STANDARD REPORTING TEMPLATE - (HIGHLAND) ADP ANNUAL REPORT Document Details: ADP Reporting Requirements Financial Framework

Transcription

1 STANDARD REPORTING TEMPLATE - (HIGHLAND) ADP ANNUAL REPORT Document Details: ADP Reporting Requirements Financial Framework 2. Ministerial Priorities 3. Additional Information The Scottish Government copy should be sent by 23 October 2017 for the attention of Amanda Adams to: Alcoholanddrugdelivery@gov.scot

2 1. FINANCIAL FRAMEWORK Your report should identify all sources of income that the ADP has received (via your local NHS Board and, where relevant, Integration Joint Board), alongside the monies that you have spent to deliver the priorities set out in your local plan. It would be helpful to distinguish appropriately between your own core income and other expenditure on alcohol and drug prevention, treatment and support, or recovery services which each ADP partner has provided a contribution towards. You should also highlight any underspend and proposals on future use of any such monies. Total Income from all sources Income Substance Misuse (Alcohol and Drugs) Earmarked funding from Scottish Government 2,407,303 * Funding from Local Authority Nil Funding from NHS (excluding funding earmarked from Scottish Government) 2,468,367 Funding from other sources Nil Total 4,875,670 ** * Note Total SG allocation for 16/17 now within HB recurrent funding but maintained at previous level. The 15/16 allocation of 3,655,485 includes 1,248,182 for A&B with the balance noted above. ** Note there is a small difference between the enclosed finance report and this table as there are small amounts held within unspent reserves until expenditure is determined. Total Expenditure from sources Prevention (include community focussed, early years, educational inputs/media, young people, licensing objectives, ABIs) Treatment & Support Services (include interventions focussed around treatment for alcohol and drug dependence) Recovery Dealing with consequences of problem alcohol and drug use in ADP locality Substance Misuse (Alcohol and Drugs) 844,807 3,535,955 Incl in above treatment line Total 4,380,762 Note there was a total underspend against the budget of 450k part from earmarked allocations and part from HB resource

3 End Year Balance for Scottish Government earmarked allocations Substance Misuse Income Expenditure End Year Balance 2,407,303 2,198, , Total Underspend from all sources Underspend Proposals for future use 25,898 N&W Operational Unit vacant posts filled part way through year 145,741 S&M Operational Unit multiple vacancies 9,052 HADP support team post filled part way through year 6,720 GP enhanced services variable spend patterns. Support in kind Provider Description

4 Prevention Treatment & Recovery Recovery Conse- quences

5 1. Health: People are healthier and experience fewer risks as a result of alcohol and drug use 2. Prevalence: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others 3. Recovery: Individuals are improving their health, well-being and life chances by recovering from problematic drug and alcohol use 4. Families: Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved life chances 5. Community Safety: Communities and individuals are safe from alcohol and drug related offending and anti-social behaviour 6. Local Environment: People live in positive, health promoting local environments where alcohol and drugs are less readily available 7. Services: Alcohol and drugs services are high quality, continually improving, efficient, evidence based and responsive, ensuring people move through treatment into sustained recovery National Core 2014/ % 2015/ % % 2014/ s 2015/ s s Outcome , , , , , ,728,401 1,507,611 1,775, , , , , , , , , , ,124,481 1,122,915 1,204,933 Total (for s) 4,610,821 4,406,461 4,850,557

6 Financial report - Drugs & Alcohol misuse funds - 12 months to 31st March 2017 Alcohol Misuse Drugs Misuse Support Costs Total Budget NHSH Core Funding Total Annual Budget Annual costs Year End variance against earmarked funds Year End variance against NHSH core funds wte 's 's 's 's 's 's 's 's 's Budgeted Establishment Recurrent NHSH Scottish Government Funding for Drug & Alcohol Total year end variance North & West Operational Unit N&W ,168 43, , , , ,117 25,898 15,773 41,670 South & Mid Operational Unit S&M , , ,245, ,539 1,896,956 1,678, ,741 72, ,311 South & Mid Operational Unit - Mental Health Services S&M (MH) , , , , , , ,351 15,506 Hep B Needle Exchange/methadone - NHS H services NHS H , ,978 76,022 99,000 99, Raigmore - CAMHS & Emergency Department (ABIs) ,000 35, , ,000 48, Highland Council - Youth Workers & Action For Children THC ,000 20, ,000 30, ,310 79,189 20,747 24,374 45,121 Adult Social Care - ISC support for D&A ASC ,401 47,401 65,712 0 (18,311) (18,311) Highland ADP Support Costs NHS H , , ,228 34, , ,806 9, ,300 Voluntary Organisations NHS H ,907 43,907 38, ,402 5,402 GP Enhanced Services NHS H , , , , ,505 6, , ,468 Beechwood Support Services & Out Of Area Referrals ASC/NHS H , , ,138 0 (22,901) (22,901) Total ,624, , ,983 2,365,961 2,468,367 4,834,328 4,380, , , ,566

7 2. MINISTERIAL PRIORITIES ADP funding allocation letters outlined a range of Ministerial priorities and asks ADPs to describe in this ADP Report their local Improvement goals and measures for delivering these during Please outline these below. PRIORITY 1. Compliance with the Drug and Alcohol Treatment Waiting Times LDP Standard, including, increasing the level of fully identifiable records submitted to the Drug and Alcohol Treatment Waiting Times Database (DATWTD) *IMPROVEMENT GOAL % of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. No one will wait longer than 6 weeks to receive appropriate treatment. 100% data compliance from services delivering tier 3 and 4 drug and alcohol treatment in Scotland DELIVERY MEASURES In 2016/17, 81.3% of drug and alcohol clients commenced treatment within 3 weeks of referral and 91.4% within 5 weeks. Level of fully identifiable records submitted, for clients assessed for a service, improved to 73% for 2016/17 from 67% baseline. Work is ongoing to achieve the LDP standard with the latest performance data showing 81.3% of clients seen within 3 weeks. A Rapid Process Improvement Workshop (RPIW) will take place in June 2017, focused on achieving and sustaining the standard within the Inner Moray Firth Operational Unit. Updates will be provided via regular report outs (60, 90 and 120 days) and scrutinised by NHS executive officers. Improvements from the RPIW will be cascaded across operational units. ADDITIONAL INFORMATION Ongoing challenges of recruiting to professional posts, particularly in remote and rural localities. Management restructure within the Inner Moray Firth operational unit should increase capacity to attain the standard over the next year. Progress regularly reported to Scottish Government via monthly phone calls. Comparison with other ADP s and national trends provides learning opportunities. Long waits continue to sit on the risk register for NHS Highland. Drug and Alcohol profiles at local community planning partnership (LCPP) level to be piloted. May act as an indicator for the locality adult services plan. Data reports on the Highland wide and individual performance of statutory and

8 Third sector services are scrutinised on a monthly basis by the Head of Service. Quarterly updates via progress reports and verbal inputs provided to the HADP strategy group. 2. Compliance with the LDP Standard for delivering Alcohol Brief Interventions (ABIs) Deliver above 100% of the ABI standard by 2018 to exceed compliance. Invitations to attend a drop-in or the Harm Reduction Service is embedded in to routine practice in relevant localities 4,940 interventions delivered across NHS Highland in 2016/17, achieving 134% of the LDP standard. Inclusion of ABI s to be promoted to LCPP s for inclusion in locality adult service plans. Deliver 80% of ABI s in priority settings and 20% in wider settings by Albeit the LDP standard continues to be exceeded, overall there has been a decrease. Planning underway to produce profiles at LCPP level inclusive of ABI delivery data. Increase delivery to harder to reach groups and deprived communities by Ongoing engagement with partners to broaden delivery in wider settings including; Fire Service, Police Scotland, Criminal Justice Service and Unison. Discussing Drugs and Alcohol with Young People brief intervention training course delivered to 200 professionals working directly with young people in the first year of roll out: Discussing Drugs & Alcohol with Young People Data profiles to be used to influence delivery among GP cluster groups. Planning underway to produce a visually interactive report combining; a Geographical Information System (GIS), SEP Index, SIMD to inform ABI activities to reduce inequalities. NHS Highland communication to all GP practices following the renewal of the Local Enhanced Service for 2017/18 to increase delivery and reporting.

9 HADP continues to focus on improving delivery in the most deprived communities and harder to reach groups. 3. Increasing Data Compliance Scottish Drugs Misuse Database (SDMD) both SMR25 A and B. 4. Preparing Local Systems to Comply with the new Drug & Alcohol Information System (DAISy) Progressively increase the levels of compliance towards 100% for SMR 25a by 2017 Progressively increase the level of compliance for SMR 25b by 2017 Substance Misuse Services to be 100% system ready within 6 months of DAISy introduction by 2017/18 Third Sector partners to be 100% system ready within 6 months of DAISy introduction by 2017/18 Recovery Outcome (RO) Tool to go live from 1 st Jan 2017 Continue the local programme of work informed by ISD guidance. Continue local monitoring of compliance levels reported via ISD. ISD reports circulated to services for action. Increased Team Leader/Advanced Practitioner capacity will improve data quality. DAISY scoping exercise completed. Increased Team Leader/Advanced Practitioner capacity will improve data quality. Detailed DAISy implementation plan in place and being progressed by SIG. Attendance/representation on national implementation group. RO Tool training delivered in April 2017 followed, by early implementation across tier 3/4 services. Ongoing support on RO Tool guidance, spreadsheet use and reporting provided to partners including the Third Sector HMP Inverness and Criminal Justice Monitoring of ISD reports continues to demonstrate improvements with above average performance in a number of sections for SMR 25a & b. Main focus is currently on preparing for implementation of DAISy. Range of outstanding IT issues to be resolved. Resourcing of implementation to be resolved. Comments submitted on draft information sharing protocol (ISP) by August Ongoing liaison with ISD to keep pace with developments at a national level. Highland has improved guidance on children element of the RO Tool.

10 Service. 5. Increasing the reach and coverage of the national naloxone programme for people at risk of opiate overdose, including those on release from prison. Sustain levels of kit distribution above 210 per 1,000 by Kits offered to 100% of new clients receiving opiate replacement therapy (ORT) by Kits offered to 100% of those released from prison with a history of opiate use by Quarterly reports on the progress of DAISy including resource implications for implementation provided to HADP strategy group. Latest published data (2015/16) indicates 454 THN kits distributed across NHS Highland, a rate of 227 per 1,000 people with problem drug use. These figures include intranasal supplies excluded from published rates now considered good practice. Planning for intranasal Naloxone to be rolled out across Police Scotland Highland command area Kits routinely offered to all new clients receiving opiate replacement therapy (ORT). Kits offered to 100% of those released from HMP Inverness with a history of opiate use. Intranasal administration of naloxone increasingly considered as good practice. Argyll & Bute ADP to implement intranasal programme. Other ADP areas and Police forces have expressed an interest in intranasal option. From April 2016, the withdrawal of reimbursement funding for naloxone packs has resulted in funding pressures within NHS Highland. Training being refreshed with a greater family focus. Patient group direction has been updated for the supply of take home naloxone to support broader supply and distribution. Harm reduction outreach services continuing to be offered in Houses of Multiple Occupancy (HMO s) to those at high risk of overdose. Appointment of a Drug and Alcohol Recovery Service Nurse for homelessness will strengthen outreach and improvement integrated practice with housing, HMO s, HMP Inverness, primary and secondary care. Peer naloxone training for prisoners

11 through partnership between HMP Inverness and the Harm Reduction Service. 6. Tackling drug related deaths (DRD)/risks in your local ADP area. Reduce rate to 6.5 per 100,000 by There were 19 drug related deaths in 2016, a decrease of 5 from 24 in the previous year. Standardised rates not published at the time of this annual report submission. Annual report summarising Highland trends from NRS report produced and discussed at DRD Review group and HADP Strategy Group. Numbers of drug related deaths are low in Highland and subject to year on year fluctuations in the rate, although the overall trend is increasing alongside the national position. Annual report accessible via website to strengthen awareness and accountability Drug-related Deaths in Highland 2016 ISP with the Scottish Ambulance Service (SAS) refreshed in Non-fatal overdose alert system passed to Drug and Alcohol Recovery Services for further improvement in Resurrecting six monthly flash reports designed to feed back to partners on patterns and trends to be considered. Role and remit of drug related death review group to be revised with an associated prevention group established to produce a prevention strategy. Improvements and actions identified from reviewing relevant deaths followed up. Staying Alive in Scotland good practice audit completed and plan for SDF to visit review and prevention groups for

12 advice on development. Cross referencing of mental health daily huddle and non-fatal overdose alert system ongoing, to identify and support those at risk of overdose and drug death. Ongoing promotion and referral to bereavement service administered by Scottish Families Affected by Alcohol and Drugs (SFAD). Promotion of family inclusive practice and linkage between Children and Drug and Alcohol Recovery Service ongoing. Improved quality of data entered in to the national drug related death database (NDRDDB) and alignment with National Records for Scotland (NRS) annual report. 7. Implementing improvement methodology including implementation of the Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services. Deliver four recovery orientated workforce development events by Increase by 50% the number of SMART Recovery peer facilitators by Ongoing partnership working with the Sudden Fatality Investigation Unit (SFIU) to review drug related deaths. Four plus recovery orientated workforce development events delivered by peer facilitators trained in 2016, increasing to 35 trained by A 500% increase in uptake among peers accessing face to face training. Plans underway to harness momentum from developing recovery communities to support an infrastructure for people with lived experience. Consolidate and increase Total number of active SMART

13 mutual aid groups by 100% (6 groups) by recovery groups across Highland in 2017 is 9, a 200% increase from 3 groups in SIG continues to lead on implementation of the Quality Principles and RPIW Position statement accessible via website to strengthen transparency and accountability: HADP Quality Principles Position Statement Care Inspectorate feedback applied to inform a quality principles improvement plan. Rebranding to Drug and Alcohol Recovery Service. Annual stakeholder event delivered in May 2016 to promote quality framework, report Quality Principles progress and consult with stakeholders: HADP Stakeholder Event 2017 Recovery café event delivered in Caithness in August 2016 and very well evaluated by the 64 attendees. Hearing children voices/family recovery multi-agency workshop delivered in Sept Strategy group development day delivered in Sept 2016 applying improvement methodology to refresh

14 HADP drug and alcohol strategy. Refreshed drug and alcohol strategy completed in March 2017 using Production House methodology as a central focus: HADP Strategy Highland participation in the national recovery walk for 3 years in a row. People in recovery being empowered to lead development. 8. Responding to the recommendations outlined in the 2013 independent expert group on opioid replacement therapies. Sustain quarterly meetings of an ORT working group by ORT work plan agreed and regularly monitored and reviewed by Development of a performance system that will allow extract of reports by ORT group has been disbanded due to lack of engagement. Work plan being progressed by the drug related death review group and SIG. Pharmacy audit of ORT to be completed for second year. Improved intelligence on numbers, gender, geography, dosage and supervisory requirements. Non-medical Prescribing Framework developed and implemented to increase access where there is no alternative provision. Local policy to be reviewed in adherence with the refreshed clinical guidelines for drug dependence (2017). Reduced staff capacity has led to a delay in the analysis of ORT audit. Service Specification being developed with pharmacy to pilot a moving on to community model. 9. Ensuring a proactive and Increase by 30% the Referral pathways embedded with

15 planned approach to responding to the needs of prisoners affected by problem drug and alcohol use and their associated through care arrangements, including women numbers of prisoners engaging in treatment by Develop a prisoner pathway and increase by 25% those referred to receive help or treatment for drug or alcohol problems with services post liberation as part of their throughcare arrangements by allocation meetings to establish key worker involvement that supports the individual throughout sentence and in throughcare. Weekly updates for community staff ongoing on expected release / court dates to ensure seamless transition. Partnership working with HMP throughcare officers and recovery orientated interventions embedded. Embed recovery orientated interventions and reduce to 20% prisoners worried that alcohol will be a problem on release by Building recovery from the inside out prison recovery cafe event delivered in July Recovery walk for prisoners in HMP Inverness delivered in September prisoners completed SMART Recovery peer facilitator training alongside community peers by Improved linkage with community mutual aid opportunities on liberation. 10. Improving identification of, and preventative activities focused on, new psychoactive Increase the number of hits to NPS pages on the Substance Awareness Planning underway to complete a review of drug treatment referral processes, prisoner engagement models, uses of motivational interviewing, peer mentoring, user voice focus groups in the prison setting and develop any necessary improvements. The toolkit achieved a cumulative total of 21,000 hits in the first 2 years, with hits to the NPS pages exceeding 300. Drug and Alcohol Awareness training being developed that will incorporate NPS.

16 substances (NPS). Toolkit website to 400 by Delivery of bespoke NPS training to 100 workers via development of in-highland resources by A redesigned Substance Awareness Toolkit went live in March Bespoke NPS training delivered to 139 professionals in 2016/17 with evaluation of learning (knowledge and skills) extremely positive. Presentation delivered to community safety forum and awareness raising via LCPP. Highland participation in RIDDOR system. NPS prevention and harm reduction incorporated in to two awareness raising initiatives by Cascade best practice to 80 workers via a learning event to share In-Highland skills and knowledge by Awareness raising session delivered to 90 student nurses in NPS incorporated in to stakeholder and other awareness raising events delivered in 2016/17. Knowledge and skills cascaded via Drug and Alcohol Recovery Service learning events and practice exchange. Ongoing monitoring of trends and awareness raising via the national and Highland Drug Trend Bulletins. Fortnightly drug trend spreadsheet developed. NPS policy developed and implemented in New Craigs Hospital. 11. On-going Implementation of a Whole Population Approach for alcohol recognising harder to reach groups, supporting a focus on communities where deprivation is greatest. Continue 100% attendance at the licensing forum to raise awareness of the public health objective by Increase the cumulative number of licensing applications that are refused to 10 through ongoing application of the overprovision statement Support for problematic NPS users provided via Drug and Alcohol Recovery Service. 100% attendance at the Highland Licensing Forum continues to raise awareness of the public health objective. Routine objections to licensing applications that contravene the overprovision statement ongoing. WPA incorporated in to all presentations / workshops and training Refresh of the alcohol overprovision statement due in 2018 will require supporting evidence, with an initial planning meeting held and timetable agreed with the Principal Solicitor, Public Health and HADP.

17 (OPS) by to raise professional and community awareness. Ongoing delivery of social media/awareness campaigns to promote low risk drinking, particularly focused on festive and festival periods and pregnancy. 12. ADP Engagement in improvements to reduce alcohol related deaths. Sustain a rate of alcohol related mortality below 20.0 per 100,000 by In 2016, there were 71 alcohol related deaths in Highland, a provisional rate of 30.0 per 100,000. Standardised rates not published at the time of this annual report submission. The long-term trend is downwards and comparable to the national position. Work underway to map alcohol related deaths to provide baseline data, improve understanding and identify opportunities for effective intervention. Collaboration with Highland Senior Citizens Network to deliver a peer education project for on older people and alcohol. With sessions in each LCPP planned for 2017/18. * SMART (Specific, Measurable, Ambitious, Relevant, Time Bound) measures where appropriate

18 3. ADDITIONAL INFORMATION 1 APRIL MARCH Please bullet point any local research that you have commissioned in the last year. What is the formal arrangement within your ADP for working with local partners to report on the delivery of local outcomes? (Most research conducted to date has been in-house and tends to be consultative. HADP is improving its quality of both qualitative and quantitative research and is very amenable to participation in national studies). Participation in Everyone Has a Story to Tell Lloyds PDI hearing children s voices in recovery national initiative. Hearing Young People s Voices: Improving Practice Consultation on supporting family recovery in Highland. Rock Challenge evaluation of impact on positive choices and delaying / reducing drug and alcohol use among young people in Highland. Stakeholder Day Evaluation Feedback from a wide range of stakeholders on future priorities. Recovery Rising in Caithness Community priorities for recovery in the Caithness area of Highland. Consistency of governance and accountability arrangements for HADP is in line with existing accountability arrangements between the Scottish Government and local partners; such as those relating to Single Outcome Agreements (SOA) / Highland Outcome Improvement Plan (HOIP) between Government and Community Planning structures and performance management arrangements adhered to by the NHS, such as Local Delivery Plan standards. Locally, HADP sits within the Safer Highland strand of the Community Planning Partnership (CPP) and local governance arrangements apply within that framework. HADP has been working to establish robust links with local community planning partnerships to enlist support to deliver the strategy in localities and ensure community concerns are reflected at a strategic level. The HADP strategy group minutes are reported on a quarterly basis to the Safer Highland leadership group for scrutiny. In addition, the HADP chair requests that the NHS Highland board, the integrated health and social care committee and the Community Planning Partnership endorse the annual report. Work is underway to strengthen the HADP relationship with the integrated health and social care committee

19 3 4 A person centered recovery focus has been incorporated into our approach to strategic commissioning. Please advise on the current status of your ROSC? Is there an ADP Workforce Development Strategy in Place, if not, are there plans to develop? What additional supports have you leveraged to facilitate this and are you working with our NCOs? and to ensure regular feedback from the CPP. The HADP chair is also a member of Safer Highland leadership group ensuring improvements in local accountability routes. ROSC is established and is enhancing further. HADP continues to recognise the requirement to update the workforce development strategy and that it needs to be informed by undertaking a multi-agency Training Needs Analysis followed by focus groups with more specialist services. A previous agreement with STRADA to support strategic workforce development was transferred to Scottish Drugs Forum (SDF), but as yet has not been initiated. There is good uptake locally of the workforce development opportunities provided by the nationally commissioned agencies. The framework of core competencies (generic through to specialist); that have the quality principles, DANOS and KSF embedded will be applied and further developed by the Team Leaders/Advanced Practitioners. Induction training for new staff in the Drug and Alcohol Recovery Service will continue to reflect the core competencies.

20 APPENDIX 1 Please provide any feedback you have on this reporting template. The template is useful way of collating a year s work, although it would be better if it were submitted earlier in the year. It is mainly on service development for people with problem drug and alcohol use, which tends to reflect and also perpetuate the historical funding situation. Greater opportunity to highlight prevention, CAPSM, recovery and partnership working would have been welcome. More opportunities for partners such as Police, Education, Housing, Criminal Justice, Children and Families, Fire Service, Youth Justice, Community Education, Community Safety, Third Sector, community organisations and people with lived experience to contribute and have their work acknowledged would assist with keeping them actively involved in the ADP. It would also help to dispel the perception that the ADP focus is on treatment instead of across a broad continuum that spans prevention through to recovery.