1. Existing services and the wraparound challenges Biba Brand West of Scotland Regional Manager

2. Core Services  Structured 1:1 work  Structured group work  Substitute prescribing  Medicated detoxification  Community rehabilitation programmes  Needle exchange  Harm reduction  Direct access drug services  Residential rehabilitation (varies by area)  Inpatient detoxification (varies by area)

3. Wraparound Services  Primary health care  Child care and parenting support  Housing support and advice  Employment and training support  Financial advice and support  Family planning services  BBV testing, support and treatment  Clinical psychology  Mental health services

4. Models of wraparound  Integrated wraparound services based within frontline drug services, but linked to mainstream providers  In-reach from wraparound services - weekly legal surgeries, mobile crèches, mobile dental units, college input  External wraparound services - Money Advice, P2W, Parenting support services  Resource Officers

5. Barriers to wraparound  Funding  Blockages in services  Overloaded frontline staff  Lack of interagency referrals  Reluctance to close cases or hand over to GPs  Highly supervised prescribing - travel, cost  ‘Recovery impatience’  Can drug policy really address other policy challenges?(…data…)

6. Methadone drug & dispensing fee (£) Scotland’s total = £12.2m

7. Cost of methadone supervision (£) + ‘handling fee’ - Scotland’s total £12.4m (+ £1m for prisoners)

8. Methadone Dispensing and Drug Deaths, 2006

9. Lothian Model  70% of GPs within the enhanced medical services (90 GP practices)  2500 stable drug users prescribed methadone within GP services. 84% are supervised once or more per annum (usually one 2 week period).  1000 unstable drug users within specialist drug services. Higher supervision  Overall: 20% daily supervised (estimate) 80% take home methadone (estimate)  No higher rates of drug deaths

10. Choices  £25m = Scotland’s spend on methadone and various fees  £12.4m cost for supervising and handling a controlled drug (+ £1m for prisoners)  methadone alone costs £1.45 = 100ml (BNF, 2004) …choices…

11. Wraparound - Employability  £3.3m pa = New Futures Fund (employability for all care groups)  1,100 service users supported annually  Are we shifting people from benefits to in- work poverty?  How much of the Incapacity Benefit Reforms are going on Progress2Work in Scotland?

12. Wraparound – Housing Support  Accessing good quality housing  Maintaining tenancies  Affordable lets and support for people ‘moving on’  Supporting People helped 164,000 people in 2005/06 - only 2,500 of this cited drug use as main problem

13. Wraparound – Welfare Advice  SDF survey of 110 drug users – average council tax debt of £2,000  Total debt of £220,000 simply due to failure to complete a form on time  What are the hidden debt challenges among the 22,000 on methadone – for mainstream drug and money advice services in Scotland?

14. Wraparound – Parenting Support  1700 foster homes needed for vulnerable children currently – Works out at £51m cost, i.e. £30k per child  Average Parent Support service working with 40 families costs £350k (approx)  £15m would support 1700 families based on these figures  Far reaching benefits with this model

15. What makes wraparound work?  More effective use of GPs  Remove blockages in services – reduce strain on services  Find resources for wraparound provision  Fund what makes a difference to drug users and what’s ‘best value’  Recommendations about wraparound support in Scotland’s Drug Strategy