End of Year Partnership Meeting on Drug and Alcohol Treatment Delivery 27 February 2012

DOMES Report Growth in successful completions for opiates – baseline for 2010/11 is 62. Q3 shows progress is -8% –Actions: Weekly reporting now underway to ensure a clear ongoing picture of completions against monthly target (12 monthly) Contract of main provider is being varied to include financial penalty for failing to discharge enough client against trajectory Data cleansed to rectify issues with drug episodes which become alcohol episodes 4 year + data audited and cohorts identified – low doses, early in treatment journey, employed, women, parents Increased capacity within social work team to allow wider implementation of care navigation work – also case tracking coordinator function extended to be system wide (was criminal justice) Assessment function now absorbed into main tier 3 provider to reduce hand-offs Workshop scheduled on 08/09 March to work on – access, coordination and discharge functions

DOMES Report Growth in proportion of those in treatment remains static, though below aspiration of % for opiates. Corrective actions as prior slide Re-presentation rate currently low compared to national, though may be masked by lower volume of discharges? Successful completions amongst Criminal Justice clients slightly above national comparison. Representations also slightly lower than national.

DOMES Report In treatment – slightly lower average length of time in treatment, though 2-4 year cohort higher than national picture: –Revised care navigation system scrutinises all new referrals, headed by Local Authority team (similar to some LASAR implementations) to organise full care package –Also enables care package to be tuned to support re-presenters with more intensive interventions

DOMES Report Criminal Justice clients remain higher proportion than national picture: –Intensive work has been undertaken with IOM to improve pathways and optimise integrated delivery –Friday prison leavers accommodated via multi-agency Saturday appointments (DISC / C4) –Also criminal justice staff working into prescribing agency to enhance engagement / target those dropping out from IOM pathways –Revised SDC programme launched on 08 February

Nos Into Effective Treatment Has dropped away by 3% across the year though static for around 9 months following initial drop However, data cleansing exercise relating to TOP will cause reduction. Corrective actions: –Also weekly reporting established in relation to new clients accessing the system –Work to engage hidden populations using Recovery Champion Function and Lifeline (as per 2009/10 recovery) –Lifeline introducing challenge to all accessing needle exchange to engage effectively in treatment –Also see care navigation / IOM improvements

TOP Outcomes Currently comparing favourably in most areas to national picture. Housing continues to require improvement: –Cyrenians now providing assertive outreach in support of homelessness team via Homeless Transition fund award –Specialist housing support from Housing Options team has been extended to provide broader coverage –Continued funding to Wearside Women in Need to provide refuge accommodation

Waiting Times / Harm Reduction No current issues with waiting times for Drugs, though pressures beginning to increase for alcohol as volume accessing services (particularly for structured psychosocial work) Harm reduction measures continue to improve slowly from last report as pathways bed in Audit underway to improve uptake of Hep C testing Campaign planned for June / July to

Parents and Families Data completeness is high, though indicating inconsistent picture with national – greater proportion with children though not residing with them Hidden Harm Workshop on 29 February: –Outcome base reporting –Augmentation of YOS FIP to provide family integrated programme –Refresh action plan from 2010 strategy –Embedding Whole Family Approach alongside partners

Summary of Key Planned Discharge Actions Weekly reporting Contract variation / financial penalties Ongoing care navigation meetings 3 way handovers introduced including maintained contact to ensure engagement is embedded Cohorts identified for targeted / accelerated work Increased inter-agency working to help re- engagement and reduce dropout

Re-design Agreement has been sought from: –Safer Sunderland Board –Prevention and Staying Healthy Board To be presented to CCG by DPH at next meeting Simplified lead provider model

Revised Model Lead Provider Self Referral DIP Hospital Professional referrals RECOVERY OUTCOMES Interim - Reduced substance misuse / Abstinence Improved H&WB -Injecting -- Housing -BBV Successful Treatment Completion Sustained - Reduced re-presentation Reduced Offending Psychosocial Interventions Clinical Interventions Specialist Harm Reduction e.g. Housing e.g. Employment Family Service Whole Family Approach

Lead Provider - Responsibilities All interventions to be delivered in line with NICE Guidelines Initial and comprehensive assessment – including setting Intervention Package / Tariff and Clustering Recovery focused care planning (encompassing both stabilisation and abstinence pathways) Pro-active case management / case conferencing Access to residential placements Hidden Harm / Safeguarding Hospital In-Reach Dual Diagnosis Harm Reduction (A+I / Referral) Peer Support and Mentoring Assertive outreach and re-engagement Access to mutual aid organisations Specialist housing support for substance misusers Community Integration and ETE Specialist Family Support for Whole Family Approach Ownership and Management of information system including outcome measures

Clinical Provision - Responsibilities All interventions to be delivered in line with NICE Guidelines Substitute prescribing Detoxification – community and inpatient General Healthcare Assessment and Interventions Communicable disease interventions – BBV screening / immunisation Expectations – rapid access (1 week) / HCA (100%) / Reduction (90%) / Abstinence (90%) / Planned Exit (80%)

Psychosocial Provision - Responsibilities All interventions to be delivered in line with NICE Guidelines A range of evidence based interventions that can be utilised on a needs-led basis –Cognitive Behavioural Therapy –Motivational Enhancement Therapy –Social Network and Environment Based Therapies –Behavioural Couples Therapy –Structured Day Programmes Expectations – rapid access (1 week) / H&WB improvement (?%) / Planned Exit (80%)

Specialist Harm Reduction - Responsibilities All interventions to be delivered in line with NICE Guidelines Open Access – drugs / alcohol / PIEDs Referral to treatment where appropriate Advice and information BBV screening and immunisation Coordination of pharmacy needle exchanges Collection of relevant data – e.g. for HPA Expectations – rapid access (open access / extended hours) / BBV uptake (?%) / Equipment Return Rate (80%)

Connected Recovery Joint venture led by NECA and NERAF –Utilising facility in central Sunderland to provide an abstinence based facility, utilised by all providers: Veteran’s groups via Forces for Good AA and NA groups IOM Structured Day Care abstinence programme Women’s group Community Integration NECA in reach to Jobcentre plus

Proposed Payment Structure Operating Year Main Payment Interim Outcomes Payment Sustained Outcomes Payment 2013/1480%20%0% 2014/1570%20%10% 2015/1660%20% Block Payment Planned Discharges H&WB Reduced substance misuse Abstinence Reduced re-presentation Reduced Re-Offending

Recovery Champion Function Recovery champion function – –30 peer mentors identified within Sunderland. Will be utilised in April / May to carry out wide scale consultation with service users to identify barriers to progress –Following this to be completed with workforce following exercise in Durham –Recovery brand under development after Middlesbrough model providing a unified brand across diverse services –Legal support sourced via Sunderland University legal department

Any questions?