Midlothian and East Lothian Drugs and Alcohol Partnership
Annual Report 2014-15
Document Details:
ADP Reporting Requirements 2014-15
1.
Partnership Details
2.
Self-Assessment
3.
Finance Framework
4.
Performance Framework
5.
ADP & Ministerial Priorities
Appendix 1

Guidance Notes and Commissioning Diagram
1
1.
PARTNERSHIP DETAILS
Alcohol and Drug Partnership
ADP Chair
Contact name(s) see note 1
Contact Telephone
Date of Completion
Date Published on ADP website(s)
Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP)
Eibhlin McHugh (Director, Midlothian Health and Social Care Partnership)
Martin Bonnar
01316535160
28th August 2015
15th September 2015
The content of this Annual Report has been agreed as accurate by the Alcohol and Drug Partnership, and has been shared
with our Community Planning Partnership/Integration Joint Board through our local accountability route.
MELDAP Chair
The Scottish Government copy should be sent for the attention of Amanda Adams to:
Alcoholanddrugdelivery@scotland.gsi.gov.uk
2
ADP SELF-ASSESSMENT 1 APRIL 2014 – 31 MARCH 2015
2.
ANALYSE – Please evidence your ADPs analysis activities/progress
Theme
1
ADP Joint Strategic Needs
Assessment has been
undertaken and provides a
clear, coherent
assessment/analysis of
need, which takes into
consideration the changing
demographic
characteristics of people
(and their families and local
communities) affected by
problem drug and/ or
alcohol use in your area.
Please state when this was
undertaken and when it is
next planned.
Please also include here
any local research that you
have commissioned e.g.
hidden populations,
alcohol related deaths.
See Note 3
Evidence see note 2
MELDAP have commissioned three independent Needs Assessments. These are:
1] Needs Assessment Drugs and Alcohol Problems in Midlothian and East Lothian (Figure 8
2010)
2] Small Area Estimates for Health Related Behaviours (Ipsos MORI 2011)
3] Assessment of Need of Services for Children and Families Affected by Parental Substance
Misuse [CAPSM] (Create Consultancy 2013-14)
In relation to the CAPSM Needs Assessment, there has been agreement with universal services
[including Council service] to implement the recommendations in the report. This includes
assessing opportunities for joint commissioning.
MELDAP engaged Macmillan Rome Consultants to undertake a “horizon” literature and
research review, consultation and development of options appraisal for the Strategic Group to
consider. The active participation of service users and involvement of service managers was
central to this process. This led to a report “Building a Recovery Oriented System of Care to
Support Recovery Communities in Midlothian and East Lothian” accepted by the MELDAP
Strategic Group in September 2014 [provided in last year’s report]
There are elements of assessment of need within the report.
Specifically, MacMillan Rome held focus groups in East Lothian and Midlothian. The researcher
used discussions and development of “Recovery Maps” to assist members of the focus groups
to articulate what they assessed as important elements for recovery in Midlothian and East
Lothian.
3
This information confirmed that people in recovery needed much more than specialist support
and treatment. Activities for daily living feature high on a list of priorities for this group.
Therefore MELDAP needed to ensure that there were far stronger connections to community
based activities in local towns and villages.
It was also clear that carers and family members affected by others substance misuse also
needed support to assist recovery. This group have been encouraged to fully participate in the
development of two Recovery Cafe’s [Horizons in Midlothian and Starfish in East Lothian]. A
total of 122 women completed the Pink Ladies self-management courses [funded by MELDAP]
These women have all experienced mental health/substance misuse difficulties and/or are
carers of substance misusers. MELDAP have more than doubled the level of funding provided
by (VOCAL) to family members and carers.
The report recommended the development of a “Recovery Network” in Midlothian and East
Lothian supported and financed [in its start up phase] by MELDAP. The Network’s primary
function as a “co-ordinating body will be established to nurture, support and develop an ethos
of recovery amongst individuals in recovery, their families and the wider community. The
Network is not be a service provider; it would be “a proactive and reactive recovery
champion, linking with current recovery assets such as recovery cafes, peer mentors and
mutual aid groups and explore broader community assets and new resources that can be
utilised to promote recovery.”
The MELDAP Strategic Group agreed to this proposal and work started in May 2015 to
establish the Recovery Network. The initial phase of work includes connecting with people
who run and/or use the two Recovery Cafes. This has led to a number of individuals becoming
involved in the development of a Recovery Network Group.
MELDAP plan to undertake a re-assessment of need, similar to the one completed in
2010, from March 2017 to inform our next ADP Delivery Plan 2018/20.
2
An outcomes based ADP
Joint Performance
Framework is in place that
The MELDAP Delivery Plan 2012-15 was structured around four thematic areas:
1] Preventing future harm caused by the misuse of alcohol and drugs
2] Reducing harm and promoting recovery
4
reflects the ADP Local
Outcomes and the National
Core Outcomes.
See note 4
3] Protecting and safeguarding children, young people and communities
4]Commissioning and assuring high quality, cost effective recovery focused services
There were linked outcomes identified for each of these four areas. These outcomes were
aligned with the 2 Local Authority Single Outcome Agreements and the 7 National Outcomes
for ADPs.
Services submit an annual performance report which provides data and a narrative for these
outcomes. These reports provide one source of evidence of the effectiveness and quality of
service delivery.
However, as part of data gathering procedures for the MELDAP Delivery Plan 2015-18, it
became clear that some services did not provide clear outcome data information. The main
reason was that IT systems were not able to provide the type of report required by MELDAP
for the Delivery plan. MELDAP will work with services this year to ensure that data is collected
and scrutinised on a regular basis working towards the full implementation of the DAISy
system in October 2016.
The issue of outcome data and measurement was raised with the MELDAP Commissioning and
Performance Group in June 2015. The group agreed that the Support Team make this a focus
of the agenda in the next round of Quality Assurance meetings.
In the MELDAP Delivery Plan 2015-18, three thematic areas were used to structure the plan:
1] Reducing harm and promoting recovery
2] Protecting and safeguarding children, young people and communities
3]Commissioning and assuring high quality, cost effective recovery focused services
3
Integrated Resource
Framework Process
Suitable data has been
used to scope the
programme budget and a
A significant proportion of current service provision developed organically over a number of
years, often linked to emerging funding streams.
MELDAP took the decision in late 2012 to undertake a process of systemic re-design/reorganisation to ensure services matched need and reflected current patterns of substance
use.
5
baseline position has been
established regarding
activity, costs and
variation.
This led to a significant stakeholder’s events in November 2012 with the title “Over the
Horizon”. During the process of consultation and planning for change, a number of
opportunities occurred to strengthen the portfolio of recovery opportunities in Midlothian
and East Lothian.
Note 5
Since 2012 MELDAP has reduced expenditure on Tier 3 and Tier 4 services from 85% of budget
to 79%. Over the last year additional funding has been directed towards the growth of post
treatment recovery orientated services such as the Recovery Cafés, Recovery College, Peer
Support Workers and Alive and Kicking which uses football as a way to engage with men with
substance misuse/mental health difficulties. These services were developed as an integral part
of MELDAP’s strategic commitment to develop a ROISC.
In the process of developing these responses, MELDAP worked in co-production with
client/carer groups to develop some of these recovery orientated resources. In particular,
both Recovery Cafe’s were developed with the assistance of specialist staff for NHS substance
misuse services, council and third sector partners but controlled and implemented by the two
steering groups made up of people in recovery or carers of people in recovery.
A Recovery Network Group was established in early 2015 which comprised primarily of people
with lived experience from substance misuse and mental health. The group will pilot some of
the approaches of the planned Recovery Network, for example, managing small grants to
support people in recovery.
4
Integrated Resource
Framework - Outcomes
Note 5
The financial resource outlaid in the development of these cafe groups and other ROISC
responses [as set out above] has provided opportunities to maximise people and community
resources and as a consequence provide value for money in terms of the number of clients
engaging with these post treatment services.. To date the funding provided to ROISC noted
above is approx circa £150,000.
The Macmillan Rome Consultants report included an options appraisal for the Strategic Group
to consider. The active participation of service users and involvement of service managers was
central to this process.
The draft findings were reported to the MELDAP Strategic group in June 2014.
The final report concluded that MELDAP consider three possible options. Option 2.2; Phased
6
A coherent approach has
been applied to selecting
and prioritising investment
and disinvestment options
– building prevention into
the design and delivery of
services.
Change – ‘No wholesale changes to the nature of services but change the environment in
which the services operate and/ or develop the roles and accountabilities of service providers,’
was approved by the Strategic Group.
In the Annual Report 2013-14, MELDAP indicated that work would begin on a “blue print” to
deliver option 2.2. Running in parallel with the redesign was the agreement nationally to bring
substance misuse services within the scope of Health and Social Care legislation. This required
MELDAP to consider how these wider changes might impact on its own redesign processes.
The new legislation is most relevant to Social Work and NHS services commissioned by
MELDAP. A Lothian wide group was set up to look at the future of NHSL services currently
managed as a central function by the Substance Misuse Directorate (SMD). The main issues
that the SMD Collaborative Group considered, included which services currently managed
and/or provided at a Lothian wide level should continue and which services should move to
local management.
Following discussions at a number of meetings, the SMD group agreed that Lothian and
Edinburgh Abstinence Programme [LEAP], the Ritson Clinic and the Harm Reduction Team
[HRT] should remain as services provided and managed at a Lothian level as it was thought
that the economies of scale provided the most efficient and effective model of delivery of
care.
It was also agreed that the Substance Misuse Service teams currently providing care in each
locality but managed at a Lothian wide level should be moved within the management of each
Health and Social Care Partnership within an IJB structure.
In March 2015, there was agreement to set up a “Project Delivery Core Group” within the two
Health and Social Care Partnerships [including involvement with the 3rd sector] under the
direction of MELDAP. These core groups worked to deliver the phased changes as noted in
option 2.2 above. These two groups considered a recovery hub type model including
“spoke” locality provision in areas of Midlothian and East Lothian.
MELDAP are currently working with lead influencers within Primary Care and both Clinical
7
directors for Health and Social Care, to pilot innovative ways of primary care involvement in
the “spoke” locality provision.
PLAN - Please evidence your ADPs Planning activities/progress
5
Theme
Evidence see note 2
We have a shared vision
and joint strategic
objectives for people
affected by problem
substance use & those
affected, which are aligned
with our local partnerships,
e.g child protection
committees, violence
against women, community
safety, prevention
including education etc.
In June 2014 – the MELDAP Team co-located with the Public Protection Team [PPT] with the
intention to strengthen opportunities for closer working among the services for Alcohol and
Drugs, Child Protection, Adult Protection and Violence Against Women. Senior managers who
attend both the MELDAP Strategic Group and the Public Protection Committee regularly
feedback any relevant information from MELDAP. This arrangement has improved information
sharing as well as encouraged stronger working relationships. Partners from MELDAP and the
PPT are working on a “joined up” offer to each Local Authority in relation to an education
programme covering Drugs and Alcohol, Violence Against Women [VAW], Child Protection and
Adult Protection.
MELDAP is a core partner in the CAPSM training programme offered to a range of partners.
The uniqueness of this programme is that the experience of people (parents) in recovery is a
central element of the training. This allowed staff to see the personal impact of substance
misuse on the parent and better understand the complex nature of addiction. The service user
contribution was always evaluated as the session most beneficial to attending professionals.
MELDAP Team members are involved in both council’s GIRFEC Groups and the joint Public
Protection Quality Assurance Group.
MELDAP is a member the “Signs of Safety” Steering Group in East Lothian which uses an asset
based, active family participation approach to Child Protection.
MELDAP is a member of both Local Authority areas Licensing Fora. The ADP works closely with
other partners in the Licensing Fora to influence the strategic direction and decision making of
the respective Licensing Boards.
8
7
Service Users and carers
are embedded within the
partnership commissioning
processes
8
A person centered
recovery focus has been
incorporated into our
approach to strategic
commissioning.
Please advise if your ROSC
is ‘in place’; ‘in
development’ or in place
and enhancing further.
Describe the progress your
ADP has made in
implementing a Recovery
Oriented System of Care
(ROSC), please include
what your priorities are in
implementing this during
2015-16. This may include:
 ROSC service
review and redesign
 Identify and
commission against
key recovery
outcomes
 Recovery outcome
reporting across
alcohol and drug
MELDAP have made good progress in this area but as yet is not fully embedded in its
commissioning processes. Two Peer Support Workers with lived experience are part of
Commissioning and Performance Group. A Recovery Network Group comprising of people
with lived experience has been allocated a sum of £5000 to fund applications from people for
low cost activities to support recovery.
MELDAP used the views from Service Users and Carers in the paper “ The Experiences
and Views of the Users of Drug and Alcohol Services in East Lothian and Midlothian” to inform
many of the post treatment recovery options in the last two years These were noted in
(Section 3). Engaging with families and services users has been primarily at the commissioning
end of the process. Most of the recently commissioned services were as a result of MELDAP’s
programme of service user feedback linked to the Delivery Plan.
Please also see (Section 7) above.
MELDAP’s Recovery Oriented Integrated System of Care [ROISC] is in place. See (Sections 1, 3,
4 and 6) for descriptions of the work that has been implemented towards ROISC in the last few
years. The majority of recent expenditure has been targeted towards post treatment, recovery
focused services as evidenced in (Section 3). The last steps are being implemented with the
maximisation of a ROSC that is integrated [ROISC] within service delivery in East Lothian and
Midlothian. This ROISC work will include the development of a Recovery Hub and spoke model
to deliver services to meet the needs of people with co-occurring disorders living in the semiurban and rural areas of Midlothian and East Lothian.
There is no single recovery tool used by all services. Outcomes Star is used by a main third
sector partner and TOPS, CORE and RAD by NHS Substance Misuse Services. This arrangement
will be changed to have more services adopt Outcomes Star.
From service user consultations and discussion with services through QI visits MELDAP is
aware that the arrangements for recovery planning and review are too variable. This aspect of
practice will be addressed through the introduction of the Quality Principles; Principles 5 and
6.
The two Recovery Cafes provide a focal point for a number of individuals and family members
including linked SMART Recovery Groups. Peer Support Workers actively support clients to
9


9
services (Please
outline what
current/planned
recovery tool you
are using)
Individual recovery
care plan and review
Involved mutual aid
and recovery
communities
Please include your recovery
outcomes for all individuals
within your alcohol and drug
treatment system for 2014/15
if available.
All relevant statutory
requirements regarding
Equality Impact
Assessments have been
addressed during the
compilation of your ADP
Strategy and Delivery Plan.
Please advise when this was
undertaken and is next
planned.
engage with mutual aid groups. A MELDAP Get Connected booklet with details of local mutual
aid and other recovery groups has been developed. The first round of training of peer
volunteers has been completed and the involvement of peer volunteers will continue to be an
approach for supporting people recovering from addiction by those with lived experience.
MELDAP undertook an EqIA with all its services in 2012-13 with targeted support, if required,
for service managers. MELDAP has used the equalities profile [see Appendix 1] which was
commissioned through Engender to inform development of the MELDAP Delivery Plan 201518.
In relation to support for women, MELDAP and partners are expanding the Pink Ladies service
into East Lothian. For men, MELDAP has commissioned Alive and Kicking which is a
programme using football/exercise as a vehicle to encourage healthy living and recovery. The
men normally come from the most deprived areas in Midlothian and East Lothian.
Support to carers [particularly older carers] in Midlothian and East Lothian has been
significantly expanded through increased funding.
10
DELIVER - Please evidence your ADPs Delivery activities/progress
10
Theme
Evidence see note 2
Delivery of 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.
MELDAP continued to facilitate training in Midlothian and East Lothian in relation to Children
Affected By Parental Substance Misuse Guidelines.
see note 7
MELDAP and its services have undertaken an exercise to identify outcomes for the workforce
development plan. The process is supported by STRADA. Due to effects of the closure of
Drugscope and its impact on STRADA, this process has slowed in recent months. Scottish
Drugs Forum [SDF] that are now responsible for assisting MELDAP with this work are meeting
with the ADP support team to plan the next steps. This will involve a small group of MELDAP
partner agency representatives to produce outcome indicators for the development plan.
The MELDAP Support Team is also involved in bespoke training for elected representatives,
Health Care and Social Work staff and other training sessions appropriately.
MELDAP is a member of the Learning & Practice Development Sub-committee in Midlothian
and East Lothian. MELDAP work in partnership with the East & Midlothian Public Protection
Committee. The group is responsible for ascertaining local training needs, ensuring that
appropriate training is provided and taking a strategic overview of multi-agency training to
promote effective and efficient practice to support and protect children and adults who may
be at risk of harm.
Plans have been finalised to deliver training on the use of Outcomes Star and Motivational
Interviewing for staff in the Autumn of 2015.
11
11
Please provide a bullet
point summary of your
ADP’s Alcohol and Drug
Provision, to demonstrate
the range of prevention,
treatment/recovery &
support interventions
(including early
interventions)
commissioned by the ADP
which have been delivered
in the reporting period.
We recognise there will be
overlaps – please use local
definitions.
Tier 1
Tier 2
Tier 3
Health
Friday Friends
Cafe
MYPAS
Prevalence
GP Practices
C&F Social
Workers
GP Practices (NES)
NEON Bus
Tier 4
Substance
Misuse Social
Workers
SMS (Mid), SMS
(East)
Harm Reduction
Team, ASUS
Nurse
MELD
Recovery
Horizons and
Starfish Recovery
Cafés, Peer
Support Workers,
Recovery Coordinator
Families
Recovery Network
Olive Bank
Children and
Family Centre
Community
Safety
Local
Environment
Services
Alive and Kicking,
Pink Ladies
Recovery College
LEAP,
ELCA
Prison Alcohol
Service
Simpson House
Ritson Clinic
ARBD Unit
st
Children 1 ,
ELYCP, DASS,
VOCAL
Lifeline
CLEAR
MELDAP and service approaches to Quality Improvement, *DRD
Coordinator
12
Please provide a brief
summary of the
interventions your ADP has
delivered to support
communities:
MELDAP have been closely involved with the development of both East Lothian and
Midlothian Licensing Board’s over-provision statements. This included providing statistics,
research and assessment in relation to the potential health and community impacts of the
over- provision of alcohol in the Local Authority areas. The MELDAP Team is represented on
both Licensing Fora.
a) Prevention of developing
problem alcohol/drug use
As part of our response to preventing the development of problem alcohol/ drug use, MELDAP
commissions the services of two children’s Social Workers who offer support to school aged
12
b) Community Safety/
violence against
women/Reducing
Reoffending
c) Children/ CAPSM
d) Supporting People in
moving on from treatment
and care services for
ongoing recovery (e.g Self
Directed Support, mutual
aid/recovery communities)
children and young people living in East Lothian whose lives have been affected by their own
substance misuse or that of their parents or carers. The workers offer support at school, home
and in the community on a 1:1 basis and through group work.
MYPAS provides drug and alcohol services for young people (12 to 21 year olds) who want
information, advice or support through 1:1 counselling, group work, art therapy and sexual
health drop-ins for young people in Midlothian. The alcohol and drug team also provide
preventative group programmes in schools and diversionary activities.
MELDAP have been able to ensure that Drugs and Alcohol has been identified as a high
priority in the work of the Community Safety Partnerships, specifically looking at the work
being done around recovery, support for families and the emerging trends in use of NPS.
A CAB worker is co-located in the Horizons Recovery Cafe providing advice/information to
clients on a range of issues most notably welfare and benefits issues.
MELDAP commissions a number of services to minimise the negative impact on children of
their parents or carers substance misuse.
East Lothian Young Carers offers respite by running club nights which run 3 nights out of 4,
individual support and support to families with a wide range of issues such as benefits advice,
food banks etc
The Children 1st Midlothian Young Carers Service provides support and advice tailored to
meet the individual needs of young people across Midlothian who finds themselves caring for
a dependent relative at home. Their staff provide individual support; group activities and
respite aimed at helping the young people enjoy their lives.
The Children 1st Family Support: Direct Assistance and Support Service (DASS) provides an
intensive 12 week, seven days a week, needs led family support in Midlothian for families who
are experiencing stress and difficulties, where parents have substance misuse issues.
Please also see the statement above in Section 10 regarding CAPSM Training.
Please see sections 1, 3, 4 and 6 for descriptions of the work that has been implemented
towards ROISC in the last few years.
13
13
A. A transparent
performance management
framework is in place for all
ADP Partner organisations
who receive funding
through the ADP, including
statutory provision
B. Describe how all ADP
Partners contribute to
delivering outcomes
identified in the Joint
Strategic Needs
Assessment (box 1) which
includes prevention,
recovery, treatment,
support and throughcare
services through ROSC
provision, where in place.
A variety of service performance and quality issues are monitored during quarterly Quality
Improvement visits. There is an agreed agenda, which covers service issues, ways in which
MELDAP can support the service, issues around Service User/Carer Involvement as well as
progress towards and reporting on agreed outcomes.
MELDAP commenced its second programme of service presentations to the Commissioning
and Performance Group for 2014-15. The focus of these presentations has continued to be the
delivery of outcomes for individuals and families and the impact each service makes on the
lives of the clients they work with.
While nearly all services have an SLA with agreed outcomes and associated reporting
arrangements it became clear as part of gathering data for the MELDAP Delivery Plan 2015-18,
that some services were not able to provide robust outcome data information. The main
reason was that IT systems did not provide the type of data required by MELDAP for the
Delivery Plan. MELDAP will work with these services this year to ensure that data is collected
and scrutinised on a regular basis working towards the full implementation of the Daisy
system in October 2016.
The issue of outcome data quality and measurement was raised with the MELDAP
Commissioning and Performance Group. The group agreed that the Support Team make this a
focus for the next round of Quality Improvement meetings.
The MELDAP Children young people and family Group continued to progress the actions from
the CAPSM Needs Assessment. There has been broad agreement with universal services
[including Council service] to implement the recommendations in the report. This includes
assessing opportunities for joint commissioning.
All partners of MELDAP are involved in the latter phase of delivery of the “Over the Horizon”
redesign process. (See relevant sections above)
14
REVIEW - Please evidence your ADPs Delivery activities/progress in reviewing Strategies/Outcomes
Theme
14
ADP Delivery Plan is
reviewed on a regular
basis, which includes a
review of the provision of
prevention activity,
recovery, treatment and
support services (ROSC).
Evidence see note 2
A number of the priorities lie within the remit of the various subgroups which take
responsibility for progressing specific actions. The Commissioning and Performance Group has
a key role in monitoring the implementation of the plan. Service presentations support this
process.
The work undertaken towards the delivery of the “Over the Horizon” system redesign is
scrutinised at regular intervals. The MELDAP Strategic Group [every quarter] and the
Commissioning and Performance Group [every 6-8 weeks] and the Lothian Wide Substance
Misuse Collaborative meetings [approximately every 6-8 weeks].
The MELDAP programme of quarterly service visits collects information on service
contributions to the relevant Delivery Plan’s priorities.
The MELDAP Strategic Group, Service User and Carers from Midlothian and East Lothian and
stakeholders commented on the draft Delivery Plan for 2015-18 at a number of consultation
events.
15
16
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 schedule for service
monitoring and review is in
MELDAP have developed Outcome Focused Service Level Agreements with most funded
services. These follow a contract format agreed by East Lothian Council, Midlothian Council
and NHS Lothian with performance reporting requirements noted. Depending on the original
agreement these SLAs are reviewed and updated on a 12-24 months basis.
MELDAP continued to support the successful use of the “Outcomes Star” monitoring tool with
front line Drug and Alcohol Services. Feedback from Quality Assurance processes is that this
outcomes assessment tool was very useful in showing improvements in the individual’s life
circumstances. Another training programme for this tool will be delivered in October 2015 to
up skill new staff. In order to bring a more uniformed approach new or updated SLAs are likely
to have the use of Outcomes Star as requirement.
MELDAP are committed to a process of quality improvement underpinned by an annual
15
place, which includes
statutory provision.
17
18
Service Users and their
families play a central role
in evaluating the impact of
our statutory and third
sector services.
A. There is a robust quality
assurance system in place
which governs the ADP
and evidences the quality,
effectiveness and
efficiency of services.
B. Please advise when
(and how) your ADP
has/plans to undertake an
assessment of local
implementation of the
‘Quality Principles:
Standard Expectations of
Care and Support in Drug
programme of formal visits by the MELDAP Team to all services.
Since 2010 MELDAP has an agreed programme of QI visits using the National Quality
Standards. Service’s outcomes/performance is discussed during Quality Improvement visits.
There is an agenda that covers service issues, ways in which MELDAP can support service
development, issues around Service User/Carer Involvement and reporting service
performance against HEAT standards and Naloxone targets. A record of the meeting with
agreed actions is shared with service managers. From 2015-16 onwards the use of the Quality
Standards will be replaced by the Quality Principles drawing on the learning from the
Lanarkshire ADP pilot.
As part of the work undertaken by MacMillan Rome, Service Users and Carers were consulted
about possible pathways that may be required to deliver recovery oriented services. The
feedback from this session contributed to the proposed commissioning of an innovative
Independent Recovery Network.
Engaging with families and services users has been primarily at the commissioning end of the
process. Most of the recently commissioned services were as a result of MELDAP’s
programme of service user feedback linked to identifying priorities for the Delivery Plan. As
yet service users and families do not play a ‘central role in evaluating services’ This aspect will
be explored through the use of the Quality Principles.
MELDAP are committed to a process of quality improvement underpinned by a programme of
planned formal visits by the Support Team to all commissioned services. The team works with
services in the role of ‘critical friend’ supporting, challenging, providing accountability and
most importantly helping to improve service quality.
A key purpose of these formal visits is to develop within all services a culture of planned
critical self evaluation as well as to discuss emerging issues such as NPS use. Action groups
have been used to address specific service issues, for example, addressing the low level of
THN kits issued to clients.
In addition to this, further work has been done with the MELDAP Commissioning and
Performance Group regarding service presentations with a stronger emphasis on service
outcomes and linked performance data.
As stated above in Section 1, further work is required with services regarding providing robust
performance measures to the partnership. There are a number of different tools for
16
and alcohol Services.
See notes 9 and 10
19
Describe the progress your
ADP has made in taking
forward the
recommendations from the
Independent Expert Review
of Opioid Replacement
Therapies in Scotland.
Please include any
information around the
following:
 your (updated, if
applicable) Key Aim
Statement
 a specific update on
your progress in
implementing it –
have you achieved
it/when do you plan
to do so?
 Outline the work of
your ORT
Accountable Officer
 How many people
were in receipt of
opiate replacement
therapies in your
area between 1
April 2014 & 31
measuring outcomes, for example, Outcomes Star.
MELDAP services are well placed to implement the Quality Principles based on their
experiences of using the National Quality Standards since 2010. MELDAP has developed the
Quality Principles into a working tool to support service self-evaluation. A short-life working
group has been set up to provide guidance, including timescale for full implementation during
2015-16.
MELDAP’s key aim is that its services will implement the Ten Network Core Standards for
Recovery Based Services in tandem with a Charter “Practises which support recovery” (See
Appendix 2)
MELDAP have made good progress in significant elements and aspects of the Independent
Expert Review of Opioid Replacement Therapies as set out in its improvement plan. (See
Appendix 3)
In relation to other recommendations, NHS Lothian has identified Dr David Farquarson,
Medical Director, NHS Lothian who has agreed to be the ORT Accountable Officer. The MD has
led work to improve the consistency in the use of ORT across acute, specialist, primary care
and prison services in Lothian, in line with UK clinical guidelines.
This work reflected the commitment of NHS Lothian and the three Lothian ADPs to a personcentred ROISC.
For 2014-15 the NHS Lothian spend on methadone and buprenorphine was £1,480,879 a slight
reduction on the 2013-14 costs in part due to the reduction in methadone price.
Number of Prescriptions (all form types)
Methadone
62,946
Buprenorphine
15,179
Drug Costs (£)
Methadone
857,415
Buprenorphine
623,464
The Community Pharmacy fee for locally negotiated substance misuse services (Includes
methadone dispensing and supervision, buprenorphine supervision, injecting provision and
dental costs ) for 2014-15 was £2,130,797
17




March 2015?
Information on
length of time on
ORT and dose
Information about
any related staff
training in ORT
provision or
recovery orientated
systems of care.
Detail of any ORT
focussed groups
operating in the
area.
GP engagement –
how drug and
alcohol treatment is
being delivered in
primary care
Additional Lothian wide training was provided for a number of different staff groups. This
included a two day course Working With Drug Users course, which was attended by 25 GPs.
BBV training was provided to approx 110 staff; primary and community care staff including
GPs, practice nursing, community midwifery and health visitors.
settings.
20
See note 10
Please describe in brief
bullet points how your ADP
and partners are
contributing to delivery of a
Whole Population
Approach for Alcohol.





MELDAP made significant contributions to both Local Authority's Licensing Board’s
over provision statements.
The MELDAP Support Team is a member of both Local Authority Licensing Fora
MELDAP support staff provided training to elected members in relation to local
alcohol prevalence, availability, MELDAP priorities in this area and how these
contribute to the delivery of national policy.
MELDAP commissions preventative services young people and families from
Midlothian Young Peoples Advisory Service, East Lothian Young Carers, two Children’s
Substance Misuse Workers and Olive Bank Children and Families Centre [piloting the
use of the OH-LILA! resource]
MELDAP co-facilitates CAPSM Training to staff of partner agencies.
18
21
22
23
How many service users
are in receipt of
prescriptions for problem
alcohol use?
How many service users
are receiving
counselling/support
through ADP
commissioned services?
How many service users
have received treatment for
ARBD in the reporting
period?
 There was 4634 Alcohol Brief Interventions [ABI] delivered in the MELDAP area.
No data available as yet from NHS Lothian.
Those receiving counselling and/or support from Alcohol Services in 2014/15 =621
Those receiving counselling and/or support from Drug Services in 2014/15 =604
These figures are from a range of services for younger people as well as those focused on
adults.
There is a 10 bedded ARBD Step Down unit at Milestone. It anticipated that annually approx 8
people from Midlothian and East Lothian will be provided with a place at the unit. Clients with
an ARBD diagnosis are also supported through services such as the Recovery Cafes, AA and
SMART groups.
19
3. FINANCIAL FRAMEWORK
Your Report should identify both the earmarked alcohol and the earmarked drug 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/support services or recovery 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
Funding from Local Authority
Funding from NHS (excluding funding earmarked from
Scottish Government)
Funding from other sources
Reserve Funds
Total
Alcohol
Drugs
Total
£1,183,887 £1,259,886 £2,443,773 [includes monies held in
reserve by NHSL]
£164,739
£122,740
£287,479
£854,052
£854,052
£1,708,104
£20,981
£20,981
£295,663
£295,663
£591,326
£2,498,341 £2,553,322 £5,051,663
20
Total Expenditure from sources
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
Alcohol
Drugs
Total
£271,969
£235,969
£507,938
£1,866,754
£1,766,755
£3,633,509
£65,532
See above
amounts
£2,204,255
£65,531
See above
amounts
£2,068,255
£131,063
See above
amounts
£4,272,510
End Year Balance for Scottish Government earmarked allocations
Income (£)
Drug
Alcohol
Total
£2,553,322
£2,498,31
£5,051,663
Expenditure (£)
£2,068,255
£2,204,255
£4,272,510
End Year Balance (£)
£485,067
£294,086
£779,153
Total Underspend from all sources
Underspend (£)
10,300
100,000
5,000
15,000
Proposals for future use
C.L.E.A.R
Service Redesign – Recovery Network
Recovery Cafes
Services Training (NPS, Recovery Orientated Care, Other)
21
Peer Support Workers
Recovery Co-ordinator
Recovery Hub Model Implementation (Start Up – Development of ROSC)
East Lothian Recovery Cafe
Pink Ladies 1st
Midlothian Community Recovery Resources
Alive & Kicking
VOCAL
Remaining balance of £393,751 will c/f to continue funding some of the
above in 2016-17 pending delivery of Recovery Hubs within a mid/long range
sustainable budget.
25,000
30,000
100,000
23,000
17,520
10,000
15,782
33,800
£385,402
Support in kind
Provider
Description
All ADP partners provide Officer and Senior Officer to carry forward on behalf of the
ADP and service ASDOP meetings. This includes staff time for HR, finance and other
areas of organisational support.
4. PERFORMANCE FRAMEWORK - PROGRESS
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.
22
4.1
As with the 2013-14 Annual Report the ScotPHO data has been used to compare the data set for MELDAP with Scotland and four other ADPs with
similar population characteristics. The exercise is intended to give a more accurate and balanced analysis of how MELDAP compares to other ‘similar’ ADP
areas. The comparator ADPs were Angus, Moray, Stirling and Scottish Borders. These comparator authorities have been used previously to benchmark
against a range of council based services. The results were as follows:
MELDAP data is statistically significantly ‘worse’ than comparator ADP value
MELDAP data is statistically not different from comparator ADP value
MELDAP is statistically significantly ‘better’ than comparator ADP value
Alcohol Profile (2014)
Domain
Indicator
Health
Prevalence
CAPSM/Families
Community Safety
1. Alcohol related hospital discharges
2. Alcohol related mortality
3. Males exceeding daily/weekly drinking limits
4.Females exceeding daily/weekly drinking limits
5. Individuals exceeding daily/weekly drinking limits
6.Males binge drinking
7.Females binge drinking
8. Individuals problem drinking
9. Males problem drinking
10. Females problem drinking
11. Individuals problem drinking
12.Weekly drinkers (aged 15)
13.Child protection with parental alcohol/drug
misuse
14.Child protection with parental alcohol misuse
15. Serious assault
16.Common assault
17.Vandalism
Scotland
Angus
Moray
Scottish
Borders
Stirling
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
23
Environment
Services
Drugs Profile (2014)
Domain
18.Breach of the peace
19.The % of people perceiving rowdy behaviour
very/fairly common in neighbourhood
20. Premise license in force- On trade
21.Premise license in force- Off trade
22.Premise license in force- Total
23.Personal licenses in force
24.ABIs delivered
25.Alcohol treatment waiting times
Indicator
Health
1. Drug hospital discharges
2. Drug related mortality
3. Hepatitis-C positive among PWID
Prevalence
4. Population prevalence of problem drug use
5. Male prevalence of problem drug use
6. Female prevalence of problem drug use
7. Drug use in the last month (pupils aged 15)
8. Drug use in the last year (pupils aged 15)
9. Drugs spend reduction
10. Maternities with drug use
11. Child protection with parental drug use
12.Child protection with parental alcohol or drug
use
13. Drug use funded by crime
14. Children being offered drugs (aged 15)
15. Drug misuse in neighbourhood
16. Drug treatment waiting times
17. SDMD completeness
18. SDMD follow-up completeness
Recovery
CAPSM/Families
Community Safety
Environment
Services
Quality
No data
No data
No data
No data
No data
Scotland
Angus
Moray
Scottish
Borders
Stirling
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
No data
24
4.2
The ScotPHO data for Alcohol in the domains of Community Safety (indicators 16, 18) and Environment (indicators 20, 22) with their associated
range of alcohol indicators, MELDAP continues to compare favourably against its group of comparator ADPs. Since last year there have been improvements
in the domains Health (indicators 1, 2) and CAPSM/Families (indicator 14).
4.3
The ScotPHO data for Drugs shows that in terms of our comparator ADPs, MELDAP are consistently significantly worse in the indicators (10, 11, and
12) related to the Outcome CAPSM/Families. However, local data would suggest an improving picture in terms of the number of children on the Child
Protection Register (1,000 per 0-15 population (See Fig 1)
Fig1.
2011-12
Number
East Lothian
Midlothian
66
95
Rate
3.5
6.1
2012-13
Number
Rate
53
49
2.8
3.1
2013-14
Number
59
79
Rate
3.1
1.7
2014-15
Number
31
21
Rate
1.7
1.3
(Source: Framework i East Lothian and Midlothian Councils)
4.4
Since June 2104 the MELDAP Team has been co-located with the East and Midlothian Public Protection Office (Child Protection, Adult Protection,
Violence Against Women, Police Scotland Public Protection Team). MELDAP are also represented on the Signs of Safety Steering Group (East Lothian), the
East and Midlothian Public Protection Performance and Quality Improvement Group and both councils GIRFEC groups.
MELDAP have also increased funding for CAPSM/Families work through the Direct Assistance and Support Service in Midlothian and through a whole centre
approach at Olive Bank Children and Family Centre. All these actions have the capacity to have an impact on this area of service activity, the relevant
indicators and longer term outcomes.
4.5
The Children young people and families group continues to take the lead role in implementing key recommendations from the CAPSM Needs
Assessment. MELDAP are also involved in the CAPSM training for all staff and one of the recently appointed Peer Support Workers has worked closely with
‘hard to reach’ substance misusing women with children.
4.6
Indicators (5, 6) male and female prevalence levels are also consistently worse than comparator ADPs. Local data would indicate that some 50% of
new clients entering treatment services have dependent children living with them or have access to them. As with previous years the indicator maternities
with drug use continues to be significantly worse than comparator ADPs with the caveat that the ScotPHO data ‘has to be treated with caution due to the
manner in which this data is collected across Health Board areas, for example, some areas recording ‘main concern’ while others record ‘any concern’.
25
Additional support for pregnant mothers has been increased through the appointment of a part-week PrePare Nurse whose role will focus on pregnant
women with substance misuse problems and infants considered 'high risk' because of injecting drug use, chaotic lifestyles, and child protection issues.
4.7
In the 2015-18 Delivery Plan MELDAP worked with its commissioned services to develop a number of local performance measures. These are
included below. Very few measures relate to a specific service, rather these are aggregated measures to which a number of services will contribute, for
example, the number of clients actively engaged in recovery based activities. Reflecting the progress MELDAP have made in developing ROISC it is in the
area of recovery where most Local Indicators have been developed and where MELDAP has allocated its greatest increase in spend. A significant change
since the 2014 Annual Report has been the development of a range of local Recovery Indicators (included below) reflecting the very good progress MELDAP
has made in developing a Recovery Orientated Integrated System of Care (ROISC).
MELDAP Theme: Reducing immediate risk, future harm and promoting recovery
National
Outcome
1. Health: People are healthier and experience fewer risks as a result of alcohol and drug use
Indicators
Baseline
Improvement
Goal/Target
2012
498.5
2013
488.6
2012
93.1
2013
112.1
Reduce rate by 3.5% to
470 by 2018
Reduction in 2012 rate.
ScotPHO data shows MELDAP rate is significantly better than Scotland
Average
Reduce rate to 100 by
2018
Rate of alcohol-related mortality (per
100,000 pop)
2012
14.6
2013
13.4
Reduce number of
alcohol related deaths
by 2 by 2016
The 2012 and 2013 rate is both lower than the national rate. The 2013
MELDP figure is higher than to the 2012 rate which may reflect the
deteriorating health needs of an aging opiate using population.
ScotPHO data shows that the MELDAP rate is significantly better than
the Scotland Average
The 2013 rate is lower than 2102 figure and the Scotland Average of
21.2 (ScotPHO).
In 2013 there were 25 alcohol related deaths compared to the 2012
total of 27.
Reduce the numbers of drug related
deaths
2013
16
Reduce the number of
deaths by 2 annually
Rate of alcohol related hospital stays
(per100,000 pop)
Rate of drug-related hospital stays
(per100,000 pop)
RAG
Comments/key actions delivered to support this outcome in
2014-15
While the DRD rate is still below national rate, in 2013 there were 16
DRD up from 14 in 2012.
There is the challenge of dealing with an aging injecting population
26
2014
14
Reduce the number of HEP-C positives
among PWID
Increase the total number of Take
Home Naloxone Kits issued
National
Outcome
2010
30.1%
2011
20.6%
2014
231
whose underlying health is poor.
A local DRD review group was established by November 2014.
Work with services to reduce the level of methadone related deaths.
The MELDAP rate is consistently lower than the national rate and
comparator ADPs. Possible emerging risk through higher levels of NPS
injecting.
Increased level of BBV
testing through HRT.
Reduce rate to 19.6 by
2018
Increase to 540 by 2016
Good progress has been made over the last 6 months from a low base.
THN group set up to increase level of distribution.
2. Prevalence: Fewer Adults and children are drinking or using drugs at levels or patterns that are damaging to
themselves and others
Indicators
Baseline
Improvement
Goal/Target
Estimated prevalence(%) of problem
drug use (15-64 years)
2012
1.5%
Drug use in the last month (pupils
aged 15)
2013
9.9%
Sustain level below
national rate and similar
to that of comparator
ADPs
Reduce to match
National figure
Improve school
participation rate
Reduce Illicit drug use in last month
% of individuals currently sharing
needles/syringes
Drug use in the last year (pupils aged
15 years)
2010-11
82%
2010-11
23%
2010-11
4%
2013
16%
Increase the number of 13 year olds
who have never been drunk
2013
53%
% of clients currently injecting
Reduce by 5% by 2015
Reduce by 10% by 2018
Reduce by 1% by 2015
Reduce to match
National figure
Increase to 55% by 2018
RAG
Comments/key actions delivered to support this outcome in
2014-15
The prevalence rates for both males and females a significantly better
than the Scotland Average (ScotPHO)
Since the 2010 SALSUS there has been a 0.5% increase in 15 year old
pupils reporting drug use in last month. School participation rate is
higher than national figure (+6%). There are significant differences in
levels across the two MELDAP areas
The 2013-14 showed a significant reduction to 63%, a lower % than
comparator ADPs
The 2013-14 figure was 15 % down 3% since 2011-12
The figure for 2013-14 showed a small increase to 5%. This figure was
2% lower than that for 2012-13.
Since 2010 there has been a 0.2% decrease which is a smaller decrease
than the national figure of -3%
There has been an increase of 5% since 2010. Figure is still lower than
National figure.
27
Reduce the number of 15 year olds
drinking on a weekly basis
The % of 15 year old pupils who say
their parents ‘sometimes allow them
to drink at home’
National
Outcome
2013
11%
Reduce by 2% by 2018
There has been a -13% reduction since 2010. However, those drinking
on a weekly basis report drinking more in terms of units consumed up
to 19 units/week compared to 11 units/week in 2010.
Specialist young person’s alcohol and drug service provided a range of
alcohol interventions in schools and informal settings.
2010
74%
2013
78%
(SALSUS)
Reduce by 5% by 2018
Presentations on alcohol SALSUS data to secondary HTs and Schools
Councils. Start early development work on local campaigns including
work place initiatives.
3. Recovery: Individuals are improving their health, well being and life-chances by recovering from problematic
drug and alcohol use
Indicators
Baseline
Improvement
Goal/Target
The number of clients receiving 1:1
support reporting reduced levels of
alcohol use
The number of clients receiving 1:1
support reporting reduced levels of
illicit drug use
Establish MELDAP Recovery Network
2014
52%
Increase to 60% by 2018
2014
55%
Increase to 65% by 2018
None
Recovery Network n
place by 2018
None
Two by 2018
2014
70 annually
Increase to 80 annually
by 2018
Establish two Integrated Recovery
Hubs
Increase the number of adults
successfully engaging in education,
training, volunteering and
employment opportunities through
MELDAP Recovery College
RAG
Comments/key actions delivered to support this outcome in
2014-15
Sustained funding to funding to main alcohol services.
Good progress has been made by external consultant to develop
structure, procedure and protocols necessary for the Recovery
Network. A Recovery Network group comprising of service users will
pilot some of the approaches proposed in the consultant’s 2014 report.
Paper on possible composition of multi-agency team including colocated services has been produced.
First cohort of MELDAP students graduated from the Recovery College
in June 2015.
28
Increase the number of people in
recovery actively engaged with
recovery services on a weekly basis
Increase the number of peer
volunteers successfully completing 5day training programme
Increase the number of women
successfully completing 10 week selfmanagement and improvement
course
Increase the number of peer
volunteers supporting clients
Increase the number of GP surgeries
offering clients access to peer
supporter
Increase the percentage of clients
completing intensive 12 week
rehabilitation programme
Develop community based housing to
support people in recovery
Improve information for clients about
the work of the fellowships and
recovery services
2014
95 per week
Increase to 120 per
week by 2018
2014
12 annually
Increase to 30 annually
by 2018
1 day per week, five week programme was developed to include those
in recovery from addiction and mental health issues.
2014
84%
(94 women)
Increase to 90% by 2016
Pilot developed to include programme for East Lothian women. During
2014 a total of 196 women participated in self-management course.
2014
45
2014
1 surgery
Increase to 55 by 2018
2014
60%
Increase to 70% by 2018
2014
None
No recovery
booklet for
clients
2016
1 house established
2015
Develop recovery
booklet
4 surgeries by 2018
Alive and Kicking programme for men started Aug’ 2014. Second
Recovery Cafe (Starfish) opened in Jan’ 2015.
Training delivered in conjunction with mental health services
Three potential surgeries have expressed an interest.
20 clients annually are allocated place at 12 week abstinence
programme.
Obtained positive support from both council’s Housing Department.
Recovery booklet- Get Connected , recovery for drugs and alcohol
completed
29
MELDAP Theme: Protecting and safeguarding children, young people and communities
National
Outcome
4. Families: People are healthier and experience fewer risks as a result of alcohol and drug use
5. Community Safety: Communities and individuals are safe from alcohol and drug related offending and
anti-social behaviour
6. Local Environment: People live in positive, health promoting local environments where alcohol and
drugs are less readily available
Indicators
Baseline
Improvement
Goal/Target
2011-13
64
Reduce to 60 by 2018
Rate of child protection with alcohol
misuse
2013
8.9
Reduce to 2011-12 rate
of 7.6
Rate of Child Protection with alcohol
or drug misuse
2014
22.4
Reduce to 2011-12 rate
of 15.3
Increase the percentage of young
carers who report they have better
coping skills
Increase the percentage of young
people receiving 1:1 support who
reduce their alcohol use
Decrease the % of 15 year olds
offered drugs
Reduce the % of pupils who had been
trouble with the police as a result of
their drinking
Increase the number of young people
affected by parental substance misuse
living in safer home environment
Increase the number of adult/ older
2014
65%
70% by 2018
2014
50%
(21 clients)
2010
44%
2010
15%
55% by 2018
Rate of maternities with drug use
2014
86%
(173 children)
2014
Reduce by 5% by 2018
Match national figure by
2015
100% by 2018
80-100 annually by 2018
RAG
Comments/key actions delivered to support this outcome in
2014-15
Introduction of MELDAP area nurse as part of the NHS Lothian PrePare
Team working with pregnant women and women who have just given
birth and are affected by substance misuse. Rate significantly worse
than comparator ADPs.
Recent data pointing to the significant reduction in the number of
children placed on the Child Protection register. Improved joint
working with the Public Protection Office.
MELDAP has historically had higher percentage of clients entering
treatment services with dependent children with the MELDAP figure
some 10% than the national one.
MELDAP fund two young carer’s services.
Well established young people’s service directed at young people aged
12-21 years already drinking in harmful manner. Increased level of 1:1
support available.
In 2014 figure was 46%. A 2% increase since 2010. Linked work with
Community Safety Partnerships (CSP)
The 2013 SALSUS -figure for 13 and 15 year olds was 10% compared to
the nation figure of 14%.
Developed whole centre approach with Children and Family Centre
where all staff will receive MI training. Centre will also pilot use of Oh
Lila resource from AFS.
Additional funding has been provided to increase significantly support
30
carers provided with advice and
support.
Increase the number of Bars
participating in accredited award
schemes.
Reduce the number of dwelling fires
where alcohol/drug use is a
contributing factor
25 annually
for this group of people whose needs often go undetected.
2014
8
10 Bars/clubs by 2018.
2014
14
Reduce to fewer than 12
by 2018
Work has commenced with both Licensing Fora to encourage higher
levels of participation amongst Bars and Clubs.
Data suggest an increasing problem. Initial discussions have taking
place with Scottish Fire Service with regards to developing local
initiatives.
MELDAP Theme: Commissioning and assuring high quality, cost effective outcomes focused services
National
Outcome
7. Services: Alcohol and drug prevention, treatment and support services are high quality, continually improving,
efficient, evidence –based and responsive, ensuring people move through treatment into sustained recovery
Indicators
Baseline
Improvement
Goal/Target
All services have adopted and are
using the National Quality Principles
in line with MELDAP expectations
All services rated Very Good or
Excellent against delivery of Quality
Principles
Two services have achieved first level
PQASSO quality mark
Complete and implement workforce
development strategy
HEAT A11 access Standard Improved
2014
0 services
All services by 2016
2014
0 services
All services achieve
rating by 2018
2011
0
2014
None
2014
95%
1 service by 2016 and
second by 2018
In place by 2016
2011-12
28%
Increase to 30% by 2018
SDMD 12-week follow up
completeness (% of clients)
2018
98%
RAG
Comments/key actions delivered to support this outcome in
2014-15
MELDAP proforma developed, one service has piloted material and
SLWG will publish guidance by October 2015. Discussions on
implementation were discussed with mangers during QI visits.
All services were previously rated Good or Very good against range of
performance measures including National Quality Standards for
Substance Misuse Services and Best Value Reviews.
One service has achieved award and one service has completed initial
work.
Changes to STRADA have delayed implementation phase.
MELDAP services have consistently delivered performance in excess of
the 90% national standard. The number of new clients (348) entering
treatment in 2013-14 was the largest ever recorded up from (291) in
2012-13. 42% of new clients were aged 30-39 years of age.
The 2013-14 figure was slightly down at 27%. However this was a 10%
increase on the 2012-13 figure. The 27% figure was amongst the
highest of all ADPs.
31
MELDAP Services contribute to the
delivery of NHS Lothian ABI HEAT
Standard
All services have Service Level
Agreement with agreed outcomes and
linked performance measures
Have service users actively involved as
members MELDAP Strategic Group
and its Commissioning group
As part of ROISC increase the number
of people with lived experience
recruited as paid Peer Support
Workers
Improve information for clients about
the work of the fellowships and other
recovery services
5.
2011-12
18%
2014-15
20%
2014
75%
100% by 2018
2014
0
5 services users by 2018
2014
0
5 by 2018
None
Develop recovery
booklet- Get Connected
In 2013-14 MELDAP delivered 22% of ABIs in primary care settings in
Lothian against an expected population based target of 20%. The
figure for 2014-15 was 19% (4634 individuals)
Nearly all third sector partners have performance agreement. The
challenge is to develop comprehensive SLA with statutory service
providers; NHS and council’s substance misuse services.
Two people with lived experience joined the Commissioning and
Performance Group in 2015.
Two part time paid support workers were appointed in January 2015.
Following 6 month pilot both are now full time. The post of Recovery
coordinator was advertised in may 2015.
A Recovery Network group was established in April 2015 to develop
approaches described in Building a Recovery Orientated System of Care
to Support Recovery Communities in East Lothian and Midlothian.
MELDAP produced booklet call Get Connected giving details of all
locally based mutual aid and other recovery groups/services.
ADP & MINISTERIAL PRIORITIES
ADP Priorities 2014/15
Please list the progress you have made in taking forward your ADP’s five key commitments for 2014/15.
MELDAP’s five commitments were:
1. Provide additional peer support training programmes and increase the number of paid Peer Support Workers.
2. In relation to ROSC, MELDAP will complete the redesign process including procuring a provider to develop and deliver the suggested “Recovery
Network” in Midlothian and East Lothian.
3. MELDAP through its services will implement the Ten Network Core Standards for Recovery Based Services in tandem with a Charter “Practises
which support recovery”
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4. MELDAP and its partners will continue to implement the recommendations of the Children Affected by Parental Substance Misuse [CAPSM] Needs
Assessment.
5. Enhance the MELDAP programme of Quality Improvement through the introduction of the new Quality Principles and deliver linked training for all
staff.
The five commitments for 2014-15 were progressed as part on an interrelated set of activities linked to the three key MELDAP themes.
Reducing immediate harm, future harm and promoting recovery
MELDAP have increased the level of funding towards preventative type activities, interventions and services. Young people’s services continue to deliver
targeted support towards young people misusing alcohol and drugs through 1:1 counselling and group work interventions as well as inputs to schools
through lunch time drop-ins and contributing to school’s PSHE programmes. Presentations were made to secondary Head Teachers on the outcomes of
SALSUS, implications for school programmes and changing parental attitudes.
Developing a Recovery Orientated Integrated System of Care (ROISC) has been the main MELDAP priority, in particular developing post treatment services
based on what people with lived experience say they need to change their behaviour and support recovery. The MELDAP Strategic Group approved the
appointment of an external consultant to develop the structures, policies and procedures necessary to create a functioning Recovery Network, a key
recommendation from the 2014 report, Building a Recovery Orientated System of Care to Support Recovery Communities in East Lothian and Midlothian.
In partnership with Access to Industry the MELDAP Recovery College is now in its second year with the number of referrals (92) and people achieving
qualifications including employment ahead of expectations. From the referrals, 57 started the college with 48 completing training goals.
For academic year 2014-15 20 qualifications were achieved in SQA Personal Effectiveness 2 (SCQF Level 4): 6 qualifications were achieved in SQA Job
Seeking Skills (SCQF Level 4): 3 qualifications were achieved in ICT Core Skills SCQF Level 4 and 2 students have achieved outcomes towards their ECDL. In
August 2015 during the Edinburgh Festival three MELDAP students participated in a week long course about all aspects of radio work which included
producing own podcasts, which were aired on local FM stations, interviewing tourists/performers. At the end all students achieved SVQ Level 2 qualification
in ‘introduction to media studies and working with others’.
A second recovery cafe, Starfish was opened in January 2015. Both recovery cafes continue to thrive, Horizons Cafe in Dalkeith has increased the number of
days it opens and both cafes steering groups have plans to grow the businesses. The cafes now have a combined average weekly attendance of some 100+
customers making them a genuine community based resource. To support the work of the cafes MELDAP have earmarked funding for the appointment of
Recovery Co-ordinator (August 2015 appointment) to support and develop the work of the two cafes and other recovery based services.
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A 5-week, one day per week programme of training was delivered to 12 peer volunteers with substance/mental health problems. A pilot project using
volunteers from this programme in a GP surgery is in place. Pending a formal evaluation there are plans to increase the number of participating surgeries
providing access to peer volunteers/supporters.
Alive and Kicking has extended its reach into East Lothian and developed links with Hibs FC to make use of the club’s East Lothian training facilities for the
men’s recovery group. Weekly attendance is normally around 20 men. Links were also developed with men’s mental health services to widen participation.
Additional funding was provided to Pink Ladies to increase the number of women, approx 100 annually, with substance use/ mental health issues
participating in the 10-week self-management programme. MELDAP and East Lothian Council collaborated to provide joint funding to allow Pink Ladies to
pilot its 10-week programme for East Lothian women.
A Recovery Network Group has been established. Comprising primarily of people with lived experience from substance misuse/mental health and
supported by staff from CLEAR the group will pilot some of the approaches of the proposed Recovery Network, for example, managing small grants to
support people in recovery.
Additional funding was provided to support the needs of older carers increasing the number of carers supported from 30 to 100 annually. This is a group
whose needs are often overlooked and because of issues around stigma do not immediately disclose that they are caring for someone misusing alcohol
and/or drugs.
NPS Training delivered by CREW and by MELDAP services was attended by over 200 members of staff from a range of partner services; police, social work,
education/CLD and health
Protecting and safeguarding, children, young people and communities
The Direct Assistance and Support Service (DASS) part funded by Lloyd’s TSB is in its second year. The intensive 12-week whole family support service has
worked with some 20+families and provided support to more than 30 children. A new partnership has been established with a Children and Family Centre.
The centre will have all staff trained in Motivational Interviewing, an approach recommended in the CAPSM Needs Assessment (2014). The centre will also
provide outreach support to families, support a Dad’s group and introduce the AFS resource, Oh Lila! Early discussions have begun on the use of Outcomes
Star (Early Years).
MELDAP have continued in partnership with the Public Protection Team to deliver multi-agency CAPSM training, though there has been the challenge of
increasing the number of participants from education.
In line with a CAPSM Needs Assessment recommendation Olive Bank Children and Family Centre has been provided with funding to develop a whole service
approach to supporting families. Planning has been completed to deliver MI training to all staff.
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Commissioning and assuring high quality, cost effective recovery focused services
Service performance against the HEAT standard was consistently above the 95% target set in the MELDAP 2012-15 Delivery Plan with a few services
delivering a 100% level of performance. MELDAP services contributed towards the NHS Lothian target for ABIs and for 2014-2015, in relation to the NHS
board target, delivered a 245% level of performance.
A partnership short life working group developed guidance on the use of the Quality Principles. Documentation to support self-evaluation for use by all
MELDAP services was approved. The role of partner/peer support in the area of service user involvement is currently being developed.
The role of the Commissioning and Performance Group was strengthened by the inclusion of the third sector partners and two people with lived
experience. The programme of service presentations to the group is 80% complete. Issues around robust performance data quality as evidence towards
service outcomes has been identified as an area for future development.
All the new services commissioned were based on evidence of need identified from the extensive consultations conducted during 2013-14, in particular the
role in services for people with lived experience. Two part week Peer Support Workers were appointed in January 2015. The 6 month evaluation of their
work was so positive that from June 2015 both were made full-time.
Ministerial Priorities 2014-15
1.
Compliance with the Alcohol Brief Interventions (ABIs) HEAT Standard
MELDAP services contributed a proportionate number of ABIs (approx 20% based on population) to the delivery of the NHS Lothian target. This helped
deliver a 245% level of performance against the target for 2014-15. MELDAP services also contributed to specific programme objectives set out in the NHS
Lothian, Alcohol Brief Intervention (ABI) Action Plan – 1st April 2014 to 31st March 2015, for example, ABI delivery in wider non-health settings and
increased the number of staff trained to deliver ABIs. An ABI e-learning module was developed and rolled out to increase the range of staff accessing
training.
2.
Increasing compliance with the Scottish Drugs Misuse Database (SDMD)
All relevant services provide data related to the HEAT A11 standard. In East Lothian, MELDAP have seen an increase of 53% in SMR25 submissions for
2014/15 against 2013/14. The increase is due to services improving their recording processes to ensure that submissions are maximised.
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3.
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)
MELDAP services have consistently delivered a level of performance against the HEAT standard in excess of the 95% target set in the 2012-15 Delivery Plan.
Some services have consistently delivered a 100% level of performance. The Gateways to Recovery continued to play an important part in improving access
through localised venues as demonstrated by the high number of self-referrals recorded.
In 2013-14 75% of records submitted to the DATWTD were fully identifiable. By 2014-15 this figure had risen to 80%.
4.
Increasing the reach and coverage of the National Naloxone Programme and tackling drug related death (DRD)/risks in your local ADP
From a low level in terms of the number of THN kits issued in 2013-14 (54 kits) good progress has been made by MELDAP services and Needle Exchange
Outreach Network (NEON) part of the Harm Reduction Team to increase significantly the number of kits issued. In 2014-15, 168 THN kits were issued a
300%+ improvement of the previous 12 month period.
In partnership with other Lothian ADPs MELDAP continued to fund the appointment of Edinburgh and the Lothians Drug Related Deaths Review Group Coordinator. The group developed an Action Plan for 2014-15 setting out a number of key actions to be implemented under the following areas of activity:
 Engaging with 'at risk' groups & targeting information, advice and support
 Take-home Naloxone programme
 Data sharing
 Non-drug treatment services -notifying concerns
 Supporting safer prescribing
 Dealing with New Psychoactive Substances (NPS)
 Supporting the bereavement needs of children
The group identified possible trends from the information provided by the different partners. In 2014 the three trends identified were the:
 continued rise in intravenous usage and heroin implicated deaths
 small number of NPS related deaths
 occurrence of repeated episodes of non-fatal overdose
In relation the third area, a non- fatal overdose protocol between Scottish Ambulance service and NHS Lothian was agreed in April 2015.
Data collated by the group would suggest that for 2014 there were 14 deaths in the MELDAP area (12 in East Lothian 2 in Midlothian)
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5.
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;
MELDAP have adapted the National Quality Principles (NQP) into a working document (See Appendix 4) to help all services self-evaluate against the 8
principles. A partnership short life working group was established to produce guidance on the use of the materials including agreeing a timescale for full
implementation. MELDAP’s program of quality improvement visits made clear the ADPs expectations regarding the use of the material with an
unambiguous commitment to fully involve service users and carers. Future reporting and presentations to the Commissioning and Performance Group will
be against the successful implementation of the NQP and reporting on the outcomes of service self-evaluation.
6.
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;
ELCA provided alcohol counselling services in HMP Edinburgh and HMP Addiewell. The Edinburgh and Midlothian Recovery Service (EMORS) is provided by
Lifeline Project. Support continued to be provided by ELCA in community settings following liberation. EMORS has a clear recovery focus, working with
individuals to build and develop recovery capital, helping service users to move away from problematic substance use and other issues that increase the
likelihood of re-offending. As a consequence of the closure of Haddington Sheriff Court there is a need to review and develop new arrangements for East
Lothian.
7.
Improving identification of, and preventative activities focused on, new psychoactive substances (NPS).
MELDAP have implemented a number of actions from its NPS Action Plan (See Appendix 5) and contributed to the work of the Lothian wide NPS plan (See
Appendix 6). Multi-agency training was provided by CREW and MELDAP services to more than 200 participants. Services report low levels of use with young
people preferring cannabis to synthetic cannabinoids. Older users continue to be existing intravenous users who have switched.
ADP Priorities in 2015/16
Please list your ADP’s five key commitments for 2015/16 following this self-assessment.
Reducing immediate harm, future harm and promoting recovery
1. Establish a Recovery Network (ROISC) including finalising the arrangements to achieve charitable status and to manage delegated funding to
support recovery activities in line with the recommendation included in the report Developing a Recovery Orientated System of Care to Support
Recovery Communities in Midlothian and East Lothian (2013)
2. Working with the two Health and Social Care Partnerships finalise the arrangements for and begin work to establish two multi disciplinary Recovery
Hubs to provide a more holistic service for people affected by substance misuse and mental health.
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Protecting and safeguarding, children, young people and communities
3. Continue to implement the recommendations set out in the MELDAP CAPSM Needs Assessment (2014)
4. Increase the level of and type of support provided for carers of someone misusing alcohol or drugs
Commissioning and assuring high quality, cost effective recovery focused services
5. Complete actions related to the National Quality Principles to ensure they are embedded in and used by all services and the outcomes of selfevaluation are reported to the Commissioning and Performance Group through formal reports and service presentations.
Ministerial Priorities
ADP funding allocation letters 2015-16 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 2015/16. Please outline these below.

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.
The partnership SLWG will set out a clear timetable for implementation by all services. Additional training will be offered and the use of the
Quality Principles will be linked to the MELDAP programme of service presentations to the Commissioning and Performance Group. Developing
ROISC has been and will continue to be a core priority.

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
Continue to fund the services provided by ELCA and Lifeline. Examine how the Lifeline Project could be extended to include East Lothian
Offenders.

Compliance with the Drug and Alcohol Treatment Waiting Times Local Delivery Plan (LDP) Standard, including,
increasing the level of fully identifiable records submitted to the Drug and Alcohol Treatment Waiting Times Database
(DATWTD)
Continue to deliver MELDAP’s well established system and arrangements for monitoring and providing feedback to services on the quality and
accuracy of their data. Continue to deliver a 95%+ level of performance against HEAT Access Standard.
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
Preparing local systems to comply with the new Drug & Alcohol Information System (DAISy) which is expected to be
operational by Autumn 2016
The MELDAP representative who currently provides scrutiny of Waiting Times Data is a member of the national group and reports back on the
work of the group and possible implications for the partnership. MELDAP will actively support local initiatives to improve the quality and range
of data provided by services.

Compliance with the Alcohol Brief Interventions (ABIs) Local Delivery Plan (LDP) Standard
MELDAP should contribute 20% towards the NHS Lothian Target, which in 2014-15 achieved 245% of original target. Approximately 43% of
ABIs are conducted in ‘wider settings’. An ABI e-module developed in 2104-15 should make easier for staff to undertake first level training.

On-going implementing of a Whole Population Approach for alcohol recognising harder to reach groups, supporting a
focus on communities where deprivation is greatest
MELDAP is a core member of both council’s Licensing Forum and previously made a significant contribution to the development of both
council’s overprovision statements. Enhanced targeted support to parents’ groups, school councils on role of parents in influencing their
children’s attitude to drinking.

ADP engagement in improvements to reduce alcohol related deaths.
The number of new clients entering treatment services is at record level. Peer support workers have been used to support difficult to reach
clients into treatment and recovery based services. The rate of alcohol related mortality is significantly better than the national rate and
comparable to MELDAPs benchmark ADPs.

Increasing compliance with the Scottish Drugs Misuse Database (SDMD), both SMR25a and b;
In East Lothian, MELDAP have seen an increase of 53% in SMR25 submissions for 2014/15 against 2013/14. The increase is due to services
improving their recording processes to ensure that submissions are maximised. MELDAP will continue to encourage an improvement in
submissions of SMR25a and 25b information in the planned Quality Improvement visits with service managers.

Increasing the reach and coverage of the national naloxone programme and tackling drug related death(DRD)/risks in your
local ADP
MELDAP are committed to achieving the national THN target for ADPs. Work is planned to increase role of GPs and Community Pharmacists.
Peer Support Workers provide information and support to people who are difficult to engage with. With the proposed changes in legislation
MELDAP services will implement a programme of training and improve the level of reach of THN into variety of settings. MELDAP will amend
SLAs to include this aspect of service provision.
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
Improving identification of, and preventative activities focused on, new psychoactive substances (NPS)
MELDAP leads the local NPS Group and participates in key Lothian NPS groups. The MELDAP NPS Action plan and NHS Lothian NPS plan both
contain a number of actions to be delivered over the next 12 months. These will include a set of core messages covering topics such as:
 Acute presentation/challenging behaviour
 Child and adult protection (unborn child)
 Harm reduction (general/injecting/non-injecting
 Communication (media/parents and carers)
Continue to deliver NPS training as part of workforce development.
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.
Aspects of the reporting arrangements at times seemed to be asking for the same information in slightly different contexts, for example, section 8 developing
ROSC and section 12(d) which is also about ROSC. Section 19 also covers ROSC as it is part of the recommendations of the Expert Review of Opioid
Replacement Therapies in Scotland (Recommendations 6-7)
Parts of section 8 seemed quite service specific, in particular arrangements ‘for individual care/recovery planning and review.’
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