Midlothian and East Lothian Drugs and Alcohol Partnership Annual Report

Transcription

1 Midlothian and East Lothian Drugs and Alcohol Partnership Annual Report -15 Document Details: ADP Reporting Requirements Partnership Details 2. Self-Assessment 3. Finance Framework 4. Performance Framework 5. ADP & Ministerial Priorities Appendix 1 Guidance Notes and Commissioning Diagram 1

2 1. PARTNERSHIP DETAILS Alcohol and Drug Partnership Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP) ADP Chair Eibhlin McHugh (Director, Midlothian Health and Social Care Partnership) Contact name(s) see note 1 Martin Bonnar Contact Telephone Date of Completion 28 th August 2015 Date Published on ADP website(s) 15 th September 2015 The content of this Annual Report has been agreed as accurate by the Alcohol and Drug Partnership, and has been shared with our Community Planning Partnership/Integration Joint Board through our local accountability route. MELDAP Chair The Scottish Government copy should be sent for the attention of Amanda Adams to: Alcoholanddrugdelivery@scotland.gsi.gov.uk 2

3 2. ADP SELF-ASSESSMENT 1 APRIL 31 MARCH 2015 ANALYSE Please evidence your ADPs analysis activities/progress Theme Evidence see note 2 1 ADP Joint Strategic Needs Assessment has been undertaken and provides a clear, coherent assessment/analysis of need, which takes into consideration the changing demographic characteristics of people (and their families and local communities) affected by problem drug and/ or alcohol use in your area. Please state when this was undertaken and when it is next planned. Please also include here any local research that you have commissioned e.g. hidden populations, alcohol related deaths. See Note 3 MELDAP have commissioned three independent Needs Assessments. These are: 1] Needs Assessment Drugs and Alcohol Problems in Midlothian and East Lothian (Figure ) 2] Small Area Estimates for Health Related Behaviours (Ipsos MORI 2011) 3] Assessment of Need of Services for Children and Families Affected by Parental Substance Misuse [CAPSM] (Create Consultancy ) In relation to the CAPSM Needs Assessment, there has been agreement with universal services [including Council service] to implement the recommendations in the report. This includes assessing opportunities for joint commissioning. MELDAP engaged Macmillan Rome Consultants to undertake a horizon literature and research review, consultation and development of options appraisal for the Strategic Group to consider. The active participation of service users and involvement of service managers was central to this process. This led to a report Building a Recovery Oriented System of Care to Support Recovery Communities in Midlothian and East Lothian accepted by the MELDAP Strategic Group in September [provided in last year s report] There are elements of assessment of need within the report. Specifically, MacMillan Rome held focus groups in East Lothian and Midlothian. The researcher used discussions and development of Recovery Maps to assist members of the focus groups to articulate what they assessed as important elements for recovery in Midlothian and East Lothian. 3

4 This information confirmed that people in recovery needed much more than specialist support and treatment. Activities for daily living feature high on a list of priorities for this group. Therefore MELDAP needed to ensure that there were far stronger connections to community based activities in local towns and villages. It was also clear that carers and family members affected by others substance misuse also needed support to assist recovery. This group have been encouraged to fully participate in the development of two Recovery Cafe s [Horizons in Midlothian and Starfish in East Lothian]. A total of 122 women completed the Pink Ladies self-management courses [funded by MELDAP] These women have all experienced mental health/substance misuse difficulties and/or are carers of substance misusers. MELDAP have more than doubled the level of funding provided by (VOCAL) to family members and carers. The report recommended the development of a Recovery Network in Midlothian and East Lothian supported and financed [in its start up phase] by MELDAP. The Network s primary function as a co-ordinating body will be established to nurture, support and develop an ethos of recovery amongst individuals in recovery, their families and the wider community. The Network is not be a service provider; it would be a proactive and reactive recovery champion, linking with current recovery assets such as recovery cafes, peer mentors and mutual aid groups and explore broader community assets and new resources that can be utilised to promote recovery. The MELDAP Strategic Group agreed to this proposal and work started in May 2015 to establish the Recovery Network. The initial phase of work includes connecting with people who run and/or use the two Recovery Cafes. This has led to a number of individuals becoming involved in the development of a Recovery Network Group. MELDAP plan to undertake a re-assessment of need, similar to the one completed in 2010, from March 2017 to inform our next ADP Delivery Plan 2018/20. 2 An outcomes based ADP Joint Performance Framework is in place that The MELDAP Delivery Plan was structured around four thematic areas: 1] Preventing future harm caused by the misuse of alcohol and drugs 2] Reducing harm and promoting recovery 4

5 reflects the ADP Local Outcomes and the National Core Outcomes. See note 4 3] Protecting and safeguarding children, young people and communities 4]Commissioning and assuring high quality, cost effective recovery focused services There were linked outcomes identified for each of these four areas. These outcomes were aligned with the 2 Local Authority Single Outcome Agreements and the 7 National Outcomes for ADPs. Services submit an annual performance report which provides data and a narrative for these outcomes. These reports provide one source of evidence of the effectiveness and quality of service delivery. However, as part of data gathering procedures for the MELDAP Delivery Plan , it became clear that some services did not provide clear outcome data information. The main reason was that IT systems were not able to provide the type of report required by MELDAP for the Delivery plan. MELDAP will work with services this year to ensure that data is collected and scrutinised on a regular basis working towards the full implementation of the DAISy system in October The issue of outcome data and measurement was raised with the MELDAP Commissioning and Performance Group in June The group agreed that the Support Team make this a focus of the agenda in the next round of Quality Assurance meetings. In the MELDAP Delivery Plan , three thematic areas were used to structure the plan: 1] Reducing harm and promoting recovery 2] Protecting and safeguarding children, young people and communities 3]Commissioning and assuring high quality, cost effective recovery focused services 3 Integrated Resource Framework Process Suitable data has been used to scope the programme budget and a A significant proportion of current service provision developed organically over a number of years, often linked to emerging funding streams. MELDAP took the decision in late 2012 to undertake a process of systemic re-design/reorganisation to ensure services matched need and reflected current patterns of substance use. 5

6 baseline position has been established regarding activity, costs and variation. Note 5 This led to a significant stakeholder s events in November 2012 with the title Over the Horizon. During the process of consultation and planning for change, a number of opportunities occurred to strengthen the portfolio of recovery opportunities in Midlothian and East Lothian. Since 2012 MELDAP has reduced expenditure on Tier 3 and Tier 4 services from 85% of budget to 79%. Over the last year additional funding has been directed towards the growth of post treatment recovery orientated services such as the Recovery Cafés, Recovery College, Peer Support Workers and Alive and Kicking which uses football as a way to engage with men with substance misuse/mental health difficulties. These services were developed as an integral part of MELDAP s strategic commitment to develop a ROISC. In the process of developing these responses, MELDAP worked in co-production with client/carer groups to develop some of these recovery orientated resources. In particular, both Recovery Cafe s were developed with the assistance of specialist staff for NHS substance misuse services, council and third sector partners but controlled and implemented by the two steering groups made up of people in recovery or carers of people in recovery. A Recovery Network Group was established in early 2015 which comprised primarily of people with lived experience from substance misuse and mental health. The group will pilot some of the approaches of the planned Recovery Network, for example, managing small grants to support people in recovery. 4 Integrated Resource Framework - Outcomes Note 5 The financial resource outlaid in the development of these cafe groups and other ROISC responses [as set out above] has provided opportunities to maximise people and community resources and as a consequence provide value for money in terms of the number of clients engaging with these post treatment services.. To date the funding provided to ROISC noted above is approx circa 150,000. The Macmillan Rome Consultants report included an options appraisal for the Strategic Group to consider. The active participation of service users and involvement of service managers was central to this process. The draft findings were reported to the MELDAP Strategic group in June. The final report concluded that MELDAP consider three possible options. Option 2.2; Phased 6

7 A coherent approach has been applied to selecting and prioritising investment and disinvestment options building prevention into the design and delivery of services. Change No wholesale changes to the nature of services but change the environment in which the services operate and/ or develop the roles and accountabilities of service providers, was approved by the Strategic Group. In the Annual Report , MELDAP indicated that work would begin on a blue print to deliver option 2.2. Running in parallel with the redesign was the agreement nationally to bring substance misuse services within the scope of Health and Social Care legislation. This required MELDAP to consider how these wider changes might impact on its own redesign processes. The new legislation is most relevant to Social Work and NHS services commissioned by MELDAP. A Lothian wide group was set up to look at the future of NHSL services currently managed as a central function by the Substance Misuse Directorate (SMD). The main issues that the SMD Collaborative Group considered, included which services currently managed and/or provided at a Lothian wide level should continue and which services should move to local management. Following discussions at a number of meetings, the SMD group agreed that Lothian and Edinburgh Abstinence Programme [LEAP], the Ritson Clinic and the Harm Reduction Team [HRT] should remain as services provided and managed at a Lothian level as it was thought that the economies of scale provided the most efficient and effective model of delivery of care. It was also agreed that the Substance Misuse Service teams currently providing care in each locality but managed at a Lothian wide level should be moved within the management of each Health and Social Care Partnership within an IJB structure. In March 2015, there was agreement to set up a Project Delivery Core Group within the two Health and Social Care Partnerships [including involvement with the 3 rd sector] under the direction of MELDAP. These core groups worked to deliver the phased changes as noted in option 2.2 above. These two groups considered a recovery hub type model including spoke locality provision in areas of Midlothian and East Lothian. MELDAP are currently working with lead influencers within Primary Care and both Clinical 7

8 directors for Health and Social Care, to pilot innovative ways of primary care involvement in the spoke locality provision. PLAN - Please evidence your ADPs Planning activities/progress Theme Evidence see note 2 5 We have a shared vision and joint strategic objectives for people affected by problem substance use & those affected, which are aligned with our local partnerships, e.g child protection committees, violence against women, community safety, prevention including education etc. In June the MELDAP Team co-located with the Public Protection Team [PPT] with the intention to strengthen opportunities for closer working among the services for Alcohol and Drugs, Child Protection, Adult Protection and Violence Against Women. Senior managers who attend both the MELDAP Strategic Group and the Public Protection Committee regularly feedback any relevant information from MELDAP. This arrangement has improved information sharing as well as encouraged stronger working relationships. Partners from MELDAP and the PPT are working on a joined up offer to each Local Authority in relation to an education programme covering Drugs and Alcohol, Violence Against Women [VAW], Child Protection and Adult Protection. MELDAP is a core partner in the CAPSM training programme offered to a range of partners. The uniqueness of this programme is that the experience of people (parents) in recovery is a central element of the training. This allowed staff to see the personal impact of substance misuse on the parent and better understand the complex nature of addiction. The service user contribution was always evaluated as the session most beneficial to attending professionals. MELDAP Team members are involved in both council s GIRFEC Groups and the joint Public Protection Quality Assurance Group. MELDAP is a member the Signs of Safety Steering Group in East Lothian which uses an asset based, active family participation approach to Child Protection. MELDAP is a member of both Local Authority areas Licensing Fora. The ADP works closely with other partners in the Licensing Fora to influence the strategic direction and decision making of the respective Licensing Boards. 8

9 7 Service Users and carers are embedded within the partnership commissioning processes 8 A person centered recovery focus has been incorporated into our approach to strategic commissioning. Please advise if your ROSC is in place ; in development or in place and enhancing further. Describe the progress your ADP has made in implementing a Recovery Oriented System of Care (ROSC), please include what your priorities are in implementing this during This may include: ROSC service review and redesign Identify and commission against key recovery outcomes Recovery outcome reporting across alcohol and drug MELDAP have made good progress in this area but as yet is not fully embedded in its commissioning processes. Two Peer Support Workers with lived experience are part of Commissioning and Performance Group. A Recovery Network Group comprising of people with lived experience has been allocated a sum of 5000 to fund applications from people for low cost activities to support recovery. MELDAP used the views from Service Users and Carers in the paper The Experiences and Views of the Users of Drug and Alcohol Services in East Lothian and Midlothian to inform many of the post treatment recovery options in the last two years These were noted in (Section 3). Engaging with families and services users has been primarily at the commissioning end of the process. Most of the recently commissioned services were as a result of MELDAP s programme of service user feedback linked to the Delivery Plan. Please also see (Section 7) above. MELDAP s Recovery Oriented Integrated System of Care [ROISC] is in place. See (Sections 1, 3, 4 and 6) for descriptions of the work that has been implemented towards ROISC in the last few years. The majority of recent expenditure has been targeted towards post treatment, recovery focused services as evidenced in (Section 3). The last steps are being implemented with the maximisation of a ROSC that is integrated [ROISC] within service delivery in East Lothian and Midlothian. This ROISC work will include the development of a Recovery Hub and spoke model to deliver services to meet the needs of people with co-occurring disorders living in the semiurban and rural areas of Midlothian and East Lothian. There is no single recovery tool used by all services. Outcomes Star is used by a main third sector partner and TOPS, CORE and RAD by NHS Substance Misuse Services. This arrangement will be changed to have more services adopt Outcomes Star. From service user consultations and discussion with services through QI visits MELDAP is aware that the arrangements for recovery planning and review are too variable. This aspect of practice will be addressed through the introduction of the Quality Principles; Principles 5 and 6. The two Recovery Cafes provide a focal point for a number of individuals and family members including linked SMART Recovery Groups. Peer Support Workers actively support clients to 9

10 services (Please outline what current/planned recovery tool you are using) Individual recovery care plan and review Involved mutual aid and recovery communities engage with mutual aid groups. A MELDAP Get Connected booklet with details of local mutual aid and other recovery groups has been developed. The first round of training of peer volunteers has been completed and the involvement of peer volunteers will continue to be an approach for supporting people recovering from addiction by those with lived experience. Please include your recovery outcomes for all individuals within your alcohol and drug treatment system for /15 if available. 9 All relevant statutory requirements regarding Equality Impact Assessments have been addressed during the compilation of your ADP Strategy and Delivery Plan. Please advise when this was undertaken and is next planned. MELDAP undertook an EqIA with all its services in with targeted support, if required, for service managers. MELDAP has used the equalities profile [see Appendix 1] which was commissioned through Engender to inform development of the MELDAP Delivery Plan In relation to support for women, MELDAP and partners are expanding the Pink Ladies service into East Lothian. For men, MELDAP has commissioned Alive and Kicking which is a programme using football/exercise as a vehicle to encourage healthy living and recovery. The men normally come from the most deprived areas in Midlothian and East Lothian. Support to carers [particularly older carers] in Midlothian and East Lothian has been significantly expanded through increased funding. 10

11 DELIVER - Please evidence your ADPs Delivery activities/progress Theme Evidence see note 2 10 Delivery of Joint Workforce plans, as outlined in Supporting The Development of Scotland s Alcohol and Drug Workforce statement are in place across all levels of service delivery which are based on the needs of your population. see note 7 MELDAP continued to facilitate training in Midlothian and East Lothian in relation to Children Affected By Parental Substance Misuse Guidelines. MELDAP is a member of the Learning & Practice Development Sub-committee in Midlothian and East Lothian. MELDAP work in partnership with the East & Midlothian Public Protection Committee. The group is responsible for ascertaining local training needs, ensuring that appropriate training is provided and taking a strategic overview of multi-agency training to promote effective and efficient practice to support and protect children and adults who may be at risk of harm. MELDAP and its services have undertaken an exercise to identify outcomes for the workforce development plan. The process is supported by STRADA. Due to effects of the closure of Drugscope and its impact on STRADA, this process has slowed in recent months. Scottish Drugs Forum [SDF] that are now responsible for assisting MELDAP with this work are meeting with the ADP support team to plan the next steps. This will involve a small group of MELDAP partner agency representatives to produce outcome indicators for the development plan. The MELDAP Support Team is also involved in bespoke training for elected representatives, Health Care and Social Work staff and other training sessions appropriately. Plans have been finalised to deliver training on the use of Outcomes Star and Motivational Interviewing for staff in the Autumn of

12 11 Please provide a bullet point summary of your ADP s Alcohol and Drug Provision, to demonstrate the range of prevention, treatment/recovery & support interventions (including early interventions) commissioned by the ADP which have been delivered in the reporting period. We recognise there will be overlaps please use local definitions. 12 Please provide a brief summary of the interventions your ADP has delivered to support communities: a) Prevention of developing problem alcohol/drug use Health Prevalence Recovery Families Community Safety Local Environment Services Tier 1 Tier 2 Tier 3 Tier 4 Friday Friends Cafe GP Practices GP Practices (NES) Horizons and Starfish Recovery Cafés, Peer Support Workers, Recovery Coordinator Recovery Network Olive Bank Children and Family Centre Alive and Kicking, Pink Ladies MYPAS C&F Social Workers NEON Bus MELD Recovery College Children 1 st, ELYCP, DASS, VOCAL Lifeline CLEAR Substance Misuse Social Workers SMS (Mid), SMS (East) Harm Reduction Team, ASUS Nurse ELCA Prison Alcohol Service Simpson House MELDAP and service approaches to Quality Improvement, *DRD Coordinator LEAP, Ritson Clinic ARBD Unit MELDAP have been closely involved with the development of both East Lothian and Midlothian Licensing Board s over-provision statements. This included providing statistics, research and assessment in relation to the potential health and community impacts of the over- provision of alcohol in the Local Authority areas. The MELDAP Team is represented on both Licensing Fora. As part of our response to preventing the development of problem alcohol/ drug use, MELDAP commissions the services of two children s Social Workers who offer support to school aged 12

13 b) Community Safety/ violence against women/reducing Reoffending c) Children/ CAPSM d) Supporting People in moving on from treatment and care services for ongoing recovery (e.g Self Directed Support, mutual aid/recovery communities) children and young people living in East Lothian whose lives have been affected by their own substance misuse or that of their parents or carers. The workers offer support at school, home and in the community on a 1:1 basis and through group work. MYPAS provides drug and alcohol services for young people (12 to 21 year olds) who want information, advice or support through 1:1 counselling, group work, art therapy and sexual health drop-ins for young people in Midlothian. The alcohol and drug team also provide preventative group programmes in schools and diversionary activities. MELDAP have been able to ensure that Drugs and Alcohol has been identified as a high priority in the work of the Community Safety Partnerships, specifically looking at the work being done around recovery, support for families and the emerging trends in use of NPS. A CAB worker is co-located in the Horizons Recovery Cafe providing advice/information to clients on a range of issues most notably welfare and benefits issues. MELDAP commissions a number of services to minimise the negative impact on children of their parents or carers substance misuse. East Lothian Young Carers offers respite by running club nights which run 3 nights out of 4, individual support and support to families with a wide range of issues such as benefits advice, food banks etc The Children 1 st Midlothian Young Carers Service provides support and advice tailored to meet the individual needs of young people across Midlothian who finds themselves caring for a dependent relative at home. Their staff provide individual support; group activities and respite aimed at helping the young people enjoy their lives. The Children 1 st Family Support: Direct Assistance and Support Service (DASS) provides an intensive 12 week, seven days a week, needs led family support in Midlothian for families who are experiencing stress and difficulties, where parents have substance misuse issues. Please also see the statement above in Section 10 regarding CAPSM Training. Please see sections 1, 3, 4 and 6 for descriptions of the work that has been implemented towards ROISC in the last few years. 13

14 13 A. A transparent performance management framework is in place for all ADP Partner organisations who receive funding through the ADP, including statutory provision B. Describe how all ADP Partners contribute to delivering outcomes identified in the Joint Strategic Needs Assessment (box 1) which includes prevention, recovery, treatment, support and throughcare services through ROSC provision, where in place. A variety of service performance and quality issues are monitored during quarterly Quality Improvement visits. There is an agreed agenda, which covers service issues, ways in which MELDAP can support the service, issues around Service User/Carer Involvement as well as progress towards and reporting on agreed outcomes. MELDAP commenced its second programme of service presentations to the Commissioning and Performance Group for -15. The focus of these presentations has continued to be the delivery of outcomes for individuals and families and the impact each service makes on the lives of the clients they work with. While nearly all services have an SLA with agreed outcomes and associated reporting arrangements it became clear as part of gathering data for the MELDAP Delivery Plan , that some services were not able to provide robust outcome data information. The main reason was that IT systems did not provide the type of data required by MELDAP for the Delivery Plan. MELDAP will work with these services this year to ensure that data is collected and scrutinised on a regular basis working towards the full implementation of the Daisy system in October The issue of outcome data quality and measurement was raised with the MELDAP Commissioning and Performance Group. The group agreed that the Support Team make this a focus for the next round of Quality Improvement meetings. The MELDAP Children young people and family Group continued to progress the actions from the CAPSM Needs Assessment. There has been broad agreement with universal services [including Council service] to implement the recommendations in the report. This includes assessing opportunities for joint commissioning. All partners of MELDAP are involved in the latter phase of delivery of the Over the Horizon redesign process. (See relevant sections above) 14

15 REVIEW - Please evidence your ADPs Delivery activities/progress in reviewing Strategies/Outcomes Theme Evidence see note 2 14 ADP Delivery Plan is reviewed on a regular basis, which includes a review of the provision of prevention activity, recovery, treatment and support services (ROSC). A number of the priorities lie within the remit of the various subgroups which take responsibility for progressing specific actions. The Commissioning and Performance Group has a key role in monitoring the implementation of the plan. Service presentations support this process. The work undertaken towards the delivery of the Over the Horizon system redesign is scrutinised at regular intervals. The MELDAP Strategic Group [every quarter] and the Commissioning and Performance Group [every 6-8 weeks] and the Lothian Wide Substance Misuse Collaborative meetings [approximately every 6-8 weeks]. The MELDAP programme of quarterly service visits collects information on service contributions to the relevant Delivery Plan s priorities. The MELDAP Strategic Group, Service User and Carers from Midlothian and East Lothian and stakeholders commented on the draft Delivery Plan for at a number of consultation events. 15 Progress towards outcomes focussed contract monitoring arrangements being in place for all commissioned services, which incorporates recommendation 6 from the Delivering Recovery Report. see note 8 16 A schedule for service monitoring and review is in MELDAP have developed Outcome Focused Service Level Agreements with most funded services. These follow a contract format agreed by East Lothian Council, Midlothian Council and NHS Lothian with performance reporting requirements noted. Depending on the original agreement these SLAs are reviewed and updated on a months basis. MELDAP continued to support the successful use of the Outcomes Star monitoring tool with front line Drug and Alcohol Services. Feedback from Quality Assurance processes is that this outcomes assessment tool was very useful in showing improvements in the individual s life circumstances. Another training programme for this tool will be delivered in October 2015 to up skill new staff. In order to bring a more uniformed approach new or updated SLAs are likely to have the use of Outcomes Star as requirement. MELDAP are committed to a process of quality improvement underpinned by an annual 15

16 place, which includes statutory provision. 17 Service Users and their families play a central role in evaluating the impact of our statutory and third sector services. 18 A. There is a robust quality assurance system in place which governs the ADP and evidences the quality, effectiveness and efficiency of services. B. Please advise when (and how) your ADP has/plans to undertake an assessment of local implementation of the Quality Principles: Standard Expectations of Care and Support in Drug programme of formal visits by the MELDAP Team to all services. Since 2010 MELDAP has an agreed programme of QI visits using the National Quality Standards. Service s outcomes/performance is discussed during Quality Improvement visits. There is an agenda that covers service issues, ways in which MELDAP can support service development, issues around Service User/Carer Involvement and reporting service performance against HEAT standards and Naloxone targets. A record of the meeting with agreed actions is shared with service managers. From onwards the use of the Quality Standards will be replaced by the Quality Principles drawing on the learning from the Lanarkshire ADP pilot. As part of the work undertaken by MacMillan Rome, Service Users and Carers were consulted about possible pathways that may be required to deliver recovery oriented services. The feedback from this session contributed to the proposed commissioning of an innovative Independent Recovery Network. Engaging with families and services users has been primarily at the commissioning end of the process. Most of the recently commissioned services were as a result of MELDAP s programme of service user feedback linked to identifying priorities for the Delivery Plan. As yet service users and families do not play a central role in evaluating services This aspect will be explored through the use of the Quality Principles. MELDAP are committed to a process of quality improvement underpinned by a programme of planned formal visits by the Support Team to all commissioned services. The team works with services in the role of critical friend supporting, challenging, providing accountability and most importantly helping to improve service quality. A key purpose of these formal visits is to develop within all services a culture of planned critical self evaluation as well as to discuss emerging issues such as NPS use. Action groups have been used to address specific service issues, for example, addressing the low level of THN kits issued to clients. In addition to this, further work has been done with the MELDAP Commissioning and Performance Group regarding service presentations with a stronger emphasis on service outcomes and linked performance data. As stated above in Section 1, further work is required with services regarding providing robust performance measures to the partnership. There are a number of different tools for 16

17 and alcohol Services. See notes 9 and Describe the progress your ADP has made in taking forward the recommendations from the Independent Expert Review of Opioid Replacement Therapies in Scotland. Please include any information around the following: your (updated, if applicable) Key Aim Statement a specific update on your progress in implementing it have you achieved it/when do you plan to do so? Outline the work of your ORT Accountable Officer How many people were in receipt of opiate replacement therapies in your area between 1 April & 31 measuring outcomes, for example, Outcomes Star. MELDAP services are well placed to implement the Quality Principles based on their experiences of using the National Quality Standards since MELDAP has developed the Quality Principles into a working tool to support service self-evaluation. A short-life working group has been set up to provide guidance, including timescale for full implementation during MELDAP s key aim is that its services will implement the Ten Network Core Standards for Recovery Based Services in tandem with a Charter Practises which support recovery (See Appendix 2) MELDAP have made good progress in significant elements and aspects of the Independent Expert Review of Opioid Replacement Therapies as set out in its improvement plan. (See Appendix 3) In relation to other recommendations, NHS Lothian has identified Dr David Farquarson, Medical Director, NHS Lothian who has agreed to be the ORT Accountable Officer. The MD has led work to improve the consistency in the use of ORT across acute, specialist, primary care and prison services in Lothian, in line with UK clinical guidelines. This work reflected the commitment of NHS Lothian and the three Lothian ADPs to a personcentred ROISC. For -15 the NHS Lothian spend on methadone and buprenorphine was 1,480,879 a slight reduction on the costs in part due to the reduction in methadone price. Number of Prescriptions (all form types) Drug Costs ( ) Methadone Buprenorphine Methadone Buprenorphine 62,946 15, , ,464 The Community Pharmacy fee for locally negotiated substance misuse services (Includes methadone dispensing and supervision, buprenorphine supervision, injecting provision and dental costs ) for -15 was 2,130,797 17

18 March 2015? Information on length of time on ORT and dose Information about any related staff training in ORT provision or recovery orientated systems of care. Detail of any ORT focussed groups operating in the area. GP engagement how drug and alcohol treatment is being delivered in primary care settings. Additional Lothian wide training was provided for a number of different staff groups. This included a two day course Working With Drug Users course, which was attended by 25 GPs. BBV training was provided to approx 110 staff; primary and community care staff including GPs, practice nursing, community midwifery and health visitors. See note Please describe in brief bullet points how your ADP and partners are contributing to delivery of a Whole Population Approach for Alcohol. MELDAP made significant contributions to both Local Authority's Licensing Board s over provision statements. The MELDAP Support Team is a member of both Local Authority Licensing Fora MELDAP support staff provided training to elected members in relation to local alcohol prevalence, availability, MELDAP priorities in this area and how these contribute to the delivery of national policy. MELDAP commissions preventative services young people and families from Midlothian Young Peoples Advisory Service, East Lothian Young Carers, two Children s Substance Misuse Workers and Olive Bank Children and Families Centre [piloting the use of the OH-LILA! resource] MELDAP co-facilitates CAPSM Training to staff of partner agencies. 18

19 21 How many service users are in receipt of prescriptions for problem alcohol use? 22 How many service users are receiving counselling/support through ADP commissioned services? 23 How many service users have received treatment for ARBD in the reporting period? There was 4634 Alcohol Brief Interventions [ABI] delivered in the MELDAP area. No data available as yet from NHS Lothian. Those receiving counselling and/or support from Alcohol Services in /15 =621 Those receiving counselling and/or support from Drug Services in /15 =604 These figures are from a range of services for younger people as well as those focused on adults. There is a 10 bedded ARBD Step Down unit at Milestone. It anticipated that annually approx 8 people from Midlothian and East Lothian will be provided with a place at the unit. Clients with an ARBD diagnosis are also supported through services such as the Recovery Cafes, AA and SMART groups. 19

20 3. FINANCIAL FRAMEWORK Your Report should identify both the earmarked alcohol and the earmarked drug funding from Scottish Government which the ADP has received (via your local NHS Board) and spent in order to deliver your local plan. It would be helpful to identify any other expenditure on drugs and/or alcohol prevention, treatment/support services or recovery which each ADP partner has contributed from their core budgets to deliver the Plan. You should also highlight any underspend and proposals on future use of any such monies. Total Income from all sources Income Alcohol Drugs Total Earmarked funding from Scottish Government 1,183,887 1,259,886 2,443,773 [includes monies held in reserve by NHSL] Funding from Local Authority 164, , ,479 Funding from NHS (excluding funding earmarked from 854, ,052 1,708,104 Scottish Government) Funding from other sources 20,981 20,981 Reserve Funds 295, , ,326 Total 2,498,341 2,553,322 5,051,663 20

21 Total Expenditure from sources Prevention (include community focussed, early years, educational inputs/media, young people, licensing objectives, ABIs) Treatment & Support Services (include interventions focussed around treatment for alcohol and drug dependence) Alcohol Drugs Total 271, , ,938 1,866,754 1,766,755 3,633,509 Recovery 65,532 65, ,063 Dealing with consequences of problem alcohol and drug use in ADP See above See above See above locality amounts amounts amounts Total 2,204,255 2,068,255 4,272,510 End Year Balance for Scottish Government earmarked allocations Income ( ) Expenditure ( ) End Year Balance ( ) Drug 2,553,322 2,068, ,067 Alcohol 2,498,31 2,204, ,086 Total 5,051,663 4,272, ,153 Total Underspend from all sources Underspend ( ) Proposals for future use 10,300 C.L.E.A.R 100,000 Service Redesign Recovery Network 5,000 Recovery Cafes 15,000 Services Training (NPS, Recovery Orientated Care, Other) 21

22 25,000 Peer Support Workers 30,000 Recovery Co-ordinator 100,000 Recovery Hub Model Implementation (Start Up Development of ROSC) 23,000 East Lothian Recovery Cafe 17,520 Pink Ladies 1 st 10,000 Midlothian Community Recovery Resources 15,782 Alive & Kicking 33,800 VOCAL 385,402 Remaining balance of 393,751 will c/f to continue funding some of the above in pending delivery of Recovery Hubs within a mid/long range sustainable budget. Support in kind Provider Description All ADP partners provide Officer and Senior Officer to carry forward on behalf of the ADP and service ASDOP meetings. This includes staff time for HR, finance and other areas of organisational support. 4. PERFORMANCE FRAMEWORK - PROGRESS Please include progress made re-establishing baselines, local improvement goals/targets and progress using the ScotPHO website for all national outcomes. You may submit your annual update on your performance framework from your delivery plan, however please include local indicators, linkage between activities, indicators and outcomes, how you will measure if a ROSC has been successfully implemented in your area. 22

23 4.1 As with the Annual Report the ScotPHO data has been used to compare the data set for MELDAP with Scotland and four other ADPs with similar population characteristics. The exercise is intended to give a more accurate and balanced analysis of how MELDAP compares to other similar ADP areas. The comparator ADPs were Angus, Moray, Stirling and Scottish Borders. These comparator authorities have been used previously to benchmark against a range of council based services. The results were as follows: MELDAP data is statistically significantly worse than comparator ADP value MELDAP data is statistically not different from comparator ADP value MELDAP is statistically significantly better than comparator ADP value Alcohol Profile () Domain Indicator Scotland Angus Moray Scottish Stirling Borders Health 1. Alcohol related hospital discharges 2. Alcohol related mortality Prevalence 3. Males exceeding daily/weekly drinking limits No data No data No data No data No data 4.Females exceeding daily/weekly drinking limits No data No data No data No data No data 5. Individuals exceeding daily/weekly drinking limits No data No data No data No data No data 6.Males binge drinking No data No data No data No data No data 7.Females binge drinking No data No data No data No data No data 8. Individuals problem drinking No data No data No data No data No data 9. Males problem drinking No data No data No data No data No data 10. Females problem drinking No data No data No data No data No data 11. Individuals problem drinking No data No data No data No data No data 12.Weekly drinkers (aged 15) CAPSM/Families 13.Child protection with parental alcohol/drug misuse 14.Child protection with parental alcohol misuse Community Safety 15. Serious assault 16.Common assault 17.Vandalism 23

24 18.Breach of the peace Environment 19.The % of people perceiving rowdy behaviour very/fairly common in neighbourhood 20. Premise license in force- On trade 21.Premise license in force- Off trade 22.Premise license in force- Total 23.Personal licenses in force Services 24.ABIs delivered No data No data No data No data No data 25.Alcohol treatment waiting times Drugs Profile () Domain Indicator Scotland Angus Moray Scottish Borders Health 1. Drug hospital discharges 2. Drug related mortality 3. Hepatitis-C positive among PWID Prevalence 4. Population prevalence of problem drug use 5. Male prevalence of problem drug use 6. Female prevalence of problem drug use 7. Drug use in the last month (pupils aged 15) 8. Drug use in the last year (pupils aged 15) Recovery 9. Drugs spend reduction No data No data No data No data No data CAPSM/Families 10. Maternities with drug use No data 11. Child protection with parental drug use No data 12.Child protection with parental alcohol or drug use Community Safety 13. Drug use funded by crime Environment 14. Children being offered drugs (aged 15) 15. Drug misuse in neighbourhood Services 16. Drug treatment waiting times Quality 17. SDMD completeness No data No data No data No data No data 18. SDMD follow-up completeness Stirling 24

25 4.2 The ScotPHO data for Alcohol in the domains of Community Safety (indicators 16, 18) and Environment (indicators 20, 22) with their associated range of alcohol indicators, MELDAP continues to compare favourably against its group of comparator ADPs. Since last year there have been improvements in the domains Health (indicators 1, 2) and CAPSM/Families (indicator 14). 4.3 The ScotPHO data for Drugs shows that in terms of our comparator ADPs, MELDAP are consistently significantly worse in the indicators (10, 11, and 12) related to the Outcome CAPSM/Families. However, local data would suggest an improving picture in terms of the number of children on the Child Protection Register (1,000 per 0-15 population (See Fig 1) Fig Number Rate Number Rate Number Rate Number Rate East Lothian Midlothian (Source: Framework i East Lothian and Midlothian Councils) 4.4 Since June 2104 the MELDAP Team has been co-located with the East and Midlothian Public Protection Office (Child Protection, Adult Protection, Violence Against Women, Police Scotland Public Protection Team). MELDAP are also represented on the Signs of Safety Steering Group (East Lothian), the East and Midlothian Public Protection Performance and Quality Improvement Group and both councils GIRFEC groups. MELDAP have also increased funding for CAPSM/Families work through the Direct Assistance and Support Service in Midlothian and through a whole centre approach at Olive Bank Children and Family Centre. All these actions have the capacity to have an impact on this area of service activity, the relevant indicators and longer term outcomes. 4.5 The Children young people and families group continues to take the lead role in implementing key recommendations from the CAPSM Needs Assessment. MELDAP are also involved in the CAPSM training for all staff and one of the recently appointed Peer Support Workers has worked closely with hard to reach substance misusing women with children. 4.6 Indicators (5, 6) male and female prevalence levels are also consistently worse than comparator ADPs. Local data would indicate that some 50% of new clients entering treatment services have dependent children living with them or have access to them. As with previous years the indicator maternities with drug use continues to be significantly worse than comparator ADPs with the caveat that the ScotPHO data has to be treated with caution due to the manner in which this data is collected across Health Board areas, for example, some areas recording main concern while others record any concern. 25

26 Additional support for pregnant mothers has been increased through the appointment of a part-week PrePare Nurse whose role will focus on pregnant women with substance misuse problems and infants considered 'high risk' because of injecting drug use, chaotic lifestyles, and child protection issues. 4.7 In the Delivery Plan MELDAP worked with its commissioned services to develop a number of local performance measures. These are included below. Very few measures relate to a specific service, rather these are aggregated measures to which a number of services will contribute, for example, the number of clients actively engaged in recovery based activities. Reflecting the progress MELDAP have made in developing ROISC it is in the area of recovery where most Local Indicators have been developed and where MELDAP has allocated its greatest increase in spend. A significant change since the Annual Report has been the development of a range of local Recovery Indicators (included below) reflecting the very good progress MELDAP has made in developing a Recovery Orientated Integrated System of Care (ROISC). MELDAP Theme: Reducing immediate risk, future harm and promoting recovery National Outcome 1. Health: People are healthier and experience fewer risks as a result of alcohol and drug use Indicators Baseline Improvement Goal/Target Rate of alcohol related hospital stays (per100,000 pop) Rate of drug-related hospital stays (per100,000 pop) Rate of alcohol-related mortality (per 100,000 pop) Reduce rate by 3.5% to 470 by 2018 Reduce rate to 100 by 2018 Reduce number of alcohol related deaths by 2 by 2016 RAG Comments/key actions delivered to support this outcome in -15 Reduction in 2012 rate. ScotPHO data shows MELDAP rate is significantly better than Scotland Average The 2012 and 2013 rate is both lower than the national rate. The 2013 MELDP figure is higher than to the 2012 rate which may reflect the deteriorating health needs of an aging opiate using population. ScotPHO data shows that the MELDAP rate is significantly better than the Scotland Average The 2013 rate is lower than 2102 figure and the Scotland Average of 21.2 (ScotPHO). In 2013 there were 25 alcohol related deaths compared to the 2012 total of 27. Reduce the numbers of drug related deaths Reduce the number of deaths by 2 annually While the DRD rate is still below national rate, in 2013 there were 16 DRD up from 14 in There is the challenge of dealing with an aging injecting population 26

27 Reduce the number of HEP-C positives among PWID Increase the total number of Take Home Naloxone Kits issued National Outcome % % 231 Increased level of BBV testing through HRT. Reduce rate to 19.6 by 2018 Increase to 540 by 2016 whose underlying health is poor. A local DRD review group was established by November. Work with services to reduce the level of methadone related deaths. The MELDAP rate is consistently lower than the national rate and comparator ADPs. Possible emerging risk through higher levels of NPS injecting. Good progress has been made over the last 6 months from a low base. THN group set up to increase level of distribution. 2. Prevalence: Fewer Adults and children are drinking or using drugs at levels or patterns that are damaging to themselves and others Indicators Baseline Improvement Goal/Target % Estimated prevalence(%) of problem drug use (15-64 years) Drug use in the last month (pupils aged 15) % Sustain level below national rate and similar to that of comparator ADPs Reduce to match National figure Improve school participation rate RAG Comments/key actions delivered to support this outcome in -15 The prevalence rates for both males and females a significantly better than the Scotland Average (ScotPHO) Since the 2010 SALSUS there has been a 0.5% increase in 15 year old pupils reporting drug use in last month. School participation rate is higher than national figure (+6%). There are significant differences in levels across the two MELDAP areas Reduce Illicit drug use in last month % % of clients currently injecting % % of individuals currently sharing needles/syringes 4% Drug use in the last year (pupils aged years) 16% Reduce by 5% by 2015 The showed a significant reduction to 63%, a lower % than comparator ADPs Reduce by 10% by 2018 The figure was 15 % down 3% since Reduce by 1% by 2015 Reduce to match National figure The figure for showed a small increase to 5%. This figure was 2% lower than that for Since 2010 there has been a 0.2% decrease which is a smaller decrease than the national figure of -3% Increase the number of 13 year olds who have never been drunk % Increase to 55% by 2018 There has been an increase of 5% since Figure is still lower than National figure. 27