Document Details: ADP Reporting Requirements 2013/14. 1 Partnership Details. 2 Self-Assessment: 3 Finance Framework

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1 Document Details: ADP Reporting Requirements 2013/14 1 Partnership Details 2 Self-Assessment: 3 Finance Framework 4 Core & Local Indicators and key activities 2013/14 5 ADP & Ministerial priorities Appendix 1 Guidance Notes and Commissioning Diagram 1

2 1. PARTNERSHIP DETAILS Alcohol & Drug Partnership: Lanarkshire ADP Chair Colin Sloey Contact name(s): See note 1 Stewart Marshall Contact telephone Stewart.marshall@lanarkshire.scot.nhs.uk Date of Completion: 12/09/2014 Date published on ADP October 2014 website(s) The content of this template has been agreed as accurate by the Alcohol and Drug Partnership, and has been shared with our Community Planning Partnership:.. ADP 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 March 2014 Theme ANALYSE 1 ADP Joint Strategic Needs Assessment has been undertaken and provides a clear, coherent assessment of need, which takes into consideration the changing demographic characteristics of substance misusers in your area. Please also include here any local research that you have commissioned See Note 3 R A G See 1 G Evidence See Note 2 There is one ADP across the Lanarkshire Health Board area. NHS Lanarkshire and North and South Lanarkshire Councils therefore play a fundamental role in our partnership, together with other key stakeholders such as Police Scotland, Scottish Prison Service, Lanarkshire Community Justice Authority, Scottish Fire and Rescue, and the Crown Office and Procurator Fiscal Service. In 2011/12, in preparation for the ADP Strategy and delivery plan , a full needs assessment was completed involving analysis from data and profiles, community and service provider engagement and local intelligence. Lanarkshire ADP continues to utilise available profiles and data from Information Services Division Scotland (ISD) to help form an understanding of need. We also use additional statistical information such as the Scottish Health Survey and Scottish Adolescent Lifestyle and Substance Use Survey (SALSUS). Lanarkshire ADP is closely aligned to the North Lanarkshire and South Lanarkshire Community Planning Partnerships (CPPs) and representation on the ADP Board involves senior management from all partnership organisations. The Lanarkshire ADP Implementation and Finance Group (I+F) consult with Partnership Boards and Forums in relation to the commissioning and de-commissioning of services. We continue to measure local referral rates and type of referrals to monitor the need of service users and to develop appropriate plans. In 2013/14 we engaged in capacity planning exercises and workload measures to ensure services were able to provide the necessary intervention and support. 3

4 Theme R A G See 1 Evidence See Note 2 As per last year s report Lanarkshire ADP, in partnership with Scottish Training on Drugs and Alcohol (STRADA) and North Lanarkshire Integrated Addiction Services (NLIAS), conducted a needs assessment in relation to the workforce within alcohol and drug services. This work was used to inform the workforce development model for 2013/14 consistent with the emergence of a recovery orientated system of care. It is expected that the learning and work from the needs assessment be shared and carried across to services in South Lanarkshire. papers/documents/september/item-12-developing-blueprint-for-alcohol-and-drug- Workforce-Development-Model-in-North-Lanarkshire.pdf As noted in last year s report, for the past 5 years we have engaged in health improvement research related to service users discharged from a psychiatric in-patient setting. This has been in collaboration with mental health colleagues. The research has shown a significant lower life expectancy for service users, particularly with alcohol and/or drug issues. As a result of the findings we initiated 2 working groups, 1 group looking at the close pathways between substance misuse and mental health services (particularly in the community) and the second group looking at the physical health needs for service user s with alcohol and/or drug issues and ensuring that these health issues are met. The work taking place fits with recommendations from the Opioid Replacement Therapy (ORT) review around improved primary care linkage and access to universal services We concluded a Community Justice scoping exercise in 2012/13 to look at available services This work incorporated local and national statistics and involved colleagues from the community justice arena. From the exercise there was acknowledgement of the areas that worked well and the areas for improvement. In 2013/14 an action plan was developed from the exercise and involved a number of recommendations including increasing the number of Community Payback Orders (CPOs) with an Alcohol or Drug Requirement, improved linkage between community justice and mental health services, 4

5 Theme R A G See 1 Evidence See Note 2 development of supports for offenders at post order, increased well being checks for offenders and a focus on Health Improvement agenda within prison settings. The ADP and community justice colleagues have worked closely to meet the recommendations, an example of the work being an agreed pathway in relation to CPOs involving alcohol/drug offenders, the facilitation of Self Management and Recovery Training (SMART) groups in the Drug Treatment and Testing Order Service and joint working between community justice and Keep Well Nursing staff. The work with community justice colleagues emphasised the value of the Community Bridges Project. The project offers close, voluntary, through care support for offenders with a history of substance misuse, and has been shown to make a difference in the offending patterns and substance use of the offenders they are working with. In light of the recognised worth of the model, the detailed history of many of the offenders going back to youth offending and local intelligence indicating an increasing, concerning area around youth offenders within HMYOI Polmont, the ADP has agreed to provide funding for the Youth Bridges Project in 2014/15. Last year a joint strategic needs assessment on Community Safety within South Lanarkshire was commenced. The needs assessment involved data analysis from different outlets, and local intelligence on community safety priorities. It is expected that this work will be completed shortly and fed into the Safer South Lanarkshire Board for discussion and decision making. Last year the Lanarkshire ADP and Lanarkshire NHS Public Health Department commissioned work looking at overprovision. This work has involved data collection and analysis, engagement with key members from licensing, public health and ADP, as well as public engagement. The work is designed to help members understand the alcoholrelated issues across Lanarkshire that may be linked to overprovision and provide guidance to licensing boards and forums with policy statement and decision-making. The work will be concluded mid 2014 and an update provided at the next Annual Report. As part of Service development and continuous improvement the ADP has provided 5

6 Theme R A G See 1 Evidence See Note 2 funding for the external evaluation of the North Lanarkshire Integrated Addiction Service. This work will be completed in January In response to workforce development requests from practitioners, and in light of the Children and Young People Bill, the ADP has been at the forefront of development around Getting it Right for Every Child (GIRFEC) and Adult Substance Misuse Services. In 2013/14 work has involved the development of guidance for addiction staff on promoting the wellbeing for children affected by substance misuse when working with adults who have parental/caring responsibilities. The ADP continued to fund diversionary projects in 2013/14. The diversionary work took place in areas identified by health and police colleagues as problematic in relation to young people and anti social behaviour. Data from police colleagues suggest that the right areas have been targeted as there has been a noticeable decrease in antisocial behaviour in the areas where the diversionary work has taken place. In conjunction with STRADA, Lanarkshire ADP has been working since November 2011 to design, deliver, monitor and evaluate training tailored to address young people and their relationship and consumption of alcohol, by employing alcohol brief interventions (ABIs) using a health behavioural approach. The delivery and effectiveness of ABIs to young people to date has not been evidenced nationally as such. This work continued through 2013/14. 2 An outcomes based ADP Joint Performance Framework is in place that reflects the ADP National Outcomes. See note 4 G The ADP Delivery plan accurately reflects the 7 core ADP outcomes (health, prevalence, recovery, children and families, community safety, environment and services). The delivery plan emphasises the importance of joint working and monitoring performance. Data, targets and indicators clearly identified within the delivery plan help to monitor performance and highlight services that are responsible and accountable for service delivery. 6

7 Theme R A G See 1 Evidence See Note 2 There is clear read-across with performance indicators and outcomes stipulated in the ADP delivery plan and other key plans and strategies including both North and South Lanarkshire s Substance Misuse, Community Safety and Children s Services Plans. 3 G The mapping exercise of community justice services helped to scope activity, costs and variation in service delivery to support resource transfer across ADP and Community Justice Authority. This work led to continued funding and support for the Persistent Offender s Project, Arrest Referral Service, Community Bridges Project as well as providing additional funding for the initiation of the Youth Bridges Project. The exercise assisted with the work taking place in relation to the transfer of resource from Police Scotland to NHS Lanarkshire for delivery of NHS led healthcare within Police Custody Suites. The ADP is committed to ensuring that Healthcare within Police Custody Suites is complimentary and aligned to supports available in the community The Transfer of resource from SPS to NHS Lanarkshire to ensure the delivery of NHS healthcare within the prison setting took place two years ago. Additional ADP funding has helped to develop healthcare provision further within the prison setting with a particular emphasis on Health Improvement and promoting recovery for offenders. Integrated Resource Framework - Process Suitable data has been used to scope the programme budget and a baseline position has been established regarding activity, costs and variation. Note 5 Development and delivery of diversionary work throughout Lanarkshire has involved a multi agency approach in relation to data analysis, cost and diversionary activity. The cost and delivery has been facilitated by numerous partners, including ADP, Police Scotland, NHS, Local Authority and is a good example of agencies working together to divert young people away from harm, providing a safe place for young people to engage with peers and participate in meaningful activities and to reduce anti social behaviour impacting on local communities. The ADP I+F group have the remit to review and monitor ADP spend against key outcomes. A performance and financial framework is utilised with the group that provides detailed breakdown of costs, activity and performance. 7

8 Theme 4 Integrated Resource Framework - Outcomes Note 5 A coherent approach has been applied to selecting and prioritising investment and disinvestment options building prevention into the design and delivery of services. R A G See 1 G Evidence See Note 2 The community justice scoping exercise provided identification of areas for investment and a move towards co-ordination and a shared vision of service provision. This coincided with the transfer of resources related to healthcare within police custody suites which has allowed the ADP and health colleagues to proceed with identifying a model of care and taking the necessary procedural steps towards live initiation of NHS healthcare. The model of care (now live) will provide effective healthcare within the custody setting and help to link individuals with alcohol and/or drug problems, to the appropriate community based supports that will assist them in their recovery. In relation to the transfer of resources within the prison setting. This has enabled NHS healthcare delivery with particular focus around key performance indicators such as health improvement for prisoners. The HEAT (Health Efficiency Access Treatment) 4 Standard for Alcohol Brief Intervention (ABI) has been fully embedded into the main priority areas (primary care, maternity, acute) thanks to the co-ordination and investment led by the HEAT 4 Steering group that links accordingly to the ADP I+F group and ADP Board. The HEAT A11 access to drug/alcohol treatment target has been consistently surpassed in Lanarkshire due to the co-ordinated actions and investment of the South Lanarkshire Substance Misuse Planning and Performance (P+P) Group and the North Lanarkshire Addiction Partnership Board (APB). Both, the P+P and APB have membership from different partnership agencies tasked with planning services and care. Both link to the ADP I+F group and ADP Board. In 2012/13 the Lanarkshire Youth Counselling Service (LYCS) and Child and Adolescent Mental Health Service (CAMHS) merged to offer integrated access to children and young people. Last year witnessed the consolidation of integration and the tiered level of service delivery has ensured that children/young people are able to access mental health/support services at the level required and the point of need. 8

9 Theme R A G See 1 Evidence See Note 2 The ADP provided funding to the Safer Lanarkshire Campaign led by Police Scotland and involving Community Planning Partners. This investment, which included spend on prevention and crime reduction, contributed to the improvement in the quality of life in Lanarkshire as a whole. By utilising The Measuring Preventative Spend A Cost Toolkit for Community Safety and looking at costs and savings around violent crime, serious assault, assault and vandalism, it is estimated that for every 1 spent on the Safer Lanarkshire Initiative, 164 is being saved by partners elsewhere. PLAN Theme R A G Evidence 5 We have a shared vision and joint strategic objectives, which is aligned with our local partnerships, e.g. child protection committees, violence against women, community safety etc. G Lanarkshire ADP work with our partners to achieve equality of access to services, combined with value for money. We accept alcohol and drug misuse is multi-factorial and as such, for intervention and support to be truly effective, this must take place on an interagency basis. We work to achieve the Lanarkshire ADP strategy aims and objectives via our contribution to the existing community planning arrangements and as mentioned above, our strategic objectives are in line with other key local Plans thus contributing towards achieving the best outcomes for all children, young people and families in Lanarkshire. The Strategy is supported by our 3 year delivery plan which outlines our national and local outcomes, local targets, and key actions. The Strategy and Delivery Plan clearly contributes to the South Lanarkshire and North Lanarkshire Single Outcome Agreement (SOA). ADP-Strategy pdf 9

10 PLAN 6 A The Lanarkshire ADP Delivery Plan is clearly linked to community planning arrangement and Single Outcome Agreements. We follow a commissioning cycle of annual local needs assessment, planning, commissioning, monitoring and reviewing The I+F group provides direction on the investment of services based on the information derived from the commissioning cycle taking place annually. With impending Health and Social Care integration, as well as the emergence of Self Directed Support, the ADP is well placed to support change to service delivery. The development of an updated Commissioning Strategy will be taken forward, post integration, to ensure the strategy is closely aligned with the collaborative approaches. A. Our strategic commissioning work is clearly linked to Community Planning priorities and processes. Please include your ADP Commissioning Plan or Strategy if available. Please include information on your formal relationship to your local child protection committee and Criminal Justice Adult Services. B. What is the formal arrangement within your ADP for reporting on your Annual Reports/ Delivery Plans/shared documents, through your local accountability route. See note 6 In relation to Health and Social Care integration it is important to note that service delivery for alcohol and drug services within North Lanarkshire is already delivered in an integrated manner. The integrated service is monitored by the North Lanarkshire Addiction Partnership Board to ensure a culture of continuous improvement and formal performance scrutiny. The ADP has representation and close links to public protection committees such as the Adult Protection Committee, Child Protection Committee and Multi Agency Public Protection Arrangements (MAPPA) Committee. There is a well established ADP/Community Justice Authority (CJA) working group responsible for coordinating delivery of care and support and some of the work has been mentioned previously. There has been a newly established ADP/Child Protection Committee working group involving ADP Development officers, Child Protection Committee Coordinators and Lanarkshire Substance Misuse Leads. This group will focus on areas around workforce development, and improving linkage between child/family services and adult substance misuse services. It should be noted that both the North and South Lanarkshire Substance Misuse Workforce Development Groups contain representation from child and adult 10

11 PLAN 7 Service Users and carers are embedded within the partnership commissioning processes A services. ADP draft and final annual reports are reported directly into both the North and South Lanarkshire Community Planning Partnerships. All stakeholders are encouraged to provide comment and assistance to the annual report. Post submission of the annual report both CPPs are provided with a presentation and written report detailing the salient points of the annual report. This is provided also to the CJA Board, Adult Protection Committees, Child Protection Committees, MAPPA Committee, and Community Safety Partnerships. As part of the ADP Strategy we helped to establish a network of recovery champions within all organisations across Lanarkshire. We have continued to assist recovery champions in developing and facilitating recovery events for practitioners, service users, families and carers alike. At the events we have consistently encouraged feedback into the quality of service provision in Lanarkshire and asked in what areas we can improve. An example of such an event took place in Airdrie last year. The event looked at raising awareness to services, service users, families and carers of all the different supports and groups available to aid recovery. The event took place in the shape of a speed networking exercise and was facilitated by recovery champions and over 20 service providers and group supports including mutual aid. Part of the event also included a drama delivered by community recovery champions specifically aimed at highlighting the recovery resources available in the form of marking someone s recovery journey/walk. There is a service user delegate at the Lanarkshire ADP Board meetings usually in the form of representation from The Lanarkshire Communities of Recovery Service that is facilitated by Phoenix Futures. Within our commissioned services we have highlighted in service level agreements (SLAs) the importance of regular service user consultation to chart quality of service and possible service improvements. An example of such work would be the Substance Misuse Service within South Lanarkshire who continues to conduct annual service user consultations looking at the help their service provides and the outcomes that service users achieved whilst engaged. Feedback remains largely positive and helps to re-enforce good practice and areas for possible improvement. 11

12 PLAN The ADP commissioned Self Management and Recovery Training (SMART) recovery to enhance self efficacy and coping mechanisms for service users. Staff complete SMART training and facilitate SMART groups with the understanding that service users be identified to become SMART facilitators and the groups eventually become peer led. The ADP sees SMART as an addition to other supports available and continues to encourage assertive linkage between treatment services and other mutual aid organisations. Lanarkshire ADP, in partnership with the Scottish Recovery Consortium (SRC), has agreed to take forward a Lanarkshire Recovery College in the spring of 2014 (May). This will support individuals with lived experience of recovery who have expressed an interest in giving something back and working with others affected by substance misuse. This work demonstrates the ADP commitment to support individuals with the lived experience of substance misuse becoming recovery assets and supporting services and service users. Last year at a local event attended by family members and carers, including young and kinship carers, the clear message from family members was that they wanted to access help and support for themselves, however, they often simply did not know where to start. Following this, a pan-lanarkshire working group was convened, comprising representation from substance misuse services and local carers organisations, in order to put the voiced needs of those family members, who attended the local event, into practice. e group have developed a local signposting resource, particularly aimed at those hidden family members who are unlikely to come into contact with services and instead try to deal with their problems within the family unit. The pack, which is almost print ready, contains information on the local supports available, information on understanding dependency and talking to a loved one about their dependency, Dr Jan Ligon s Six Survival skills for families and also stories of family recovery in order to convey the message that families and family members can and do recover. Although there has been considerable work involving service users, families and carers The ADP acknowledges there is a need for the updated commissioning strategy to ensure that service users and carers are very much part of the commissioning process. 12

13 8 PLAN A The ADP recovery strategy highlights the importance of a person centred recovery focus within service delivery. For every commissioned service there are recovery orientated outcomes within their SLAs. We endorse the process of outcome based commissioning and expect services to demonstrate a recovery focus and demonstrate that they have assisted in meeting the needs of service users engaged with their service. A person centered recovery focus has been incorporated into our approach to strategic commissioning. Describe the progress your ADP has made in implementing a ROSC, please include what your priorities are in implementing this during This may include: Recovery Orientated System of Care service review and redesign Identify and commission against key recovery outcomes Recovery outcome reporting across alcohol and drug services eg. Outcome STAR. Other Individual recovery care plan and review Involved mutual aid and recovery communities Please include your outcomes for all individuals within your alcohol and drug treatment system for 2013/14 if available. We commenced a working group looking at the consistency of outcome measures across all service provision. This group was chaired by the Clinical Director for Addiction Services in Lanarkshire. Last year it was agreed from the group that a pilot be commenced with a select number of practitioners using the Drug and Alcohol Outcome Star. The pilot is currently taking place across Lanarkshire with evaluation on the tool to take place towards Sept Early indications from staff using the outcome tool is encouraging and there is a plan for wider implementation of the Outcome Star across Alcohol and Drug treatment services in 2014/15 if the pilot is deemed a success. The ADP commission a tier 2 service, Meridian, that offers intervention and support to individuals and families affected by problematic levels of alcohol/drug use. As part of the reporting arrangements Meridian use the Clinical Outcomes in Routine Evaluation (CORE) tool. This tool gives a qualitative indication of the positive impact the Meridian service is having on recovery and is accompanied by regular case studies and service user testimonies. We have clinical governance requirements specific to NHS alcohol and drug services and the clinical governance group conduct regular reviews and audits of service to ensure person centred care planning and intervention is taking place. NHS Team Leaders for alcohol and drug services were also asked to complete the Scottish Recovery Indicator 2 (SRI 2) toolkit last year. The feedback from SRI2 allowed services to demonstrate the areas where they were meeting recovery and areas for development. The blueprint workforce development work has allowed service providers and practitioners the opportunities to reflect on where they sit within a ROSC and how services and 13

14 PLAN practitioners can be developed to ensure seamless linkage and shared values between statutory, third sector and mutual aid.. 9 G As aforementioned there has been a great deal of work to bring adult addiction services into compliance with GIRFEC. This work will include staff training and the development of guidance documentation to help staff promote the wellbeing of young people/children affected by substance misuse. A Training for Trainers course for Addiction staff on Getting it Right for Every Child (GIRFEC) was developed in order to continue to build capacity and sustainability within the workforce. Developments such as this are essential in working towards and enabling whole family recovery. The ADP Support Team continues to support the Recovery Worker s forums in Lanarkshire and there has been the introduction of a number of conversation cafes. Members of the recovery worker s forums received cafe host training to help with further facilitation. For the ADP Strategy and Delivery Plan an Equality Impact Assessment was complete. All relevant statutory requirements regarding Equality Impact assessments have been addressed during the compilation of our ADP Strategy and Delivery Plan DELIVER 10 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) G Equality Impact Assessments are completed as part of the governance arrangements for commissioned services and all ADP commissioned services are expected to comply with the relevant framework As aforementioned Lanarkshire ADP in partnership with STRADA and NLIAS completed a needs assessment for workforce development. This was implemented in 13/14 and has been vital to the continued development of a ROSC. Alcohol and Drugs Workforce Development is a vital element within our ADP Strategy and delivery plan. We have two active workforce development groups (North and South Lanarkshire) and both are populated by key individuals from the statutory and third sector as well as from children and young people s services, community justice, adult services and service user representation. 14

15 PLAN The development of the workforce is also supported by formal processes in place with statutory organisations such as personal development plans, performance appraisal and supervision. Third sector services, within their SLAs, provide similar governance and supporting arrangement. There have been numerous areas of work taking place across Lanarkshire. Adult Support and Protection training has been rolled out across Lanarkshire in light of the increasing number of referrals that involve vulnerable individuals with alcohol and/or drug issues. Alcohol Related Brain Disease (ARBD) training has been facilitated in North Lanarkshire and about to be facilitated in South Lanarkshire. This training has focused (and will continue to do so) not just on drug and alcohol treatment providers but also other areas of service delivery such as community care staff. To support this further a ARBD website is being developed by North Lanarkshire Council and NHS Lanarkshire and will go live June The website will be available to all agencies/colleagues across Scotland to support staff development in the area of ARBD and will also be available to the public. As noted earlier we continue to work closely with STRADA in the area of ABIs and young people. As well as focusing on how much young people drink this training was designed to look at the need to understand why they drink and hence had a strong emphasis on engagement process, different in content to ABI training delivered for adults. 2013/14 saw the delivery of a total of eleven ABI training events and two Young People and ABI Training for Trainers events. 121 Participants took place from 2013/14 with a total 60.2% attendance. Participants ranged from housing and homeless services, local authority (not including social work), National Health Service (NHS), police services, social work as well as Voluntary organisations. The majority of participants on the ABI for young people course were from the voluntary and local authority sectors whilst the majority of participants on training for trainer s course were from NHS and Voluntary sectors. Over 95% of respondents to an on line evaluation stated that the learning outcomes met their expectations and were relevant to their role and over 90% of respondents stated that the content was pitched at an appropriate level and that a satisfactory range of training 15

16 PLAN methods had been employed and on average 84.7% of respondents rated that the coverage of intended learning outcomes were fully covered, as well as 82.2% stating that they had improved skills and 80% saying improved knowledge. 100% stated that they had increased knowledge following this event in relation to their practice with a 90% increase in their confidence. 11 A transparent performance management framework is in place for all ADP Partner organisations who receive funding through the ADP, including statutory provision G It would appear from the evaluation responses received that this course met the expectations of the majority of participants who attended. The ADP commission 2 specialist midwives to work with pregnant mothers with alcohol and/or drug issues. This work has helped to support mothers and families and to strengthen relationships between health and social care treatment agencies. The service plays an active part in stretch aim 1 of the Early Years Collaborative (EYC). The midwives also took the lead in developing a substance misuse resource for colleagues and partners. In response to increasing concerns over New Psychoactive Substances (NPS) the ADP commissioned NPS training for alcohol and drug and mental health treatment staff (both statutory and third sector). This training will continue to be offered in 2014 with a view to further discussion around sustainability. We continue to work closely with nationally commissioned services such as STRADA, National Education Scotland (NES) and SRC. Last year both STRADA and SRC provided specialist training and recovery workshops to the workforce. Lanarkshire ADP funding regulations require clear outcome performance reporting. We have a very transparent performance management framework in place for commissioned services. This takes shape in the form Quarterly reviews to monitor the Service level agreement Annual reports provided by the service demonstrating activities undertaken and achievements Annual performance visits to every service by members of the ADP Implementation and Finance (I+F) group Annual ADP Performance event where all funded services present on their performance. The event allows for further discussion around performance, service improvement and partnership working. 16

17 PLAN Regular updates to ADP Implementation and Finance group and ADP Board members. For all drug and alcohol treatment services we have a performance framework (local improvement targets LITs) that services must report on quarterly. The LITs encompass performance in relation to waiting times, DNA, assertive linkage with community based groups, assertive linkage with employability/education, SMR completion, hepatitis vaccination, BBV testing, overdose awareness training and naloxone provision. On top of the above arrangements we reserve the right to access records regarding the services, including any staffing, financial and complaints records and reserve the right to consult with staff, volunteers and service users as to the effectiveness of the service. REVIEW 12 ADP Delivery Plan is reviewed on a regular basis. 13 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) G A The ADP Delivery plan is reviewed on a regular basis and an annual report is submitted to ADP Board and I+F group. Reports include the recording of progress being made, any variance against plans and any requirement for remedial actions Lanarkshire-ADP-Delivery-Plan pdf As stipulated all commissioned services have SLA s with a clear expectation of what is expected in terms of outcome measures and the performance management framework in place to monitor this. As part of NHS internal audit processes the NHS Internal Audit department regularly audit contracts to ensure that the contracts are being monitored against expected output and outcomes. Recently two commissioned services were randomly selected for internal audit of which the internal audit department remarked they were impressed with the frameworks and monitoring arrangements in place. The LITs are intentionally recovery orientated to ensure that services are offering harm 17

18 REVIEW reduction advice, psychosocial interventions and assertive linkage to pro social group and/or employability where appropriate. The ADP s stretch aim from the ORT review challenges drug and alcohol treatment providers to offer recovery focused care reviews to all service users in receipt of ORT. The review should be person centred and holistic in nature. To meet this aim the ADP has been assessing current arrangements around care reviews which have primarily focused on service users deemed high risk. The expectation is that in 2014/15 the number of care reviews will be gradually increased to meet demand. 14 A schedule for service monitoring and review is in place, which includes statutory provision G There is a clear schedule for ADP outcome contract monitoring through steering groups and community planning groups (North Partnership board) (South Planning and Performance). 15 Service Users and their families play a central role in evaluating the impact of our statutory and third sector services. A As noted earlier the Substance Misuse Service within South Lanarkshire conduct annual service user questionnaires which highlight the importance of service users being treated with dignity and the integral part service users and families play in a person s recovery. It is important to highlight that within all service SLA s it is emphasised that service users and families should play a central role in evaluating the care and support they receive. We continued to help facilitate a number of recovery events allowing service users and family members/carers the opportunity to discuss the impact of services and what they would like to see change and/or improve. NLIAS remain involved in the Circle of Care pilot. The circle of care approach places the service user at the heart of care and asks the service user to identify the interventions, supports and services that they would like to be involved. This approach helps to focus on the individuals personal recovery and allows him/her to take control over their life. The pilot continues to be evaluated and illustrates Lanarkshire s commitment to person centred care and service users and families being integral to service delivery and improvement. 18

19 REVIEW Within NLIAS there is the Strengthening Families programme working with families and young people (aged between years) affected by substance misuse. A key part of this programme is engagement with families and feedback from families and young people is therefore very helpful. A number of ADP funded young people s services are now using the young people s wellbeing indicator which is a self-completion tool that helps to measure a young person s level of functioning and satisfaction with the service or intervention that they are in receipt of. The tool covers the 8 indicators pertaining to GIRFEC and encourages the young person to consider their strengths and threats against the indicators. Data from Lanarkshire Youth Counselling Service has yielded some encouraging results through the use of the tool and appears to indicate that a significant number of young people engaged with their service report increased strengths in a number of areas 12-Youth-Counselling-Service-analysis-of-Wellbeing-Indicator-data.pdf Our tier 2 commissioned service, Meridian, underwent external evaluation involving significant engagement with service users and families. 117 individuals engaged in the evaluation with the majority providing positive feedback. 19

20 16 REVIEW A A) Lanarkshire ADP has very clear quality assurance systems in place as noted and described above. However what is clear is that there is a place in the near future for an over-arching Quality Assurance Strategy that captures the systems in place and aligns to the Alcohol and Drug Quality Improvement Framework, the Quality Alcohol Treatment and Support (QATS) recommendations and the Healthcare Quality Strategy. In 2013/14 key Lanarkshire ADP stakeholders met with the Minister for Health and Wellbeing to discuss the good work taking place in Lanarkshire 12-Lanarkshire-ADP-Report-to-Cabinet-Secretary-for-Health-and-Wellbeing-Mr-Alex-Neil- MSP.pdf Lanarkshire ADP is happy to take the lead on the quality agenda and for the forthcoming year has agreed to pilot the Quality Principles contained within the National Quality Improvement Framework for Alcohol and Drug Services. A. There is a robust quality assurance system in place which governs the ADP and evidences the quality, effectiveness and efficiency of services. See note 9 B. Describe the progress your ADP has made in taking forward the recommendations from the Independent Expert Review of Opioid Replacement Therapies in Scotland. Please also include your Key Aim Statement and a specific update on your progress in implementing. B) The ADP is committed to the Key Aim Statement, 100% of service users in receipt of an opioid replacement therapy will be offered regular, formalised, recovery-focused reviews, involving all the individuals/services/groups that are participating in their recovery plan, by the end of March Encouragingly the aim statement fits with the newly developed quality principles. The ADP has progressed a number of areas from the ORT review. As aforementioned we are currently reviewing the existing review process with service users with a view to wider rollout in the forthcoming months. We are also in the process of recruitment for a medical officer that will assist with the process. The NHS Primary Care Link continues to lead a specific piece of work designed to enhance relationships and linkage between General Practitioners and Lanarkshire Substance Misuse Services. This covers a number of areas such as the physical health needs of individuals who are prescribed ORT; poly-pharmacy in relation to pain relief, antidepressant and anxiolytic medications prescribed by GPs and the potential interaction with ORT; raising awareness of the risks around drug related death; and promoting the 20

21 REVIEW provision of naloxone medication in general practice. Lanarkshire ADP has planned a full day event in early summer 2014 facilitated by colleagues from the National Drug and Alcohol Advisory Group, with delegates drawn from a wide range of service providers from Health, Local Authority, and Third Sector. This will provide an opportunity for exploration and discussion around partnership working and how local services aim to meet the needs of individuals, families and communities affected by substance misuse. The session will also present an opportunity to use the Drug and Alcohol Improvement game. 21

22 3. Financial Framework Your Report should identify both the earmarked drug and the earmarked alcohol 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 or support 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 3,682,231 2,253,762 5,935,993 Funding from Local Authority 1,697,112 Funding from NHS (excluding funding earmarked from Scottish Government) 3,232,169 Funding from other sources 744,124 Total 11,609,403 Total Expenditure from sources Alcohol Drugs Total Prevention (include community focussed, early years, educational 1,691,985 inputs/media, young people, licensing objectives, ABIs) Treatment & Support Services (include interventions focussed around 8,532,129 treatment for alcohol and drug dependence) Recovery 931,700 Dealing with consequences of problem alcohol and drug use in ADP 453,589 locality Total 11,609,403 22

23 End Year Balance for Scottish Government earmarked allocations Income Expenditure End Year Balance Drug 2,253,762 2,253,762 0 Alcohol 3,682,231 3,682,231 0 Total 5,935,993 5,935,993 0 Total Underspend from all sources Underspend Proposals for future use 114,400 Police Scotland 50,000 External evaluation of NLIAS 19, Scottish Fire and Rescue 39,780 Harm Reduction 4,500 Overprovision Feasibility Study 3,795 Recovery Steps to Excellence 49, Education/training 96, Diversionary work Support in kind Provider NHS Lanarkshire Description Provide office space and accommodation for ADP Support Team 23

24 4. Core and Local Indicators 2013/14 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 and please state how many people are in receipt of opiate replacement therapies in your area. Health: People are healthier and experience fewer risks as a result of alcohol and drug use ADP Core Indicator 2008/ / / / /13 RAG General acute inpatient & day case discharges (EASR) with a diagnosis of drug misuse in any position; by year. EASR per 100,000 Source: ScotPHO profiles General acute inpatient & day case discharges (EASR) with a diagnosis of alcohol misuse in any position; by year. EASR per 100,000 Source: ScotPHO profiles Lanarkshire ADP Scotland Lanarkshire ADP Scotland ADP Ranking A 11 of 30 G 15 of 30 Progress/comments The rate of drug-related discharges has increased slightly in Lanarkshire whilst the national average has fallen. Despite this increase Lanarkshire continues to sit well below the national average rate and is currently ranked 11 th in Scotland for this measure. The rate of alcohol-related discharges has fallen since 2011/12 but remains higher than the rate seen in previous years. The rate remains lower than the national average. Substance Misuse Liaison nurses are placed in each acute hospital in Lanarkshire. They provide prompt treatment, advice and appropriate onward referral to those with alcohol and drug problems attending via A&E and other routes. 24

25 ADP Core Indicator 2008/ / / / /13 RAG Rank Progress/comments Alcohol related deaths (underlying cause) - per 100,000 population; single years. Source: ScotPHO profiles Lanarkshire ADP Scotland A 23 of 28 Over the last 5 years the rate of alcoholrelated deaths has fallen steadily in Lanarkshire from 32 to 28 per 100,000. Whilst this is significant the rate of fall has not been as great in Lanarkshire as is seen in the national average. This may be indicative of the significant areas of socioeconomic deprivation present in Lanarkshire. ADP Core Indicator 2008/ /12 RAG Rank Progress/comments Prevalence of hepatitis C among people who inject drugs (based on all injecting drug users tested) Source: ScotPHO profiles Lanarkshire ADP 55.1% 49.7% 45.6% Scotland 54.6% 56.4% 53.0% G 9 of 25 The prevalence of Hep C in injecting drug users has fallen by nearly 10% in Lanarkshire over the last 3 years. The prevalence of Hep C in Lanarkshire continues to be considerably lower than the national average with Lanarkshire currently being ranked 9 th in Scotland for this measure. Within the local performance framework for alcohol and drug services we have included a target around BBV testing and the increase in BBV testing, along with improved investment in the provision of injecting paraphernalia, may have a positive impact on the reduction in transmission. 25

26 ADP Core Indicator (new) Number of drug-related deaths - per 100,000 population; single years Source: ScotPHO profiles Annual average Lanarkshire Scotland N.B. The data presented here is that provided annually by NRS. This will differ from data presented by ISD and from local sources. RAG Rank Progress/comments Tackling drug related deaths remains a priority area. A 14 of 25 Last year service users in receipt of opioid replacement therapy were provided naloxone unless the service user requested to opt out. Drug related death awareness sessions took place in the three hospital sites in Lanarkshire designed to raise knowledge in the topic and generate discussion around partnership working. Naloxone provision and overdose awareness training remains part of the Local Improvement Targets and performance is reported quarterly. Local Indicator Proportion of IDUs reporting using shared needles/syringes in past month Source: ISD (SDMD Initial Assessment Report) 2006 / / / / / / /13 RAG Rank Progress/comments The proportion of IDUs reporting sharing of Lanarkshire needles remains low in Lanarkshire, despite a slight increase in 2011/12. Currently Lanarkshire are ranked 3 rd in Scotland (of NHS G 3 of 9 boards providing data) in relation to this measure. Scotland Whilst moving towards a recovery oriented system of care, harm reduction remains an important area of work in Lanarkshire. 26

27 Local Indicator 2009/ / / / /14 Target RAG Progress/comments Total needles and syringes distributed Source: NHSL Harm Reduction Team 421, , , , ,516 Increase by 10% by 2015 A The amount of injecting equipment distributed in Lanarkshire has not reached the same level as was seen in 2009/10, however it is important to note that in 2010/11 there was a change in how IEP was recorded which might explain the drop (for example data used to record barrels and needles separately but now this is counted as a single injection episode). The recovery agenda may also have had an impact on injecting episodes. There has been a steady increase over the last 3 years. IEP continues to play an important part in reducing the harm of injecting drug use. Local Indicator 2009/ / / /13 Target RAG Rank Progress/comments % of known injecting drug users vaccinated for hepatitis B Source: ISD (SDMD Initial Assessment Report) % of known injecting drug users tested for hepatitis C Source: ISD (SDMD Initial Assessment Report) Lanarkshire Scotland % by % by 2015 A 4 of 11 A 4 of 11 The introduction of BBV testing and vaccination to the Lanarkshire Alcohol & Drug Service Performance Framework has resulted in a significant improvement in these measures, most notably between 2010/11 and 2011/12. This level has been maintained into 2012/13 but has improved only a little. 27

28 Prevalence: Fewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others ADP Core Indicator /10 RAG Rank Progress/comments Estimated prevalence of problem drug use amongst year olds in Scotland, by age group. Source: ISD (National Prevalence Study) Estimated prevalence of injecting drug use amongst year olds in Scotland. Lanarkshire ADP 1.60% 1.27% 1.36% 1.50% Scotland 2.00% 1.84% 1.62% 1.71% A 19 of 30 Data not currently available The drug prevalence rate was found to increase to 1.5% in Lanarkshire in the last prevalence study. Whilst rates remain lower than the Scottish average Lanarkshire is only ranked 19 th out of 30 ADP s in relation to this measure. A planned study to examine further how to access hidden populations may help to lower this in the future. The results of the most recent prevalence study are awaited to further assess if any progress has been made in recent years. ADP Core Indicator RAG Rank Progress/comments Percentage of 15 year old pupils who usually take illicit drugs at least once a month (areas with larger prevalence). Source : ISD (SALSUS) Lanarkshire ADP 18% 14% Scotland 14% 11% A 25 of 30 Both these indicators have shown significant improvements in Lanarkshire between 2006 and Unfortunately the proportion of 15 year olds self-reporting illicit drug use remains higher in Lanarkshire than the Scottish average. Youth Counselling Services (YCS) are available in every high school in Lanarkshire; amongst other things the YCS will help to tackle the causes of drug use at a very early stage. Percentage of 15 year old pupils who have taken an illicit drug in the last year (areas with lower prevalence). Source : ISD (SALSUS) Lanarkshire ADP 28% 21% Scotland 23% 19% 25 of 30 The results of the upcoming SALSUS survey are awaited to assess how this indicator may have changed since It is hoped the SALSUS survey will provide some insight into current trends in the use of new psychoactive substances amongst the school-age population in Lanarkshire. 28

29 ADP Core Indicator Men Women Total RAG Progress/comments The proportion of individuals drinking above daily and/or weekly recommended limits Source: SHS (aggregated ) The proportion of individuals drinking above twice daily ( binge drinking) recommended limits Source: SHS (aggregated ) The proportion of individuals who are alcohol dependent (two or more problem drinking indicators as per CAGE) Source: SHS (aggregated ) Lanarkshire 51.9% 41.5% 46.4% Scotland 48.7% 38.6% 43.4% Lanarkshire 32.6% 18.8% 25.3% Scotland 26.0% 16.7% 21.1% Lanarkshire 14.2% 10.0% 12.1% Scotland 13.9% 9.5% 11.7% A A A Currently the proportion of individuals reporting exceeding recommended alcohol limits, binge drinking and/or are indicated to be in the problem drinking category is higher in Lanarkshire than it is in Scotland. However recent local analysis did show that mean weekly consumption had fallen by 3 units in the Lanarkshire population compared with an average fall of 1.7 units in Scotland (Scottish Health Survey, 2003 compared with 2008/09). In the same analysis the proportion of the Lanarkshire population in harmful and hazardous drinking categories was found to have fallen. ADP Core Indicator RAG Rank Progress/comments Proportion of 15 year olds drinking on a weekly basis Source : ISD (SALSUS) Lanarkshire ADP 32% 20% Scotland 30% 20% 15 of 29 The proportion of 15 year olds in Lanarkshire who report drinking on a weekly basis has fallen significantly and at the last survey was in line with the national average. Despite this the mean weekly consumption for this group remained higher than the national average by 2 units. Mean weekly consumption in last week Source : ISD (SALSUS) Lanarkshire ADP Scotland A Youth Counselling Services (YCS) are available in every high school in Lanarkshire; amongst other things the YCS will help to tackle the causes of harmful alcohol consumption at a very early stage. The results of the upcoming SALSUS survey are awaited to assess how this indicator may have changed. 29

30 Recovery: Individuals are improving their health, well-being and life-chances by recovering from problematic drug and alcohol use ADP Core Indicator Percentage reduction in daily drugs spend during treatment Reduction in the percentage of clients injecting in the last month during treatment Proportion of clients who abstain from illicit drugs between initial assessment and 12 week follow-up Proportion of clients receiving drugs treatment experiencing improvements in employment/education profile during treatment No data is currently available for these indicators Local Indicator Target 2012/ /14 RAG Progress/comments Number of peer support volunteers in services Source: Local annual reports 10 peer volunteers engaged with services across Lanarkshire by March G Other activity aimed at implementing and supporting a recovery oriented system of care includes: Commissioned Peer Support Service operating pan Lanarkshire Lanarkshire ADP commissions Communities of Recovery, a service aimed at training individuals or family members with experience of recovery, as peer mentors. Peer mentors then support other individuals in their recovery journey as they transition from specialist treatment services to mainstream community services. In 2013/14 30 individuals were recruited and trained as peer mentors. Local Recovery events both pan Lanarkshire and locally in North and South. Focussing on integration into community; families and carers of people in recovery as well as promulgation of conversation cafes approach with view to these being delivered more locally. This has happened in both North and South and is both therapeutic and community recovery champion led. Monthly Therapeutic Recovery Workers Forums (recovery champions) held in both North and South Lanarkshire Training of Cafe hosts delivered to various interested partners to allow conversation cafes to spread throughout Lanarkshire. 7 hosts trained in total. SMART recovery (peer led mutual aid) initiated in May 2013 throughout Lanarkshire comprising of several partnerships from statutory and third sector participating 30

31 Local improvement targets around linking clients to recovery groups, employability and training have been implemented. Local data show that in 2013/ clients have been linked into recovery groups and 168 to employability and/or training through Lanarkshire s substance misuse services. Regular partnership working with Scottish Recovery consortium with Recovery Matters events delivered in North Lanarkshire and date identified for South Lanarkshire. Scottish Recovery Consortium (SRC) to facilitate Recovery College in Lanarkshire in May 2014 Treatment Process Model (TPM) delivered to all integrated addiction services staff as well as Shotts and Addiewell addiction staff and commissioned services in relation to recovery trained. 31

32 Families: Children and family members of people misusing alcohol and drugs are safe, well-supported and have improved life-chances ADP Core Indicator Rate of maternities recording drug use, per 1000 maternities (three year rolling average) Source: ScotPHO profiles Lanarkshire ADP 2005/ / / / / / / / Scotland / /12 RAG Rank Progress/comments Two Specialist Midwives in Substance Misuse are funded through Lanarkshire ADP. Over the past year there have been a number of key activities that will likely have led to an increase in identified drug use during pregnancy: the development and promotion of the Substance G 5 of 27 Misuse in Pregnancy: Antenatal Patient Pathway which provides guidance for any professional who confirms a pregnancy for a women experiencing substance misuse problems as well as training days for link community midwives who will deliver care and support to families as per the Pathway of Care. ADP Core Indicator Number (Rate per 10,000 population) of Child Protection Case Conferences where parental drug and/or alcohol misuse has been identified Source: ScotPHO profiles Aug July 2012 Aug 2012 July 2013 RAG Rank Progress/comments As is well known there are close links between parental substance misuse and child protection. In Lanarkshire we Lanarkshire have developed Getting it Right: Promoting Wellbeing for 70 (5.2) 55 (4.1) ADP Children and Young People Living with Substance Misuse to enable staff working within adult focussed substance misuse G 2 of 27 services in order to support substance misuse service staff with their role in promoting, developing and safeguarding children s well-being. Moreover, a decision has been taken to Scotland 918 (8.8) 993 (9.6) convene a Lanarkshire CPC/ADP Working Group to take forward joint effective planning and workforce development in order to support practitioners and front line managers to deliver services through a whole family recovery approach. 32

33 ADP Core Indicator 2011/ / /14 RAG Progress/comments Proportion of positive ABI screenings in ante-natal setting Source: Local database 7.7% (0.6% during pregnancy) 6.7% (0.2% during pregnancy) 6.4% (0.7% during pregnancy) G A screening tool is not used in ante-natal services. ABI's are delivered on the basis of pre-pregnant drinking levels (>14 units per week), during pregnancy drinking levels (>0 units per week) and/or disclosure of regular binge drinking. An ABI would be delivered based on a 'positive' response to any of these criteria. Specialist Substance Misuse Midwives continue to promote ABI training within workforce of Midwives. Wellbeing Scores Assessment Discharge Local Indicator Demonstrate improvement in Wellbeing Indicator scores for young people Source: Local database Strengths Threats RAG G Progress/comments Lanarkshire ADP commissioned the development of the Wellbeing Indicator (WBI), a tool for measuring outcomes in young people engaged in services. Data shows improvements in both strength and threats scores (strengths should go up, threats down) of those young people engaged with services in Lanarkshire. The most robust data is that for Lanarkshire Youth Counselling Service (LYCS). Positive results were noted for young people s strengths scores. These increased from 26.1 to 28.8, with increases most notable in relation to the wellbeing domains of Safe, Achieving, Respected and Responsible. Similarly an overall decrease from 16.6 to 14.5 was seen in threats scores. What are more encouraging are the particularly notable reductions in threats for the Safe and Nurtured domains. Work is ongoing to roll out the WBI across ADP commissioned services who have contact with young people with the aim of demonstrating improvement in the lives of Lanarkshire s young population. 33

34 Local Indicator Trend RAG Progress/comments Number of domestic abuse incidents Source: Local police analyst G Lanarkshire ADP continues to fund the Ending Violence Against Women (EVA) Service. This is a specialist department within NHS Lanarkshire, working on issues of gender-based violence. EVA work with women over 16-years of age, who have experienced abuse at any time in their lives. Women referred to EVA typically have experienced at least 3 episodes of abuse in their lifetime, at the hands of different perpetrators. Depending on risk and resilience factors, some women require only short information-based support, whilst some require long-term practical and therapeutic intervention. In 2013/14 there was a slight reduction in domestic abuse incidents. Tackling domestic abuse remains a priority area for community partners and the reduction may be due to community safety arrangements between partner organisations looking at preventative and early intervention approaches, as well as specialist treatment and support. 34

35 Community safety: Communities and individuals live their lives safe from alcohol and drug related offending and antisocial behaviour ADP Core Indicator 2009/ / / /13 RAG Progress/comments Percentage of new clients at specialist drug treatment services who report funding their drug use through crime Source: ISD Lanarkshire ADP 14.2% 14.4% 16.4% 21.1% Scotland 17.7% 22.4% 21.2% Not available A This information is obtained during assessment and engagement between the client and service provider. Given the current financial climate and correlation between illicit drug use and crime there is no surprise that there is an increase in this being reported. However with clients being seen promptly in Lanarkshire following referral to treatment services and receiving the right support to aid their recovery, coupled with preventative work that Lanarkshire ADP has invested in with young people, this should reduce over a period of time. ADP Core Indicator 2007/ / / / /12 RAG Progress/comments One year reconviction rate (number of reconvictions per offender), for offenders given a Drug Treatment and Testing Order Source: Scottish Government North and South Lanarkshire Scotland A There is a well established Drug Treatment and Testing Order service in Lanarkshire. This multi-disciplinary and intensive approach has helped to improve the outcomes for offenders engaged with the service. ADP Core Indicator 2011/ /13 RAG Progress/comments Number of Community Payback Orders issued where alcohol and drug treatment is required, and the proportion that are successfully completed. Lanarkshire ADP Scotland A Within Lanarkshire ADP there are links between community justice services and alcohol and drug services aimed at establishing the suitability for an offender to be placed on a CPO with a drug and alcohol treatment requirement. There is a pathway in place between community justice and alcohol and drug services that an individual, where necessary, will be promptly assessed for suitability of a community payback order with alcohol or drug requirement 35

36 ADP Core Indicator Lanarkshire ADP 2009 /10 Serious Assault /11 / / /10 Common Assault /11 / / RAG Rank Progress/Comments Lanarkshire ADP continues to invest in community safety initiatives. ADP investment to the Safer Lanarkshire Campaign helped police colleagues address community safety issues in a pro-active manner. Through this investment we expect to see these figures continue to fall. Number of cases with anti-social behaviour per 10,000 population, including Serious Assault, Common Assault, Vandalism and Breach of the Peace Source: ScotPHO profiles Scotland Lanarkshire ADP 2009 /10 Vandalism 2010 / / / /10 Breach of the Peace 2010 / / / Scotland A Serious Assault: 22 of 30 Common Assault: 12 of 30 Vandalism: 22 of 30 Breach of the Peace: 17 of 30 Local crime summary looking at 5 year average trends list a number of key findings, namely that listed crimes, serious assaults, vandalism, and possession of offensive weapon have all reduced. The summary also reports that drug possession crimes and public consumption of alcohol cases have increased which is possibly indicative of a co-ordinated and proactive response by community partners against substance use. North Lanarkshire is currently participating in a pilot of the Best Bar None scheme. The scheme awards drinking establishments which show a real commitment to reducing incidents of crime and curbing irresponsible promotions which can lead to binge drinking and antisocial behaviour. Partners in the Scottish Government, NHS, the alcohol industry, Police Scotland and the Best Bar None Board are now working together in tracking and evaluating the benefits of accredited pubs and bars which meet the high standards of safe, secure and customer focused premises. 36

37 ADP Core Indicator Proportion of victims of a crime who reported that the offender was under the influence of alcohol / drugs Source: Scottish Crime and Justice Survey Criminal Justice Alcohol Drugs RAG Progress/comments Area 2009/ / / / / /13 As noted above Lanarkshire ADP continue to Lanarkshire CJA 17% 32% 14% 13% 20% 13% invest in community safety campaigns to ensure individuals/families do not feel threatened by criminal behaviour related to A alcohol and/or drug use. We invested Scotland 23% 22% 22% 12% 13% 13% 114,400 in the Safer Lanarkshire Campaign and continue to work closely with Community Safety Partners. Local Indicator 2009/ / / / /14 RAG Progress/comments Reduce the number of antisocial behaviour offences reported Source: Local police analyst North Lanarkshire South Lanarkshire Lanarkshire G The number of anti-social behaviour offences being reported in Lanarkshire has decreased by approximately 61% over the last 5 years. This reflects the investment in the Safer Lanarkshire campaigns and other work described above. 37

38 Local environment: People live in positive, health-promoting local environments where alcohol and drugs are less readily available ADP Core Indicator RAG Rank Progress/comments Percentage of young people who have been offered drugs in the last year Source : ISD (SALSUS) Lanarkshire ADP 64% 44% Scotland 53% 42% G 21 of 30 Significant improvement is seen in this indicator with a reduction of 20% between 2006 and The figure in 2010 is much more comparable with the national picture than previously seen. The 2014 survey is awaited to assess if this reduction is sustained. ADP Core Indicator 2007/ / RAG Rank Progress/comments Percentage of people perceiving drug misuse or dealing to be very or fairly common in their neighbourhood Source: ScotPHO profiles Percentage of people perceiving rowdy behaviour (e.g. drunkenness, hooliganism or loutish behaviour) to be very or fairly common in their neighbourhood Source: ScotPHO profiles Lanarkshire ADP 14.2% 11.1% 16.1% Scotland 12.5% 11.6% 12.9% Lanarkshire ADP 20% 16% 18% Scotland 17% 15% 14% A 23 of 30 A 26 of 30 Although a slight increase this may be a result of the proactive work taking place within community safety campaigns urging residents to report concerns related to alcohol/drug use. Youths causing annoyance was seen as the most common problem amongst communities during public consultation over community safety. To that end Lanarkshire ADP in 2013/14 invested in diversionary activities for young people. Many of these activities were hosted in areas earmarked as problematic for young people, drinking and anti social behaviour. It should be noted this type of behaviour appears to have lessened significantly as a result of the diversionary activities. Through the pilot scheme of Best Bar None, an evaluation has been conducted by Scottish Business Crime Centre in relation to alcohol abuse as a negative aspect of neighbourhood. We await results of this. 38

39 ADP Core Indicator 2012/ /14 RAG Rank Progress/comments Number of premise licences in force per 10,000 population On Trade Source: ScotPHO profiles Number of premise licences in force per 10,000 population Off Trade Source: ScotPHO profiles Number of premise licences in force per 10,000 population Total Source: ScotPHO profiles Lanarkshire ADP 17 8 Scotland Lanarkshire ADP 10 6 Scotland Lanarkshire ADP Scotland G 1 of 30 G 1 of 30 G 1 of 30 All functioning local licensing forums in Lanarkshire attended quarterly with encouragement to link up with NHS Public Health Director. We also conducted a feasibility study looking at the issue of overprovision. This study involved data analysis and engagement with licensing members, public health, ADP and communities. The study will form part of an action plan that the ADP will take forward. The plan will enable Licensing Board members to have access to robust data evidencing the link between overprovision and harm. ADP Core Indicator Local Authority Premise licenses New applications Personal licences on sale off sale only Refused Granted Refused RAG Progress/comments Number of new applications for premise and personal licences, and proportion refused on the grounds of overprovision Source: Scottish Government (Liquor Licensing Statistics) North Lanarkshire South Lanarkshire Scotland G 39

40 Services: Alcohol and drugs prevention, treatment and support services are high quality, continually improving, efficient, evidence-based and responsive, ensuring people move through treatment into sustained recovery ADP Core Indicator 2011/ / /14 RAG Progress/comments The number of screenings (using a validated screening tool) for alcohol use disorders delivered and the percentage screening Total screened % positive % Total screened % positive % Total screened % positive % positive with the % eligible for % eligible for % eligible for G breakdown of i) % eligible 13.0% 11.0% 10.5% ABI ABI ABI for ABI and ii) % eligible for referral to treatment services Source: Local database % eligible for referral 7.8% % eligible for referral 6.8% % eligible for referral Screening for alcohol problems continues to be a priority area in Lanarkshire and as such is now well embedded into standard clinical practice in priority settings and continues to be developed in wider settings. ADP Core Indicator 2008/ / / / / /14 RAG Rank Progress/comments The number of alcohol brief interventions delivered in accordance with the HEAT Standard guidance expressed as a percentage of target Source: ScotPHO profiles Lanarkshire 19% 190% 146% 146% 157% 151% Scotland 61% 112% 177% 159% 155% 171% 6.8% G 7 of 14 NHS Lanarkshire has again exceeded the trajectory of this HEAT standard. Screening for alcohol problems continues to be a priority area in Lanarkshire and as such is now well embedded into standard clinical practice. Delivery in wider settings continues with the use of the CRAFFT tool now well established in a number of young people s services and screening being delivered in many mental health services. ADP Core Indicator Number of treatments drug service clients receive at 3 month and 12 month follow-up (and annually after that) Data not currently available 40

41 ADP Core Indicator Percentage of drug clients waiting more than three weeks between referral to a specialist drug and alcohol service and commencement of treatment Source: ScotPHO profiles Percentage of alcohol clients waiting more than three weeks between referral to a specialist drug and alcohol service and commencement of treatment Source: ScotPHO profiles Lanarkshire ADP 2011/ / /14 % % % Scotland Lanarkshire ADP Scotland RAG Rank Progress/comments G 6 of 30 G 5 of 30 Lanarkshire continues to perform very favourably in relation to access to drug and alcohol treatment. During 2013/14 virtually all clients began treatment within 3 weeks of referral. Local Indicator 2011/ /13 RAG Rank Progress/comments SDMD initial completeness (proportion of patients entered to DATWT for drug misuse who also have an initial SDMD record) Source: ScotPHO profiles Lanarkshire ADP 64.5% 62.9% Scotland 74.3% 62.9% A 14 of 24 Despite a slight fall in the proportion of completed SMR25a s last year, Lanarkshire performs quite well relative to the national figure. Local analysis would suggest that our statutory and voluntary services are completing SMR25a returns for the majority of clients (93%). However a small number of services who submit waiting times data do not also submit SMR25 returns; this is having an impact on this figure. SDMD follow up completeness (proportion of patients with an initial SDMD record who also have a follow-up 8-16 weeks later) Source: ScotPHO profiles Lanarkshire ADP 22.5% 29.4% Scotland 12.1% 14.6% G 3 of 22 In relation to SMR25b returns, Lanarkshire performs very favourably, ranked 3 rd nationally. The inclusion of compliance with SMR25a and b submission within Lanarkshire s local performance framework has helped to maintain the profile of the importance of this. Lanarkshire ADP would now like to see this data being used more readily, such as in the reporting of the ADP core recovery indicators (above) which we again are unable to report on due to a lack of access to data. 41

42 Local Indicator 2011/ / /14 RAG Progress/comments Reduce DNA rates by 10% by 2015 Source: DATWT system (local analysis) 35% 36% 36% N.B. this is the average rate across all Lanarkshire services submitting data to the DATWT. A DNA rates across drug and alcohol services have traditionally been high in Lanarkshire. There is considerable variation in the proportion of DNAs across different parts of the system. In order to improve efficiency in treatment access, Lanarkshire ADP aim to reduce the average DNA rate in all statutory and third sector services by 10% by With that aim in mind the monitoring of DNA rates at assessment has been built in to the Local Improvement Targets and is monitored quarterly. Whilst individual services may have made some improvements the average rate across all services has not changed. This continues to be a challenging area. Local Indicator 2011/ / /14 RAG Progress/comments Numbers of individuals in receipt of Opioid Replacement Therapy (ORT) Approximately 2850 service users received opioid replacement therapy in A It is difficult to give an exact number for the amount of individuals in receipt of ORT due to issues around the Electronic Systems currently used in Lanarkshire. The Community Prescribing Service in Lanarkshire consists of practitioners from medical, nursing and pharmacy background and Lanarkshire ADP is currently in discussions with IT colleagues to agree the best way of recording and reporting on prescribing numbers. This area will be progressed in 2014/15 and the introduction of recovery reviews for all service users in receipt of ORT will help to aid the process. 42

43 LOCAL IMPROVEMENT TARGETS 2013/14 National Outcome Local Outcome LIT 1 LIT 2 National Outcome Local Outcome LIT 3 LIT 4 Our public services are high quality, continually improving, efficient & responsive to local people s needs All young people, adult and family services will be equitable and readily accessible 2013/14 Performance Status Comment 100% of drug/alcohol clients start treatment within 3 weeks of referral (HEAT A11) 99.5% G Services continue to perform at an excellent level Services should ensure that the DNA rate for drug/alcohol clients does not exceed 40% 36% G Work is ongoing to reduce DNA rates further. In 2013/14 improvement methodology was adopted around this topic in areas such as engagement with GPs, electronic referral, assertive linkage and locality planning groups. Our public services are high quality, continually improving, efficient & responsive to local people s needs Services offer service users tailored packages of treatment & care ranging from basic information to more structured therapeutic interventions which focus on outcomes that lead to recovery 2013/14 Performance Status Comment Reduce the cost of Opiate Substitute Treatment (OST) by 10% per capita N/A N/A Data still being collected in relation to this target. 50% of service users will have completed a psychosocial intervention by case closure. 70% G Services continue to offer appropriate psychosocial intervention to service users. Where, applicable, staff practitioners receive psycho-social intervention training around anxiety management, anger management, trauma, relapse prevention and community reinforcement. This is delivered by the Lanarkshire Addiction Psychology Service. 43

44 National Outcome Local Outcome We live longer, healthier lives Individuals in Lanarkshire will experience reduced levels of harm associated with their alcohol/drug use enabling them to live longer, healthier lives, realise their potential & make a positive contribution to society & the economy 2013/14 Performance Status Comment LIT 5 By case closure 50% of clients should have been linked into recovery groups (including mutual aid) and community activities. 32% A There have been some issues around data collection for this target. Discussion is ongoing in regards to data input improvement LIT 6 Again there have been issues around data collection which are By case closure 50% of clients should have been linked into 26% A being addresses. Welfare reform also appears to have had a employability services/education/training. negative impact on the target LIT 7 Where appropriate, 100% of drug users have an SMR 25A This remains a priority and services are aware of the 93% A form completed at assessment importance of completing SMR 25A where appropriate LIT 8 100% of ISD requested SMR 25B forms completed by quarter 57% A There is ongoing issue around SMR 25B notifications. These are being picked up through dialogue with ISD. Lanarkshire ADP has actively participated in the consultation around the Drug and Alcohol Information System (DAISy) LIT 9 LIT 10 LIT 11 LIT 12 Deliver overdose awareness training to 10% of the estimated problem drug using population per locality each year. Provide 10% of the estimated problem drug using population per locality with Take Home Naloxone each year. Vaccinate 10% of the estimated drug injecting population per locality against Hepatitis B. Test 10% of the estimated drug injecting population per locality against Hepatitis C. 8.3% A 7.6% A 5% A 28% G This remains a priority and services continue to offer overdose awareness training in line with naloxone provision Lanarkshire reached the National Naloxone target of 15% and remain on course to reach the new naloxone target of 25%. Services report that a significant number of service users that are open have already received Hep B vaccinations hence this target is difficult to achieve. This will be reviewed over the next year including an audit trail of service users to ensure they have been offered and received Hep B vaccinations. Services have surpassed the local target and deserve praise. The introduction of Dry Blood Spot Testing has eased the process and made testing more accessible. 44

45 5. ADP & Ministerial Priorities ADP Priorities 2013/14 Please list the progress you have made in taking forward your ADP s five key commitments for 2013/14. Quality Assurance Strategy Lanarkshire ADP continues to comply with the Quality Alcohol Treatment and Support (QATS) recommendations and NHS Healthcare Strategy. NHS Lanarkshire is currently consulting on a new Quality Assurance and Service Improvement Strategy for , Transforming Patient Safety and Quality of Care in NHS Lanarkshire, and many ADP stakeholders are involved in the consultation process. Lanarkshire ADP has agreed to take the lead in testing the Quality Principles as part of the newly developed National Quality Improvement Framework for Alcohol and Drug Services. Lanarkshire ADP continues to have robust quality assurances in place for example quarterly and annual reports, steering groups, outcome focused service level agreements, and local improvement targets, The combination of the work above will place Lanarkshire in a stronger position to prepare a Quality Assurance Strategy that takes cognisance of new developments nationally and locally. Commissioning Strategy An initial draft of the commissioning strategy was prepared. This work has been delayed pending the integration of health and social care and further clarification around the role of the ADP within the new Health and Social Care structures. We continue to follow a commissioning cycle of annual local needs assessment, planning, commissioning, monitoring and reviewing. The I+F group provides direction on the investment of services based on the information derived from the commissioning cycle taking place annually. Outcome Measures 45

46 The ADP is currently piloting the Drug and Alcohol Outcome Star with a view to wider implementation if the pilot is successful. The ADP is looking at ways to ensure the outcome star tool is complimentary to the review process for service users and the Local Improvement Targets. Similar work is also taking place with colleagues in community justice. This will, ideally, lead to an outcome tool that is used by different partner agencies and is able to give us more understanding of the service user s recovery journey when engaged with different services. Blueprint Workforce Development Plan The recommendations from the paper continue to be taken forward. Emphasis is on understanding the roles and responsibilities of all service providers and practitioners and ensuring services are aligned with a recovery orientated system of care. The ADP proposes to take the learning from this work into the South Lanarkshire area. It should be noted that Substance Misuse Services in North Lanarkshire are integrated and in South Lanarkshire Health and Social Care Substance Misuse Services, albeit working closely together, are separate. It is envisaged that the workforce development plan can support the process of integration that is likely to take place in South Lanarkshire Substance Misuse Services in 2014/15. Tackling Drug Related Deaths This remains a priority area for Lanarkshire ADP. We reached our Naloxone provision target set as part of the National Naloxone Programme and remain committed to the programme. We have since implemented a system where all service users on ORT will automatically receive overdose awareness training and provision of naloxone, unless they opt out. We have local improvement targets in place to maintain focus around overdose awareness training and naloxone provision and we have worked closely with pharmacy, GPs, housing and community justice colleagues to ensure overdose training and naloxone provision is available to as many service providers and service users as possible. We have facilitated 3 drug awareness events in the 3 acute sites in NHS Lanarkshire. These events have been geared towards raising awareness to hospital and community staff from all disciplines about the growing concern over drug related deaths and what can be done to tackle the problem. We continue to look at ways in which we can engage with our hard to reach population who may be at risk and are exploring the use of peer supporters as a means of engagement. 46

47 We have reviewed prescribing policies for service users in receipt of ORT and have clear guidelines in place regards ORT prescribing, take home and benzodiazepine prescribing. In Lanarkshire the number of drug related deaths with benzodiazepines implicated in death has reduced and we believe the benzodiazepine guideline has had a particular positive effect with reducing harm. The Drug Related Death Executive Group has robust membership involving all key partners. ADP Priorities in Safeguarding and promoting the interests of children, young people and families affected by substance misuse. - Reducing the level of alcohol and drug related harm at a community level - Supporting individuals with alcohol and/or drug problems - A new ADP Strategy and Delivery Plan for To support this there will be a thorough engagement process with partner agencies, individuals, families, carers, young people and communities. - As in line with the ministerial priorities a continued effort and focus to reduce drug related death taking into consideration national and local data and a change in trends of drug use, particularly in relation to prescribed medication and New Psychoactive Substances. 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 2014/15. Please outline these below. Compliance with the Alcohol Brief Interventions (ABIs) HEAT Standard; Increasing compliance with the Scottish Drugs Misuse Database (SDMD); HEAT Drug and Alcohol Treatment Waiting Times Standard, including, increasing the level of fully identifiable records submitted to the Drug and Alcohol Treatment Waiting Times Database (DATWTD); Increasing the reach and coverage of the national naloxone programme and tackling drug related death(drd)/risks in your local ADP; Implementing improvement methodology at local level, including implementation of the Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services and responding to the recommendations outlined in the independent expert group on opioid replacement therapies; 47

48 Ensuring a proactive and planned approach to responding to the needs of prisoners affected by problem drug and alcohol use and their associated through care arrangements; and Improving identification of, and preventative activities focused on, new psychoactive substances (NPS). Compliance with ABI delivery We have a Heat 4 steering group responsible for the coordination of ABI training and the data collection and analysis of ABI screening and delivery. We continue to invest in services such as the Lanarkshire Addiction Midwifery Service and Substance Liaison Nursing Services who work with the maternity and acute sectors and deliver ABI training as part of their remit. We have been working with colleagues in youth services looking at the delivery of ABIs and ways in which we can chart the positive impact of an ABI. We have consistently met the ABI standard and expect with the training and performance systems in place that we will continue to meet projected targets. Compliance with SDMD database Compliance with the SDMD database is part of the Local Improvement Targets we have in place. Drug and Alcohol service performance against the targets is reported quarterly to the Board/Group in North and South Lanarkshire responsible for delivering alcohol and drug treatment and support. This mechanism helps to remind services of the expectation around compliance with SDMD, encourages constant evaluation of performance, and enables service improvement (where applicable). The ADP support Team has 2 Information and Research Officers available to support services with any issues related to SDMD compliance. HEAT Waiting Times We will continue to monitor waiting times closely and with the reporting and governance structures in place we are able to monitor performance and take swift, appropriate actions if there is any deviation on waiting times performance. 48

49 We are confident that with the investment and structures in place we will continue to lead the way in relation to the HEAT Waiting Times Target. We will continue to work closely with services to increase the level of fully identifiable records and where appropriate we will utilise awareness sessions with services to increase their understanding of the benefits to providing identifiable records whilst providing reassurance around information governance. National Naloxone Programme Provision of naloxone and reduction in DRDs will remain a high priority for the ADP. Last year we successfully met our national target in relation to naloxone provision and we will continue to support the programme and make every effort to increase the reach of naloxone. We have within our local performance framework a target for naloxone provision and a further target for overdose awareness training. The performance framework will help to keep a focus on this important area and chart our progress. As aforementioned we have adopted an opt out scheme in relation to naloxone provision for service users in receipt of ORT and this appears to have had a positive effect. This is now common practice across Lanarkshire Substance Misuse Services. We will also look at ways to engage with the hidden population through peer support and working with different agencies such as community justice colleagues, housing and mental health. We intend to hold a DRD seminar in September open to service users and providers. The seminar will focus on many areas, including naloxone provision. Their will speakers from different agencies, such as Police Scotland, Procurator Fiscal, Scottish Ambulance Service and NHS Lanarkshire, as well as the personal experience of service users and a drama looking at the impact of DRD on families and communities. We have invited a keynote speaker from Scottish Government to the event. Implementing Improvement Methodology and Responding to the ORT review We will continue to use improvement science as a tool to continuously improve and develop service provision. Last year we used tests of change in different areas ranging from reduction of DNAs to improving linkage between child and adult services. We will hold a development day in Early Summer 2014, Drug and Alcohol Improvement Game, and this will be attended by different partners. The focus of the day will be around partnership working and improving service delivery. There will be discussion around 49

50 the ORT recommendations, improvement science and the National Quality Improvement Framework. The event will raise further awareness around the subject matters and enable discussion around further tests of changes that can be coordinated and taken forward. In relation to the Lanarkshire ADP Key Aim statement we intend to run small tests of change looking at the structure and content of the review process, with the aim of evolving reviews to ensure they are relevant, person centred and collaborative. We have agreed to pilot the Quality Principles within the Quality Improvement Framework and will feed back our evaluation to Scottish Government in Meeting the Needs of Prisoners affected by Substance Misuse There is currently a great deal of good work taking place in Lanarkshire. There is a well established ADP/CJA working group which contains representation including the Scottish Prison Service. This group is responsible for co-ordinating action on offenders with alcohol and/or dug issues and the group reports to the ADP Board, CJA Board and Community Planning Partners. The Community Bridges Project has been cited as an area of good practice in relation to through care and working with offenders with substance misuse issues. There is a scheduled visit by the Minister for Public Health and Minister for Community Safety in 2014 to hear more about the service. Within the ADP Board there is representation from HMP Shotts and HMP Addiewell and there are well established connections between prison settings and the ADP. In 2014 we will support HMP Shotts with their Health Improvement and Substance Misuse Strategies and continue to work closely with HMP Addiewell in relation to through care. In 2014/15 We have agreed to continue to invest in a number of services for offenders affected by substance misuse, namely Community Bridges, Youth Bridges, Persistent Offender s Project and Healthcare within HMP Shotts. We have also invested in the Forensic Healthcare Service within Police Custody Suites and there will be work ongoing in 2014/15 to support the service and ensure close linkage between healthcare in custody suites and healthcare in the community. New Psychoactive Substances 50

51 We have a well established Emerging Trends Group in Lanarkshire. The group provides up to date information to ADP services on the different trends taking place in Lanarkshire. A great deal of this information is harnessed through colleagues in Police Scotland, presentations at A+E departments and service user disclosure at Substance Misuse Services. We invested in workforce development around NPS last year and will continue this investment in 2014/15. Initially we have targeted front line staff for NPS training and further rollout of training to wider services/disciplines will be explored at the North and South Lanarkshire Workforce Development Groups. The NPS training provided has received favourable feedback from delegates. Notable feedback has been that practitioners were reassured that they already have the necessary skill set to support service users who present or disclose that they are using NPS. We intend to fully promote the UK Legal High Survey as much as possible and will look at circulating information on the survey through our communication department and community resources. We intend to facilitate a NPS Conference in November 2014 to raise further awareness around NPS and allow discussion around partnership working and service delivery. APPENDIX 1: NOTES 1. Please complete the RAG column for each theme according to the following definitions: Red: No action is yet underway Amber: Action is underway but is not yet completed Green: Action is completed 2. This column should be used to describe the range of evidence used to support the RAG Score. We do not require the source documents to be attached unless specifically requested 3. Joint Strategic Needs Assessment: Joint strategic needs assessments (JSNAs) analyse the health needs of populations to inform and guide commissioning of health, well-being and social care services within local authority areas. The main goal of a JSNA is to accurately assess the health needs of a local population in order to improve the physical and mental health and wellbeing of individuals and communities. ( 51

52 4. Joint Performance Framework: a national assessment process on how effectively local partnerships are achieving these improvements. ( 5. Integrated Resource Framework: this is being developed jointly by the Scottish Government, NHS Scotland and COSLA to enable partners in NHS Scotland and Local Authorities to be clearer about the cost and quality implications of local decision-making about health and social care. The IRF helps partnerships to understand more clearly current resource use across health and social care, enabling better local understanding of costs, activity and variation across service planning and provision for different population groups. ( 6. Please indicate in your evidence if you have received feedback on this report from your Community Planning Partnership/ or other accountability route, specifying who that is. Strategic commissioning is informed by The Commissioning Cycle (the outer circle) which drives purchasing and contracting activities (the inner circle), and these in turn inform the on-going development of Strategic Commissioning. Strategic commissioning is defined as term used for all activities involved in assessing and forecasting needs, links investment to desired outcomes, considering options, planning the nature, range and quality of services and working in partnership to put this in place. Strategic commissioning process is defined by four stages, analyse, plan, deliver and review as presented visually in the diagram below. 52

53 7. The Alcohol and Drug Workforce Statement is addressed to anyone who has a role in improving outcomes for an individual, families or communities experiencing problematic drug and alcohol use. 8. A full range of essential care Services include identifiable community rehabilitation services including using people with lived experience; access to detoxification and residential rehabilitation; access to a full range of psychological and psychiatric services; services addressing employability and accommodation issues Quality Assurance Framework: A guidance document which sets out the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met. Examples of how to improve the 53