Document Details:
ADP Reporting Requirements 2013/14
1
Partnership Details
2
Self-Assessment:
3
Finance Framework
4
Core & Local Indicators and key activities 2013/14
5
ADP & Ministerial priorities
Appendix 1

Guidance Notes and Commissioning Diagram
4 June 2014
1
1.
PARTNERSHIP DETAILS
Alcohol & Drug Partnership:
ADP Chair
Contact name(s): See note 1
Contact telephone
Email:
Date of Completion:
Date published on ADP
website(s)
Lanarkshire
Colin Sloey
Stewart Marshall
01236 703105
Stewart.marshall@lanarkshire.scot.nhs.uk
12/09/2014
October 2014
The content of this template has been agreed as accurate by the Alcohol and Drug Partnership, and has been
shared with our Community Planning Partnership:
…………
…………………………..
ADP Chair
The Scottish Government copy should be sent for the attention of Amanda Adams to:
Alcoholanddrugdelivery@scotland.gsi.gov.uk
4 June 2014
2
2.
ADP Self-Assessment 1 April 2013 – 31 March 2014
Theme
R
A
G
Evidence See Note 2
See 1
ANALYSE
1
ADP Joint Strategic Needs
Assessment
has
been
undertaken and provides a clear,
coherent assessment of need,
which takes into consideration
the
changing
demographic
characteristics
of
substance
misusers in your area. Please
also include here any local
research
that
you
have
commissioned
See Note 3
G
There is one ADP across the Lanarkshire Health Board area. NHS Lanarkshire and
North and South Lanarkshire Councils therefore play a fundamental role in our
partnership, together with other key stakeholders such as Police Scotland, Scottish
Prison Service, Lanarkshire Community Justice Authority, Scottish Fire and Rescue, and
the Crown Office and Procurator Fiscal Service.
In 2011/12, in preparation for the ADP Strategy and delivery plan 2012-2015, a full needs
assessment was completed involving analysis from data and profiles, community and
service provider engagement and local intelligence.
Lanarkshire ADP continues to utilise available profiles and data from Information
Services Division Scotland (ISD) to help form an understanding of need. We also use
additional statistical information such as the Scottish Health Survey and Scottish
Adolescent Lifestyle and Substance Use Survey (SALSUS).
Lanarkshire ADP is closely aligned to the North Lanarkshire and South Lanarkshire
Community Planning Partnerships (CPPs) and representation on the ADP Board involves
senior management from all partnership organisations.
The Lanarkshire ADP Implementation and Finance Group (I+F) consult with Partnership
Boards and Forums in relation to the commissioning and de-commissioning of services.
We continue to measure local referral rates and type of referrals to monitor the need of
service users and to develop appropriate plans. In 2013/14 we engaged in capacity
planning exercises and workload measures to ensure services were able to provide the
necessary intervention and support.
4 June 2014
3
Theme
R
A
G
Evidence See Note 2
See 1
As per last year’s report Lanarkshire ADP, in partnership with Scottish Training on Drugs
and Alcohol (STRADA) and North Lanarkshire Integrated Addiction Services (NLIAS),
conducted a needs assessment in relation to the workforce within alcohol and drug
services. This work was used to inform the workforce development model for 2013/14
consistent with the emergence of a recovery orientated system of care. It is expected that
the learning and work from the needs assessment be shared and carried across to
services in South Lanarkshire.
http://www2.nhslanarkshire.org.uk/boards/2014-boardpapers/Documents/September/Item-12-Developing-Blueprint-for-Alcohol-and-DrugWorkforce-Development-Model-in-North-Lanarkshire.pdf
As noted in last year’s report, for the past 5 years we have engaged in health
improvement research related to service users discharged from a psychiatric in-patient
setting. This has been in collaboration with mental health colleagues. The research has
shown a significant lower life expectancy for service users, particularly with alcohol
and/or drug issues. As a result of the findings we initiated 2 working groups, 1 group
looking at the close pathways between substance misuse and mental health services
(particularly in the community) and the second group looking at the physical health needs
for service user’s with alcohol and/or drug issues and ensuring that these health issues
are met. The work taking place fits with recommendations from the Opioid Replacement
Therapy (ORT) review around improved primary care linkage and access to universal
services
We concluded a Community Justice scoping exercise in 2012/13 to look at available
services This work incorporated local and national statistics and involved colleagues from
the community justice arena. From the exercise there was acknowledgement of the
areas that worked well and the areas for improvement. In 2013/14 an action plan was
developed from the exercise and involved a number of recommendations including
increasing the number of Community Payback Orders (CPOs) with an Alcohol or Drug
Requirement, improved linkage between community justice and mental health services,
4 June 2014
4
Theme
R
A
G
Evidence See Note 2
See 1
development of supports for offenders at post order, increased well being checks for
offenders and a focus on Health Improvement agenda within prison settings. The ADP
and community justice colleagues have worked closely to meet the recommendations, an
example of the work being an agreed pathway in relation to CPOs involving alcohol/drug
offenders, the facilitation of Self Management and Recovery Training (SMART) groups in
the Drug Treatment and Testing Order Service and joint working between community
justice and Keep Well Nursing staff.
The work with community justice colleagues emphasised the value of the Community
Bridges Project. The project offers close, voluntary, through care support for offenders
with a history of substance misuse, and has been shown to make a difference in the
offending patterns and substance use of the offenders they are working with. In light of
the recognised worth of the model, the detailed history of many of the offenders going
back to youth offending and local intelligence indicating an increasing, concerning area
around youth offenders within HMYOI Polmont, the ADP has agreed to provide funding
for the Youth Bridges Project in 2014/15.
Last year a joint strategic needs assessment on Community Safety within South
Lanarkshire was commenced. The needs assessment involved data analysis from
different outlets, and local intelligence on community safety priorities. It is expected that
this work will be completed shortly and fed into the Safer South Lanarkshire Board for
discussion and decision making.
Last year the Lanarkshire ADP and Lanarkshire NHS Public Health Department
commissioned work looking at overprovision. This work has involved data collection and
analysis, engagement with key members from licensing, public health and ADP, as well
as public engagement. The work is designed to help members understand the alcoholrelated issues across Lanarkshire that may be linked to overprovision and provide
guidance to licensing boards and forums with policy statement and decision-making.
The work will be concluded mid 2014 and an update provided at the next Annual Report.
As part of Service development and continuous improvement the ADP has provided
4 June 2014
5
Theme
R
A
G
Evidence See Note 2
See 1
funding for the external evaluation of the North Lanarkshire Integrated Addiction Service.
This work will be completed in January 2015.
In response to workforce development requests from practitioners, and in light of the
Children and Young People Bill, the ADP has been at the forefront of development
around Getting it Right for Every Child (GIRFEC) and Adult Substance Misuse Services.
In 2013/14 work has involved the development of guidance for addiction staff on
promoting the wellbeing for children affected by substance misuse when working with
adults who have parental/caring responsibilities.
The ADP continued to fund diversionary projects in 2013/14. The diversionary work took
place in areas identified by health and police colleagues as problematic in relation to
young people and anti social behaviour. Data from police colleagues suggest that the
right areas have been targeted as there has been a noticeable decrease in antisocial
behaviour in the areas where the diversionary work has taken place.
In conjunction with STRADA , Lanarkshire ADP has been working since November 2011
to design, deliver, monitor and evaluate training tailored to address young people and
their relationship and consumption of alcohol, by employing alcohol brief interventions
(ABIs) using a health behavioural approach. The delivery and effectiveness of ABIs to
young people to date has not been evidenced nationally as such. This work continued
through 2013/14.
2
An outcomes based ADP Joint
Performance Framework is in
place that reflects the ADP
National Outcomes.
See note 4
4 June 2014
G
The ADP Delivery plan accurately reflects the 7 core ADP outcomes (health, prevalence,
recovery, children and families, community safety, environment and services). The
delivery plan emphasises the importance of joint working and monitoring performance.
Data, targets and indicators clearly identified within the delivery plan help to monitor
performance and highlight services that are responsible and accountable for service
delivery.
6
Theme
R
A
G
Evidence See Note 2
See 1
There is clear read-across with performance indicators and outcomes stipulated in the
ADP delivery plan and other key plans and strategies including both North and South
Lanarkshire’s Substance Misuse, Community Safety and Children’s Services Plans.
3
G
The mapping exercise of community justice services helped to scope activity, costs and
variation in service delivery to support resource transfer across ADP and Community
Justice Authority. This work led to continued funding and support for the Persistent
Offender’s Project, Arrest Referral Service, Community Bridges Project as well as
providing additional funding for the initiation of the Youth Bridges Project.
The exercise assisted with the work taking place in relation to the transfer of resource
from Police Scotland to NHS Lanarkshire for delivery of NHS led healthcare within Police
Custody Suites. The ADP is committed to ensuring that Healthcare within Police
Custody Suites is complimentary and aligned to supports available in the community
The Transfer of resource from SPS to NHS Lanarkshire to ensure the delivery of NHS
healthcare within the prison setting took place two years ago. Additional ADP funding
has helped to develop healthcare provision further within the prison setting with a
particular emphasis on Health Improvement and promoting recovery for offenders.
Integrated Resource Framework Process
Suitable data has been used to
scope the programme budget
and a baseline position has been
established regarding activity,
costs and variation.
Note 5
4 June 2014
Development and delivery of diversionary work throughout Lanarkshire has involved a
multi agency approach in relation to data analysis, cost and diversionary activity. The
cost and delivery has been facilitated by numerous partners, including ADP, Police
Scotland, NHS, Local Authority and is a good example of agencies working together to
divert young people away from harm, providing a safe place for young people to engage
with peers and participate in meaningful activities and to reduce anti social behaviour
impacting on local communities.
The ADP I+F group have the remit to review and monitor ADP spend against key
outcomes. A performance and financial framework is utilised with the group that
provides detailed breakdown of costs, activity and performance.
7
Theme
R
A
G
Evidence See Note 2
See 1
4
Integrated Resource Framework Outcomes
Note 5
A coherent approach has been
applied to selecting and
prioritising investment and
disinvestment options – building
prevention into the design and
delivery of services.
G
The community justice scoping exercise provided identification of areas for investment
and a move towards co-ordination and a shared vision of service provision.
This coincided with the transfer of resources related to healthcare within police custody
suites which has allowed the ADP and health colleagues to proceed with identifying a
model of care and taking the necessary procedural steps towards live initiation of NHS
healthcare. The model of care (now live) will provide effective healthcare within the
custody setting and help to link individuals with alcohol and/or drug problems, to the
appropriate community based supports that will assist them in their recovery.
In relation to the transfer of resources within the prison setting. This has enabled NHS
healthcare delivery with particular focus around key performance indicators such as
health improvement for prisoners.
The HEAT (Health Efficiency Access Treatment) 4 Standard for Alcohol Brief Intervention
(ABI) has been fully embedded into the main priority areas (primary care, maternity,
acute) thanks to the co-ordination and investment led by the HEAT 4 Steering group that
links accordingly to the ADP I+F group and ADP Board.
The HEAT A11 access to drug/alcohol treatment target has been consistently surpassed
in Lanarkshire due to the co-ordinated actions and investment of the South Lanarkshire
Substance Misuse Planning and Performance (P+P) Group and the North Lanarkshire
Addiction Partnership Board (APB). Both, the P+P and APB have membership from
different partnership agencies tasked with planning services and care. Both link to the
ADP I+F group and ADP Board.
In 2012/13 the Lanarkshire Youth Counselling Service (LYCS) and Child and Adolescent
Mental Health Service (CAMHS) merged to offer integrated access to children and young
people. Last year witnessed the consolidation of integration and the tiered level of
service delivery has ensured that children/young people are able to access mental
health/support services at the level required and the point of need.
4 June 2014
8
Theme
R
A
G
Evidence See Note 2
See 1
The ADP provided funding to the Safer Lanarkshire Campaign led by Police Scotland
and involving Community Planning Partners. This investment, which included spend on
prevention and crime reduction, contributed to the improvement in the quality of life in
Lanarkshire as a whole. By utilising ‘The Measuring Preventative Spend – A Cost Toolkit
for Community Safety’ and looking at costs and savings around violent crime, serious
assault, assault and vandalism, it is estimated that for every £1 spent on the Safer
Lanarkshire Initiative, £164 is being saved by partners elsewhere.
PLAN
Theme
5
We have a shared vision and joint
strategic objectives, which is
aligned with our local
partnerships, e.g. child protection
committees, violence against
women, community safety etc.
R
A
G
G
Evidence
Lanarkshire ADP work with our partners to achieve equality of access to services,
combined with value for money. We accept alcohol and drug misuse is multi-factorial and
as such, for intervention and support to be truly effective, this must take place on an interagency basis.
We work to achieve the Lanarkshire ADP strategy aims and objectives via our contribution
to the existing community planning arrangements and as mentioned above, our strategic
objectives are in line with other key local Plans thus contributing towards achieving the
best outcomes for all children, young people and families in Lanarkshire.
The Strategy is supported by our 3 year delivery plan which outlines our national and local
outcomes, local targets, and key actions. The Strategy and Delivery Plan clearly
contributes to the South Lanarkshire and North Lanarkshire Single Outcome Agreement
(SOA).
http://www2.nhslanarkshire.org.uk/boards/2014-board-papers/Documents/September/Item-12-LanarkshireADP-Strategy-2012-2015.pdf
4 June 2014
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PLAN
6
A
The Lanarkshire ADP Delivery Plan is clearly linked to community planning arrangement
and Single Outcome Agreements. We follow a commissioning cycle of annual local needs
assessment, planning, commissioning, monitoring and reviewing
The I+F group provides direction on the investment of services based on the information
derived from the commissioning cycle taking place annually.
With impending Health and Social Care integration, as well as the emergence of Self
Directed Support, the ADP is well placed to support change to service delivery. The
development of an updated Commissioning Strategy will be taken forward, post
integration, to ensure the strategy is closely aligned with the collaborative approaches.
A. Our strategic commissioning
work
is
clearly
linked
to
Community Planning priorities
and processes.
In relation to Health and Social Care integration it is important to note that service delivery
for alcohol and drug services within North Lanarkshire is already delivered in an integrated
manner. The integrated service is monitored by the North Lanarkshire Addiction
Partnership Board to ensure a culture of continuous improvement and formal performance
scrutiny.
Please
include
your
ADP
Commissioning Plan or Strategy if
available.
The ADP has representation and close links to public protection committees such as the
Adult Protection Committee, Child Protection Committee and Multi Agency Public
Protection Arrangements (MAPPA) Committee.
Please include information on your
formal relationship to your local child
protection committee and Criminal
Justice Adult Services.
There is a well established ADP/Community Justice Authority (CJA) working group
responsible for coordinating delivery of care and support and some of the work has been
mentioned previously.
B. What is the formal arrangement
within your ADP for reporting on
your Annual Reports/ Delivery
Plans/shared documents, through
your local accountability route.
There has been a newly established ADP/Child Protection Committee working group
involving ADP Development officers, Child Protection Committee Coordinators and
Lanarkshire Substance Misuse Leads. This group will focus on areas around workforce
development, and improving linkage between child/family services and adult substance
misuse services. It should be noted that both the North and South Lanarkshire Substance
Misuse Workforce Development Groups contain representation from child and adult
See note 6
4 June 2014
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PLAN
services.
7
Service Users and carers are
embedded within the partnership
commissioning processes
A
ADP draft and final annual reports are reported directly into both the North and South
Lanarkshire Community Planning Partnerships. All stakeholders are encouraged to
provide comment and assistance to the annual report. Post submission of the annual
report both CPPs are provided with a presentation and written report detailing the salient
points of the annual report. This is provided also to the CJA Board, Adult Protection
Committees, Child Protection Committees, MAPPA Committee, and Community Safety
Partnerships.
As part of the ADP Strategy we helped to establish a network of ‘recovery champions’
within all organisations across Lanarkshire. We have continued to assist recovery
champions in developing and facilitating recovery events for practitioners, service users,
families and carers alike. At the events we have consistently encouraged feedback into
the quality of service provision in Lanarkshire and asked in what areas we can improve.
An example of such an event took place in Airdrie last year. The event looked at raising
awareness to services, service users, families and carers of all the different supports and
groups available to aid recovery. The event took place in the shape of a ‘speed
networking exercise’ and was facilitated by recovery champions and over 20 service
providers and group supports including mutual aid. Part of the event also included a
drama delivered by community recovery champions specifically aimed at highlighting the
recovery resources available in the form of marking someone’s recovery journey/walk.
There is a service user delegate at the Lanarkshire ADP Board meetings usually in the
form of representation from ‘The Lanarkshire Communities of Recovery Service’ that is
facilitated by Phoenix Futures.
Within our commissioned services we have highlighted in service level agreements (SLAs)
the importance of regular service user consultation to chart quality of service and possible
service improvements. An example of such work would be the Substance Misuse Service
within South Lanarkshire who continues to conduct annual service user consultations
looking at the help their service provides and the outcomes that service users achieved
whilst engaged. Feedback remains largely positive and helps to re-enforce good practice
and areas for possible improvement.
4 June 2014
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PLAN
The ADP commissioned Self Management and Recovery Training (SMART) recovery to
enhance self efficacy and coping mechanisms for service users. Staff complete SMART
training and facilitate SMART groups with the understanding that service users be
identified to become SMART facilitators and the groups eventually become peer led. The
ADP sees SMART as an addition to other supports available and continues to encourage
assertive linkage between treatment services and other mutual aid organisations.
Lanarkshire ADP, in partnership with the Scottish Recovery Consortium (SRC), has
agreed to take forward a Lanarkshire Recovery College in the spring of 2014 (May). This
will support individuals with lived experience of recovery who have expressed an interest
in ‘giving something back ‘and working with others affected by substance misuse. This
work demonstrates the ADP commitment to support individuals with the lived experience
of substance misuse becoming recovery assets and supporting services and service
users.
Last year at a local event attended by family members and carers, including young and
kinship carers, the clear message from family members was that they wanted to access
help and support for themselves, however, they often simply did not know “where to start”.
Following this, a pan-Lanarkshire working group was convened, comprising representation
from substance misuse services and local carers organisations, in order to put the voiced
needs of those family members, who attended the local event, into practice.
e group have developed a local signposting resource, particularly aimed at those “hidden”
family members who are unlikely to come into contact with services and instead try to deal
with their problems within the family unit. The pack, which is almost print ready, contains
information on the local supports available, information on understanding dependency and
talking to a loved one about their dependency, Dr Jan Ligon’s Six Survival skills for
families and also stories of family recovery in order to convey the message that families
and family members can and do recover.
Although there has been considerable work involving service users, families and carers
The ADP acknowledges there is a need for the updated commissioning strategy to ensure
that service users and carers are very much part of the commissioning process.
4 June 2014
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PLAN
8
A
A person centered recovery focus
has been incorporated into our
approach to strategic
commissioning.
Describe the progress your ADP
has made in implementing a
ROSC, please include what your
priorities are in implementing this
during 2014-15. This may include:
• Recovery Orientated
System of Care service
review and redesign
• Identify and commission
against key recovery
outcomes
• Recovery outcome
reporting across alcohol
and drug services eg.
Outcome STAR. Other
• Individual recovery care
plan and review
• Involved mutual aid and
recovery communities
Please include your outcomes for all
individuals within your alcohol and
drug treatment system for 2013/14 if
available.
4 June 2014
The ADP recovery strategy highlights the importance of a person centred recovery focus
within service delivery. For every commissioned service there are recovery orientated
outcomes within their SLAs. We endorse the process of outcome based commissioning
and expect services to demonstrate a recovery focus and demonstrate that they have
assisted in meeting the needs of service users engaged with their service.
We commenced a working group looking at the consistency of outcome measures across
all service provision. This group was chaired by the Clinical Director for Addiction
Services in Lanarkshire. Last year it was agreed from the group that a pilot be
commenced with a select number of practitioners using the Drug and Alcohol Outcome
Star. The pilot is currently taking place across Lanarkshire with evaluation on the tool to
take place towards Sept 2014. Early indications from staff using the outcome tool is
encouraging and there is a plan for wider implementation of the Outcome Star across
Alcohol and Drug treatment services in 2014/15 if the pilot is deemed a success.
The ADP commission a tier 2 service, Meridian, that offers intervention and support to
individuals and families affected by problematic levels of alcohol/drug use. As part of the
reporting arrangements Meridian use the Clinical Outcomes in Routine Evaluation (CORE)
tool. This tool gives a qualitative indication of the positive impact the Meridian service is
having on recovery and is accompanied by regular case studies and service user
testimonies.
http://www2.nhslanarkshire.org.uk/boards/2014-boardpapers/Documents/September/Item-12-Meridian-Average-CORE-Scores-2013-2014.pdf
We have clinical governance requirements specific to NHS alcohol and drug services and
the clinical governance group conduct regular reviews and audits of service to ensure
person centred care planning and intervention is taking place. NHS Team Leaders for
alcohol and drug services were also asked to complete the Scottish Recovery Indicator 2
(SRI 2) toolkit last year. The feedback from SRI2 allowed services to demonstrate the
areas where they were meeting recovery and areas for development.
The blueprint workforce development work has allowed service providers and practitioners
the opportunities to reflect on where they sit within a ROSC and how services and
13
PLAN
practitioners can be developed to ensure seamless linkage and shared values between
statutory, third sector and mutual aid..
As aforementioned there has been a great deal of work to bring adult addiction services
into compliance with GIRFEC. This work will include staff training and the development of
guidance documentation to help staff promote the wellbeing of young people/children
affected by substance misuse. A Training for Trainers course for Addiction staff on
Getting it Right for Every Child (GIRFEC) was developed in order to continue to build
capacity and sustainability within the workforce. Developments such as this are essential
in working towards and enabling whole family recovery.
9
G
The ADP Support Team continues to support the Recovery Worker’s forums in
Lanarkshire and there has been the introduction of a number of conversation cafes.
Members of the recovery worker’s forums received cafe host training to help with further
facilitation.
For the ADP Strategy and Delivery Plan an Equality Impact Assessment was complete.
Equality Impact Assessments are completed as part of the governance arrangements for
commissioned services and all ADP commissioned services are expected to comply with
the relevant framework
All relevant statutory
requirements regarding Equality
Impact assessments have been
addressed during the compilation
of our ADP Strategy and Delivery
Plan
DELIVER
10
Joint Workforce plans, as
outlined in ’Supporting The
Development of Scotland’s
Alcohol and Drug Workforce’
statement are in place across all
levels of service delivery which
are based on the needs of your
population. (see note 7)
4 June 2014
G
As aforementioned Lanarkshire ADP in partnership with STRADA and NLIAS completed a
needs assessment for workforce development. This was implemented in 13/14 and has
been vital to the continued development of a ROSC. Alcohol and Drugs Workforce
Development is a vital element within our ADP Strategy and delivery plan.
We have two active workforce development groups (North and South Lanarkshire) and both
are populated by key individuals from the statutory and third sector as well as from children
and young people’s services, community justice, adult services and service user
representation.
14
PLAN
The development of the workforce is also supported by formal processes in place with
statutory organisations such as personal development plans, performance appraisal and
supervision. Third sector services, within their SLAs, provide similar governance and
supporting arrangement.
There have been numerous areas of work taking place across Lanarkshire. Adult Support
and Protection training has been rolled out across Lanarkshire in light of the increasing
number of referrals that involve vulnerable individuals with alcohol and/or drug issues.
Alcohol Related Brain Disease (ARBD) training has been facilitated in North Lanarkshire
and about to be facilitated in South Lanarkshire. This training has focused (and will
continue to do so) not just on drug and alcohol treatment providers but also other areas of
service delivery such as community care staff. To support this further a ARBD website is
being developed by North Lanarkshire Council and NHS Lanarkshire and will go live June
2014. The website will be available to all agencies/colleagues across Scotland to support
staff development in the area of ARBD and will also be available to the public.
As noted earlier we continue to work closely with STRADA in the area of ABIs and young
people. As well as focusing on how much young people drink this training was designed to
look at the need to understand why they drink and hence had a strong emphasis on
engagement process, different in content to ABI training delivered for adults.
2013/14 saw the delivery of a total of eleven ABI training events and two “Young People
and ABI Training for Trainers events. 121 Participants took place from 2013/14 with a total
60.2% attendance. Participants ranged from housing and homeless services, local
authority (not including social work), National Health Service (NHS), police services, social
work as well as Voluntary organisations. The majority of participants on the ABI for young
people course were from the voluntary and local authority sectors whilst the majority of
participants on training for trainer’s course were from NHS and Voluntary sectors.
Over 95% of respondents to an on line evaluation stated that the learning outcomes met
their expectations and were relevant to their role and over 90% of respondents stated that
the content was pitched at an appropriate level and that a satisfactory range of training
4 June 2014
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PLAN
methods had been employed and on average 84.7% of respondents rated that the
coverage of intended learning outcomes were fully covered, as well as 82.2% stating that
they had improved skills and 80% saying improved knowledge. 100% stated that they had
increased knowledge following this event in relation to their practice with a 90% increase in
their confidence.
It would appear from the evaluation responses received that this course met the
expectations of the majority of participants who attended.
The ADP commission 2 specialist midwives to work with pregnant mothers with alcohol
and/or drug issues. This work has helped to support mothers and families and to
strengthen relationships between health and social care treatment agencies. The service
plays an active part in stretch aim 1 of the Early Years Collaborative (EYC). The midwives
also took the lead in developing a substance misuse resource for colleagues and partners.
In response to increasing concerns over New Psychoactive Substances (NPS) the ADP
commissioned NPS training for alcohol and drug and mental health treatment staff (both
statutory and third sector). This training will continue to be offered in 2014 with a view to
further discussion around sustainability.
11
A
transparent
performance
management framework is in
place for all ADP Partner
organisations
who
receive
funding
through
the
ADP,
including statutory provision
4 June 2014
G
We continue to work closely with nationally commissioned services such as STRADA,
National Education Scotland (NES) and SRC. Last year both STRADA and SRC provided
specialist training and recovery workshops to the workforce.
Lanarkshire ADP funding regulations require clear outcome performance reporting.
We have a very transparent performance management framework in place for
commissioned services. This takes shape in the form
• Quarterly reviews to monitor the Service level agreement
• Annual reports provided by the service demonstrating activities undertaken and
achievements
• Annual performance visits to every service by members of the ADP Implementation
and Finance (I+F) group
• Annual ADP Performance event where all funded services present on their
performance. The event allows for further discussion around performance, service
improvement and partnership working.
16
PLAN
•
Regular updates to ADP Implementation and Finance group and ADP Board
members.
For all drug and alcohol treatment services we have a performance framework (local
improvement targets LITs) that services must report on quarterly.
The LITs encompass performance in relation to waiting times, DNA, assertive linkage with
community based groups, assertive linkage with employability/education, SMR completion,
hepatitis vaccination, BBV testing, overdose awareness training and naloxone provision.
On top of the above arrangements we reserve the right to access records regarding the
services, including any staffing, financial and complaints records and reserve the right to
consult with staff, volunteers and service users as to the effectiveness of the service.
REVIEW
12
ADP Delivery Plan is reviewed on
a regular basis.
G
The ADP Delivery plan is reviewed on a regular basis and an annual report is submitted to
ADP Board and I+F group. Reports include the recording of progress being made, any
variance against plans and any requirement for remedial actions.
http://www2.nhslanarkshire.org.uk/boards/2014-board-papers/Documents/September/Item12-Lanarkshire-ADP-Delivery-Plan-2012-2015.pdf
13
Progress towards outcomes
focussed contract monitoring
arrangements being in place for
all commissioned services,
which incorporates
recommendation 6 from the
Delivering Recovery Report (see
note 8)
A
As stipulated all commissioned services have SLA’s with a clear expectation of what is
expected in terms of outcome measures and the performance management framework in
place to monitor this.
As part of NHS internal audit processes the NHS Internal Audit department regularly audit
contracts to ensure that the contracts are being monitored against expected output and
outcomes. Recently two commissioned services were randomly selected for internal audit
of which the internal audit department remarked they were impressed with the frameworks
and monitoring arrangements in place.
The LITs are intentionally recovery orientated to ensure that services are offering harm
4 June 2014
17
REVIEW
reduction advice, psychosocial interventions and assertive linkage to pro social group
and/or employability where appropriate.
The ADP’s stretch aim from the ORT review challenges drug and alcohol treatment
providers to offer recovery focused care reviews to all service users in receipt of ORT. The
review should be person centred and holistic in nature. To meet this aim the ADP has
been assessing current arrangements around care reviews which have primarily focused
on service users deemed high risk. The expectation is that in 2014/15 the number of care
reviews will be gradually increased to meet demand.
14
A schedule for service
monitoring and review is in
place, which includes statutory
provision
15
G
There is a clear schedule for ADP outcome contract monitoring through steering groups
and community planning groups (North Partnership board) (South Planning and
Performance).
A
As noted earlier the Substance Misuse Service within South Lanarkshire conduct annual
service user questionnaires which highlight the importance of service users being treated
with dignity and the integral part service users and families play in a person’s recovery. It
is important to highlight that within all service SLA’s it is emphasised that service users and
families should play a central role in evaluating the care and support they receive.
We continued to help facilitate a number of recovery events allowing service users and
family members/carers the opportunity to discuss the impact of services and what they
would like to see change and/or improve.
Service Users and their families
play a central role in evaluating
the impact of our statutory and
third sector services.
4 June 2014
NLIAS remain involved in the ‘Circle of Care’ pilot. The circle of care approach places the
service user at the heart of care and asks the service user to identify the interventions,
supports and services that they would like to be involved. This approach helps to focus on
the individuals’ personal recovery and allows him/her to take control over their life. The
pilot continues to be evaluated and illustrates Lanarkshire’s commitment to person centred
care and service users and families being integral to service delivery and improvement.
18
REVIEW
Within NLIAS there is the Strengthening Families programme working with families and
young people (aged between 10-14 years) affected by substance misuse. A key part of
this programme is engagement with families and feedback from families and young people
is therefore very helpful.
A number of ADP funded young people’s services are now using the young people’s
wellbeing indicator which is a self-completion tool that helps to measure a young person’s
level of functioning and satisfaction with the service or intervention that they are in receipt
of. The tool covers the 8 indicators pertaining to GIRFEC and encourages the young
person to consider their strengths and threats against the indicators. Data from
Lanarkshire Youth Counselling Service has yielded some encouraging results through the
use of the tool and appears to indicate that a significant number of young people engaged
with their service report increased strengths in a number of areas
http://www2.nhslanarkshire.org.uk/boards/2014-board-papers/Documents/September/Item12-Youth-Counselling-Service-analysis-of-Wellbeing-Indicator-data.pdf
Our tier 2 commissioned service, Meridian, underwent external evaluation involving
significant engagement with service users and families. 117 individuals engaged in the
evaluation with the majority providing positive feedback.
4 June 2014
19
REVIEW
16
A
A) Lanarkshire ADP has very clear quality assurance systems in place as noted and
described above. However what is clear is that there is a place in the near future for an
over-arching Quality Assurance Strategy that captures the systems in place and aligns to
the Alcohol and Drug Quality Improvement Framework, the Quality Alcohol Treatment and
Support (QATS) recommendations and the Healthcare Quality Strategy.
In 2013/14 key Lanarkshire ADP stakeholders met with the Minister for Health and
Wellbeing to discuss the good work taking place in Lanarkshire
http://www2.nhslanarkshire.org.uk/boards/2014-board-papers/Documents/September/Item12-Lanarkshire-ADP-Report-to-Cabinet-Secretary-for-Health-and-Wellbeing-Mr-Alex-NeilMSP.pdf
Lanarkshire ADP is happy to take the lead on the quality agenda and for the forthcoming
year has agreed to pilot the Quality Principles contained within the National Quality
Improvement Framework for Alcohol and Drug Services.
A. There is a robust quality
assurance system in place which
governs the ADP and evidences
the quality, effectiveness and
efficiency of services.
See note 9
B. Describe the progress your
ADP has made in taking forward
the recommendations from the
Independent Expert Review of
Opioid Replacement Therapies in
Scotland. Please also include
your Key Aim Statement and a
specific update on your progress
in implementing.
4 June 2014
B) The ADP is committed to the Key Aim Statement, ‘100% of service users in receipt of an
opioid replacement therapy will be offered regular, formalised, recovery-focused reviews,
involving all the individuals/services/groups that are participating in their recovery plan, by
the end of March 2015’. Encouragingly the aim statement fits with the newly developed
quality principles.
The ADP has progressed a number of areas from the ORT review. As aforementioned we
are currently reviewing the existing review process with service users with a view to wider
rollout in the forthcoming months. We are also in the process of recruitment for a medical
officer that will assist with the process.
The NHS Primary Care Link continues to lead a specific piece of work designed to enhance
relationships and linkage between General Practitioners and Lanarkshire Substance
Misuse Services. This covers a number of areas such as the physical health needs of
individuals who are prescribed ORT; poly-pharmacy in relation to pain relief, antidepressant and anxiolytic medications prescribed by GPs and the potential interaction with
ORT; raising awareness of the risks around drug related death; and promoting the
20
REVIEW
provision of naloxone medication in general practice.
Lanarkshire ADP has planned a full day event in early summer 2014 facilitated by
colleagues from the National Drug and Alcohol Advisory Group, with delegates drawn from
a wide range of service providers from Health, Local Authority, and Third Sector. This will
provide an opportunity for exploration and discussion around partnership working and how
local services aim to meet the needs of individuals, families and communities affected by
substance misuse. The session will also present an opportunity to use the Drug and
Alcohol Improvement game.
4 June 2014
21
3. Financial Framework
Your Report should identify both the earmarked drug and the earmarked alcohol funding from Scottish Government which the ADP
has received (via your local NHS Board) and spent in order to deliver your local plan. It would be helpful to identify any other
expenditure on drugs and/or alcohol prevention, treatment or support which each ADP partner has contributed from their core
budgets to deliver the Plan. You should also highlight any underspend and proposals on future use of any such monies.
Total Income from all sources
Income
Earmarked funding from Scottish Government
Alcohol
3,682,231
Drugs
2,253,762
Total
5,935,993
Funding from Local Authority
Funding from NHS (excluding funding earmarked from Scottish Government)
1,697,112
3,232,169
Funding from other sources
744,124
Total
11,609,403
Total Expenditure from sources
Alcohol
Prevention (include community focussed, early years, educational
inputs/media, young people, licensing objectives, ABIs)
Treatment & Support Services (include interventions focussed around
treatment for alcohol and drug dependence)
Recovery
Dealing with consequences of problem alcohol and drug use in ADP
locality
Total
4 June 2014
Drugs
Total
1,691,985
8,532,129
931,700
453,589
11,609,403
22
End Year Balance for Scottish Government earmarked allocations
Drug
Income £
2,253,762
Expenditure £
2,253,762
0
Alcohol
3,682,231
3,682,231
0
Total
5,935,993
5,935,993
End Year Balance £
0
Total Underspend from all sources
Underspend £
114,400
50,000
19,462.32
39,780
4,500
3,795
49,012.80
96,301.40
Proposals for future use
Police Scotland
External evaluation of NLIAS
Scottish Fire and Rescue
Harm Reduction
Overprovision Feasibility Study
Recovery – Steps to Excellence
Education/training
Diversionary work
Support in kind
Provider
NHS Lanarkshire
4 June 2014
Description
Provide office space and accommodation for ADP Support Team
23
4.
Core and Local Indicators 2013/14
Please include progress made re-establishing baselines, local improvement goals/targets and progress using the
ScotPHO website for all national outcomes. You may submit your annual update on your performance framework from
your delivery plan, however please include local indicators, linkage between activities, indicators and outcomes, how you
will measure if a ROSC has been successfully implemented in your area and please state how many people are in receipt
of opiate replacement therapies in your area.
Health: People are healthier and experience fewer risks as a result of alcohol and drug use
ADP Core Indicator
2008/09
2009/10
2010/11
2011/12
2012/13
52
46
46
63
66
General acute inpatient & day
case discharges (EASR) with a
diagnosis of drug misuse in any
position; by year. EASR per
100,000
Lanarkshire
ADP
Source: ScotPHO profiles
Scotland
110
108
116
118
107
General acute inpatient & day
case discharges (EASR) with a
diagnosis of alcohol misuse in
any position; by year. EASR per
100,000
Lanarkshire
ADP
740
636
624
722
673
Source: ScotPHO profiles
Scotland
4 June 2014
RAG
ADP
Ranking
A
11 of 30
The rate of alcohol-related discharges
has fallen since 2011/12 but remains
higher than the rate seen in previous
years. The rate remains lower than the
national average.
G
828
772
759
749
24
693
Progress/comments
The rate of drug-related discharges has
increased slightly in Lanarkshire whilst
the national average has fallen. Despite
this increase Lanarkshire continues to
sit well below the national average rate
and is currently ranked 11th in Scotland
for this measure.
15 of 30
Substance Misuse Liaison nurses are
placed in each acute hospital in
Lanarkshire. They provide prompt
treatment, advice and appropriate
onward referral to those with alcohol
and drug problems attending via A&E
and other routes.
ADP Core Indicator
Alcohol related deaths
(underlying cause) - per 100,000
population; single years.
Source: ScotPHO profiles
Lanarkshire
ADP
Scotland
ADP Core Indicator
Prevalence of hepatitis C among
people who inject drugs (based
on all injecting drug users
tested)
Source: ScotPHO profiles
4 June 2014
Lanarkshire
ADP
Scotland
2008/09
2009/10
2010/11
2011/12
2012/13
32
30
31
30
28
29
26
2008/09
2010
2011/12
55.1%
49.7%
45.6%
54.6%
56.4%
26
25
53.0%
25
21
RAG
Rank
G
9 of 25
RAG
Rank
A
23 of 28
Progress/comments
Over the last 5 years the rate of alcoholrelated deaths has fallen steadily in
Lanarkshire from 32 to 28 per 100,000.
Whilst this is significant the rate of fall
has not been as great in Lanarkshire as
is seen in the national average. This
may be indicative of the significant
areas of socioeconomic deprivation
present in Lanarkshire.
Progress/comments
The prevalence of Hep C in injecting drug users has fallen
by nearly 10% in Lanarkshire over the last 3 years. The
prevalence of Hep C in Lanarkshire continues to be
considerably lower than the national average with
Lanarkshire currently being ranked 9th in Scotland for this
measure.
Within the local performance framework for alcohol and
drug services we have included a target around BBV
testing and the increase in BBV testing, along with
improved investment in the provision of injecting
paraphernalia, may have a positive impact on the
reduction in transmission.
ADP Core
Indicator (new)
2008
2009
2010
2011
2012
8
8
10
9
10
Lanarkshire
Number of
drug-related
deaths - per
100,000
population;
single years
Source:
ScotPHO
profiles
Scotland
11
9
11
6
11
7
RAG
9
Progress/comments
Tackling drug related deaths remains a priority
area.
10
Last year service users in receipt of opioid
replacement therapy were provided naloxone
unless the service user requested to ‘opt out’.
A
Rank
14 of
25
N.B. The data presented here is that provided annually by NRS. This will differ
from data presented by ISD and from local sources.
Local Indicator
Proportion of IDUs
reporting using shared
needles/syringes in past
month
Lanarkshire
Source: ISD (SDMD Initial
Assessment Report)
Scotland
4 June 2014
10
Annual average
2001 2007 2006
2012
2006
/07
2007
/08
2008
/09
2009
/10
2010
/11
2011
/12
2012
/13
11
8
10
6
5
7
5
12
10
10
9
7
7
26
Drug related death awareness sessions took place
in the three hospital sites in Lanarkshire designed
to raise knowledge in the topic and generate
discussion around partnership working.
Naloxone provision and overdose awareness
training remains part of the Local Improvement
Targets and performance is reported quarterly.
RAG
Rank
G
3 of 9
Progress/comments
The proportion of IDUs reporting sharing of
needles remains low in Lanarkshire, despite a
slight increase in 2011/12. Currently
Lanarkshire are ranked 3rd in Scotland (of NHS
boards providing data) in relation to this
measure.
Whilst moving towards a recovery oriented
system of care, harm reduction remains an
important area of work in Lanarkshire.
Local Indicator
Total needles and
syringes distributed
Source: NHSL Harm
Reduction Team
2009/10
2010/11
2011/12
2012/13
2013/14
Target
RAG
421,511
366,889
356,408
370,049
393,516
Increase by
10% by 2015
A
2009/10
2010/11
Local Indicator
% of known injecting drug users
vaccinated for hepatitis B
Source: ISD (SDMD Initial
Assessment Report)
% of known injecting drug users
tested for hepatitis C
Source: ISD (SDMD Initial
Assessment Report)
4 June 2014
2011/12
Progress/comments
The amount of injecting equipment distributed in Lanarkshire
has not reached the same level as was seen in 2009/10,
however it is important to note that in 2010/11 there was a
change in how IEP was recorded which might explain the drop
(for example data used to record barrels and needles
separately but now this is counted as a single injection
episode). The recovery agenda may also have had an impact
on injecting episodes. There has been a steady increase over
the last 3 years. IEP continues to play an important part in
reducing the harm of injecting drug use.
2012/13
Target
A
4 of 11
A
4 of 11
Lanarkshire
68
71
79
79
100% by
2015
Scotland
69
71
79
81
100% by
2015
27
RAG
Rank
Progress/comments
The introduction of BBV testing and
vaccination to the Lanarkshire Alcohol
& Drug Service Performance
Framework has resulted in a significant
improvement in these measures, most
notably between 2010/11 and
2011/12. This level has been
maintained into 2012/13 but has
improved only a little.
Prevalence: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves
or others
ADP Core Indicator
Estimated prevalence of
problem drug use amongst
15-64 year olds in Scotland,
by age group.
Lanarkshire
ADP
Source: ISD (National
Prevalence Study)
Scotland
2000
2003
2006
2009/10
1.60%
1.27%
1.36%
1.50%
2.00%
1.84%
1.62%
RAG
Rank
A
19 of 30
1.71%
Estimated prevalence of
injecting drug use amongst
15-64 year olds in Scotland.
Data not currently available
ADP Core Indicator
Percentage of 15 year old pupils who
usually take illicit drugs at least once a
month (areas with larger prevalence).
Lanarkshire
ADP
Source : ISD (SALSUS)
Scotland
2006
2010
18%
14%
RAG
Rank
25 of 30
14%
11%
A
Percentage of 15 year old pupils who
have taken an illicit drug in the last year
(areas with lower prevalence).
Lanarkshire
ADP
Source : ISD (SALSUS)
Scotland
4 June 2014
Progress/comments
The drug prevalence rate was found to increase to 1.5%
in Lanarkshire in the last prevalence study. Whilst rates
remain lower than the Scottish average Lanarkshire is
only ranked 19th out of 30 ADP’s in relation to this
measure. A planned study to examine further how to
access hidden populations may help to lower this in the
future. The results of the most recent prevalence study
are awaited to further assess if any progress has been
made in recent years.
28%
21%
25 of 30
23%
19%
28
Progress/comments
Both these indicators have shown significant improvements in
Lanarkshire between 2006 and 2010. Unfortunately the
proportion of 15 year olds self-reporting illicit drug use
remains higher in Lanarkshire than the Scottish average.
Youth Counselling Services (YCS) are available in every high
school in Lanarkshire; amongst other things the YCS will help
to tackle the causes of drug use at a very early stage.
The results of the upcoming SALSUS survey are awaited to
assess how this indicator may have changed since 2010. It is
hoped the SALSUS survey will provide some insight into
current trends in the use of new psychoactive substances
amongst the school-age population in Lanarkshire.
ADP Core Indicator
Men
Women
Total
51.9%
41.5%
46.4%
The proportion of individuals drinking above daily
and/or weekly recommended limits
Lanarkshire
Source: SHS (aggregated 2008-2011)
Scotland
48.7%
38.6%
43.4%
The proportion of individuals drinking above twice
daily (“binge” drinking) recommended limits
Lanarkshire
32.6%
18.8%
25.3%
Source: SHS (aggregated 2008-2011)
Scotland
26.0%
16.7%
21.1%
The proportion of individuals who are alcohol
dependent (two or more problem drinking
indicators as per CAGE)
Lanarkshire
14.2%
10.0%
12.1%
A
Currently the proportion of individuals reporting exceeding
recommended alcohol limits, binge drinking and/or are
indicated to be in the problem drinking category is higher
in Lanarkshire than it is in Scotland.
However recent local analysis did show that mean weekly
consumption had fallen by 3 units in the Lanarkshire
population compared with an average fall of 1.7 units in
Scotland (Scottish Health Survey, 2003 compared with
2008/09). In the same analysis the proportion of the
Lanarkshire population in harmful and hazardous drinking
categories was found to have fallen.
A
ADP Core Indicator
Proportion of 15 year olds drinking
on a weekly basis
Lanarkshire ADP
Source : ISD (SALSUS)
Scotland
13.9%
9.5%
2006
2010
32%
20%
11.7%
RAG
Rank
15 of 29
30%
20%
A
Mean weekly consumption in last
week
Lanarkshire ADP
-
21.6
Source : ISD (SALSUS)
Scotland
-
19.6
4 June 2014
Progress/comments
A
Scotland
Source: SHS (aggregated 2008-2011)
RAG
29
Progress/comments
The proportion of 15 year olds in Lanarkshire who report
drinking on a weekly basis has fallen significantly and at
the last survey was in line with the national average.
Despite this the mean weekly consumption for this group
remained higher than the national average by 2 units.
Youth Counselling Services (YCS) are available in every high
school in Lanarkshire; amongst other things the YCS will
help to tackle the causes of harmful alcohol consumption
at a very early stage. The results of the upcoming SALSUS
survey are awaited to assess how this indicator may have
changed.
Recovery: Individuals are improving their health, well-being and life-chances by recovering from problematic drug and
alcohol use
ADP Core Indicator
Percentage reduction in daily drugs spend during treatment
Reduction in the percentage of clients injecting in the last month during treatment
Proportion of clients who abstain from illicit drugs between initial assessment and 12 week follow-up
No data is currently available for these
indicators
Proportion of clients receiving drugs treatment experiencing improvements in employment/education profile during treatment
Local Indicator
Number of peer support
volunteers in services
Source: Local annual
reports
Target
2012/13
2013/14
RAG
10 peer volunteers
engaged with services
across Lanarkshire by
March 2015
35
30
G
Progress/comments
Lanarkshire ADP commissions Communities of Recovery, a service aimed
at training individuals or family members with experience of recovery, as
peer mentors. Peer mentors then support other individuals in their
recovery journey as they transition from specialist treatment services to
mainstream community services.
In 2013/14 30 individuals were recruited and trained as peer mentors.
Other activity aimed at implementing and supporting a recovery oriented system of care includes:
•
Commissioned Peer Support Service operating pan Lanarkshire
•
Local Recovery events both pan Lanarkshire and locally in North and South. Focussing on integration into community; families and carers of people
in recovery as well as promulgation of conversation cafes approach with view to these being delivered more locally. This has happened in both
North and South and is both therapeutic and community recovery champion led.
•
Monthly Therapeutic Recovery Workers’ Forums (recovery champions) held in both North and South Lanarkshire
•
Training of Cafe hosts delivered to various interested partners to allow conversation cafes to spread throughout Lanarkshire. 7 hosts trained in
total.
•
SMART recovery (peer led mutual aid) initiated in May 2013 throughout Lanarkshire comprising of several partnerships from statutory and third
sector participating
4 June 2014
30
•
Local improvement targets around linking clients to recovery groups, employability and training have been implemented. Local data show that in
2013/14 213 clients have been linked into recovery groups and 168 to employability and/or training through Lanarkshire’s substance misuse
services.
•
Regular partnership working with Scottish Recovery consortium with “Recovery Matters “ events delivered in North Lanarkshire and date identified
for South Lanarkshire.
•
Scottish Recovery Consortium (SRC) to facilitate Recovery College in Lanarkshire in May 2014
•
Treatment Process Model (TPM) delivered to all integrated addiction services staff as well as Shotts and Addiewell addiction staff and
commissioned services in relation to recovery trained.
4 June 2014
31
Families: Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved
life-chances
ADP Core Indicator
Rate of maternities
recording drug use, per
1000 maternities (three
year rolling average)
Source: ScotPHO profiles
Lanarkshire
ADP
Scotland
2005/06
2007/08
2006/07
2008/09
2007/08
2009/10
2008/09
2010/11
2009/10
2011/12
5.1
5.1
5.4
7.1
7.7
9.5
ADP Core Indicator
Number (Rate per 10,000 population)
of Child Protection Case Conferences
where parental drug and/or alcohol
misuse has been identified
Source: ScotPHO profiles
4 June 2014
Lanarkshire
ADP
Scotland
9.9
11.9
15.8
Aug 2011 July 2012
Aug 2012 –
July 2013
70 (5.2)
55 (4.1)
918 (8.8)
993 (9.6)
32
RAG
Rank
G
5 of 27
18.8
RAG
Rank
G
2 of 27
Progress/comments
Two Specialist Midwives in Substance Misuse are
funded through Lanarkshire ADP. Over the past
year there have been a number of key activities
that will likely have led to an increase in
identified drug use during pregnancy: the
development and promotion of the Substance
Misuse in Pregnancy: Antenatal Patient Pathway
which provides guidance for any professional
who confirms a pregnancy for a women
experiencing substance misuse problems as well
as training days for “link” community midwives
who will deliver care and support to families as
per the Pathway of Care.
Progress/comments
As is well known there are close links between parental
substance misuse and child protection. In Lanarkshire we
have developed Getting it Right: Promoting Wellbeing for
Children and Young People Living with Substance Misuse to
enable staff working within adult focussed substance misuse
services in order to support substance misuse service staff
with their role in promoting, developing and safeguarding
children’s well-being. Moreover, a decision has been taken to
convene a Lanarkshire CPC/ADP Working Group to take
forward joint effective planning and workforce development
in order to support practitioners and front line managers to
deliver services through a “whole family” recovery approach.
ADP Core Indicator
Proportion of positive ABI screenings in ante-natal
setting
Source: Local database
2011/12
2012/13
2013/14
RAG
7.7%
(0.6% during
pregnancy)
6.7%
(0.2% during
pregnancy)
6.4%
(0.7% during
pregnancy)
G
Progress/comments
A screening tool is not used in ante-natal services. ABI's
are delivered on the basis of pre-pregnant drinking levels
(>14 units per week), during pregnancy drinking levels
(>0 units per week) and/or disclosure of regular binge
drinking. An ABI would be delivered based on a 'positive'
response to any of these criteria. Specialist Substance
Misuse Midwives continue to promote ABI training within
workforce of Midwives.
Wellbeing Scores
Assessment Discharge
Local Indicator
Demonstrate
improvement in
Wellbeing Indicator
scores for young people
Source: Local database
4 June 2014
Strengths
26.1
RAG
28.8
G
Threats
16.6
14.5
Progress/comments
Lanarkshire ADP commissioned the development of the Wellbeing Indicator (WBI), a tool
for measuring outcomes in young people engaged in services. Data shows improvements
in both strength and threats scores (strengths should go up, threats down) of those young
people engaged with services in Lanarkshire. The most robust data is that for Lanarkshire
Youth Counselling Service (LYCS). Positive results were noted for young people’s strengths
scores. These increased from 26.1 to 28.8, with increases most notable in relation to the
wellbeing domains of Safe, Achieving, Respected and Responsible. Similarly an overall
decrease from 16.6 to 14.5 was seen in threats scores. What are more encouraging are the
particularly notable reductions in threats for the Safe and Nurtured domains.
Work is ongoing to roll out the WBI across ADP commissioned services who have contact
with young people with the aim of demonstrating improvement in the lives of
Lanarkshire’s young population.
33
Local
Indicator
Trend
RAG
Number
of
domestic
abuse
incidents
G
Source:
Local
police
analyst
4 June 2014
34
Progress/comments
Lanarkshire ADP continues to fund the ‘Ending
Violence Against Women’ (EVA) Service. This is
a specialist department within NHS Lanarkshire,
working on issues of gender-based violence. EVA
work with women over 16-years of age, who
have experienced abuse at any time in their lives.
Women referred to EVA typically have
experienced at least 3 episodes of abuse in their
lifetime, at the hands of different perpetrators.
Depending on risk and resilience factors, some
women require only short information-based
support, whilst some require long-term practical
and therapeutic intervention.
In 2013/14 there was a slight reduction in
domestic abuse incidents. Tackling domestic
abuse remains a priority area for community
partners and the reduction may be due to
community safety arrangements between
partner organisations looking at preventative
and early intervention approaches, as well as
specialist treatment and support.
Community safety: Communities and individuals live their lives safe from alcohol and drug related offending and antisocial behaviour
ADP Core Indicator
Percentage of new
clients at specialist
drug treatment
services who report
funding their drug use
through crime
Lanarkshire
ADP
2009/10
2010/11
2011/12
2012/13
14.2%
14.4%
16.4%
21.1%
A
Scotland
17.7%
22.4%
21.2%
Source: ISD
ADP Core Indicator
One year reconviction rate
(number of reconvictions per
offender), for offenders given a
Drug Treatment and Testing
Order
North and South
Lanarkshire
Not
available
2008/09
2009/10
2010/11
2011/12
1.77
1.42
1.08
2.13
1.10
RAG
A
Scotland
ADP Core Indicator
Number of Community Payback
Orders issued where alcohol and
drug treatment is required, and
the proportion that are
successfully completed.
Progress/comments
This information is obtained during assessment and engagement between
the client and service provider. Given the current financial climate and
correlation between illicit drug use and crime there is no surprise that
there is an increase in this being reported. However with clients being
seen promptly in Lanarkshire following referral to treatment services and
receiving the right support to aid their recovery, coupled with preventative
work that Lanarkshire ADP has invested in with young people, this should
reduce over a period of time.
2007/08
1.94
1.77
2011/12
2012/13
121
58
1.68
Source: Scottish Government
4 June 2014
RAG
Lanarkshire ADP
Scotland
772
1.60
1.45
Progress/comments
There is a well established Drug Treatment
and Testing Order service in Lanarkshire.
This multi-disciplinary and intensive
approach has helped to improve the
outcomes for offenders engaged with the
service.
RAG
Progress/comments
A
Within Lanarkshire ADP there are links between community justice services and
alcohol and drug services aimed at establishing the suitability for an offender to be
placed on a CPO with a drug and alcohol treatment requirement. There is a
pathway in place between community justice and alcohol and drug services that an
individual, where necessary, will be promptly assessed for suitability of a
community payback order with alcohol or drug requirement
575
35
Serious Assault
2009 2010 2011 2012
/10
/11
/12
/13
ADP Core Indicator
Lanarkshire
ADP
Number of cases
with anti-social
behaviour per
10,000 population,
including Serious
Assault, Common
Assault, Vandalism
and Breach of the
Peace
Scotland
Source: ScotPHO
profiles
4 June 2014
12
10
10
9
8
8
6
6
Vandalism
Common Assault
2009 2010 2011 2012
/10
/11
/12
/13
124
129
105
92
123
117
2010
/11
2011
/12
2012
/13
Lanarkshire
ADP
183
159
138
Scotland
151
136
127
2009
/10
2010
/11
Rank
Serious
Assault:
22 of 30
102
2011
/12
2012
/13
108
53
48
100
63
47
36
RAG
81
Breach of the Peace
2009
/10
Progress/Comments
A
Common
Assault:
12 of 30
Vandalism:
22 of 30
Breach of
the Peace:
17 of 30
Lanarkshire ADP continues to invest in
community safety initiatives. ADP investment to
the Safer Lanarkshire Campaign helped police
colleagues address community safety issues in a
pro-active manner. Through this investment we
expect to see these figures continue to fall.
Local crime summary looking at 5 year average
trends list a number of key findings, namely that
listed crimes, serious assaults, vandalism, and
possession of offensive weapon have all reduced.
The summary also reports that drug possession
crimes and public consumption of alcohol cases
have increased which is possibly indicative of a
co-ordinated and proactive response by
community partners against substance use.
North Lanarkshire is currently participating in a
pilot of the Best Bar None scheme. The scheme
awards drinking establishments which show a
real commitment to reducing incidents of crime
and curbing irresponsible promotions which can
lead to binge drinking and antisocial behaviour.
Partners in the Scottish Government, NHS, the
alcohol industry, Police Scotland and the Best Bar
None Board are now working together in tracking
and evaluating the benefits of accredited pubs
and bars which meet the high standards of safe,
secure and customer focused premises.
ADP Core Indicator
Proportion of victims of a
crime who reported that the
offender was under the
influence of alcohol / drugs
Source: Scottish Crime and
Justice Survey
Criminal Justice
Area
2009/10
Alcohol
2010/11
2012/13
2009/10
Drugs
2010/11
2012/13
Lanarkshire CJA
17%
32%
14%
13%
20%
13%
A
Scotland
Local Indicator
23%
22%
22%
12%
13%
2009/10
2010/11
2011/12
2012/13
2013/14
Reduce the number of antisocial behaviour offences
reported
North Lanarkshire
51995
46234
37531
32691
19522
South Lanarkshire
45341
39740
32142
29329
17817
Source: Local police analyst
Lanarkshire
97336
85974
69673
62020
37339
4 June 2014
RAG
37
13%
RAG
G
Progress/comments
As noted above Lanarkshire ADP continue to
invest in community safety campaigns to
ensure individuals/families do not feel
threatened by criminal behaviour related to
alcohol and/or drug use. We invested
£114,400 in the Safer Lanarkshire Campaign
and continue to work closely with
Community Safety Partners.
Progress/comments
The number of anti-social behaviour offences being
reported in Lanarkshire has decreased by
approximately 61% over the last 5 years. This
reflects the investment in the Safer Lanarkshire
campaigns and other work described above.
Local environment: People live in positive, health-promoting local environments where alcohol and drugs are less readily
available
ADP Core Indicator
Percentage of young people who have been
offered drugs in the last year
Lanarkshire ADP
Source : ISD (SALSUS)
Scotland
ADP Core Indicator
Percentage of people
perceiving drug misuse or
dealing to be very or
fairly common in their
neighbourhood
Source: ScotPHO profiles
Lanarkshire
ADP
Scotland
Percentage of people
Lanarkshire
perceiving rowdy
ADP
behaviour (e.g.
drunkenness, hooliganism
or loutish behaviour) to
be very or fairly common
in their neighbourhood
Scotland
2006
2010
64%
44%
53%
2007/08
2009/10
2012
14.2%
11.1%
16.1%
12.5%
11.6%
12.9%
20%
16%
18%
17%
15%
Rank
G
21 of 30
42%
RAG
Rank
A
23 of 30
A
26 of 30
Progress/comments
Significant improvement is seen in this indicator with
a reduction of 20% between 2006 and 2010. The
figure in 2010 is much more comparable with the
national picture than previously seen. The 2014
survey is awaited to assess if this reduction is
sustained.
Progress/comments
Although a slight increase this may be a result of the proactive work taking place within community safety campaigns
urging residents to report concerns related to alcohol/drug
use.
Youths causing annoyance was seen as the most common
problem amongst communities during public consultation
over community safety. To that end Lanarkshire ADP in
2013/14 invested in diversionary activities for young people.
Many of these activities were hosted in areas earmarked as
problematic for young people, drinking and anti social
behaviour. It should be noted this type of behaviour appears
to have lessened significantly as a result of the diversionary
activities.
Through the pilot scheme of Best Bar None, an evaluation has
been conducted by Scottish Business Crime Centre in relation
to alcohol abuse as a negative aspect of neighbourhood. We
await results of this.
14%
Source: ScotPHO profiles
4 June 2014
RAG
38
ADP Core Indicator
Number of premise licences in force
per 10,000 population 18+ - On
Trade
Source: ScotPHO profiles
Number of premise licences in force
per 10,000 population 18+ - Off
Trade
Lanarkshire ADP
2012/13
2013/14
17
8
Scotland
27
27
Lanarkshire ADP
10
6
Scotland
11
11
Number of premise licences in force
per 10,000 population 18+ - Total
Lanarkshire ADP
27
14
Source: ScotPHO profiles
Scotland
Source: ScotPHO profiles
ADP Core Indicator
Number of new applications for
premise and personal licences, and
proportion refused on the grounds
of overprovision
Source: Scottish Government (Liquor
Licensing Statistics)
4 June 2014
Local Authority
39
RAG
Rank
Progress/comments
G
1 of 30
G
1 of 30
G
1 of 30
All functioning local licensing forums in Lanarkshire attended
quarterly with encouragement to link up with NHS Public
Health Director. We also conducted a feasibility study
looking at the issue of overprovision. This study involved
data analysis and engagement with licensing members,
public health, ADP and communities. The study will form
part of an action plan that the ADP will take forward. The
plan will enable Licensing Board members to have access to
robust data evidencing the link between overprovision and
harm.
38
Premise licenses
New applications
on sale
off sale
Personal licences
only
Refused
Granted
Refused
North Lanarkshire
4
13
0
226
1
South Lanarkshire
8
9
0
243
1
219
172
12
5608
20
Scotland
39
RAG
G
Progress/comments
Services: Alcohol and drugs prevention, treatment and support services are high quality, continually improving, efficient,
evidence-based and responsive, ensuring people move through treatment into sustained recovery
ADP Core Indicator
The number of screenings
(using a validated screening
tool) for alcohol use
disorders delivered and the
percentage screening
positive with the
breakdown of i) % eligible
for ABI and ii) % eligible for
referral to treatment
services
2011/12
2012/13
2013/14
RAG
Total screened
15894
Total screened
19918
Total screened
17803
% positive
20.8%
% positive
17.8%
% positive
17.3%
% eligible for
ABI
13.0%
% eligible for
ABI
11.0%
% eligible for
ABI
10.5%
% eligible for
referral
7.8%
% eligible for
referral
6.8%
% eligible for
referral
6.8%
G
Progress/comments
Screening for alcohol problems continues
to be a priority area in Lanarkshire and as
such is now well embedded into standard
clinical practice in priority settings and
continues to be developed in wider
settings.
Source: Local database
ADP Core Indicator
The number of alcohol
brief interventions
delivered in
accordance with the
HEAT Standard
guidance expressed as
a percentage of target
Source: ScotPHO
profiles
Lanarkshire
Scotland
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
19%
190%
146%
146%
157%
151%
61%
112%
177%
159%
155%
RAG
Rank
G
7 of 14
171%
Progress/comments
NHS Lanarkshire has again exceeded the
trajectory of this HEAT standard. Screening
for alcohol problems continues to be a
priority area in Lanarkshire and as such is
now well embedded into standard clinical
practice.
Delivery in wider settings continues with
the use of the CRAFFT tool now well
established in a number of young people’s
services and screening being delivered in
many mental health services.
ADP Core Indicator
Number of treatments drug service clients receive at 3 month and 12 month follow-up (and annually after that)
4 June 2014
40
Data not currently available
ADP Core Indicator
Percentage of drug clients waiting
more than three weeks between
referral to a specialist drug and
alcohol service and commencement
of treatment
Source: ScotPHO profiles
Percentage of alcohol clients waiting
more than three weeks between
referral to a specialist drug and
alcohol service and commencement
of treatment
2011/12
%
2012/13
%
2013/14
%
1.3
0.1
0.8
Lanarkshire
ADP
Scotland
Lanarkshire
ADP
17.0
2.1
8.3
RAG
Rank
G
6 of 30
4.9
0.3
Lanarkshire continues to perform very favourably in relation to
access to drug and alcohol treatment. During 2013/14 virtually
all clients began treatment within 3 weeks of referral.
0.4
G
Scotland
13.0
Progress/comments
7.9
5 of 30
3.2
Source: ScotPHO profiles
Local Indicator
2011/12 2012/13
SDMD initial completeness
(proportion of patients entered to
DATWT for drug misuse who also
have an initial SDMD record)
Lanarkshire ADP
Source: ScotPHO profiles
Scotland
SDMD follow up completeness
(proportion of patients with an
initial SDMD record who also have
a follow-up 8-16 weeks later)
Lanarkshire ADP
Source: ScotPHO profiles
Scotland
4 June 2014
64.5%
74.3%
22.5%
RAG
Rank
A
14 of 24
62.9%
62.9%
In relation to SMR25b returns, Lanarkshire performs very favourably,
ranked 3rd nationally. The inclusion of compliance with SMR25a and
b submission within Lanarkshire’s local performance framework has
helped to maintain the profile of the importance of this.
29.4%
G
12.1%
Progress/comments
Despite a slight fall in the proportion of completed SMR25a’s last
year, Lanarkshire performs quite well relative to the national figure.
Local analysis would suggest that our statutory and voluntary
services are completing SMR25a returns for the majority of clients
(93%). However a small number of services who submit waiting
times data do not also submit SMR25 returns; this is having an
impact on this figure.
14.6%
41
3 of 22
Lanarkshire ADP would now like to see this data being used more
readily, such as in the reporting of the ADP core recovery indicators
(above) which we again are unable to report on due to a lack of
access to data.
Local Indicator
Reduce DNA rates
by 10% by 2015
Source: DATWT
system (local
analysis)
Local Indicator
Numbers of
individuals in
receipt of Opioid
Replacement
Therapy (ORT)
4 June 2014
2011/12
2012/13
2013/14
35%
36%
36%
N.B. this is the average rate across all
Lanarkshire services submitting data to the
DATWT.
2011/12
2012/13
2013/14
Approximately 2850 service users received
opioid replacement therapy in 2013-14
RAG
A
RAG
A
Progress/comments
DNA rates across drug and alcohol services have traditionally been high in Lanarkshire.
There is considerable variation in the proportion of DNAs across different parts of the
system. In order to improve efficiency in treatment access, Lanarkshire ADP aim to
reduce the average DNA rate in all statutory and third sector services by 10% by 2015.
With that aim in mind the monitoring of DNA rates at assessment has been built in to the
Local Improvement Targets and is monitored quarterly. Whilst individual services may
have made some improvements the average rate across all services has not changed.
This continues to be a challenging area.
Progress/comments
It is difficult to give an exact number for the amount of individuals in receipt of ORT due
to issues around the Electronic Systems currently used in Lanarkshire. The Community
Prescribing Service in Lanarkshire consists of practitioners from medical, nursing and
pharmacy background and Lanarkshire ADP is currently in discussions with IT colleagues
to agree the best way of recording and reporting on prescribing numbers. This area will
be progressed in 2014/15 and the introduction of recovery reviews for all service users in
receipt of ORT will help to aid the process.
42
LOCAL IMPROVEMENT TARGETS 2013/14
National Our public services are high quality, continually improving, efficient & responsive to local people’s needs
Outcome
Local
Outcome All young people, adult and family services will be equitable and readily accessible
2013/14 Performance Status
Comment
100% of drug/alcohol clients start treatment within 3 weeks
LIT 1
99.5%
G
Services continue to perform at an excellent level
of referral (HEAT A11)
Work is ongoing to reduce DNA rates further. In 2013/14
Services should ensure that the DNA rate for drug/alcohol
improvement methodology was adopted around this topic in
36%
G
LIT 2
clients does not exceed 40%
areas such as engagement with GPs, electronic referral,
assertive linkage and locality planning groups.
National
Outcome Our public services are high quality, continually improving, efficient & responsive to local people’s needs
Local
Services offer service users tailored packages of treatment & care ranging from basic information to more structured therapeutic interventions which focus on
Outcome outcomes that lead to recovery
2013/14 Performance Status
Comment
Reduce the cost of Opiate Substitute Treatment (OST) by 10%
LIT 3
N/A
N/A
Data still being collected in relation to this target.
per capita
Services continue to offer appropriate psychosocial
intervention to service users. Where, applicable, staff
practitioners receive psycho-social intervention training
50% of service users will have completed a psychosocial
70%
G
LIT 4
around anxiety management, anger management, trauma,
intervention by case closure.
relapse prevention and community reinforcement. This is
delivered by the Lanarkshire Addiction Psychology Service.
4 June 2014
43
National We live longer, healthier lives
Outcome
Individuals in Lanarkshire will experience reduced levels of harm associated with their alcohol/drug use enabling them to live longer, healthier lives, realise
Local
Outcome their potential & make a positive contribution to society & the economy
2013/14 Performance
Status
32%
A
LIT 5
By case closure 50% of clients should have been linked into
recovery groups (including mutual aid) and community
activities.
LIT 6
By case closure 50% of clients should have been linked into
employability services/education/training.
26%
A
LIT 7
Where appropriate, 100% of drug users have an SMR 25A
form completed at assessment
93%
A
LIT 8
100% of ISD requested SMR 25B forms completed by quarter
57%
A
LIT 9
Deliver overdose awareness training to 10% of the estimated
problem drug using population per locality each year.
8.3%
A
LIT 10
Provide 10% of the estimated problem drug using population
per locality with Take Home Naloxone each year.
7.6%
A
LIT 11
Vaccinate 10% of the estimated drug injecting population per
locality against Hepatitis B.
5%
A
LIT 12
Test 10% of the estimated drug injecting population per
locality against Hepatitis C.
28%
G
4 June 2014
44
Comment
There have been some issues around data collection for this
target. Discussion is ongoing in regards to data input
improvement
Again there have been issues around data collection which are
being addresses. Welfare reform also appears to have had a
negative impact on the target
This remains a priority and services are aware of the
importance of completing SMR 25A where appropriate
There is ongoing issue around SMR 25B notifications. These
are being picked up through dialogue with ISD. Lanarkshire
ADP has actively participated in the consultation around the
Drug and Alcohol Information System (DAISy)
This remains a priority and services continue to offer overdose
awareness training in line with naloxone provision
Lanarkshire reached the 2011-2014 National Naloxone target
of 15% and remain on course to reach the new 2014-15
naloxone target of 25%.
Services report that a significant number of service users that
are open have already received Hep B vaccinations hence this
target is difficult to achieve. This will be reviewed over the
next year including an audit trail of service users to ensure
they have been offered and received Hep B vaccinations.
Services have surpassed the local target and deserve praise.
The introduction of Dry Blood Spot Testing has eased the
process and made testing more accessible.
5.
ADP & Ministerial Priorities
ADP Priorities 2013/14
Please list the progress you have made in taking forward your ADP’s five key commitments for 2013/14.
Quality Assurance Strategy
Lanarkshire ADP continues to comply with the Quality Alcohol Treatment and Support (QATS) recommendations and NHS
Healthcare Strategy.
NHS Lanarkshire is currently consulting on a new Quality Assurance and Service Improvement Strategy for 2014-17, Transforming
Patient Safety and Quality of Care in NHS Lanarkshire, and many ADP stakeholders are involved in the consultation process.
Lanarkshire ADP has agreed to take the lead in testing the Quality Principles as part of the newly developed National Quality
Improvement Framework for Alcohol and Drug Services.
Lanarkshire ADP continues to have robust quality assurances in place for example quarterly and annual reports, steering groups,
outcome focused service level agreements, and local improvement targets,
The combination of the work above will place Lanarkshire in a stronger position to prepare a Quality Assurance Strategy that takes
cognisance of new developments nationally and locally.
Commissioning Strategy
An initial draft of the commissioning strategy was prepared. This work has been delayed pending the integration of health and
social care and further clarification around the role of the ADP within the new Health and Social Care structures.
We continue to follow a commissioning cycle of annual local needs assessment, planning, commissioning, monitoring and
reviewing.
The I+F group provides direction on the investment of services based on the information derived from the commissioning cycle
taking place annually.
Outcome Measures
4 June 2014
45
The ADP is currently piloting the Drug and Alcohol Outcome Star with a view to wider implementation if the pilot is successful. The
ADP is looking at ways to ensure the outcome star tool is complimentary to the review process for service users and the Local
Improvement Targets.
Similar work is also taking place with colleagues in community justice. This will, ideally, lead to an outcome tool that is used by
different partner agencies and is able to give us more understanding of the service user’s recovery journey when engaged with
different services.
Blueprint Workforce Development Plan
The recommendations from the paper continue to be taken forward. Emphasis is on understanding the roles and responsibilities of
all service providers and practitioners and ensuring services are aligned with a recovery orientated system of care.
The ADP proposes to take the learning from this work into the South Lanarkshire area. It should be noted that Substance Misuse
Services in North Lanarkshire are integrated and in South Lanarkshire Health and Social Care Substance Misuse Services, albeit
working closely together, are separate. It is envisaged that the workforce development plan can support the process of integration
that is likely to take place in South Lanarkshire Substance Misuse Services in 2014/15.
Tackling Drug Related Deaths
This remains a priority area for Lanarkshire ADP. We reached our Naloxone provision target set as part of the National Naloxone
Programme and remain committed to the programme. We have since implemented a system where all service users on ORT will
automatically receive overdose awareness training and provision of naloxone, unless they opt out.
We have local improvement targets in place to maintain focus around overdose awareness training and naloxone provision and we
have worked closely with pharmacy, GPs, housing and community justice colleagues to ensure overdose training and naloxone
provision is available to as many service providers and service users as possible.
We have facilitated 3 drug awareness events in the 3 acute sites in NHS Lanarkshire. These events have been geared towards
raising awareness to hospital and community staff from all disciplines about the growing concern over drug related deaths and what
can be done to tackle the problem.
We continue to look at ways in which we can engage with our hard to reach population who may be at risk and are exploring the
use of peer supporters as a means of engagement.
4 June 2014
46
We have reviewed prescribing policies for service users in receipt of ORT and have clear guidelines in place regards ORT
prescribing, take home and benzodiazepine prescribing. In Lanarkshire the number of drug related deaths with benzodiazepines
implicated in death has reduced and we believe the benzodiazepine guideline has had a particular positive effect with reducing
harm.
The Drug Related Death Executive Group has robust membership involving all key partners.
ADP Priorities in 2014-15
-
Safeguarding and promoting the interests of children, young people and families affected by substance misuse.
Reducing the level of alcohol and drug related harm at a community level
Supporting individuals with alcohol and/or drug problems
A new ADP Strategy and Delivery Plan for 2015-2018. To support this there will be a thorough engagement process with
partner agencies, individuals, families, carers, young people and communities.
As in line with the ministerial priorities a continued effort and focus to reduce drug related death taking into consideration
national and local data and a change in trends of drug use, particularly in relation to prescribed medication and New
Psychoactive Substances.
Ministerial Priorities
ADP funding allocation letters 2014-15 outlined a range of Ministerial priorities and asks ADPs to describe in this ADP Report their
local Improvement goals and measures for delivering these during 2014/15. Please outline these below.
 Compliance with the Alcohol Brief Interventions (ABIs) HEAT Standard;
 Increasing compliance with the Scottish Drugs Misuse Database (SDMD);
 HEAT Drug and Alcohol Treatment Waiting Times Standard, including, increasing the level of fully identifiable records
submitted to the Drug and Alcohol Treatment Waiting Times Database (DATWTD);
 Increasing the reach and coverage of the national naloxone programme and tackling drug related death(DRD)/risks in
your local ADP;
 Implementing improvement methodology at local level, including implementation of the Quality Principles: Standard
Expectations of Care and Support in Drug and Alcohol Services and responding to the recommendations outlined in the
independent expert group on opioid replacement therapies;
4 June 2014
47
 Ensuring a proactive and planned approach to responding to the needs of prisoners affected by problem drug and
alcohol use and their associated through care arrangements; and
 Improving identification of, and preventative activities focused on, new psychoactive substances (NPS).
Compliance with ABI delivery
We have a Heat 4 steering group responsible for the coordination of ABI training and the data collection and analysis of ABI
screening and delivery.
We continue to invest in services such as the Lanarkshire Addiction Midwifery Service and Substance Liaison Nursing Services
who work with the maternity and acute sectors and deliver ABI training as part of their remit.
We have been working with colleagues in youth services looking at the delivery of ABIs and ways in which we can chart the positive
impact of an ABI.
We have consistently met the ABI standard and expect with the training and performance systems in place that we will continue to
meet projected targets.
Compliance with SDMD database
Compliance with the SDMD database is part of the Local Improvement Targets we have in place.
Drug and Alcohol service performance against the targets is reported quarterly to the Board/Group in North and South Lanarkshire
responsible for delivering alcohol and drug treatment and support. This mechanism helps to remind services of the expectation
around compliance with SDMD, encourages constant evaluation of performance, and enables service improvement (where
applicable).
The ADP support Team has 2 Information and Research Officers available to support services with any issues related to SDMD
compliance.
HEAT Waiting Times
We will continue to monitor waiting times closely and with the reporting and governance structures in place we are able to monitor
performance and take swift, appropriate actions if there is any deviation on waiting times performance.
4 June 2014
48
We are confident that with the investment and structures in place we will continue to lead the way in relation to the HEAT Waiting
Times Target.
We will continue to work closely with services to increase the level of fully identifiable records and where appropriate we will utilise
awareness sessions with services to increase their understanding of the benefits to providing identifiable records whilst providing
reassurance around information governance.
National Naloxone Programme
Provision of naloxone and reduction in DRDs will remain a high priority for the ADP. Last year we successfully met our national
target in relation to naloxone provision and we will continue to support the programme and make every effort to increase the reach
of naloxone.
We have within our local performance framework a target for naloxone provision and a further target for overdose awareness
training. The performance framework will help to keep a focus on this important area and chart our progress.
As aforementioned we have adopted an ‘opt out’ scheme in relation to naloxone provision for service users in receipt of ORT and
this appears to have had a positive effect. This is now common practice across Lanarkshire Substance Misuse Services.
We will also look at ways to engage with the hidden population through peer support and working with different agencies such as
community justice colleagues, housing and mental health.
We intend to hold a DRD seminar in September open to service users and providers. The seminar will focus on many areas,
including naloxone provision. Their will speakers from different agencies, such as Police Scotland, Procurator Fiscal, Scottish
Ambulance Service and NHS Lanarkshire, as well as the personal experience of service users and a drama looking at the impact of
DRD on families and communities. We have invited a keynote speaker from Scottish Government to the event.
Implementing Improvement Methodology and Responding to the ORT review
We will continue to use improvement science as a tool to continuously improve and develop service provision. Last year we used
tests of change in different areas ranging from reduction of DNAs to improving linkage between child and adult services.
We will hold a development day in Early Summer 2014, Drug and Alcohol Improvement Game, and this will be attended by different
partners. The focus of the day will be around partnership working and improving service delivery. There will be discussion around
4 June 2014
49
the ORT recommendations, improvement science and the National Quality Improvement Framework. The event will raise further
awareness around the subject matters and enable discussion around further tests of changes that can be coordinated and taken
forward.
In relation to the Lanarkshire ADP Key Aim statement we intend to run small tests of change looking at the structure and content of
the review process, with the aim of evolving reviews to ensure they are relevant, person centred and collaborative.
We have agreed to pilot the Quality Principles within the Quality Improvement Framework and will feed back our evaluation to
Scottish Government in 2014.
Meeting the Needs of Prisoners affected by Substance Misuse
There is currently a great deal of good work taking place in Lanarkshire.
There is a well established ADP/CJA working group which contains representation including the Scottish Prison Service. This
group is responsible for co-ordinating action on offenders with alcohol and/or dug issues and the group reports to the ADP Board,
CJA Board and Community Planning Partners.
The Community Bridges Project has been cited as an area of good practice in relation to through care and working with offenders
with substance misuse issues. There is a scheduled visit by the Minister for Public Health and Minister for Community Safety in
2014 to hear more about the service.
Within the ADP Board there is representation from HMP Shotts and HMP Addiewell and there are well established connections
between prison settings and the ADP. In 2014 we will support HMP Shotts with their Health Improvement and Substance Misuse
Strategies and continue to work closely with HMP Addiewell in relation to through care.
In 2014/15 We have agreed to continue to invest in a number of services for offenders affected by substance misuse, namely
Community Bridges, Youth Bridges, Persistent Offender’s Project and Healthcare within HMP Shotts.
We have also invested in the Forensic Healthcare Service within Police Custody Suites and there will be work ongoing in 2014/15
to support the service and ensure close linkage between healthcare in custody suites and healthcare in the community.
New Psychoactive Substances
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We have a well established Emerging Trends Group in Lanarkshire. The group provides up to date information to ADP services on
the different trends taking place in Lanarkshire. A great deal of this information is harnessed through colleagues in Police
Scotland, presentations at A+E departments and service user disclosure at Substance Misuse Services.
We invested in workforce development around NPS last year and will continue this investment in 2014/15. Initially we have
targeted front line staff for NPS training and further rollout of training to wider services/disciplines will be explored at the North and
South Lanarkshire Workforce Development Groups.
The NPS training provided has received favourable feedback from delegates. Notable feedback has been that practitioners were
reassured that they already have the necessary skill set to support service users who present or disclose that they are using NPS.
We intend to fully promote the UK Legal High Survey as much as possible and will look at circulating information on the survey
through our communication department and community resources.
We intend to facilitate a NPS Conference in November 2014 to raise further awareness around NPS and allow discussion around
partnership working and service delivery.
APPENDIX 1: NOTES
1.
Please complete the RAG column for each theme according to the following definitions:
Red: No action is yet underway
Amber: Action is underway but is not yet completed
Green: Action is completed
2.
This column should be used to describe the range of evidence used to support the RAG Score. We do not require the
source documents to be attached unless specifically requested
3.
Joint Strategic Needs Assessment: Joint strategic needs assessments (JSNAs) analyse the health needs of populations
to inform and guide commissioning of health, well-being and social care services within local authority areas. The main goal of a
JSNA is to accurately assess the health needs of a local population in order to improve the physical and mental health and wellbeing of individuals and communities. (http://www.nhsconfed.org/Publications/briefings/Pages/joint-strategic-needsassessment.aspx)
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4.
Joint Performance Framework: a national assessment process on how effectively local partnerships are achieving these
improvements. (http://www.sehd.scot.nhs.uk/publications/cc2004_02.pdf)
5.
Integrated Resource Framework: this is being developed jointly by the Scottish Government, NHS Scotland and COSLA to
enable partners in NHS Scotland and Local Authorities to be clearer about the cost and quality implications of local decision-making
about health and social care. The IRF helps partnerships to understand more clearly current resource use across health and social
care, enabling better local understanding of costs, activity and variation across service planning and provision for different
population groups. (http://www.shiftingthebalance.scot.nhs.uk/initiatives/sbc-initiatives/integrated-resource-framework/)
6.
Please indicate in your evidence if you have received feedback on this report from your Community Planning
Partnership/ or other accountability route, specifying who that is.
Strategic commissioning is informed by The
Commissioning Cycle (the outer circle) which drives purchasing and contracting activities (the inner circle), and these in turn inform
the on-going development of Strategic Commissioning. Strategic commissioning is defined as ‘term used for all activities involved
in assessing and forecasting needs, links investment to desired outcomes, considering options, planning the nature, range and
quality of services and working in partnership to put this in place. Strategic commissioning process is defined by four stages,
analyse, plan, deliver and review as presented visually in the diagram below.
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7.
The Alcohol and Drug Workforce Statement is addressed to anyone who has a role in improving outcomes for an individual,
families or communities experiencing problematic drug and alcohol use.
8.
A full range of essential care Services include identifiable community rehabilitation services – including using people with
lived experience; access to detoxification and residential rehabilitation; access to a full range of psychological and psychiatric
services; services addressing employability and accommodation issues.
http://www.scotland.gov.uk/Resource/Doc/217018/0058174.pdf)
9.
Quality Assurance Framework: A guidance document which sets out the systematic monitoring and evaluation of the
various aspects of a project, service, or facility to ensure that standards of quality are being met. Examples of how to improve the
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quality of your services may be found at
http://www.qihub.scot.nhs.uk/media/458288/efficient%20and%20effective%20cmht%20prototype%20version%201.pdf
The Independent Expert Review of Opioid Replacement Therapies in Scotland ‘Delivering Recovery’ can be found at
http://www.scotland.gov.uk/Publications/2013/08/9760/downloads
The Quality Principles will be published in the coming weeks. This template will be updated with a link to them upon publication.
We are looking to improve this self-assessment for ADPs on a regular basis. Please describe briefly whether you found
the questions asked to be useful in considering your current position.
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