who are homeless
Deaf issues
33
Response
The idea of this is to identify those who earn
over 18k as it would be a less intensive
exercise
Has been investigated, no further action
required
This measure is designed to reduce the risk
that people from neighbouring areas could
migrate to Salford as a result of offering a
high level of provision. There is a finite
housing provision in Salford.
Included in amendments to the CIA
language support.
34