4.1 Sarah Scott, Director of Public Health introduced the report with further information provided by Jennifer Taylor, Lead Commissioner - Public Health and Steve O’Neill, Commissioning Manager Drug and Alcohol services. The report summarised the recent context for adult (18+) drug and alcohol treatment services in Gloucestershire as well as the current activity and performance and key priorities for the coming year. Some case studies had been provided to show the complexity of the service.
4.2 Gloucestershire County Council Public Health was responsible for commissioning the drug and alcohol treatment recovery services for adults. Improving outcomes from drug and alcohol services was a condition of the Public Health grant. Since 1 January 2017 the service had been provided by the national organisation Change, Grow, Live (CGL). This contract included a budget reduction from £5.9m per year to £5.1m, as well as the scope to better integrate services, delivering more than the previous service had. This had resulted in a new service model in Gloucestershire that had seen higher caseloads and increased group work. There had been a reduction in fixed hub with a greater emphasis on outreach work across the County.
4.3 The primary performance
measure which was reported to scrutiny was:
· Proportion of adult alcohol misusers who had left treatment successfully
· Proportion of all opiate users who have left treatment successfully, not representing in six months
· Proportion of all non-opiate users who have left treatment successfully, not representing in six months
4.4 Although Gloucestershire saw a dip in treatment completions following recommissioning, the service was now performing well against national comparators. The upturn in performance that was shown in early-mid 2018 had been sustained and was beginning to plateau at its current level. Members understood that there was a wide range of performance across the country and discussed how close certain performance measures were to being in the top quartile of comparator local authorities, for example successful completions of opiate users.
4.5 Demand for services at the front door remained high for both alcohol and drug treatment with 2,569 people accessing services in 2018/19. The treatment population was not evenly distributed across the county with nearly two thirds residing in Gloucester and Cheltenham.
4.6 Areas of focus going forward:
· Harm reduction including spread of MSRA
· Understanding impact of alcohol use on the hospitals
· Work with CCG, 2gether trust – effective support for those with mental health and drug and alcohol services
4.7 One member stated that she
welcomed the improvement that had been shown following the dip in
performance during the transition phase. She asked where assessment
took place in the system and who referred individuals into it. It
was explained that self-referral was the main entry point.
Assessment took place in the hubs mainly, but there was some
outreach that took place in districts to find a more convenient
location. It was clarified that the three week measure was from the
self-referral to treatment so the assessment took place in that
4.8 It was explained that there were good links between CGL and 2gether Trust in terms of working with people who have co-existing mental health conditions. Members were referred to the case studies which provided examples of the complex work being carried out.
4.9 One member explained that in America there was a lot of media coverage on opioids and he asked whether this was a problem in Gloucestershire. In response it was explained that due to a number of factors this was not a ‘crisis’ in Britain but that there was clearly an issue around opioids. The CCG were doing some work on this and a recent report was published by Public Health England (PHE).. It was suggested that further information be provided to members once available.
ACTION Jennifer Taylor
4.10 One member welcomed the geographical breakdown of the data within the paper. In response to his questions it was explained that the data was being closely examined to set the future direction of the service, particularly at the stage where it would need to be recommissioned.. One member raised the issue of those clients coming back into the system as opposed to new clients. It was explained that this was the nature of addiction that individuals could be referred multiple times. A deep dive exercise of the data would help to identify which individuals were new clients. Members would receive an update of this work in six months time.
ACTION Jennifer Taylor
4.11 There was some discussion regarding ‘County Lines’ and the impact of drug dealing; members wondered how information was provided to and from the police, without compromising the integrity of the service. In response it was explained that there was good communication with the Police. While County Lines did not equate to a significant amount of individuals accessing the service, the real concern was regarding the strength of the drugs being dealt and the impact on people accessing them. The Police would also refer individuals for help where they were engaged in County Lines. One member asked whether people who were homeless received support with drug and alcohol problems. It was confirmed that they were a group who special efforts were made to reach.
4.12 It was questioned, what efforts were being made to draw people into the service. It was explained that the contract involved a number of aspects that involved partners to help reach those that perhaps did not want to be reached. So far those attempts had not generated a need that the service was not resourced to meet.
4.13 Members were provided with details of the approach being taken by the ‘Blue Lights Project’ pilot which was an assertive multi-disciplinary team that looked to get individuals into treatment and access to support.