1 NTA More treatment, better treatment, fairer treatment National injecting conference Annette Dale-Perera Director of Quality

2 NTA More treatment, better treatment, fairer treatment Context: expansion in drug treatment Rapid expansion in structured drug treatment Improvements in access: reduced waiting times, more offenders Rapid increase in drug treatment workforce New NTA push on “Treatment Effectiveness” with service users fully involved in care

3 NTA More treatment, better treatment, fairer treatment Most injectors in contact with drug treatment ? Structured drug treatment: approx 160,000 people in 04/05 – 56% injectors – 90,000 Needle exchange services: 105,000 people (overlap unknown) Estimates of injectors in England: ,000 people New populations being drawn in via DIP & prison work DIP 3000 assessed per month, most not had treatment, 35% injected in last month – high reported levels of sharing About 15,000 04/05 in treatment referred from CJ Prison work especially CARATS

4 NTA More treatment, better treatment, fairer treatment Harm Increasing infections (Nicolas Beeching) New, worrying patterns of drug taking: Nexus of Risk re crack use in the context of injecting (Tim Rhodes) Increasing BBV (Viv Hope) Hep B1: 5 Hep C2: 5 some areas higher - many unaware HIVincreasing More drug users with serious long term health problems But some good news …….Overdose Deaths are falling

5 NTA More treatment, better treatment, fairer treatment What are we trying to achieve ? Harm reduction as core activity in all drug treatment Injecting is high risk behaviour Interventions to reduce risk and improve health ie change behaviour Harm reduction interventions to help injectors reduce harm: Raise awareness amongst drug injectors Safer injecting techniques to stop spread of Blood borne Virus’s, infection, etc Injecting equipment dispersal and return Overdose prevention inc alcohol treatment, naloxone, first aid etc Reduce initiation into injecting Opiate substitution treatment: at the right dose Reduce and ideally stop injecting Continuity of drug treatment Reduce risks to others from injecting eg disposal

6 NTA More treatment, better treatment, fairer treatment So why have we got an increase in injecting related harm ? Continued focus in national guidance on harm reduction, Models of Care 2002, reducing drug related deaths % staff new: need better competence to work with injectors ? Some work not monitored as structured treatment and HR not stressed enough in structured treatment NX not proactive enough eg 80% pharmacy based Drug trends and trends in BBV ?

7 NTA More treatment, better treatment, fairer treatment National needle exchange audit 04/05 Abdulrahim &Hunt Key finding is VARIATION in range and type of NX On the surface every DAT in country has some but 10% rely on pharmacy based exchange only 40%-60% have no on-site testing for BBV Specialist NX initial assessment 15% did not cover risks sharing injecting equipment 25% did not cover OD risk Under 65% covered injecting hygiene, vein care Only 35% provided dressings/care for minor infections

8 NTA More treatment, better treatment, fairer treatment Improvement required in commissioning & provision More testing and awareness of BBV status Better health care: Hep B vacs, check injection sites, abscesses More proactive NX and open access: pharmacy alone is not enough MORE COMPETENT STAFF: more training More work with injecting in structured drug treatment Getting the dose right in prescribing Greater users involvement in design and delivery of services

9 NTA More treatment, better treatment, fairer treatment NTA/HealthCare Commission Improvement Review National improvement review and inspection of Harm reduction services 06/07 National criteria (standards) and programme developed 05/6 Every area screened against criteria and data: summer 06 Every area receive a report Dec % “inspected” (inc peer review) By March 2007 Each area with an action plan to improve harm reduction Good practice “benchmarked” and identified Action to improve commissioning, monitoring and provision

10 NTA More treatment, better treatment, fairer treatment Conclusions Local drug treatment systems need to provide better services to help injectors reduce harm We are already in contact with the majority: we need to question whether we doing enough to reduce harm THANK YOU Conference organisers and attendees Events like this will help