DUMFRIES AND GALLOWAY ALCOHOL AND DRUG PARTNERSHIP; PRIORITY ACTIONS 2013-14 AND 2014-15 RECOMMENDATION/WORKPLAN CURRENT POSITION IN D & G PLAN 1. Annual Report 1.1 Develop robust reporting mechanisms with existing Community Planning Partnership structures and emerging structures within Health and Social Care. 1.2 Develop systems which ensure service users and carers are embedded within the commissioning, delivery and ongoing review of services. 1.3 Continue to develop a ROSC within the Dumfries and Galloway Recovery Plan. 1.4 Prepare a comprehensive Workforce Development Plan which can be signed up to and agreed by all partners and endorsed by service users and carers. 1.5 Develop a self-assessment framework for commissioned services which will be agreed with services and become an integral part of the performance and quality aspect of the contract monitoring framework. ADP Reporting to the Council, the NHS and the CPP has been patchy and inconsistent and reliant on the ADP bringing papers forward. Service user involvement is integral to all contracts offered by the ADP. Development of service user involvement is patchy, inconsistent and under developed. Services are working with both SDF and SRC at present and alongside the ADP working to identify gaps in our service provision of an ROSC. Whilst individual services may have workforce development plans which include substance misuse, there is no comprehensive plan across statutory and non-statutory services. The ADP completes a self-assessment as part of the Annual Report. Commissioned services may currently self-assess but not in a systematic way as agreed by ADP and carried out as part of the contract monitoring framework. As a minimum commitment the ADP will ensure that its Annual Report is presented to the appropriate forums for sign off. Other papers as agreed by the ADP will go to the COG Public Protection. ADP will develop mechanisms to involve service users and carers in review of their services and in future commissioning processes. Service providers will be required to demonstrate their service user involvement policies and procedures in monitoring meetings. Continue to develop an ROSC using the national support organisations available. Provide ADP with six monthly updates. Begin working with the Scottish Government lead and local services to develop a comprehensive workforce development plan for substance misuse for implementation in April 2015. Develop a self assessment framework for commissioned services using nationally developed frameworks and discuss and agree with services for implementation by April 2014.
2. Quality Improvement 2.1 Deliver the HEAT Standard for drug and alcohol treatment waiting times. 2.2 Deliver the HEAT Standard for Alcohol Brief Interventions. 2.3 Increase the level of compliance and the amount of data supplied to the national Scottish Drug Misuse Database (SDMD), so that it accurately reflects the number of people engaging with drug treatment services and correlates with the information submitted to the National Drug and Alcohol Treatment Waiting Times Database (DATWTD). 2.4 Improve the quality of the data held on the DATWTD by increasing the level of fully identifiable records submitted. 2.5 Increase the reach and coverage of the national naloxone programme by increasing the number of kits supplied to people at risk of opiate overdose. 2.6 Develop local understandings of the prevalence and impact of new psychoactive substances in ADP areas based on locally available information and exposure. The HEAT Standard is currently being met by all services. Structures are in place to deliver the target in the core settings and elsewhere. Extra support is required in A & E and Primary Care where delivery is now being led by the PHP Team. All services are complying with the data collection and reporting requirements of Scottish Government Dumfries and Galloway currently complying to 99% in terms of fully identifiable records submitted. Dumfries and Galloway is currently meeting national targets for supply of naloxone kits. There is evidence of the use of NPS in Dumfries and Galloway and some awareness raising amongst staff within partner organisations has taken place. No strategic plan as yet in place. Support services as necessary to ensure compliance with the standard and reporting regimes. Continue to support delivery in the core settings and develop in other areas. Deliver a training and re-training programme to ensure maximum coverage and delivery. Develop recording and reporting mechanisms to ensure all delivery is reported to Scottish Government. Continue to report as necessary and keep services involved and informed of the development of the DAISy developments. Support services to maintain this level of compliance targeting support as necessary. We have committed to exceeding the national target by 5% year on year. We will continue to train a variety of service providers, users and carers. Initial situation paper and initial action plan to be prepared for March 2014 meeting of ADP.
3. Independent Expert Review of Opioid Replacement Therapies 3.1 Consideration should be given to the development of mechanisms bringing closer the delivery of approaches to address health inequalities and problem substance use. No formal structures or processes are in place to address health inequalities among substance misusers. Work closely with colleagues in Public Health to identify health inequalities in this services user group and bring plan forward to ADP meeting of June 2014. 3.2 Primary care services specifically General Practitioners and Community Pharmacists are essential elements of the delivery system and should be delivered to national standards. 3.3 Opioid replacement is an essential treatment with a strong evidence base. Its use remains a central component of the treatment for opiate dependency and it should be retained in Scottish services. 3.4 A national specification for pharmacy services for problematic drug users should be developed to ensure that a high quality and consistent service can be provided in Scotland. This should be supported by a nationally agreed guideline for supervised self-administration of ORT medications and initiation of improvement approaches to accelerate progress.
3.5 The mechanisms in place which determine the reimbursement cost of methadone in Scottish community treatment systems should be reviewed to ensure they deliver best value and that in balancing the competing challenges, the benefits to problem substance users are to the fore. 3.6 Recovery orientated systems of care (ROSCs) are well described in many guidance documents. All local systems should immediately publish prioritised SMART plans to ensure they can demonstrate a process towards delivery of ROSCs. Dumfries and Galloway s Development of a ROSC is not sufficiently mature enough at present and needs ongoing attention to its development. Dumfries and Galloway ADP will be presented with prioritised plans for the development of its ROSC in Smart format at its March 2014 meeting. 3.7 Within the medical and other caring professions, it is everyone s responsibility to manage drug users and their problems which extend into every clinical specialty. All practitioners can effect change and have opportunities to address drug-related problems within their professional arena. Local systems should have plans in place to ensure substance users are not excluded from generic services. NHS Dumfries and Galloway has a LES in place for drug misuse but not for alcohol misuse. Not all GP Practices have signed up to the shared care scheme for drug misusers. Not all GP practices record and report the delivery of ABIs for alcohol misusers. Work with NHS colleagues to maximise collaboration and cooperation to ensure service users are not excluded from generic servies.
3.8 The Scottish Government should seriously reconsider how to better facilitate universal and effective partnerships which respond to local need and delivery consistent and measureable outcome improvement for substance users across Scotland. 3.9 There is an urgent need to address the lack of institutional memory in the planning, delivery and governance of these systems of care. In particular, current advisory structures should be reviewed to improve impact on performance especially with regard to lines of accountability and relationships with the Scottish Government and Scottish Parliament. 3.10 The Chief Medical Officer should task the Chief Scientist to consult with the academic community in Scotland and bring forward robust plans to develop a Scottish National Research Programme addressing the key substance use questions for Scotland. The aim should be to support and facilitate the delivery of efficient, high quality research into both the natural history of problem substance us its development and progression as well as the effectiveness of a broad range of treatment approaches including psychological and social approaches as well as novel treatments.
3.11 Any proposal to further develop national information systems in the area of substance misuse at national level should be subject to meaningful and accountable project management. This should include: external scrutiny of delivery; a risk assessment to identify and address the main obstructions to delivery; publication of a realistic programme of delivery with agreed timeframes with measureable milestones and clear lines of accountability for all elements of the proposed system. 3.12 The variation of practice identified across services should be addressed using a proven improvement methodology, enshrined in the 3- Step Improvement Framework for Scotland s Public Services. This work should be given high priority by the Scottish Government and its partners. Clearly defined aims, drivers and measures should be developed for agreement at an initial collaborative learning event organised by the Scottish Government early in 2014. Dumfries and Galloway ADP will begin discussions with commissioned providers in respect of the noted improvement methodology in anticipation of any initiatives brought forward by Scottish Government. Key partners will be involved in this work which may be included in self-assessment paperwork currently in development
4. Other 4.1 Review of use of ORT in Dumfries and Galloway. Information on the use of ORT is patchy. Systems are not in place to extract and report the information required to inform development of services and patient choice. The ADP meeting of December 2013 will consider a proposal for an initial scoping exercise of ORT in Dumfries and Galloway. Plan to deliver report to ADP meeting in June 2014. 4.2 Review the Adult Substance Misuse Social Work post funded by ADP in light of proposed changes in service delivery and structures. The one dedicated substance misuse Social Work post funded by the ADP is currently based in Criminal Justice Social Work. This should be reviewed to confirm appropriateness or otherwise given service demands. Social Work Department is currently reviewing its adult care services. Social Work Senior Management Team have agreed to include review of this post in the wider service review.
4.3 All funded services will be subject of a contract or service level agreement. All commissioned services are subject to a contractual agreement, service specification and monitoring arrangements except the NHS Specialist Substance Misuse Service. Continue to contract with all commissioned services. Scope situation regarding NHS services in other parts of Scotland and begin process of developing service level agreements as appropriate.