STANDARD REPORTING TEMPLATE - (BORDERS) ADP ANNUAL REPORT 2016-17 Document Details: ADP Reporting Requirements 2016-17 1. Financial Framework 2. Ministerial Priorities 3. Additional Information The Scottish Government copy should be sent by 23 October 2017 for the attention of Amanda Adams to: Alcoholanddrugdelivery@gov.scot 1
1. FINANCIAL FRAMEWORK -- 2016-17 Your report should identify all sources of income that the ADP has received (via your local NHS Board and, where relevant, Integration Joint Board), alongside the monies that you have spent to deliver the priorities set out in your local plan. It would be helpful to distinguish appropriately between your own core income and other expenditure on alcohol and drug prevention, treatment and support, or recovery services which each ADP partner has provided a contribution towards. You should also highlight any underspend and proposals on future use of any such monies. Total Income from all sources Income Substance Misuse (Alcohol and Drugs) Earmarked funding from Scottish Government 1,049,582 Funding from Local Authority 167,231 Funding from NHS (excluding funding earmarked from Scottish Government) 120,839 Funding from other sources 235,000 Scottish Government Funded allocation C/F from 2015-16 101,000 Total 1,673,652.00 Funding from the Local Authority relates to the contribution to the Addaction, Action For Children and Residential Rehabilitation costs only Funding from NHS relates to the additional direct costs of Borders Addictions Service (excluding prescribing) only Funding from other sources relates to the support given by IJB to service contracts following reduction to ADP budget Total Expenditure from sources Prevention (include community focussed, early years, educational inputs/media, young people, licensing objectives, ABIs) Treatment & Support Services (include interventions focussed around treatment for alcohol and drug dependence) Substance Misuse (Alcohol and Drugs) 148,899 1,253,365 2
Recovery 13,882 Dealing with consequences of problem alcohol and drug use in ADP locality 184,080 Total 1,600,226 2016-17 End Year Balance for Scottish Government earmarked allocations Substance Misuse Income Expenditure End Year Balance 1,150,582 1,312,156-161,574 2016-17 Total Underspend from all sources Support in kind Underspend Proposals for future use 73,426 Offset funding to support reduction in funding and maintain service contracts Provider Alcohol Focus Scotland Crew2000 Health Scotland ISD Lloyds PDI NHS Borders Description Support with Local Licensing Forum (LLF) Alcohol Profile, national policy support. Support to Drugs Trend Monitoring Group, training on New Psychoactive Substances. Support regarding ABI delivery. Support with data retrieval and presentation for alcohol related deaths audit. Support to development of planned session relating to recovery needs of families. Leadership and influencing, representation on ADP and sub-groups, communications support, contribution to workforce directory, support to Alcohol Related Deaths audit. 3
Police Scotland Scottish Borders Council (SBC) Scottish Drugs Forum (SDF) Scottish Families Affected by Alcohol and Drugs (SFAD) Scottish Government Leadership and influencing, representation on ADP and sub-groups, ABI s in Custody Suites. Leadership and influencing, Contracts and Procurement Team, representation on ADP and sub-groups, Communications Department, Estates and Facilities (ADP Support Team located in SBC Headquarters), Alcohol Brief Interventions in Social Work Setting, Legal and Democratic Services, Business Consultant support to e.g. alcohol profile, contribution to workforce directory. Advisory support, Service User Involvement, National policy support, representation on Drug Trend Monitoring Group, training on New Psychoactive Substances and Take Home Naloxone, representative on Naloxone Steering Group, representative on Quality Principles Group. Presentations at Drug Death Seminar and Primary Care Learning Session. Delivery of bespoke training and generic training. Presentation at Drugs Death Seminar, informal support re developing family work, distribution of materials. Leadership and influencing, peer meetings for ADP Support Team, support to develop alcohol related deaths audit. 4
2. MINISTERIAL PRIORITIES ADP funding allocation letters 2016-17 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 2016-17. Please outline these below. PRIORITY *IMPROVEMENT GOAL 2016-17 DELIVERY MEASURES ADDITIONAL INFORMATION 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. 1. Compliance with the Drug and Alcohol Treatment Waiting Times LDP Standard, including, increasing the level of fully identifiable records submitted to the Drug and Alcohol Treatment Waiting Times Database (DATWTD) No one will wait longer than 6 weeks to receive appropriate treatment As identified in the 2015-16 Annual Report the standard was breached in 2016-17. 88% of clients started treatment within 3 weeks for 2016-17. This was due to capacity issues within services however at the end of Quarter 4 services had improved performance to 94%. Of 607 clients 21 individuals waited 6 weeks or more to receive appropriate treatment. 100% data compliance is expected from services delivering tier 3 and 4 drug and alcohol treatment in Scotland 100% data compliance achieved. 49% of records are entered as anonymous to DATWT via our third sector service. Discussions between Scottish Government and Addaction will be required to support third sector organisations to increase identifiable records. Locally we are in discussions with Addaction to ensure that this is reduced. 2. Compliance with the LDP Standard for delivering Alcohol Deliver 1312 ABI s with 80% in priority settings as per the LDP Standard. Improvement Goal 2017-18: Reduce anonymous records to 10% in Quarter 4 of 2017-18. 1315 (100% delivered). 79% delivered in priority settings: Working with colleagues in 5
Brief Interventions (ABIs) Embed improved screening process in A/E. (Primary Care: 71%, Antenatal: 6%, A&E: 2%) Wider Settings: 21% The screening process in A/E has been reviewed and training given to relevant staff. Improvement Goals 2017-18: To ensure information re alcohol in pregnancy is transferred to child notes by March 2018. Child Health to review how information relating to alcohol use in pregnancy is transferred to child notes 3. Increasing Data Compliance Scottish Drugs Misuse Database (SDMD) both SMR25 A and B. 4. Preparing Local Systems to Comply with the new Drug & Alcohol Information System (DAISy) To increase compliance for SMR25(a) to 100% by March 2017. Ensure services are in a position to respond when DAISy is implemented. Identify process for implementation of screening in Health Visitor pathway by March 2018. Performance this year is broadly unchanged (89% compared to 91% in 2015-16). While this is never going to be exact due to separate systems and timing it is disappointing it has not improved. Improvement Goal 2017-18: Increase compliance to 100% for Quarter 4 2017-18. Borders represented on national DAISY Implementation Group. Borders took part in the ISD pilot to improve data accuracy on SDMD as part of preparedness for moving towards DAISy. We are anticipating improvement in 2017-18 based on regular monitoring within services. Regular updates on DAISy provided at Data & Performance Subgroup and via ADP Bulletin to service managers and staff. Borders currently uses the Star Outcome tool to review outcomes in adult services, however, 6
this will be discontinued in March 2018 with transfer to Recovery Outcome Tool within DAISy for April 2018. Adult services have signed off a local information sharing protocol and we await the Information Sharing Protocol between ISD, Health Board, Local Authority and Drug & Alcohol Services to be agreed nationally. 5. Increasing the reach and coverage of the national naloxone programme for people at risk of opiate overdose, including those on release from prison. To supply first time kits to 50% of the estimated problem drug user population by 2018. Equivalent to 27 first time kits per year; cumulative delivery of 81 from April 2015-March 2018. Implement supply of Naloxone for clients discharged directly from A/E An Implementation Plan in place and will be overseen by Data & Performance Subgroup of ADP. Improvement Goal 2017-18: All identified staff trained in DAISy and implementation plan delivered by 2 April 2018 Naloxone continues to be provided as part of routine care for clients accessing drug and alcohol services as well as being available to families and carers. 30 first time kits were supplied in 2016-17 and 177 resupplies made. Cumulative total 2015-17= 61 (75% of three year target). Discussions with the A/E Consultant have taken place regarding provision to individuals discharged directly from A/E. A training date for staff has been identified. 7
Two further training for trainers provided to 20 staff across frontline services (statutory and voluntary). 6. Tackling drug related deaths (DRD)/risks in your local ADP area. To increase awareness of risk factors relating to DRD s Five overdose awareness sessions provided to staff from various agencies including Homeless Team and Domestic Abuse Advocacy Service. Improvement Goals 2017-18: Improve identification of those accessing multiple supplies for THN by: - Implementing real time data entry in Addaction s injecting equipment provision ( needle exchange ) - Identify process in Borders Addiction Service to ensure identification of multiple supplies is picked up - Raise with IEP pharmacists as part of refresher training planned for September 2017 A drug death prevention seminar was delivered in September 2016 which provided national contextual information and evidence about what works ; local data and findings from the Borders Drug Death Review Group (DDRG) alongside information on preventing and responding to overdoses and support available for family members. The seminar provided an opportunity for participants to discuss what their service/role was doing to prevent drug related deaths in 8
line with Staying Alive in Scotland. Outcomes from this event included specific actions for the DDRG which included ensuring staff are able to provide information on SFAD bereavement service where appropriate and ensuring all services hold reviews with individuals who have experienced a non-fatal overdose. A DRD briefing sheet was given to delegates attending all ADP training events (236 delegates). To complete the Staying Alive Toolkit DDRG completed Staying Alive in Scotland Good Practice Baseline Tool and is currently developing an Action Plan. Annual Report on Drug Deaths is presented to the ADP and Critical Services Oversight Group. 7. Implementing improvement methodology including implementation of the Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services. Participate in the self-validation process and develop an action plan in response to findings Improvement Goal 2017-18: Develop and implement an action plan arising from completion of the Staying Alive in Scotland Good Practice Baseline Tool (DDRG). The Quality Principles Group meets regularly and has completed the validated selfassessment process. An action plan based on initial feedback from Care Inspectorate has been developed. Baseline measures and improvement targets have been set. 9
The ADP employed a consultant (Brand Improvement Solutions) to add capacity to the ADP Support Team to undertake work to support the ADP to identify funding priorities and potential changes to the alcohol and drug recovery oriented system of care (ROSC) with recovery, capacity, demand and efficiency being key priorities for change. This work builds on previous work undertaken prior to April 2014. 8. Responding to the recommendations outlined in the 2013 independent expert group on opioid replacement therapies. Current services were designed following the 2012-13 Investment Review which has been previously reported. Work undertaken: Preparation work including review of existing performance reports Delivery of three staff stakeholder consultations (48) Delivery of two service user consultations (17) Development and analysis of service user survey (46 responses) Provision of a demand and capacity tool and analysis of data Facilitation of an ADP Workshop to review findings Completion of a funding report The joint workforce development programmes delivered by STRADA/SDF continues to support our local ROSC. BIAS (Borders Independent Advocacy Service) provides support for alcohol and drugs clients. 10
The Quality Principles group continues to take forward embedding of quality principles. 9. 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, including women To ensure transitional pathways are in place to ensure continuity of service delivery during the lead up to abandonment of the CJA and implementation of Community Justice Delivery of proactive and inclusive services in line with The Community Justice (Scotland) Act 2016, to prisoners, those on Statutory Court Orders and Early Intervention. Criminal Justice Social Work and ADP represented on local CJ Board. Criminal Justice continue to embed themselves in engagement with the integrated care management process. Refresher Drug Testing training delivered to DTTO case managers. Case managers attended SDF Motivational Interviewing training. Development proposal initiated to expand development of Women s Hub facilities, in partnership with Community Partners, including Addaction and BAS. Further dates to be arranged. Further training opportunities will be identified 17/18 10. Improving identification of, and preventative activities focused on, new psychoactive substances (NPS). Provide quality training to staff in local area on NPS. Ensured information was provided to key stakeholders on new legislation within the ADP Bulletin via usual networks. Supported dissemination of NPS research commissioned by Scottish Government. Two NPS training sessions were delivered by Crew with 23 delegates. These were positively evaluated. Ensure information is shared locally The Drug Trend Monitoring Group (DTMG) continues to meet twice yearly and shares 11
information about current trends. This group is supported by Crew and Police Scotland STOP unit. The substance misuse liaison nurse provides information relating to Emergency Department attendances and ADP share any local and national intelligence via the DTMG mailing list. 11. On-going Implementation of a Whole Population Approach for alcohol recognising harder to reach groups, supporting a focus on communities where deprivation is greatest. Implement reviewed ABI process in A/E To run a Dry January campaign via Small Change Big Difference Continue to support licensing objectives by participating in the Local Licensing Forum (LLF) and production of a Summary Alcohol Profile Improvement Goal 2017-18: To increase knowledge and awareness of current trends in drug use through providing an update session for ADP, Executive and key partners. Meetings held with A/E staff about increasing routine screening for ABIs. Training being planned for staff. Resources updated to reflect new alcohol guidelines and supporting materials provided. A Local Enhanced Service (LES) is in place to provide ABI s in primary care. There is a cap on the funding available and this is weighted to reflect relevant deprivation. The third Dry January campaign was run alongside NHS Borders Small Change Big Difference (SCBD) project. Facebook and twitter were used for communication methods. Ongoing support to Local Licensing Forum has been provided along with responding to any licensing applications on behalf of NHS Borders. The ADP Strategic Coordinator has been involved in supporting development of Health and Social Care Partnership Locality Plans. ADP supported delivery of local Best Bar None. Sign-ups increased from 6 in 2014-15 to 18 in 2016-17 with two national award winners. 12
A Summary Alcohol Profile was completed for 2015-16. This Profile aims to provide an update on the information available from Police Scotland, NHS Borders, Scottish Borders Council and Scottish Public Health Observatory. This report is shared with the Licensing Board and Local Licensing Forum to support evidence based decisions on availability. Borders ADP provided a presentation at Alcohol Focus Scotland s regional licensing event on the work of the Local Licensing Forum, highlights and challenges. Following this event good practice was shared with other LLFs. A poster presentation on previous year s community engagement work on alcohol in Langlee was succesfully submitted to the Scottish Faculty of Public Health Conference in October 2016. Following community consultation, TD1 youth project was supported to develop information materials for parents about agent purchase. Improvement Goals 2017-18: Contribute to the review of Substance Misuse Policy in Schools. Support the Licensing Board in review of Policy Statement Work with multiagency partners to identify key strategic actions to reduce alcohol related harm in young people. 13
12. ADP Engagement in improvements to reduce alcohol related deaths. To complete a cohort review of 2014 alcohol related deaths. A cohort review completed of 2014 alcohol related deaths to identify any learning points and inform potential interventions to prevent alcohol related deaths. This work involved reviewing in-patient notes, prescribing data, national reports and individually linked ISD data including health service utilisation and cost. Support has been provided from NHS Borders Clinical Governance and Quality, Scottish Government and ISD and NHS Greater Glasgow and Clyde. The report was presented to the ADP in April 2017 and Critical Services Oversight Group in August 2017. Recommendations include development of short life working group to test and refine the findings and develop recommendations. Improvement Goal 2017-18: Implement recommendations from short life working group. * SMART (Specific, Measurable, Ambitious, Relevant, Time Bound) measures where appropriate 14
3. ADDITIONAL INFORMATION 1 APRIL 2016 31 MARCH 2017 1 Please bullet point any local research that you have commissioned in the last year. 2 What is the formal arrangement within your ADP for working with local partners to report on the delivery of local outcomes? 3 A person centered recovery focus has been incorporated into our approach to strategic commissioning. Please advise on the current status of your ROSC? 4 Is there an ADP Workforce Development Strategy in Place, if not, are there plans to develop? What additional supports have you leveraged to facilitate this and are you working with our NCOs? We have not commissioned any local research. Quarterly Performance Reports are reviewed by the ADP Board and Executive. Annual Reports and Delivery Plans and other associated documents are formally reported via the Executive Management Team of the Health and Social Care Partnership. The Drug Related Death Annual Report is presented to the Critical Services Oversight Group (CSOG). Our ROSC (Recovery Oriented System of Care) is in place. We are particularly pleased with the increase of post-treatment opportunities in the form of the Serendipity Recovery Cafe and increased participation in Mutual Aid Partnership Groups in Addaction. The current funding constraints faced following the reduction of the ADP ringfenced budget has led to reduced availability in resources to support contracts. We have a Workforce Development Strategy in place. We have been supported by SDF, Crew, SRC and SFAD to provide training events and contribution to the Drug Death Seminar. In addition, colleagues from services deliver training including: Overdose Prevention; Understanding Alcohol and Drugs in Borders and briefing sessions on Children Affected by Parental Substance Misuse. Please provide any feedback you have on this reporting template. It is helpful to maintain reporting requirements. It is helpful that there is consistency in Ministerial Priorities from last year. We note there are no priorities relating to children and families. When presenting the report to colleagues we find they are also interested in up to date data therefore we have prepared a technical report including most recent nationally published data. We have attached this here for information. Supporting information and techn 15
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