Nottingham City Substance Misuse Treatment System Consultation
Stage one: June 2015
Summary
Nottingham City Council and Nottingham Crime and Drugs Partnership (CDP) are re-commissioning
the substance misuse treatment services that serve local people who are affected directly or
indirectly by substance misuse. We are consulting with a partners; service providers and service
users in the design of a service model. The purpose of this document is to provide a brief
background to the substance misuse treatment system; and the vision and expected outcomes of a
new model for delivering the services.
Context and Background
We are aiming to have the new substance misuse treatment services model and pathway in place by
1st July 2016. The final model will be subject to widespread consultation and confirmation of budgets
for 2016-17.
Since 2013 the CDP has broadened its commissioning portfolio. It now has funding from Public
Health (local Authority), Clinical Commissioning Group and the Police and Crime Commissioner, all of
whom have their own responsibilities and duties to be addressed.
Financial constraints will have an impact on the design of the treatment models and pathway but the
CDP is committed to ensuring that service users are not affected in the treatment they deserve. We
will be considering current duplication of interventions and also where co-commissioning can deliver
the best results for service users. We will also consider the service user journey and try to reduce the
need to be in more than one service.
Vision
The vision for the new model is a treatment system that delivers the best possible quality and
standards of care, maximising numbers achieving a substance free lifestyle and recovery from
substance misuse.
High quality treatment will need to be delivered within the available budget in a challenging
economic climate.
Objectives:
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Maximise the number of service users who achieve recovery
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Reduce the harm to individuals and families (including vulnerable groups) as a direct or
indirect result of substance misuse; including supporting those for who recovery is not yet
an option
Ensure service users are at the heart of the treatment system and their own recovery
journey
Provide treatment and support that is:
o Able to intervene early through identification, training and screening
o Easily accessible and easy to navigate
o Joined up – for those with poly-substance problems
o Evidence based but with freedom for expert clinically-led innovation
o Cost effective and delivering value for money
What is substance misuse treatment?
A range of brief and structured substance misuse treatment interventions including psychosocial and
prescribing based interventions are required within any local treatment system. For those who are
unable or unwilling to stop using substances, harm reduction policies, programmes and practices are
put in place with the aim of reducing harm to these people and those around them as they continue
to use drugs. Interventions to specifically reduce the health harms of drug use (such as needle
exchange and health promotion) are required and protect the wider community. Access to inpatient
and residential rehabilitation should be available for those clients who need it.
Delivering effective substance misuse treatment has a wide range of positive outcomes for
individuals, families and communities including reducing reoffending and antisocial behaviour, and
reducing health harms and improving health. Substance misuse treatment also delivers value for
money: For every £1 spent on substance misuse services, at least £4.70 is gained in health and crime
benefits.
The holistic needs of each client should be met through treatment and a personal package of care
should be developed following a full assessment of need. As well as addressing substance misuse a
successful treatment intervention will support clients to rebuild their recovery capital by addressing
physical and mental health, employment, training and education, housing and relationships.
Treatment will focus on each client as an individual with the therapeutic relationship between the
clinician and client being central. Treatment should also consider the impact of substance misuse on
others – in particular children and other vulnerable adults, and the wider community.
Treatment should be provided in line with national guidance such as Drug Misuse and Dependence:
UK Guidelines on Clinical Management (Department of Health) and NICE guidelines and the Drug
Strategy 2010.
Assessing the needs of the local population
In Nottingham there are an estimated 10,687 dependant drinkers, 14,965 increasing risk drinkers,
and 35,571 binge drinkers. Nottingham citizens drink to more dangerous levels prior to accessing
structured treatment compared to England as a whole; and yet only approximately 12% of the
estimated number of citizens appropriate for some form of treatment actually access structured
treatment. 60% of Hospital re-admissions are alcohol related.
It is estimated that approximately 2% (6,260) of Nottingham’s population might require drug
treatment. Nottingham City has an ageing cohort of heroin and crack cocaine users who have
multiple and/or complex needs. Since August 2014 there has been a slight but consistent increase in
the number of new heroin and crack users entering treatment, which is the greatest rate of increase
for two years.
New/Novel Psychoactive Substances (commonly known as ‘legal highs’) present a new challenge to
treatment provision; a significant gap in knowledge around the use of New/Novel Psychoactive
Substances and longer term effects exist.
The majority of young people in Nottingham City do not use drugs and those that do are not
presenting as substance dependent. However where substance misuse does exist there is a
considerable risk to an individual’s health, education, relationships and long-term chances in life.
Young people in treatment in Nottingham City are more likely, compared to the England average, to
have mental health problems; are more likely to self-harm; be involved in offending; and be out of
education, employment and training.
One third of clients in treatment have a child living with them which underpins the need for family
interventions.
Employment and economic activity, recognised as integral to sustained recovery, is low amongst the
substance misuse cohort in Nottingham compared to the national standard.
Accommodation needs are higher in Nottingham compared to the England average.
It is estimated that 40% of drugs users have coinciding psychiatric disorders and 37% of alcohol
clients in treatment are simultaneously receiving care from mental health services. Clients currently
accessing treatment through our main drug treatment service reveal a high level of complexity
within the treatment caseload; nearly half having mental health issues, over a third having complex
physical needs and more than a quarter having safeguarding practices in place.
Clients in Nottingham are more likely to successfully complete drug treatment compared to
nationally.
The Case for Change
The drivers for change include:
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The contracts for several large core substance misuse services come to an end in 2015/16.
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A reducing budget available for substance misuse services year on year from 2014/15 to
2015/16. It is likely that the current economic climate will continue to have an impact and it
may be necessary to look for further efficiencies within the new treatment system model.
Doing things differently – changes in funding streams and the alignment of all substance
misuse commissioning within the CDP provide the opportunity to look at the consolidation
and alignment of the full range of services and pathways for substance misusers for the first
time. This might be an opportunity to improve the service user experience and increase the
effectiveness of the substance misuse treatment.
It is essential that future services are modelled on the best available evidence; including national and
local best practice and the intelligence we have about substance misuse amongst the population of
Nottingham City.
Alongside the National and local evidence extensive efforts will be made to seek the views and
expertise of the public, service users and beneficiaries, and key stakeholders and partners. We will
also seek the views and knowledge of current service providers to understand the complexities of
the service user cohort. The findings of these consultations will inform the development of the new
model to deliver the necessary and appropriate interventions to the caseload.
What is in and out of Scope?
In scope:
The full substance misuse treatment system is potentially in scope during the consultation phase.
This means the following areas of the treatment system are currently being considered:
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Community drug treatment
Community alcohol treatment
Criminal justice community based treatment
Young people’s substance misuse treatment
Family support
Inpatient provision
Hospital liaison
Out of Scope:
The following services are currently out of scope as they are not the commissioning responsibility of
the CDP:
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Child & Adolescent Mental Health Service
Dual Diagnosis
Consultation Process
There will be two stages of consultation via questionnaire, both aiming to reach as wide an audience
as possible:
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Stage one consultation is planned to take around four weeks and run from 1st June to 29th
June
Stage two is anticipated to run for three weeks in September 2015.
Focus groups may also be established and used if a need is identified.
Consultation questionnaires will be open to services users, service managers and staff, partner
stakeholders, voluntary sector services, family and carers and the general public
This is stage one of the consultation process and it is primarily focused on obtaining feedback on
potential new models.
The CDP will also be undertaking market development activities in June and July and this will include
one-to-one meetings with providers. This is a separate process to the wider consultation being
undertaken and providers are encouraged to engage in both processes.
All responses from the first stage of consultation and market development activities will be taken
into account and will inform the development of the new treatment system model. The final model
will be consulted on in detail in stage two.
Advice on completing the questionnaire:
This questionnaire is aimed at a wide range of individuals and groups, including service users and
their families, current service providers, commissioners in other areas, partner agencies and
Nottingham citizens. Therefore it is likely that at least some of the questions may not be relevant or
of interest to you. If there are some questions you don’t want to answer then you can leave them
blank: you can complete as much or as little of the questionnaire as you like.
Your response to this questionnaire is completely anonymous and we won’t share your returned
questionnaire with anyone. Any information from questionnaires used in reports or documents will
be anonymised and will not be identifiable to any individual. You can leave your contact details if you
are interested in being involved in further consultation opportunities.
Respond from your experience, whether that is as a service user, a worker within treatment services,
someone who has referred people into treatment, or as someone affected by the substance use of
someone else (for example a family member).
The questionnaire contains six potential models and asks questions which refer specifically to these
potential models.
Please note that the final model will take account of all consultation and other findings from the
design stage. Therefore the final model may end up combining different elements of the options
presented in this consultation document. The final model will be consulted on in stage 2.
If you require a paper copy please contact 0115 876 5656 or email cdp@nottinghamcity.gov.uk and
return to:
Freepost RSKR-JYGH-YYAK
Communication and Marketing (CDP)
Nottingham City Council
Loxley House
Station Street
Nottingham
NG2 3NG
If you need help completing your questionnaire please contact 0115 876 5656 or email
cdp@nottinghamcity.gov.uk
If you need the questionnaire in a different format or language we will do our best to accommodate
your needs, please contact the CDP using the contact details above.