ADP Strategy 2011-2014
Dumfries and Galloway
Alcohol and Drugs Partnership
Strategy
2011 - 2014
Prepared By:
ADP Support Team
Lochar West, Crichton Hall, Dumfries
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ADP Strategy 2011-2014
ADP Strategy 2011-2014
Version Control
Version Date
Author
Change Description
1.0
14/07/2010
Kevin Flett
Document created
1.1
13/08/2010
Kevin Flett
Re formatting
1.2
07/09/2010
Kevin Flett
Additional information
2.0
10/11/2010
Kevin Flett
Revision incorporating feedback
2.1
26/11/2010
Kevin Flett
Update Outcome delivery and
performance frameworks
2.2
01/12/2010
Kevin Flett
Revision incorporating support
team feedback
3.0
27/01/2011
Kevin Flett
Redevelopment of Performance
Plan incorporating GIRFEC
model. Inclusion of additional
information on Homelessness
and substance misuse and
Workforce development
3.1
15/02/2011
Kevin Flett
Revision incorporating ADP
feedback
4.0
11/04/2011
Kevin Flett
Redrafting following consultation
feedback
4.1
19/04/2011
Kevin Flett
Full redraft, including financial
information
4.2
20/04/2011
Kevin Flett
Final Draft
5.0
20/05/2011
Kevin Flett
Final amendments in response
to committee comments,
including criminal justice
information
Document Name
ADP Strategy 2011-2014
Date Created (Draft)
13/08/2010
Date Approved
2011
Archive Location
Lochar West, Crichton Hall
Medium of Distribution
electronic
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ADP Strategy 2011-2014
TABLE OF CONTENTS
1 FOREWORD ............................................................................................................................ 5 2 EXECUTIVE SUMMARY ......................................................................................................... 6 3 GLOSSARY OF TERMS.......................................................................................................... 8 4 STRATEGIC VISION AND VALUES..................................................................................... 10 4.1 ADP Vision....................................................................................................................... 10 4.2 Shared Values ................................................................................................................. 10 5 BACKGROUND ..................................................................................................................... 13 5.1 ADP Formation ................................................................................................................ 13 5.2 Previous Strategies ......................................................................................................... 13 5.3 Strategy Scope ................................................................................................................ 14 5.4 Strategic Links ................................................................................................................. 14 6 THE CURRENT CONTEXT ................................................................................................... 16 6.1 Review and Assessment ................................................................................................. 16 6.2 Integrated Drug Service Review...................................................................................... 16 6.3 Service User Involvement................................................................................................ 16 6.4 Integrated Alcohol Services............................................................................................. 17 6.5 Criminal Justice ............................................................................................................... 18 6.6 Protecting Vulnerable People .......................................................................................... 18 6.6.1 Adult Support and Protection................................................................................ 18 6.6.2 Child Protection..................................................................................................... 19 6.6.3 Domestic Abuse and Violence Against Women ................................................... 19 6.7 Needs Assessment.......................................................................................................... 19 6.8 Information Analysis ........................................................................................................ 21 6.9 National Research ........................................................................................................... 22 6.9.1 Homelessness and Substance Misuse................................................................. 22 6.9.2 Workforce Development ....................................................................................... 23 6.10 Funding and Budgets .................................................................................................... 23 7 DELIVERING IMPROVEMENT.............................................................................................. 26 7.1 ADP Functions................................................................................................................. 26 7.2 From Structure to Process............................................................................................... 26 7.3 Driving Change ................................................................................................................ 27 Version # 5.0 Updated on 20/05/2011
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7.4 Quality and Delivery ........................................................................................................ 27 7.5 Programme and Project Management ............................................................................ 28 7.6 Monitoring Effectiveness ................................................................................................. 28 7.6.1 Management control and governance .................................................................. 28 7.6.2 Finance and resource management ..................................................................... 29 7.6.3 Risk management ................................................................................................. 29 7.6.4 Benefits (outcomes) management........................................................................ 30 7.6.5 Stakeholder engagement...................................................................................... 30 8 BENEFITS MANAGEMENT (OUTCOME DELIVERY) ......................................................... 32 8.1 Service Delivery Outcomes ............................................................................................. 32 8.2 Future Priorities ............................................................................................................... 33 9 STAKEHOLDER ENGAGEMENT ......................................................................................... 34 10 PERFORMANCE AND MONITORING .................................................................................. 36 10.1 Supporting Structures .................................................................................................... 36 11 PERFORMANCE PLAN ........................................................................................................ 39 11.1 Performance Plan .......................................................................................................... 39 11.2 Triangulating the evidence ............................................................................................ 40 12 KEY DOCUMENTS................................................................................................................ 41 13 APPENDICES ........................................................................................................................ 43 13.1 Appendix 1 – Outcomes ................................................................................................ 43 13.2 Appendix 2 – Templates, Tools and Frameworks ......................................................... 46 13.3 Appendix 3 – Performance Monitoring Tools ................................................................ 51 Version # 5.0 Updated on 20/05/2011
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1
FOREWORD
Significant changes have taken place over the past four years in
how alcohol and drug services are planned and delivered. A great
deal has already been achieved in Dumfries and Galloway in
improving local approaches to tackle alcohol and drug misuse.
Integrated services have delivered improved access to treatment,
with waiting times amongst the best in the country. New protocols
have been established ensuring better protection for children at
risk. Innovative approaches to the delivery of Alcohol Brief
Interventions were piloted locally, providing the basis for a model
which was largely replicated nationally.
Progress was evidenced by a range of indicators, not least a reduction in the
prevalence of drug misuse across Dumfries and Galloway. However there is a strong,
shared commitment by all ADP Partners to progress yet further and this commitment is
reflected in this new Strategy.
The Strategy establishes fresh direction and renewed impetus based on two recurring
themes of prevention and recovery. The premise is that substance misuse is not
inevitable. Through carefully targeted activities including information, education and
brief interventions, problems can be prevented altogether or be dealt with more
effectively if picked up at an early stage. Yet we know that some people do become
dependent on alcohol or drugs and the message of this Strategy is that recovery is
possible.
Closely linked to these two themes is an ongoing commitment to protecting those who
are vulnerable, as well as maintaining a focus on enforcement and limiting the
availability of alcohol and drugs.
Supporting this work across Dumfries and Galloway is a greater concentration on
achieving better outcomes for those affected by alcohol and drug misuse, be they
individuals, families or wider communities. More meaningful involvement of all
stakeholders in ensuring that responses are more effective is also vital, as is the
creation of systems which ensure that the ADP is increasingly open and transparent in
its activities, and able to demonstrate the value of its work more clearly.
We believe this fresh approach will bring long term change and benefit to individuals
and communities across Dumfries and Galloway, and on behalf of all ADP partners I
commend it to you.
Patrick Shearer
Chief Constable, Dumfries and Galloway Constabulary
Chair, Dumfries and Galloway Alcohol and Drugs Partnership
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2
EXECUTIVE SUMMARY
This Strategy delivers on a key requirement of the Scottish Government, that all
Alcohol and Drugs Partnerships (ADPs) create new strategies by April 2011. It is
targeted at those involved in the planning and development of effective responses to
alcohol and drug issues in Dumfries and Galloway, and forms one strand of our broad
approach to involving as wide a range of stakeholders as possible in ADP activities.
The Strategy establishes a balanced approach to these issues, based on clear
commitments to prevention and recovery. Prevention demands initiatives that are long
term, and require perseverance. It takes time to shift perceptions and attitudes, so as
to ensure that more people make better informed, healthier choices. Planning for
recovery is also challenging. The recovery model draws on well established models in
mental health services and has two significant features. First it is person centred.
People will trace their recovery route in different ways. Recovery changes the balance
of power, and this challenges the way in which services are designed and
commissioned. The second main feature is hope. Outcomes are central to the strategy,
changes which positively impact on the lives of individuals, with the ripple effect on
families, communities and wider society. Approaches which, though remaining
grounded in the hard realities of alcohol and drug dependence, encourage the setting
of goals, which may be small steps, but establish a positive direction and say to people
your life can change, you can recover.
The Strategy develops structures and initiatives which support these themes. Linking in
to the Dumfries and Galloway Single Outcome Agreement, and feeding in to national
HEAT targets and high level outcomes, requires a local delivery structure which is
flexible and responsive. Based on proven models which encourage improvement in the
delivery of services, there are three features of the planned approach:
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-
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There will be a clear commitment to benefits management (the delivery of good
outcomes), with systems in place which record progress for individuals in their
personal journeys of recovery, as well as at local and regional levels;
There will be the involvement of a wide range of stakeholders in all aspects of
the ADP’s work, including in planning and decision making processes as well as
at a service level, with people defining their own priorities for recovery;
There will be lighter structures, and clear mechanisms established for reporting
on the work of the ADP, offering greater accountability.
Underpinning this will be a commitment to achieving clear outcomes in relation to:
-
improving people’s health;
reducing the prevalence of harmful alcohol and drug misuse;
developing a recovery centred ethos;
supporting children and families affected by others’ alcohol and drug misuse;
promoting safer communities;
reducing the availability of alcohol and drugs;
delivering high quality and effective alcohol and drug services.
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This demands a commitment to quality standards, continuous improvement,
partnership working, protecting those who are vulnerable, evidence based practice and
person centred approaches.
The strategy commits the ADP and its partners to demonstrating its performance, using
a range of evidence to show where it has achieved as well as where it has not. The
process of continuous monitoring will allow this information to reinforce the positive and
successful, while challenging and improving areas which are proving to be less
effective.
This will be achieved through an ADP which is more accountable, and more focussed
on clear objectives (particularly around the use of its resources, the gathering and use
of information about outcomes, the processes for designing and commissioning
services and reviewing its effectiveness) contributing to achieving the vision of a region
where people are healthier, happier and safer.
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3
GLOSSARY OF TERMS
Term / Acronym
ABI
ADAT
ADP
ARBD
Audit
Scotland
BBV
CAPSM
CJ
CP
CSP
CPO
DAVAW
DDRG
DoH
DRG
DTTO
GOPR
HEAT Target
IAS
IDS
Lifebelt
NQS
OGC
Outcomes
-
RPL
SDF
SG
SIGN 74
-
Stakeholder
-
SUI
SWS
SWSCJA
Third Sector
-
Tiered
Approach
-
Alcohol Brief Intervention
Alcohol and Drug Action Team (forerunner to ADP)
Alcohol and Drugs Partnership
Alcohol-Related Brain Damage
Scottish Government body which ensures that organisations which spend
public money in Scotland use it properly, efficiently and effectively
Blood Borne Virus
Children Affected by Parental Substance Misuse
Criminal Justice
Community Planning
Community Safety Partnership
Community Payback Order
Domestic Abuse and Violence against Women
Drug-related Death Review Group
Department of Health (UK Government Department)
Delivery Reform Group
Drug Treatment and Testing Order
Getting Our Priorities Right
Scottish Government Targets (Health-Efficiency-Access-Treatment)
Integrated Alcohol Services
Integrated Drug Services
Local partnership looking at “moving on” and other services for people
with substance misuse issues
National Quality Standards for Substance Misuse Services
Office of Government Commerce
The outcomes approach focuses on real and lasting results affecting both
individuals’ lives and wider society
ADP Recognised Partners List
Scottish Drugs Forum
Scottish Government
Scottish Intercollegiate Guidelines Network (National Clinical guidelines).
SIGN 74 covers the management of harmful drinking and alcohol
dependence in primary care
a person, group or organisation that affects, or can be affected by the
ADP’s activities
Service User Involvement
Social Work Services
South West Scotland Community Justice Authority
Term used to refer to voluntary, not for profit or community sector
organisations (i.e. not private or public sector)
A four level approach to substance misuse developed by the National
Treatment Agency (NTA)
(http://www.nta.nhs.uk/uploads/nta_modelsofcare_update_2006_moc3.pdf
for further information)
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UKDPC
-
UK Drug Policy Commission
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4
STRATEGIC VISION AND VALUES
4.1
ADP Vision
The vision of the Dumfries and Galloway Alcohol and Drugs Partnership (ADP) is of a
region where people are healthier, happier and safer. Recognising the harm that
alcohol and drug misuse can cause, it is vital that we establish a strategic approach
which both prevents such misuse, and deals effectively with it when it begins to have
an impact on individuals and communities.
These two themes of prevention and recovery run throughout this Strategy. They
underpin short term outcomes which will improve the lives of those affected by
substance misuse, and the longer term vision of communities where alcohol and drug
misuse are reduced for the benefit of all.
This vision ties in strongly to outcomes inherent in the Scottish Government’s drugs
strategy (The Road to Recovery)1 and alcohol plan (Changing Scotland’s Relationship
with Alcohol).2 These are linked to national outcomes, which are reflected in the
Dumfries and Galloway Single Outcome Agreement (SOA).3 Substance misuse is one
of nine community safety priorities in the Dumfries and Galloway Community Safety
Partnership’s Strategic Assessment 4 and has been identified as a substantial risk.
The vision finds a practical focus in the seven National Core Outcomes (Appendix 1),
derived from national strategies, which will have a sustained impact on the people of
Dumfries and Galloway.
Whilst the themes of prevention and recovery run throughout the Strategy, closely
linked with them is a necessary commitment to other key areas of work. Most notable
is the commitment to children, through education and prevention as well as protecting
and supporting those who are affected by their parents’ or carers’ substance misuse
and also a wide spectrum of enforcement issues from licensing through to the seizure
of illegal drugs.
4.2
Shared Values
Underpinning this vision is a set of values which “shape what the organisation does
and the way the organisation does it – how it manages, how decisions are made, the
manner in which people work.” 5
1
Scottish Government (2008) The Road to Recovery. Edinburgh: The Scottish Government
Scottish Government (2009) Changing Scotland’s Relationship with Alcohol: A Framework for
Action. Edinburgh: The Scottish Government
3
Dumfries and Galloway Strategic Partnership (2011) Single Outcome Agreement. Dumfries: The
Dumfries and Galloway Strategic Partnership
4
Dumfries and Galloway Community Safety Partnership (2009) Dumfries and Galloway
Community Safety Partnership Strategic Assessment 2009-2010. Dumfries: The Dumfries and
Galloway Community Safety Partnership
5
Blake, G. Robinson, D. and Smerdon, M. (2006) Living Values. London: Community Links
2
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The Report of the 21st Century Social Work Review makes explicit the need for shared
values, concluding “High performing teams are interdependent. They have common
goals, shared values, shared knowledge about the needs of clients and the opportunity
to share expertise, and learn together.” 6
The 10 Essential Shared Capabilities for Mental Health Workers (NHS Education for
Scotland, 2007) recognises that values (of service users, professionals and
organisations) can affect an individual’s recovery. Values Based Practice “is about
working in a positive and constructive way with differences and diversity of values.” 7
Deriving from the values shared across a range of professional bodies, the ADP
recognises the following as shaping and guiding its approach:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Accountability
Competence
Confidentiality
Diversity, Equality and Inclusion
Empowerment
Evidence based decisions
Integrity
Minimising risk
Partnership working
Promoting recovery
Quality improvement
Respect
Self determination
Service user participation
Social justice
Central to these shared values are the principles of recovery. The UK Drug Policy
Commission defines recovery as a process of “voluntarily sustained control over
substance use which maximises health and wellbeing and participation in the rights,
roles and responsibilities of society” 8 The Scottish Government states that “recovery is
most effective when service users’ needs and aspirations are placed at the centre of
their care and treatment. In short, an aspirational, person-centred process.” 9 This
suggests a dynamic, personalised approach which for many people will include
complimentary episodes of harm reduction and abstinence based approaches.
So the recurring themes of prevention and recovery rest on two fundamental principles:
Substance misuse is not inevitable, it can be prevented through education, information and
enforcement, and when initial signs of substance misuse appear, early, brief interventions can
prevent further harm.
6
Scottish Executive (2006) The Report of the 21st Century Social Work Review. Edinburgh: The
Scottish Executive
7
NHS Education for Scotland (2007) The 10 Essential Shared Capabilities for Mental Health
Workers. Edinburgh: NHS Education for Scotland
8
UK Drug Policy Commission (2008) A Vision of Recovery. London: UKDPC
9
Scottish Government (2008) The Road to Recovery. Edinburgh: The Scottish Government
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Where substance misuse has become a serious issue for an individual, affecting them, their
family and community, recovery is possible, and people can be “enabled to move from their
problem drug use, towards a drug-free life as an active and contributing member of society.” 10
10
ibid
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5
BACKGROUND
5.1
ADP Formation
Dumfries and Galloway Alcohol and Drugs Partnership was formed in September
2009, following a review by the Scottish Government of the delivery of alcohol and drug
services across Scotland. There had also been a significant shift in the expectations
and priorities around the types of services delivered, made clear in new government
plans for alcohol and drugs. In the future the focus, particularly with respect to drug
misuse, would be on recovery, where people move towards a drug free life. Linked with
this is the greater emphasis on preventing alcohol or drug problems occurring or
getting worse, through education, public information, screening and early intervention.
The overarching aim of the ADP is to drive forward this agenda through the planning,
design and commissioning of services and approaches which are effective and
constantly improving, even during a period of more restricted public finances.
5.2
Previous Strategies
The work in this Strategy is not new; it builds on the achievements of the former
Alcohol and Drug Action Team (ADAT). The ADAT 2006-09 Strategy11 successfully
delivered in a number of key areas:
• A significant rise in numbers of people accessing treatment;
• Waiting times for accessing treatment amongst the best in Scotland;
• Creation of processes for involving service users in the design and development
of services;
• Development of a Recognised Partners List, linked to National Quality
Standards;
• Implementation of robust systems for identifying children at risk from the misuse
of substances;
• Successful Alcohol Brief Intervention Pilot in Annandale and Eskdale, rolled out
regionally, and mirrored now in national approaches;
• Development of the Drug-related Death Review Group, including new processes
for dealing with non-fatal overdose;
• Establishing service user groups and the development of service user
involvement;
• Supporting the development of local licensing forums across the region.
In the period following the completion of the 2006-09 Strategy, an interim plan guided
the development of new local structures for the planning and delivery of alcohol and
drug services. These interim arrangements have:
• Developed governance guidance, linking the ADP to local Community Planning
structures;
11
Dumfries and Galloway ADAT (2006) Strategy 2006-2009. Dumfries: Dumfries and Galloway
Alcohol and Drug Action Team
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• Reviewed the activities of its key services to provide a basis for future service
development;
• Developed commissioning frameworks, to ensure that new services are
focused on achieving clear outcomes;
• Agreed outcomes which will underpin the work of commissioned services and
the activities of other partners;
• Commissioned an independent Needs Assessment to inform the priorities for
forward planning.
This new Strategy builds on the achievements of the past, but also recognises the
significant challenges which exist and the improvements which are required.
5.3
Strategy Scope
The work of the ADP is in one sense wide ranging, in that it draws together a range of
partners from areas such as health, education, social work and law enforcement. This
is indicative of the reach of alcohol and drug issues, touching many aspects of Scottish
society. However the work of the ADP is also sharply focused, addressing specific
issues associated with alcohol and drug misuse as they impact on society. The
activities of the ADP must support and inform the work done in front line service
delivery, but delivery remains the responsibility of our partners. This is reflected in our
approach to outcomes based commissioning, where the ADP will define the outcomes
to be achieved, and ensure that current standards and frameworks are adhered to, but
our commissioned partners will be expected to develop dynamic and responsive
services which achieve those outcomes. Furthermore it is a responsibility of the ADP to
ensure the quality of delivery; a good understanding of current best practice; that
resources are targeted at the area of greatest need and that services work together in
ways which combine to meet overall goals. This approach moves us to a model where
the work of the ADP, incorporating aspects such as quality, financial planning,
commissioning and procurement, and a range of other processes and activities all
combine to support and enhance the delivery of positive outcomes through our
partners.
5.4
Strategic Links
This Strategy recognises that a clear strategic framework is essential if effective
outcomes are to be delivered. However, the Strategy is not a standalone document. In
addition to The Road to Recovery, Changing Scotland’s Relationship with Alcohol and
the Dumfries and Galloway Single Outcome Agreement (SOA), there is a series of
NHS performance targets (HEAT targets) to which alcohol and drugs services must
contribute.12
• Health Improvement for the people of Scotland – improving life expectancy and
healthy life expectancy;
• Efficiency and Governance Improvements – continually improve the efficiency
and effectiveness of the NHS;
• Access to Services – recognising patients’ need for quicker and easier use of
NHS services; and
12
Scottish Government (2010) NHS Performance Targets. Edinburgh: The Scottish Government
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/17273/targets (accessed 23/08/2010)
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• Treatment Appropriate to Individuals – ensure patients receive high quality
services that meet their needs.
Although the HEAT targets sit at a national level and are driven by national priorities,
they remain intrinsically linked to the day to day work of local services. The resources
given to the ADP are to be used in the delivery of the HEAT targets H4 and A11.
H4 – Achieve agreed number of screenings using the setting-appropriate
screening tool and appropriate alcohol brief intervention, in line with SIGN74
guidelines by 2010/11. (Further extended for the year 2011/12).
A11 – By March 2013, 90% of clients will wait no longer than 3 weeks from
referral received to appropriate drug or alcohol treatment that supports their
recovery.
Both of the targets support the two key themes of this Strategy, prevention and
recovery as well as many of the high level and longer term outcomes. The inclusion of
targets incorporating alcohol and drugs ensures that both are given adequate priority.
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6
THE CURRENT CONTEXT
6.1
Review and Assessment
Over the past two years the ADP and others have undertaken or commissioned
independent studies to guide its priorities for coming years. A significant proportion of
ADP resources fund the provision of core services for the treatment of alcohol and drug
problems, therefore the Partnership has a keen interest in how well these core services
are delivered.
6.2
Integrated Drug Service Review
Since 2006 there has been an Integrated Drug Service (IDS) operating across
Dumfries and Galloway. Delivered from five locality bases, the service was designed to
achieve two key targets; (i) to increase the numbers of those with drug problems
entering treatment services, and (ii) to ensure that those entering such services did so
quickly. Initially there was a waiting time target of 4 weeks. These targets were
achieved, and currently almost 100% of those approaching the IDS for support are
offered an appointment for assessment within 4 weeks.
In order to get behind the headline figures, Partners in Evaluation Scotland was
commissioned to conduct an independent review of the IDS in 2008/9, with a report
published in May 2009.13 It made the following recommendations:
1. Ensure local structures are in place to deliver reform;
2. Set up themed time limited working groups to consider:
a. Access to counselling, self help and psychological support;
b. Access to structured constructive activities;
c. Increased use of pharmacy locations as a base to deliver more services;
d. The role of families in recovery;
e. Widening access to education and employability programmes;
f. Transition housing and resettlement;
3. Focus all staff roles on incorporating recovery;
4. Better outcomes reporting.
The overarching theme of the report was that future development should ensure that
responses are designed to take service users beyond maintenance, with a recovery
focus which supports people to move through services.
6.3
Service User Involvement
In 2006 the Scottish Executive published National Quality Standards for Substance
Misuse Services (NQS).14 These clearly place a duty on service providers, planners
13
Bitel, M. (2009) Review of the Integrated Drugs Service in Dumfries and Galloway. Edinburgh:
Partners in Evaluation Scotland
14
Scottish Executive (2006) National Quality Standards for Substance Misuse Services.
Edinburgh: The Scottish Executive
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and commissioners to ensure that service users and their families are at the centre of
the services that are offered to them.
The NQS were a key driver in establishing Service User Involvement (SUI) across
Dumfries and Galloway. The then ADAT commissioned the Scottish Drugs Forum
(SDF) to run a two year pilot project to develop SUI, part of which involved the
seconding of an ADAT team member to SDF to oversee the project.
The rationale behind SUI is that it ensures:
•
•
•
•
•
Service users have a greater say in the planning and delivery of the services
they receive;
Services will be more efficient and effective by taking into account the views of
service users;
Purchasers and planners will make more informed decisions as a result of
effective service user involvement structures being in place;
Responses towards people who use drugs by the general public are better
informed;
The channelling of the skills of drug users and the promotion of social inclusion.
The SUI project has undertaken a range of specialist activities, including:
•
•
•
•
Conducting focus groups for the ADP needs assessment and contributing to a
paper on the NHS specialist service;
Working with NHS specialist nurses on developing methadone dispensing
protocols;
Carrying out focus groups and one to one interviews with Criminal Justice
Service clients and reporting findings to the Criminal Justice team;
Working with the ADP on the commissioning process for the new integrated
service contract, including conducting service user interviews during site visits.
6.4
Integrated Alcohol Services
In 2005 the Scottish Executive requested expressions of interest to develop a new
model of service delivery based around SIGN74.15 The approach was to support the
early detection of hazardous drinkers using a validated screening tool and then offer
individualised brief interventions to those who screened positive.
A Dumfries and Galloway pilot took place in a number of GP practices, demonstrating
success in reducing risk taking behaviours and consumption levels. The approach was
highlighted in the Scottish Executive’s update to the Plan for Action on Alcohol
Problems 16 and informed the implementation of the Scottish Government’s national
approach to Alcohol Brief Interventions.
Integrated Alcohol Services across Dumfries and Galloway developed around locality
teams including Alcohol Liaison Nurses, Counsellors and Relapse Prevention Workers
15
Scottish Intercollegiate Guidelines Network (2003) The management of harmful drinking and
alcohol dependence in primary care. Edinburgh: Royal College of Physicians
16
Scottish Executive (2007) Plan for action on alcohol problems: update. Edinburgh: The Scottish
Executive
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delivering services in community and Primary Care settings as well as Antenatal and
Accident and Emergency Departments.
6.5
Criminal Justice
The links between criminal justice and alcohol and drug misuse are well established.
For example 58% of offenders were under the influence of alcohol at the time of their
offence, and 26% were under the influence of drugs.
The South West Scotland Community Justice Authority (SWSCJA) is one of 8 CJA’s
established in 2007, with the purpose of reducing reoffending and reconviction rates
and to contribute to safer and stronger communities.
Links between the ADP (and previously the ADAT) and criminal justice services in
Dumfries and Galloway have been consistently strong, with representatives from the
Scottish Prison Service(SPS), the Crown Office and Procurator Fiscal Service
(COPFS), Criminal Justice Social Work Services, Dumfries and Galloway Constabulary
and Third Sector Partners, participating at all levels of the ADP’s work. There is also
representation from the SWSCJA on the ADP.
Significant developments in recent years, including the implementation of the Criminal
Justice and Licensing (Scotland) Act 2010 and the reorganisation of health services
within the SPS, present opportunities to progress in a number of areas of work,
including,
•
•
•
•
integrating prison based health care with the NHS, including addiction
services;
reviewing the arrest referral service;
reviewing the use of Drug Treatment and Testing Orders (DTTO) to reduce
re-offending associated with substance misuse;
implementing community payback orders (particularly with a requirement for
alcohol or drug treatment).
These shared approaches will strengthen the delivery of our shared outcomes,
particularly core outcome 5, “Communities and individuals are safe from alcohol and
drug related offending and antisocial behaviour.”
6.6
Protecting Vulnerable People
In the past five years significant policy developments have taken place to ensure the
better protection of vulnerable people. The recent introduction of the Protecting
Vulnerable Groups Scheme 17 will be reflected in the ADP’s processes, particularly in
relation to the commissioning of partners to deliver services. Three further areas
impact directly on the work of the ADP:
6.6.1 Adult Support and Protection
New Adult Support and Protection legislation was implemented in October 2008
to ensure that local multi agency structures and processes were developed for
the protection of adults considered to be at risk of harm. The Dumfries and
17
Scottish Government (2010) Protecting Vulnerable Groups Scheme Guidance for individuals,
organisations and personal employers. Edinburgh: The Scottish Government
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Galloway Adult Protection Committee (APC) was formed, with an independent
chair, and has recently developed its first strategy.18 ADP partners will be able to
benefit from the development of single referral processes, multi agency training
and professional development, which will ultimately be of benefit to service
users.
6.6.2 Child Protection
The ADP and the Dumfries and Galloway Child Protection Committee (CPC)
worked in partnership with Scottish Training on Drugs and Alcohol (STRADA) to
develop Getting our priorities right, inter agency protocols 19 in 2007. These
protocols were supported by a practitioners’ guide and staged training for staff.
Over a period of 18 months around 1000 staff were trained. Following the
publication of new National Guidance for Child Protection in Scotland 20 local
protocols will be reviewed and updated as required.
6.6.3 Domestic Abuse and Violence Against Women
The recent report of the Scottish Ministerial Advisory Group on Alcohol
Problems Essential Services Working Group, “Quality Alcohol Treatment and
Support” 21 made a number of recommendations. These included advice on
good practice for specialist services in screening for harm against women and
children as part of the service’s assessment process. The ADP will work with the
Domestic Abuse and Violence Against Women Partnership (DAVAWP), with
local alcohol and drug service providers and other partners to develop this
screening, and in line with the guidance on adult and child protection outlined
above, extend this screening where practicable to be inclusive of harm against
all vulnerable people.
In each of these three areas of work there are common themes which require cohesive
responses, including:
•
•
•
•
6.7
staff to be aware of the protection needs of children and adults, and when
and how to share concerns;
robust local policies and guidance around identifying, assessing and
managing protection issues related to alcohol and/or drug misuse;
lead professionals to be identified where several services are involved, and;
risk assessment frameworks to be agreed across all partners.
Needs Assessment
The importance of Alcohol and Drugs Partnerships conducting a needs assessment
has been highlighted in a number of national reports including those produced by the
18
Dumfries and Galloway Adult Protection Committee (2010) Adult Protection Committee.
Dumfries: Dumfries and Galloway Council
19
STRADA (2007) Getting our priorities right inter-agency protocol: Working with children and
families affected by drug and/or alcohol misuse. Glasgow: Scottish Training on Drugs and Alcohol
20
Scottish Government (2010) National Guidance for Child Protection in Scotland 2010.
Edinburgh: The Scottish Government
21
Scottish Ministerial Advisory Committee on Alcohol Problems (2011) Quality Alcohol Treatment
and Support (QATS). Edinburgh: The Scottish Government
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Delivery Reform Group. 22 More recently a key recommendation from Audit Scotland
was for public sector bodies to:
Ensure that all drug and alcohol services are based on an assessment of local
need and that they are evaluated to ensure value for money. This information
should then be used to inform decision-making in the local area. 23
In response to this recommendation, Sue Irving Ltd. was commissioned to carry out a
substance misuse needs assessment across Dumfries and Galloway.
The Department of Health guidance on Joint Strategic Needs Assessment, defines it
as,
a process that identifies current and future health and wellbeing needs in light
of existing services, and informs future service planning taking into account
evidence of effectiveness.
Joint Strategic Needs Assessment identifies “the big picture” in terms of the
health and wellbeing needs and inequalities of a local population. 24
Locally this work has been done in conjunction with a wide range of stakeholders
including service users involved with the local Service User Project. The Needs
Assessment was produced in November 2010 25 with the following key findings:
Service Design:
• better coordination with other services (e.g. housing, prisons, etc);
• more focus on moving on and aftercare;
• involving stable service users in peer support or buddying;
• more diversionary and other activities;
• single manager/ leader for all drug and alcohol services.
Service Delivery:
• a wider range of treatment options, including residential options;
• improved coordination and partnership working (rather than necessarily colocation/ sharing of premises);
• improved training for staff, particularly in relation to attitudes and approach;
• more welcoming buildings, with security proportional to the risk.
Gaps in Services:
• more support needed for families and carers;
• more work around prevention;
• clearer support for recovery;
• some services could be offered outwith normal office hours;
• greater awareness of emerging trends.
22
Delivery Reform Group (2008) Alcohol and Drugs Delivery Reform Group – Final Report.
Edinburgh: The Scottish Government
23
Auditor General For Scotland (2009) Drug and Alcohol Services in Scotland. Edinburgh: Audit
Scotland
24
Department of Health (2007) Guidance on Joint Strategic Needs Assessment. London:
Department of Health
25
Irving, S. (2010) Dumfries and Galloway Alcohol and Drugs Partnership Needs Assessment.
Langholm: Sue Irving Ltd.
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Much of the finding of the Needs Assessment echoed the findings of previous
research, including the IDS review outlined above, and the report for the Lifebelt
Steering Group. 26
6.8
Information Analysis
An important element of the Needs Assessment was the collation of significant data,
setting local information against Scottish trends and statistics. Key features of this
information include:
Drugs Services:
• The number of new service users reported in 2007-08 in Scotland as a whole
was 12,562 and of these 202 new users were in Dumfries and Galloway, a
slight decrease on the previous year. Of these only a very small number
were under the age of 20 with the median age being 28 as compared to the
Scottish median of 30;
• The routes into services are of interest ... Dumfries and Galloway has a
considerably higher rate of self referrals (at 53%) than the Scottish average
of 36% ... referrals from the health sector are much lower than the Scottish
average;
• Across Scotland as a whole 83% of new service users reported using
opiates as compared with 88% in Dumfries and Galloway;
• ... between 2006-07 and 2007-08 the number of new heroin using service
users aged under 25 dropped in Scotland by 2% and in Dumfries and
Galloway by 6% from 64% to 58%;
• ... there is a considerable difference in the numbers injecting in Dumfries and
Galloway than in Scotland as a whole. Those who injected as their only
method of administering drugs totalled 54% as compared to the national
figure of 35% which means that Dumfries and Galloway had at that time a
higher percentage than any other NHS Board area in Scotland.
Social Profile:
• In common with the rest of Scotland a small percentage of patients/clients in
Dumfries and Galloway were in employment with the majority, 78%,
unemployed. This is slightly higher than the total Scottish figure of 70%
unemployed. In this region 19% were employed and 3% in the category of
excluded from school, long term sick/disabled or in prison;
• 78% of people in Dumfries and Galloway were in owned/rented
accommodation and 21% were homeless; this figure for homelessness is 5%
higher than the overall Scottish profile. Engaging housing services in the
Alcohol and Drugs Partnership was highlighted in the professional
stakeholder consultation and this has some significance for future planning
given the accommodation profile of patients/clients.
Alcohol Services:
• ... referrals to the (NHS Specialist Drug and Alcohol Service in Dumfries and
Galloway) ... for people with alcohol problems increased by 34% whereas
referrals for drugs related problems fell by 4%. The report attributes this
increase to the development of the alcohol liaison service in Dumfries and
26
Irving, S. (2009) Lifebelt Business Case. Langholm: Sue Irving Ltd.
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•
Galloway Royal Infirmary. Of the 627 referrals for alcohol problems, 279
(44%) had no previous contact with the service which suggests that this new
route into the service may indeed have resulted in the increase as this was
21% higher than the previous year;
Alcohol Statistics Scotland 2009 shows that in 2007 17 men and 11 women
in Dumfries and Galloway died directly as a result of an alcohol related
condition. However deaths where an alcohol related condition is recorded as
either an underlying or contributory cause increases these figures to 27 men
and 25 women. Alcohol also has an impact on the use of acute hospital beds
and psychiatric beds so in 2007-08 locally 617 patients were discharged
from general acute hospitals following alcohol related diagnoses and 80 from
the psychiatric hospital.
Also worth noting is that deaths occurring as a direct result of an alcohol related
condition are generally around three times higher than those recorded as drug-related
deaths. In conjunction with partners on the Dual Diagnosis Group, the ADP has
commissioned a needs assessment around the particular requirements of those
affected by Alcohol-Related Brain Damage (ARBD). This will inform responses to the
needs of this particular group, particularly ensuring that services are linked around the
individual.
6.9
National Research
In addition to local studies and assessments, in recent years there has been a range of
specialist reports from Scottish Government which inform the approach of the ADP and
help define some of its priorities. Two key areas have emerged, which need to be
addressed through the ADP’s activities.
6.9.1 Homelessness and Substance Misuse
The Scottish Government commissioned research into the links between
homelessness and substance misuse issues. The report stated “these studies
paint a picture of homelessness and substance misuse as mutually reinforcing
conditions that are the result of sustained, multiple, compound disadvantage
through childhood and adult life.” 27 Amongst the emerging recommendations
are the need for:
•
•
•
•
•
•
•
A joint strategic response at a local level to be developed (responsibility
sitting with Alcohol and Drugs Partnerships);
A joint operational response at local level to be developed;
More flexible approaches in rural and island areas;
An individual’s priorities to be the starting point for the design and delivery of
services and support;
Ongoing evaluation of services in this field to be managed through ADP
planning and monitoring processes;
Targeted service user participation and involvement to be supported;
Training across homelessness, housing, alcohol and drug fields to be
supported in statutory and commissioned services;
27
Pleace, N. (2008) Effective Services for Substance Misuse and Homelessness in Scotland:
Evidence from an International Review. Edinburgh: Scottish Government Social Research
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•
The stigmatisation of these populations to be addressed at a local and
national level.
6.9.2 Workforce Development
The Scottish Government and COSLA issued a statement about the
development of Scotland’s Alcohol and Drug Workforce. 28 Recognising the
need for a range of organisations to play a role (including commissioners,
professional bodies, service providers, managers and individuals) it also
stresses the need for a shared, person centred vision across specialist and
generic services within all sectors in order to deliver the competencies required
to tackle Scotland’s alcohol and drug related problems. Specifically ADPs are to:
•
•
•
Promote the agreed national learning priorities for development of the drug
and alcohol misuse workforce;
Identify and articulate local workforce development needs aligned with
national learning priorities and develop local workforce strategies and costed
implementation plans to meet these needs; and
Encourage multi-disciplinary and multi-sector training in generic
competences to develop a shared vocabulary and understanding of alcohol
and drug problems, promote an integrated approach across services that
support individuals on their road to recovery.
To support this it is recommended that ADPs conduct a specific Workforce
Development Needs Assessment, which should also incorporate the views of
service users.
6.10 Funding and Budgets
Tackling alcohol and drug misuse is a priority for the Scottish Government, with funding
normally allocated on an annual basis to resource activities which achieve alcohol and
drug focussed outcomes. Decisions on how this funding is to be spent is the
responsibility of the ADP, and the funding allocation is viewed by government as the
minimum which should be spent locally, with strategic partners able to supplement
ADP funds from main budgets. In addition to the supplementary funding outlined in the
table below, strategic partners such as Dumfries and Galloway Constabulary commit
substantial “in kind” resources, including officer time to both the work of the ADP and
some aspects of service provision.
The Scottish Government expects transparent decision making processes, and will be
working with ADP’s in 2011-12 to develop national delivery frameworks which support
the Single Outcome Agreement and the achievement of HEAT targets. This includes
the development of seven core outcomes for ADP’s (Appendix 1), which will sit
alongside local outcomes. These will be reflected in Annual Action Plans (Appendix 3)
to be developed each year during the life of this Strategy.
Scottish Government and local funding allocations for 2011-12 are as follows:
28
Scottish Government and COSLA (2010) Supporting the Development of Scotland’s Alcohol
and Drug Workforce. Edinburgh: Scottish Government and Convention of Scottish Local
Authorities
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Scottish Government
Alcohol Misuse
1,228,256
Scottish Government
Alcohol Misuse
(Prison Allocation)
18,084
Scottish Government
Drug Misuse
620,042
Scottish Government
ADP Support
119,796
Dumfries and Galloway Council
NHS Dumfries and Galloway
Dumfries and Galloway
Community Safety Partnership
Third Sector Partners
383,791
1,000,000
Guidance
Tackling alcohol misuse is a major public
health priority. Approaches will be based
on the guidance issued in “Quality
Alcohol, Treatment and Support”,29 which
outlines a tiered approach, advocating a
person centred recovery focussed
approach. There is continued
development of the use of Alcohol Brief
Interventions, embedding these into
routine practice. The addition of a prison
allocation reflects the transfer of
responsibility for prisoner health care from
the Scottish Prison Service to the NHS.
Funding to tackle drug misuse has been
maintained, to support the development of
recovery focussed systems of care, using
a tiered approach based on NHS
Scotland “Guidance on Referral
Pathways.” 30
The role of ADP Support is to develop a
local strategy (2010-11), support the
implementation of this strategy (2011-12),
particularly the delivery of core outcomes
and key functions not provided by other
partners.
Based on 2010/11 allocation
Based on 2010/11 allocation
25,000 Based on 2010/11 allocation
Estimate, based on funding drawn in to
the region through grants and awards to
500,000 Third Sector Partners. Further work
required to identify and quantify this
aspect of funding
£3,894,969
Guidance from the Scottish Government is explicit in requiring its allocation to
demonstrably support the delivery of the priority outcomes determined collectively by
the ADP, based on local needs assessment, reflecting national priorities and using
systems which are accountable and transparent. A proportion of both the drug and
alcohol allocations will be combined to support the delivery of alcohol and drug HEAT
29
ibid
NHS Scotland (2009) NHS Scotland HEAT Performance management system 2009-10.
Edinburgh: The Scottish Government
30
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target A11.
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7
DELIVERING IMPROVEMENT
7.1
ADP Functions
In addressing the challenges facing the ADP, there is a need for clear structures and
processes which will underpin the work of the Partnership as well as provide a
framework which will strengthen its accountability. Amongst the key features in the
guidance from the Scottish Government, is the need for ADP’s:
-
to be firmly embedded within wider arrangements for community planning;
-
to be supported by an expert local team;
-
to develop and implement a comprehensive and evidence-based local alcohol and
drugs strategy;
-
to work to an agreed set of national core indicators;
-
to ensure that individual bodies contribute fully and openly to the operation of their
local partnership.
7.2
From Structure to Process
The approach laid out in the ADP’s initial Operating Arrangements was largely
structural, based on the inherited structures of the ADAT. This included five delivery
groups, each with a distinctive remit, linked to a particular range of outcomes. However
a structures based approach has several weaknesses. Structures tend to be static, and
a more dynamic response to the issues raised by substance misuse is demanded.
Static structures struggle to cope with remits that are not always easily defined, and
which may cross over one or more groups, leading either to duplication or gaps which
are not successfully covered. There are risks that outcomes or activities are forced to
fit into structures, rather than developing responses which support the delivery of
outcomes.
In the past there have been examples of working groups which successfully have dealt
with cross cutting outcomes and themes. One example is the Drug-related Death
Review Group, which continues to deliver tailored responses to the issues raised by
individual drug related deaths as well as wider trends. Another example was the joint
approach to developing shared protocols around child protection, linked to the
guidance in Getting Our Priorities Right (GOPR). 31
The remainder of this section develops a more dynamic model for the delivery of ADP
outcomes, based not on the continuation of current structures but on the development
of responsive processes, with much lighter structures. This will require the dissolution
of the existing standing groups, replacing them with a dynamic set of working groups,
31
Scottish Executive (2003) Getting our Priorities Right, Good Practice Guidance for working with
Children and families affected by Substance Misuse. Edinburgh: The Scottish Executive
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which are project management based, focussing on specific pieces of work agreed in
Annual Action Plans.
7.3
Driving Change
Behind this change in model for the ADP are two key factors.
First, in August 2009, the ADP completed a self assessment, based on guidance from
Audit Scotland. 32 This was updated in March 2010 by a further self assessment, using
a template designed by the Scottish Government’s National Support Coordinators.
Whilst the ADP demonstrated a number of positive areas of work, there were other
areas requiring further development:
•
•
•
•
•
•
•
Development of Strategy and planning;
Development of more effective commissioning processes;
Conducting (organisational) risk assessment;
Implementing performance monitoring processes;
Developing a focus on Quality;
Clearer lines of accountability;
Gathering better evidence upon which to base future (service) development
(including engagement with service users, analysing trends and identifying best
practice).
A number of these have seen significant progress, particularly around Strategy
development, commissioning and needs assessment, but there are other aspects
which require further development and attention.
Second, is the need to respond to changes in the funding for support arrangements.
Following a review in 2009, the Scottish Government revised its funding allocations for
ADPs, resulting in a 35% cut in support team funding to be phased in over a three year
period, to 2012/13.
Although this support budget is supplemented locally, there is still an impact on the
capacity of the ADP support team which requires a reconfiguring of its functions and
priorities, shifting from the maintenance of current structures towards supporting the
key functions and processes of the ADP. This necessitates the replacement of the
standing groups with more responsive working groups supporting the delivery of key
ADP outcomes, based on the project management model outlined below.
7.4
Quality and Delivery
To provide a framework for the continued development and reconfiguration of the ADP,
it will, over the life of this Strategy apply principles drawn from the “Maturity Model”,
which is designed to help organisations improve what they do. This model will
strengthen the Partnership’s accountability. We believe that if we are asking others
(services, partnerships, initiatives etc) to demonstrate to us how effective they are, we
must be able to demonstrate our effectiveness. Two key disciplines within the Maturity
Model are relevant for the ADP, namely Programme and Project Management, which
32
Auditor General For Scotland (2009) Drug and Alcohol Services in Scotland. Edinburgh: Audit
Scotland
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though not necessarily interdependent can be shown to be complimentary aspects of
the ADP’s work.
7.5
Programme and Project Management
Programme management describes a collection of projects or other activities which
combine to achieve a range of strategic outcomes and benefits for the organisation.
Using the principles of programme management helps to reduce the conflict that can
emerge between projects and activities, and help to ensure that resources are used
most effectively across all of the programme’s activities.
Project management centres on the creation of temporary structures developed for the
purpose of producing change. The changes produced are defined and described as
outcomes which make a real and tangible difference to behaviour or circumstances.
Project management involves planning, delegating, monitoring and controlling each
aspect of a project within agreed targets.
For the purposes of the ADP as a Partnership, it will be concerned with the full
programme of partners’ activities, overseeing the achievement of the outcomes and
benefits envisaged and ensuring the best use of resources. Particular programme
functions may be remitted to agreed working groups or to members of the ADP
Support Team, but the ADP retains ownership of these high level functions.
7.6
Monitoring Effectiveness
To assist in this process the ADP will, as part of its internal performance monitoring,
utilise the Office of Government Commerce Portfolio Management Self Assessment
Tool, 33 monitoring the activities of the Partnership in five areas:
7.6.1 Management control and governance
Specifically management control refers to ensuring that systems and processes
are in place to guide and control the work of the ADP by offering leadership and
direction, setting boundaries and ensuring activities are subject to review.
Governance sets this within a wider context, considering how the work of the
ADP is accountable to its partners, including Scottish Government, Dumfries
and Galloway Council, NHS Dumfries and Galloway and Third Sector partners.
Reference has already been made to the ADP Operating Arrangements which
underpin its structures, defining for example membership, chairing
arrangements, meeting arrangements and support arrangements as well as
outlining the ADP’s commitment to finance, performance, communication,
conduct and standards. These will be reviewed and updated where necessary to
reflect the new Programme / Project Management structures.
33
Office of Government Commerce (2010) Portfolio, Programme and Project Management
Maturity Model (P3M3®) Introduction and Guide to P3M3®. London: Office of Government
Commerce
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7.6.2 Finance and resource management
The ADP is committed to use all of its resources (including the financial
resources for which it is responsible) on the basis of good information (for
example; needs assessments and performance management information) to
ensure that those resources are targeted to activities which respond to the
greatest needs.
The ADP will operate within the financial frameworks of Dumfries and Galloway
Council and NHS Dumfries and Galloway, as well as having accountability to
national regulatory requirements including those of Audit Scotland.
Furthermore, the ADP is conscious of the need to align its Strategy development
with planning and commissioning processes. Though not formally responsible
for the procurement and commissioning of services, the ADP has a key strategic
role in ensuring that these functions are supported and informed at a strategic
level and that any subsequent contracts are monitored against outcomes and
targets which are relevant to this Strategy. Such an approach is entirely
consistent with the programme/ project management model, based on a three
yearly cycle.
7.6.3 Risk management
The ADP recognises the need to manage threats and opportunities which
present. These may emerge from developing trends and statistics, information
gathered from various engagement processes or from changes in local and
national policy.
This will require the ADP to develop systems for identifying those risks, thereby
minimising the impact of threats and maximising the opportunities. The
management of risk needs to become an embedded part of the ADP’s activities
and contribute to its decision making processes.
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7.6.4 Benefits (outcomes) management
Benefits management is the process designed to ensure that the desired
outcomes for the ADP are clear and measurable, as well as ultimately delivered.
There needs to be a clear understanding of how the outputs and activities of the
ADP will achieve results in terms of the long term benefits related to the two
strands of prevention and recovery, underpinning short term outcomes which
will improve the lives of those affected by substance misuse, and the longer
term vision of communities where alcohol and drug misuse are reduced to the
benefit of all.
7.6.5 Stakeholder engagement
Stakeholders at every level, within and outside ADP structures, need to be
engaged with effectively in order to ensure that decisions are well informed and
relevant. This includes an ongoing commitment to service user involvement,
engaging with families and carers, engaging with third sector and statutory
sector partners through the various structures and processes of the ADP and
ensuring that processes for engaging with the wider communities of Dumfries
and Galloway are improved.
This will be carried out through the use of a range of communication tools and
techniques, and will be done in accordance with National Standards for
Community Engagement and in compliance with the National Quality Standards
for Substance Misuse Services.
In order to ensure that the principles of continuous improvement are applied, for the
purposes of this strategy the five areas of work outlined above will be compressed into
three defined work-streams:
•
•
•
Benefits Management (Outcome Delivery);
Stakeholder Engagement;
Strategic Performance and Monitoring.
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This model 34 will enable the ADP to combine information from each of the three work
streams into reporting processes which in turn will support the overall monitoring and
evaluation of the work the ADP does.
34
The model is derived from work done by the Integrated Children’s Service Team, Dumfries and
Galloway Council.
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8
BENEFITS MANAGEMENT (OUTCOME DELIVERY)
This first stream adopts a broad project management approach, with a view to
delivering change, identifiable in real and measurable outcomes which contribute to the
benefits that the ADP as a whole will deliver.
8.1
Service Delivery Outcomes
A range of outcomes exist at different levels, as described in Appendix 1. Service
Delivery Outcomes, drawn from the Scottish Government’s Outcomes Toolkit 35 are
those benefits which are to be delivered by partners such as service providers,
specialist services, voluntary groups and others. The ADP will adopt a twin approach in
supporting the delivery of these outcomes.
Firstly there are some agencies which do not receive direct funding from the ADP. At
one level these organisations cannot be compelled to deliver particular outcomes.
However many do receive some form of government support and the ADP will work
with those commissioning and funding their activities to incorporate agreed outcomes
into service plans and agreements. Also there are many of the ADP’s partners
delivering statutory services including for example social work services and housing
services, where Tier 1, community focussed approaches could be encouraged to help
individuals to access treatment and support them more fully while in treatment. Not
only will this support the delivery of positive outcomes for those using their services, it
will also enable agencies to demonstrate their relevance and capability and express
their ability to deliver meaningful outcomes, which link clearly with local and national
strategies.
Then there are agencies which are directly funded by the ADP (whether statutory or
Third Sector). In agreeing to commission or fund these activities, the ADP will develop
a clear set of agreed outcomes, directly related to this Strategy. The delivery of these
outcomes will form part of the ongoing monitoring of contracts and service level
agreements. In the longer term, performance will have a bearing on decisions about
continued funding.
The rationale behind this approach is the need to maintain a balance between specific
and clear accountability for the outcomes which ADP funding should be achieving and
continuing to encourage innovation and change through a wider range of activities, but
at the same time offering a framework within which those activities can sit, and through
which partners can demonstrate their effectiveness.
Central to this will be the continuance of the ADP’s “Recognised Partners List” 36 which
invites application for membership from a broad range of partners, and supports the
implementation of National Quality Standards. Linked with this will be the development
of reporting tools which partners can use to demonstrate their outcomes and their
contribution to higher level outcomes at a regional and national level.
35
Scottish Government (2009) Delivering Better Outcomes: An Outcomes Toolkit for Alcohol and
Drugs Partnerships Version 1. Edinburgh: Scottish Government
36
Dumfries and Galloway ADP (2011) Recognised Partners List Documentation. Dumfries:
Dumfries and Galloway Alcohol and Drugs Partnership
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8.2
Future Priorities
The Needs Assessment and other studies also enable the ADP to begin to prioritise
how resources will be used, and beyond the development of core services (delivering
community rehabilitation, harm reduction, prescribing and detoxification outcomes) the
evidence of the needs assessment and other studies consistently indicate that the
following additional activities require further support and development:
Talking Therapies
Improved provision of “talking therapies” (including
psychology, Cognitive Behavioural Therapy, counselling and
mutual aid groups);
Housing
The creation of better links with housing services, including
housing providers, housing support and homelessness
services;
Families
More support for families and the involvement of families in
recovery activities;
Alternative Activities
Better access to constructive and diversionary activities;
Education and
Employment
Wider access to education, training and employability
opportunities.
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9
STAKEHOLDER ENGAGEMENT
The second stream is linked to the Scottish Government’s National Quality Standards
for Substance Misuse Services which place a clear duty on service providers, planners
and commissioners to ensure that service users and their families are at the centre of
the services that are offered to them. Standard Statement 10 is explicit in stating “The
service you receive has been designed with you, your family, and the needs of the
local community in mind.” Standard Statement 11 states, “Your views will be sought in
order to constantly monitor the type, delivery and development of services.”
In addition to the very specific direction from the National Quality Standards there are
other drivers for ensuring wide participation in the design and delivery of services. The
National Standards for Community Engagement are designed to “develop and support
better working relationships between communities and agencies delivering public
services.” 37 This is a crucial element of community planning processes, enshrined in
the Local Government in Scotland Act 2003.
In December 2007, the Scottish Government published a 5 year action plan for NHS
Scotland called “Better Health, Better Care: Action Plan”. 38 The primary focus was to
ensure that patients and members of the public are involved in their care at every level.
Of particular relevance is standard 2 “Involving people in service planning and
development” which requires that people are given the opportunity and necessary
support to be involved in the planning and development of NHS services. This was
reinforced in May 2010 with the “Healthcare Quality Strategy for NHSScotland” 39
establishing the need to listen to people’s views, ensuring that people were “at the
heart of the NHS.”
In Dumfries and Galloway the early work of the Service User Involvement group has
already contributed to these processes of engagement, facilitating the participation of
service users in the aspects of service redesign and in the commissioning of new
services. The person-centred approach to care and treatment enshrined in the ADP’s
values and the principles of recovery are not the responsibility of service providers
alone. It is incumbent upon the ADP to ensure that a wide range of service users’
views and perspectives are brought into planning and commissioning processes, along
with those of a broad constituency of stakeholders. Though there are clear benefits to
the ADP and its partners of involving service users, a key feature of the approach
taken to involve service users is that the individuals participating can also be involved
in training, in improving their personal and employability skills and developing greater
self awareness and confidence.
Throughout the life of this Strategy the ADP commits to further develop stakeholder
engagement, continuing to expand service user involvement as well as encouraging
the participation of a wide range of stakeholders, engaging more fully with the wider
population around issues of prevention and the need for a change in perceptions about
37
Scottish Executive (2005) National Standards for Community Engagement. Edinburgh: The
Scottish Executive
38
Scottish Government (2007) Better Health Better Care: Action Plan. Edinburgh: The Scottish
Government
39
Scottish Government (2010) The Healthcare Quality Strategy for NHSScotland. Edinburgh: The
Scottish Government
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alcohol and its place within Scottish society. This twin approach supports the two key
themes of this Strategy, prevention and recovery, and in particular supports the
delivery of a number of recovery and prevention outcomes which can be adopted by
individuals, groups and initiatives, including:
1. Service users have improved financial status and stability;
2. Service users have improved participation in meaningful activity;
3. Service users have improved employability status (e.g. moved into
employment / voluntary work);
4. Service users have an increased awareness of work/training opportunities
open to them;
5. Service users have improved engagement with education and training;
6. Service users have improved career aspirations;
7. Service users have an improved understanding of their rights and
responsibilities;
8. Increased knowledge of consequences and risks of alcohol consumption
and drugs use in participants of education programmes;
9. Improved and increased engagement of participants with age appropriate
social activity, positive lifestyle, community activities;
10. Fewer service users drink above recommended daily and weekly guidelines;
11. Improved engagement of participants with learning;
12. Improved parental and community engagement by service users;
13. Service users are fully involved and participate in planning for their own
sustainable recovery (i.e. a person centred approach is used).
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10
PERFORMANCE AND MONITORING
10.1 Supporting Structures
This third stream, combined with the other two, enables the ADP to demonstrate that
its partners have delivered the positive outcomes and impacts associated with the
funding and resources for which it has responsibility. This is more successfully
achieved when there are processes in place to support transparency and
accountability. A drive for quality improvement will enable the Partnership to address
the gaps identified in the Audit Scotland self assessment and the self assessment
designed by the Scottish Government’s National Support Coordinators.
To support this process the ADP will use the Office of Government Commerce
Management Self Assessment tool 40 (Appendix 3) which will enable the Partnership to
monitor effectiveness on the basis of five levels of “maturity”:
Level 1
Level 2
Level 3
Level 4
Level 5
there is very limited clarity and accountability around each of the
elements, systems are weak and ad hoc;
some aspects of accountability etc exist in pockets within the
organisation, based on key individuals, but there is no consistent or
cohesive approach across the organisation;
processes and controls are centrally defined, roles and responsibilities in
each area are clear and people are accountable;
processes exist which are well proven, and these underpin strategic
success across all areas;
there is strong evidence of excellent processes which result in
organisational excellence, with a commitment to continual improvement.
The organisation is a learning organisation.
This self assessment will be applied to all three of the ADP’s work streams:
•
•
•
Benefits Management (Outcome Delivery);
Stakeholder Engagement;
Strategic Performance and Monitoring.
To provide a baseline from which to measure improvement, the ADP will undertake a
full self assessment exercise. This will include the identification of areas which should
be monitored, which indicators should be used to demonstrate progress and where
responsibility rests for overseeing each area of work.
The commitment of the ADP is to achieve an average level of 4 across all of its
activities, thus ensuring a meaningful minimum standard of quality.
The benefits of using such a framework are:
40
Office of Government Commerce (2010) P3M3® - Programme Management Self Assessment.
London: Office of Government Commerce
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ADP Strategy 2011-2014
•
•
•
•
•
it supports the flexible approach envisaged, where new activities or initiatives
(projects) can be incorporated and measured in standardised ways for
quality and effectiveness;
it offers clarity and accountability;
it supports the ‘external’ outcomes which are central to the vision of the ADP
by ensuring that aspects such as financial management, risk management,
commissioning processes and needs assessment are routinely monitored;
it sits alongside the outcomes frameworks in Appendix 1, supporting partners
to demonstrate their strategic ‘fit’ within the ADP;
it can be incorporated into contracts and SLAs, supporting a project
management approach.
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ADP Strategy 2011-2014
11
PERFORMANCE PLAN
11.1 Performance Plan
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ADP Strategy 2011-2014
The Performance Plan draws together the three work streams and sets them into a
structure incorporating the various local and national mechanisms to which the ADP
has a connection and a degree of accountability, including the Dumfries and Galloway
Single Outcome Agreement (SOA).
11.2 Triangulating the evidence
The evidence gathered from each work stream can be used to corroborate or
contradict the evidence from other streams. This offers on one hand the possibility of
stronger evidence to support the claims of the Partnership or the case for continuing or
further developing a particular approach. On the other hand it may provide evidence of
weakness in particular areas which can inform improvement in performance or
decisions about the further commitment of resources.
Performance and Monitoring information will derive largely from the work of the ADP
support team and the strategic level information from ADP partners. Strategic partners
will be able to identify how their coordinated approaches combine to contribute to
effective change across the region through improved statistics and positive trends. This
gives an overall sense of the improvements in the quality and delivery of services and
activities, as well as the quality of the ADP’s work, including its financial management
and risk management.
The ultimate aim of an outcomes approach is to achieve positive impacts on, and
changes in, the lives of individuals, local communities and wider society. This is what
the bulk of the resources at the disposal of the ADP will be used for, and it is vital that
these ‘front line’ activities can demonstrate their positive contributions to outcomes at
different levels. These outcomes (described in Appendix 1) will be reflected in contracts
and agreements, enabling partners to demonstrate their effectiveness and value
through good quality Benefits Management information. A number of tools, templates
and frameworks are included in Appendix 2 to support this process.
The third area of evidence will emerge from the ADP’s commitment to Stakeholder
Engagement. For those using services, success will be measured in the attainment of
personal goals and progress towards recovery. Families will have views on the quality
of the services their partners, children or parents have received. Frontline workers will
have ideas and suggestions for improving their own practice and wider services.
Members of the public will have perceptions and views which may be helpful in shaping
responses that are more appropriate to their communities. Communication,
engagement and consultation can all provide useful qualitative information to support
the ADP’s planning and commissioning cycles.
Together this range of material allows the ADP to triangulate its information which
helps Partners to understand better the developing context within which they work. It is
not anticipated that all of the information would be available at the same time, but its
availability within the planning cycle described in Section 7 will allow for the preparation
of reports which relate to specific timed projects or annual reports relating to the overall
programme of the ADP as a Partnership.
This approach will apply to every aspect of the ADP’s activities and will underpin
annual planning and reporting processes, contributing to the vision of a region where
people are healthier, happier and safe
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12
KEY DOCUMENTS
Auditor General For Scotland (2009) Drug and Alcohol Services in Scotland.
Edinburgh: Audit Scotland
Bitel, M. (2009) Review of the Integrated Drugs Service in Dumfries and Galloway.
Edinburgh: Partners in Evaluation Scotland
Blake, G., Robinson, D. and Smerdon, M. (2006) Living Values. London:
Community Links
Delivery Reform Group (2008) Alcohol and Drugs Delivery Reform Group – Final
Report. Edinburgh: The Scottish Government
Department of Health (2007) Guidance on Joint Strategic Needs Assessment.
London: The Department of Health
Dumfries and Galloway ADAT (2008) Recognised Partners List Documentation.
Dumfries: Dumfries and Galloway Alcohol and Drug Action Team
Dumfries and Galloway ADAT (2006) Strategy 2006-2009. Dumfries: Dumfries and
Galloway Alcohol and Drug Action Team
Dumfries and Galloway ADP (2009) ADP Operating Arrangements. Dumfries:
Dumfries and Galloway Alcohol and Drugs Partnership
Dumfries and Galloway Adult Protection Committee (2010) Adult Protection
Strategy. Dumfries: Dumfries and Galloway Council
Dumfries and Galloway Community Safety Partnership (2009) Dumfries and
Galloway Community Safety Partnership Strategic Assessment 2009-2010.
Dumfries: The Dumfries and Galloway Community Safety Partnership
Dumfries and Galloway Council Integrated Children’s Service Team (2010)
GIRFEC Plan. Dumfries: Dumfries and Galloway Council
Dumfries and Galloway Strategic Partnership (2011) Single Outcome Agreement.
Dumfries: The Dumfries and Galloway Strategic Partnership
Irving, S. (2010) Dumfries and Galloway Alcohol and Drugs Partnership Needs
Assessment. Langholm: Sue Irving Ltd.
Irving, S. (2009) Lifebelt Business Case. Langholm: Sue Irving Ltd.
NHS Education for Scotland (2007) The 10 Essential Shared Capabilities for
Mental Health Workers. Edinburgh: NHS Education for Scotland
NHS Scotland (2009) NHS Scotland HEAT Performance management system
2009-10. Edinburgh: The Scottish Government
Office of Government Commerce (2010) Portfolio, Programme and Project
Management Maturity Model (P3M3®) Introduction and Guide to P3M3®. London:
Office of Government Commerce
Office of Government Commerce (2010) P3M3® - Programme Management Self
Assessment. London: Office of Government Commerce
Pleace, N. (2008) Effective Services for Substance Misuse and Homelessness in
Scotland: Evidence from an International Review. Edinburgh: Scottish Government
Social Research
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Scottish Executive (2003) Getting our Priorities Right, Good Practice Guidance for
working with Children and families affected by Substance Misuse. Edinburgh: The
Scottish Executive
Scottish Executive (2006) National Quality Standards for Substance Misuse
Services. Edinburgh: The Scottish Executive
Scottish Executive (2005) National Standards for Community Engagement.
Edinburgh: The Scottish Executive
Scottish Executive (2007) Plan for action on alcohol problems: update. Edinburgh:
The Scottish Executive
Scottish Executive (2006) The Report of the 21st Century Social Work Review.
Edinburgh: The Scottish Executive
Scottish Government (2007) Better Health Better Care: Action Plan. Edinburgh:
The Scottish Government
Scottish Government (2009) Changing Scotland’s Relationship with Alcohol: A
Framework for Action. Edinburgh: The Scottish Government
Scottish Government (2009) Delivering Better Outcomes: An Outcomes Toolkit for
Alcohol and Drugs Partnerships Version 1. Edinburgh: The Scottish Government
Scottish Government (2010) National Guidance for Child Protection in Scotland
2010. Edinburgh: The Scottish Government
Scottish Government (2010) NHS Performance Targets. Edinburgh: The Scottish
Government http://www.scotland.gov.uk/Topics/Health/NHSScotland/17273/targets (accessed 23/08/2010)
Scottish Government (2010) Protecting Vulnerable Groups Scheme Guidance for
individuals, organisations and personal employers. Edinburgh: The Scottish
Government
Scottish Government (2010) The Healthcare Quality Strategy for NHSScotland.
Edinburgh: The Scottish Government
Scottish Government (2008) The Road to Recovery. Edinburgh: The Scottish
Government
Scottish Government and COSLA (2010) Supporting the Development of
Scotland’s Alcohol and Drug Workforce. Edinburgh: The Scottish Government and
Convention of Scottish Local Authorities
Scottish Intercollegiate Guidelines Network (2003) The management of harmful
drinking and alcohol dependence in primary care. Edinburgh: Royal College of
Physicians
Scottish Ministerial Advisory Committee on Alcohol Problems (2011) Quality
Alcohol Treatment and Support (QATS). Edinburgh: The Scottish Government
South West Scotland Community Justice Authority (2011) Working in partnership to
reduce re-offending (Area Action Plan 2011-14). Irvine: The South West Scotland
Community Justice Authority
STRADA (2007) Getting our priorities right inter-agency protocol: Working with
children and families affected by drug and/or alcohol misuse. Glasgow: Scottish
Training on Drugs and Alcohol
UK Drug Policy Commission (2008) A Vision of Recovery. London: UKDPC
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13
APPENDICES
13.1 Appendix 1 – Outcomes
The outcomes can be described as a series of layers, with each level contributing to
the level above.
National Outcomes and Targets relating to substance misuse
These are changes envisaged as a result of Government investment, and the delivery of national policy which
are long term, impacting on wider society and measurable at a national level.
2.
4.
5.
6.
7.
8.
9.
Economic potential;
Young people successful learners;
Children get the best start in life;
Longer, healthier lives;
Tackled inequalities;
Improved life chances of those at risk;
Lives safe from crime, danger &
disorder;
11. Strong, resilient communities.
HEAT Targets
H4 - Achieve agreed number of screenings and
alcohol brief intervention, by 2011/12;
A11 – By March 2013, 90% of clients will wait no
longer than 3 weeks from referral received to
appropriate drug or alcohol treatment that
supports their recovery.
High level Outcomes
These have an impact at an area level, and can
be measured by analysing trends and statistical
changes across the whole region.
‐ Reduced Drug & Alcohol related deaths;
‐ Reduced Drug & Alcohol related crime;
‐ Better employment and education outcomes;
‐ Improved outcomes for children;
‐ Safer families and communities.
Dumfries and Galloway Single Outcome Agreement Priorities
Priorities in bold indicate those with specific links to alcohol and drug misuse and ADP Outcomes.
Priority 1 - We will provide a good start in life for all our children;
Priority 2 - We will prepare our young people for adulthood and employment;
Priority 3 - We will care for our older and vulnerable people;
Priority 4 - We will support and stimulate our local economy;
Priority 5 - We will maintain the safety and security of our region;
Priority 6 - We will protect and sustain our environment.
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Seven Core Outcomes
1.
Health
2.
Prevalence
3.
Recovery
4.
CAPSM
5.
Community
Safety
6.
Local
Environment
7.
Services
People are healthier and experience fewer risks as a result of
alcohol and drug use;
Fewer adults and children are drinking or using drugs at levels or
patterns that are damaging to themselves or others;
Individuals are improving their health, well-being and life chances by
recovering from problematic alcohol and drug use;
(Children Affected by Parental Substance Misuse)
Children and family members of people misusing alcohol and drugs
are safe, well supported and have improved life chances;
Communities and individuals are safe from alcohol and drug related
offending and anti-social behaviour;
People live in positive, health-promoting local environments where
alcohol and drugs are less readily available;
Alcohol and drugs services are high quality, continually improving,
efficient, evidence based and responsive, ensuring people move
through treatment into sustained recovery.
ADP Strategic Partners’ Outcomes
These are measured on an area wide basis, but are more directly linked to the services or activities of ADP
Partners including Social Work, Health, Education, Police, Third Sector.
1. Increased number of children in touch with services living in supportive and stable
households/ safe environments;
2. Increased participation in community activities for children affected by parental
substance misuse;
3. Improved school attendance and attainment in children affected by parental substance
misuse and in touch with service;
4. Reduced availability of alcohol;
5. Reduced alcohol and drug related violence and offences;
6. Reduced drug dealing in local area;
7. Fewer individuals drink above recommended daily and weekly guidelines;
8. Reduced mean per capita consumption;
9. Reduced acceptability of hazardous drinking and drunkenness;
10. Increased knowledge and changed attitudes to alcohol, drinking and drugs;
11. Reduced consumption in those below minimum legal purchase age;
12. Fewer women drinking/taking drugs during pregnancy;
13. Individuals in need receive timely, sensitive and appropriate support;
14. Reduction in drug use in local area;
15. Reductions in offending and re-offending associated with alcohol and drug misuse.
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Service Delivery Outcomes
Outcomes
linked to
recovery
•
•
•
•
•
•
•
•
•
Outcomes
linked to
prevention
1.
2.
3.
4.
5.
6.
Outcomes
linked to
children
1.
2.
3.
4.
5.
6.
7.
8.
Outcomes
linked to
enforcement
1.
2.
3.
4.
5.
Services make appropriate referrals to other support or treatment services when required and as
appropriate
Service users reduce chaotic or risky behaviour
Drugs
Service users stop drug misuse
Service users reduce drug use
Service users reduce drug related harm
Alcohol
Service users stop drinking alcohol
Service users reduce amount of alcohol drunk
Service users reduce alcohol related harm
Health
Service users have improved/no deterioration in health
Mental health
Service users have improved/no deterioration in mental health
Service users have increased self-awareness
Service users have increased confidence/self esteem
Social
Service users have improved/no deterioration in social functioning/personal relationships
Service users are more involved/included in their community
Finance and employment
Service users have improved financial status and stability
Service users have improved participation in meaningful activity
Service users have improved employability status (e.g. moved into employment /
voluntary work)
Service users have an increased awareness of work/training opportunities open to them
Service Users have improved engagement with education and training
Service Users have improved career aspirations
Service users have an improved understanding of their rights and responsibilities
Accommodation
Higher proportion of service users are living in safe, settled and appropriate (supported
and non-supported) accommodation
Increased knowledge of consequences and risks of alcohol consumption and drugs use in
participants of education programmes
Improved and increased engagement of participants with age appropriate social activity, positive
lifestyle, community activities
Fewer service users drink above recommended daily and weekly guidelines
Improved engagement of participants with learning
Improved parental and community engagement by service users
Service users are fully involved and participate in planning for their own sustainable recovery (i.e.
a person centred approach is used)
Improved parenting skills of service users
Increased identification and assessment of children affected by parental substance misuse
Increased number of children in touch with services living in supportive and stable
households/safe environments
Increased number of children in touch with services having positive relationships with their
substance misusing parents
Increased participation in community activities for children affected by parental substance misuse
Increase in children using services’ self confidence, allowing them to be more resilient in their
situation
Increased recognition by parents in touch with services of the impact of their substance use on
their children
Improved school attendance and attainment in children affected by parental substance misuse
and in touch with services
Increase in the enforcement of current legislation
Managers and staff have increased knowledge of their legal obligations
Supply chain of drugs in local area disrupted
Increase in confiscation (seizure) of drugs and assets
Reductions in offending and re-offending associated with alcohol and drug misuse
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ADP Draft Strategy 2011-2014
13.2 Appendix 2 – Templates, Tools and Frameworks
Example - Linking High Level Outcomes with Service delivery outcomes
The planning template would normally be used at a planning level or in a project context, to enable individual partners or groups of partners to
demonstrate their contribution to and links with a range of national and other high level outcomes. The example describes part of the planning
process for recovery focussed service development, describing the desired outcomes, how these link upward to higher level outcomes and
targets, as well as outlining the resources which would be required and the indicators which are available to evidence progress towards
achieving the general outcome.
The commissioning/ contract template would be used to establish the outcomes associated with a formal contract or Service Level Agreement.
The outcomes and indicators (columns 3 and 4) would be established by commissioners/ funders, based, for example, on service user and
strategic priorities. The activities and outputs (columns 1 and 2) would be largely developed by the provider, defining approaches and methods
which utilise the available resources and capacity. Measurement (column 5) would be negotiated and agreed between commissioners/ funders
and providers including targets, numbers etc and the means of collecting data or evidence.
The third template is an example of a template used to support a small, short term pilot project, involving a range of partners, but focussed on
a specific activity, in this case supporting and facilitating contact with services (by making appropriate referrals) for hard to reach groups,
particularly people experiencing homelessness and other forms of social exclusion. As the initiative is a pilot, targets are less defined, as the
focus is on gathering evidence of demand for such an approach, and assessing the methods employed.
The fourth template is an example of how to monitor community focussed/ Tier 1 prevention and public engagement activities.
Supporting these templates the ADP has a series of frameworks, linking the Scottish Government National Outcomes Toolkit with distinctive
areas of delivery, including Children and Young People, Enforcement & Availability, Public Engagement and Recovery. There is also guidance
on linking higher level (ADP Strategic Partners Outcomes (see above)) with the national toolkit.
All frameworks are available on www.dgadp.com
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Planning template for recovery focussed services
National / High level
Outcomes and / or
targets
SOA Priority/
Seven Core
Outcomes
ADP Strategic
Partners Outcomes
Reach
Outputs
Activities
Inputs
6. Longer healthier lives
7. Tackled inequalities
8. Improved life chances of those at risk
Priority 3 - We will care for and support older and vulnerable
people
HEAT target - A11
3. Recovery - Individuals are improving in their health ...
7. Services - people move through treatment into sustained
recovery ...
Services make appropriate referrals to other support or treatment services when required and as appropriate
Core services available on open access basis, so potentially anyone in the population experiencing
alcohol of drug problems.
ADP will ensure the availability of up to date/ accurate information
ADP will ensure that the following are in place (and adhered to):
- clear referral policies (including agreed frameworks/ timescales and referral pathways into
shared care);
- protocols for sharing information will be in place;
- clear understanding of HEAT targets and waiting times frameworks;
- Monitoring information and systems are agreed as part of contracts/ SLA’s.
Services will ensure that all staff are adequately trained and supported to administer the above
functions.
ADP support team to compile from available sources (online, SDF etc) a list of all available services
and ensure its distribution;
All policies protocols to be adhered to in the course of service delivery, including all referrals being
received / made within agreed timescales;
All information will be delivered as required, using the agreed tools and fulfilling all local and national
expectations.
ADP resources, including:
- funding for Integrated Drug and Alcohol Services (statutory and third sector);
- funding for additional services (including talking therapies, moving on services, where
resources allow);
- Support through contract monitoring processes;
- officer support re waiting times, HEAT, and other monitoring requirements.
Indicators
Information about all
services is readily
available
Number of referrals to
other agencies
% assessed as in need of
services after 12 months
% of service users moved
on to other services
% of service users who
return within 3/6/etc
months
% of service users who
are happy to move on
from service/planned
discharges
Notes
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ADP Draft Strategy 2011-2014
Commissioning/ contract template for recovery focussed services
(Example only, based on Camden Council - Sustainable Commissioning Model)
1. Activity
2. Outputs
3. Service Outcomes
4. Possible Indicators
Services make appropriate referrals to other
support or treatment services when required and
as appropriate
-
Service users reduce chaotic or risky behaviour
-
Drugs
•
Service users stop drug misuse
•
Service users reduce drug use
•
Service users reduce drug related harm
-
Alcohol
•
Service users stop drinking alcohol
•
Service users reduce amount of alcohol
drunk
•
Service users reduce alcohol related harm
-
Information about all services is readily
available
Number of referrals to other agencies
% assessed as in need of services after 12
months
% of service users moved on to other
services
% of service users who return within 3/6/etc
months
% of service users who are happy to move
on from service/planned discharges
% of those referred that have stopped
substance use
% of those referred that have reduced
substance use
proportion of intravenous drugs users
reporting sharing needles
proportion of intravenous drugs users
routinely using needle exchange services
% of those referred that have stopped
substance use
% of those referred that have reduced
substance use
% of service users that protect themselves
from Blood Borne Viruses (BBV)
% of Service users with BBV that participate
in appropriate treatment
proportion of intravenous drugs users
reporting sharing needles
Number of drug related deaths and/or drug
related overdoses
% of those referred that have reduced
substance use
% of those referred that have stopped
substance use
5. Ways of measuring
e.g.
Contract Monitoring
Outcomes Star
national data
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ADP Draft Strategy 2011-2014
Outcome and monitoring template for recovery focussed pilot project/ small service
(based on Dumfries “Drop-in” service operated by Bethany Christian Trust)
High Level
Outcomes
Intermediate
(ADP) Outcomes
Short-Term
(service)
Outcomes
Reach
Outputs
Activities
Inputs
6. Longer healthier lives
7. Tackled inequalities
8. Improved life chances of those at risk
SOA Priority 3 - We will care for and support older and vulnerable people
Core 3. Recovery - Individuals are improving in their health ...
Core 7. Services - people move through treatment into sustained recovery ...
i. Reduction in drug use in local area
ii. Individuals in need receive timely, sensitive and appropriate support
iii. Increased knowledge and changed attitudes to alcohol, drinking and drugs
Service users
Services make
Improved
Service user have Service users have
Service users
Higher proportion
reduce chaotic appropriate
engagement of
improved / no
improved / no
have improved/
of service users
or risky
referrals to other participants with
deterioration in
deterioration in
no deterioration
are living in safe,
behaviour
treatment
learning and have
health
mental health
in social
settled and
(drugs &
services
improved
… increased self
functioning
appropriate
alcohol)
understanding of
awareness
accommodation
rights and
… increased
responsibilities
confidence/ self
esteem
Service available on a direct access/ drop-in basis to anyone experiencing homelessness in Dumfries and Galloway aimed at offering a
service user centred, integrated approach to tackling homelessness, substance misuse and other issues experienced by people who
are homeless
Maximum capacity per session is ….
Target to attain an average attendance of 90% of capacity
4 partner agencies will make use of consulting room and other facilities/ opportunities
Target to attain average of 10 service users taking up opportunistic contact with partner professionals each month
To ensure that 100% of regular volunteers have received full induction training within the first six months
To ensure that 50% of regular volunteers can evidence additional training within the first six months (e.g. counselling skills, alcohol/
drug awareness, mental health awareness, BBV training etc)
To provide a healthy meal and warm, safe, welcoming environment
To provide washing, showering and laundry facilities
To offer one to one contact with trained staff and volunteers
To provide confidential consulting/ interview rooms for use by professionals from partner agencies
To facilitate networking and partnership opportunities formally and informally for staff and volunteers from across a range of agencies
Public Health (BBVMCN) - £10,000
ADP - £10,000
Christian Care for the Homeless - £5,000
Bethany Christian Trust – Management costs, start up costs, training, publicity, fund raising, Volunteer Hours - Approximately 15 hours per
session
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Outcome Template for community/ Tier 1 prevention/ public engagement activities
(based on ADP funded community activities, 2010)
Improved health and well being. Reduced incidents of drink driving, alcohol fuelled violence & alcohol related injury. Reduced inequalities in healthy life expectancy. High Level
Outcomes
BEHAVIOUR Reduced alcohol consumption levels. Reduced drunkenness, less drink driving etc Intermediate
outcomes
Short-term
outcomes
Reach
Outputs
Activities
Inputs
Reduction in local drink driving figures Awareness of safe & healthy options Awareness of campaign messages Safer & more co‐
ordinated practice Drivers within groups of customers accessing licensed premises NHS staff, key partners & volunteers at local level who may deliver on alcohol Creation of merchandise Count & report uptake ENVIRONMENTS Physical: reduced exposure to alcohol hazards Social: drunkenness less attractive: sensible drinking the norm Awareness of responsibilities of being a driver. Consequences of loosing licence Access to alcohol free events Reduce youth drinking Local staff & community Young people drinking by cascading knowledge
on the streets. & skills around alcohol Parents of underage misuse issues drinkers. Young Learner drivers through local academies. Events attended by approx 100 young people Distribute SG Folder & Pink Handbags Highlight key issues 2 sessions delivered to groups of 15 people – still ongoing Monitor & evaluate 3 afternoon sessions over 3 weeks delivered Culminating award ceremony 2 events delivered at the Oasis youth centre Evaluation positive SPENT £500 SPENT £1400 SPENT £3500 Carried out sessions over a two week period. Refer young people to school nurse or services SPENT £2000 SPENT £300 SPENT £500 SPENT £500 Support 12 local premises to promote free soft drinks to the driver in a group Raise awareness to key staff & partners of female drinking messages for consistent delivery Female Binge Drinking Campaign Support Work in partnership with ADAT & STRADA to deliver Basic Alcohol Training courses Alcohol Awareness Training Support the local Police operation in tackling underage drinking Deliver key alcohol workshop relating to driving safety Work in partnership to deliver alcohol free events & key health messages Operation Bibedo Young Drivers Scheme Bluelight Event Work in partnership with ADAT & STRADA to deliver Basic Alcohol Training Alcohol Awareness Training I’ll be DES. Awareness of alcohol messages & own drinking choices. Consistent delivery. Reduction of risk to local young people. Parents awareness raised of issues Annandale & Eskdale Awareness of alcohol messages & own drinking choices. Local staff & community by cascading knowledge & skills around issues
2 sessions delivered each to 15 people – still ongoing Monitor & evaluate Dumfries & Lower Nithsdale Version # 5.0 Updated on 20/05/2011
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13.3 Appendix 3 – Performance Monitoring Tools
Annual Action Plan Template (Example only)
Management Control and Governance
Indicative Maturity Level Level 4 attained Y/N What will be done
Why it matters
Indicators
Resources required
Responsibility
Y1
Y2
Y3
Review of ADP governance
arrangements (including
membership)
Transparency in all decision
making process
Finance & Resource Management
Financial commitments of all
partners identified and agreed
at least annually
Standardised Commissioning /
procurement framework in
place
Review of NHS Specialist Drug
and Alcohol Service, including
development of outcomes
based SLA
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ADP Draft Strategy 2011-2014
PRINCE2® Maturity Model (P2MM) Maturity Level self assessment template (adapted)
Maturity Level
Benefits
Management
(Outcome
Delivery)
Performance and Monitoring
Stakeholder
Engagement
Risk
Management
Management
Control and
Governance
Finance and
Resource
Management
Level 5 Optimised
Start, end, route, process optimising, business process ownership,
integrated with strategic direction, lessons learned being applied,
continual improvement, common good for the organisation, seamless
and automatic, sustained, value based behaviour, evidence based
management, innovation
Level 4 Managed
Integration with corporate governance and functions, accurate
information, statistical analysis, competent & qualified staff,
assurance in place, business capacity management, exec board
level ownership, mentors, process management, strategic planning
alignment, approaches reviewed, consistent behaviour, quantitative
approach to management, collaboration, adapting
Level 3 Defined
Organisational wide consistency, process ownership, standards in
place (e.g. roles and responsibilities), processes defined with inputs
and outputs, central control group, consistent use of tools, guidelines
on how to do it, system framework, governance clearly defined,
capable staff, configuration system, evidence of Subject Matter
Experts, good communications and collaboration, strategic planning
links, perceptive approach to management, flexing
Level 2 Repeatable
Locally evolved, acknowledged approach, templates, ad-hoc training,
islands of expertise, initiatives delivered in isolation, minimal evidence
of continual improvement, simple activity based plans, focus may be
on start up and initial documentation, evidence of heroes, weak inter
working
Level 1 Recognised
Undocumented, basic vocabulary (not necessarily aligned or
consistent), no guidelines and supporting documentation. Any system
is ad-hoc and uncontrolled.
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ADP Draft Strategy 2011-2014
Please contact the ADP Support Office on
01387 244351
to make arrangements for translation or for
the provision of information in larger type,
British Sign Language or on audio tape.
Version # 5.0 Updated on 20/05/2011
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