WHAT WE PROMISED WHAT WE ACHIEVED

CHANGES IMPLEMENTED - SUBSTANCE MISUSE COMMISSIONING STRATEGY 2008 – 2011

The Substance Misuse Commissioning Strategy for Substance Misuse was launched in April 2008. It was a commitment by a range of organisations, under the leadership of the Community Safety Partnership, to changes that needed to be made within Carmarthenshire in order to minimise the harm caused by drug and alcohol misuse to individuals, families and communities.

The Strategy focused on 10 Key Areas, against which a range of actions were identified. The 10 key areas were as follows:

This report highlights the important achievements and successes made against these objectives but also highlights that there is still much that can be done to minimise this harm.

PREVENTION AND EARLY INTERVENTION

This priority is focused on helping to prevent children, young people and adults to develop problems with drugs and alcohol

AIMS

ACHIEVEMENTS

To develop close links with other partnership structures and agencies to develop an holistic approach to prevention and early intervention

    Substance Misuse Strategic group chaired by Head of Children’s Services has been established and is leading on the development of a multi agency substance misuse plan for children and young people to run from April 2011.

    Youth Health Team supports individual young people with substance misuse, emotional health, sexual health and health eating issues. In 2009 – 10 they worked with 169 young people on a 1 2 1 basis, held 234 health workshops, 15 youth panels and 294 open access community drop in sessions.

    The Carmarthenshire multi - agency Prevention, Education and Training sub group have co-ordinated a variety of prevention and education initiatives including community drug and alcohol awareness events within GlanyMor and Tyisha and Parc Y Scarlets which have been very successful

    Additional funding has been received from the Assembly Government in 2010 – 2011 to support the following initiatives:

        - Parenting initiative for families affected by substance misuse

        - Young Persons Mental Health and Substance Misuse Practitioner

        - Development of a quality framework and programme for prevention activities

        - Co-ordination across services for high risk young people

        - Pilot group work for high risk young people delivered by psychologists – target 40 young people over 6 months

        - Prescribing and support for young people

    A Drug Summit was held in Llanelli, chaired by the Leader of the Council, and an action plan will be produced as a result of the day.

HIDDEN HARM

This priority is focused on responding to the actual and potential harm caused to babies born to and living with parental drug and alcohol abuse

AIMS

ACHIEVEMENTS

To develop services and initiatives to tackle the Hidden Harm agenda

    A Hidden Harm Service was commissioned in 2008 and is delivered jointly by Barnardos and the Carmarthenshire Social Care Substance Misuse Team. The service provides direct support and advice to parents with substance misuse problems and offers both a 10 week group programme and 1 2 1 support to children living with parental substance misuse. In 2009 – 10, the Social Work team worked with 32 parents with a substance misuse problem and Barnardos have worked with 13 young people.

    A bid has been submitted to the Welsh Assembly for funding for a Specialist Substance Misuse midwife. In 2009 there were 121 pregnant women identified as a cause for concern in relation to their drug or alcohol use. In January to May 2010, 49 pregnant women were identified with a substance misuse problem.

CHILDREN AND YOUNG PEOPLE

This priority is focused on helping children and young people who have developed problems with drugs and alcohol to get good quality, effective information, advice and treatment as and when they need it

AIMS

ACHIEVEMENTS

To achieve improvements in quality of service delivery and availability of services for children and young people.

    Development of robust screening and referral procedures for the SUDDS (Safer Drink and Drugs Service for under 18s)

    Reconfiguration of existing young persons service to increase capacity for number of young people able to receive treatment. In 2009, 104 referrals were received to the young persons service

    Arrangements for prescribing and assessment of complex needs for young people have been made.

ADULT DRUG AND ALCOHOL TREATMENT SERVICES

This priority is focused on ensure the provision of evidence based, accessible and cost effective drug and alcohol services that deliver measurable outcomes for people who experience a drug or alcohol problem.

ALCOHOL

AIMS

ACHIEVEMENTS

    Approach existing providers to submit a proposal for an open access, non care planned information, advice and brief interventions (Tier 2) and community based, structured care planned alcohol treatment, to include community detox

    Completed. The new adult alcohol service has been in place since 2009. It is delivered jointly by Prism and Hywel Dda Health Board substance misuse service in partnership with the Council Social Care Substance Misuse Team. Prism provides a single point of entry for clients which is the first time this has been offered.

    Implementation of a local system of screening and assessment with triage undertaken at Tier 2 and comprehensive assessment undertaken at Tier 3

    Completed. Multi agency weekly allocation meetings are now held which ensures a better, quicker service for clients.

    Development of clear integrated care pathways between and through providers and formal information sharing protocols

    Completed.

DRUG TREATMENT

AIMS

ACHIEVEMENTS

    Tender for the provision of an open access, information, advice and brief intervention service to provide a single point of entry for all drug clients

    A new Tier 2 drug service provided by Turning Point (Catalyst) commenced in October 2008. This has resulted in a significant increase in drug service capacity. In 2009 – 2010, there were 525 calls to the single point of contact telephone number and 320 referrals. 253 clients received interventions form Turning Point. 36% of these had heroin as a primary substance used and 26% cannabis. Interventions include action planning, brief solution focused therapy, anger management and coping with cravings. The service has also helped reduce waiting times to Tier 3 treatment services for clients who have more complex needs.

    Develop and implement a local system of screening and assessment, information sharing protocols and integrated care pathways across agencies

    Completed. In addition, weekly allocation meetings are held with Turning Point, West Wales Substance Misuse Service and Social Care Substance Misuse Team to ensure a streamlined approach to service delivery for clients.

    A multi agency drug service base was developed, established and opened at Vaughan Street, Llanelli. This is the first such facility in Dyfed Powys and hosts the three main drug treatment service providers in Carmarthenshire: Turning Point, West Wales Substance Misuse Service and the Social Care Substance Misuse Team. It is being held as a best practice example for other areas and the co-location has proved beneficial in terms of more integrated treatment provision.

    Review the existing community prescribing Model to ensure robust clinical governance arrangements and move on capacity between schemes and ensure contracts reflect service targets and expected outcomes

    Complete. A Prescribing Review was undertaken in 2009 and provided a number of key recommendations around ensuring drug workers are linked to GP Practices, arrangements for young people’s prescribing and performance management arrangements.

    Development and implementation of appropriate prescribing response to needs of Drug Intervention Programme (DIP) and Prolific and Priority Offender (PPO) clients

    A Drug Intervention Programme Rapid Access Prescribing Scheme was launched in November 2009 and operates from the Parish Hall in Llanelli. This very positive development means that clients identified at arrest as having a drug problem or who are leaving prison are now able to receive prescribing interventions if appropriate. Between November 09 and March 2010, 39 clients were assessed as suitable for this service.

    To retain existing investment as a minimum in Pharmacy based Supervised Consumption and Needle Exchange services, with a focus on ensuring geographical coverage is planned in line with assessed need

    Complete. The number of Pharmacies providing needle exchange and supervised consumption has increased over the life time of the Commissioning Strategy.

    To develop an agency based Needle Exchange scheme to include harm reduction advice, safer injecting as part of the Tier 2 drug service delivery.

    Discussions are still ongoing around the establishment of an agency based needle exchange scheme.

Drug and Alcohol

AIMS

ACHIEVEMENTS

    Develop a costed model for provision of Hepatitis B vaccination and Hepatitis screening and treatment

    Funding has been received from the Assembly to deliver a Hepatitis service within Carmarthenshire which will ensure testing for Hepatitis B and C, immunisation for Hepatitis B and treatment for Hepatitis C.

    Work with providers and other planning forum to explore the delivery of aftercare and structured day care within existing resources of identification of alternative funding sources

    Funding has been provided for three years, for a worker, based at West Wales Substance Misuse Service, to establish a structured daycare programme.

    Lottery funding has been obtained for a “Helping Groups to Grow” project which will expand aftercare and also includes counselling for drug and alcohol clients for issues such as child abuse, eating disorders, depression and low self esteem.

    A successful proposal was submitted to European Coastal funding for additional aftercare provision, to be led by the Council.

    A Peer Mentoring Scheme was established in 2010, delivered by Turning Point

    Improve waiting times and numbers of clients dropping out of treatment in line with the Welsh Assembly Government Targets

    Annual reports are submitted to the Welsh Assembly Government on performance against targets for both waiting times and drop out rates. There has been a reduction across service providers of drop out rates compared to 2008-09 with improvements between 6 and 10%. Waiting times have also improved significantly with an average of 50% of clients now being assessed within 10 working days. A priority for the new strategy will be an improvement in these figures.

    Implement the Welsh Assembly Government Treatment Outcome Profile Tool (TOPS)

    This has been completed and Tier 3 adult service providers are now recording treatment outcomes for all clients finishing treatment. This data will be available in the 2011 – 2012 financial year.

Mental Health and Substance Misuse

This priority is focused on ensuring there is adequate delivery of care and treatment to this client group across the spectrum of mental health and substance misuse problems from mild / moderate to severe

AIMS

ACHIEVEMENTS

    Continue to develop and implement the Carmarthenshire Substance Misuse and Mental Health Action Plan and to co-ordinate planning and delivery between mental health and substance misuse

    A Dual Diagnosis Worker based within West Wales Substance Misuse Service has made progress in raising the profile of mental health and substance misuse issues within mental health teams across the county.

    During 2010, Eiriol has been successful in obtaining funding to host a Substance Misuse and Mental Health Advocacy worker Post

Housing

This priority is focused on ensuring appropriate housing provision and support for homeless people and those with accommodation needs who have experienced substance misuse problems

AIMS

ACHIEVEMENTS

To review the guidance from the Welsh Assembly Government contained in the Substance Misuse Treatment Framework on Housing and substance misuse and develop local responses.

    Wallich Clifford was commissioned to provide a floating support and Supported Housing service for substance misuse clients.

    Red Cross provide a Supported Discharge Scheme.

    A priority for the new strategy will be the establishment of better links with Housing, in particular in relation to housing allocation policy.

Families and Communities

This priority area is focused on improving the wellbeing of families and communities directly or indirectly affected by substance misuse.

AIMS

ACHIEVEMENTS

To review and implement the recommendations contained within the Welsh Substance Misuse Strategy and Treatment Framework relating to families and communities.

    A Development worker for the families and carers of substance misusers was appointed. The worker provides 1 2 1 support to families and concerned others and also delivers support groups throughout Carmarthenshire. As at September 2009, there had been 86 referrals to the service and around 50 families continue to receive ongoing support. Three support groups are available and a number of other sessions focused on self esteem and coping mechanism for families are also delivered as well as a monthly newsletter.

    Turning Point has also provided family support since early 2009. During 2009 – 2010, 29 individuals have received family support.

    The CSP have also undertaken a range of measures aimed at reducing the harm to the community in the form of anti-social behaviour or the night time economy which address issues caused by alcohol or drug related behaviour.

SERVICE USER INVOLVEMENT

This priority is focused on ensuring there is service user involvement in the planning and commissioning of substance misuse services

AIMS

ACHIEVEMENTS

Service user involvement was identified as a key gap within Carmarthenshire and it was agreed to review the Substance Misuse Treatment Framework on service User Involvement and identify actions to improve this area.

    Job description developed for Service User Involvement co-ordinator to establish service user forums and engage with service users over planning and delivery of services in early 2010.

    Service User Involvement worker appointed September 2010 for the Dyfed region, funded for a one year period initially.

WORKFORCE DEVELOPMENT

This priority area is focused on ensuring an appropriately and adequately trained substance misuse workforce

AIMS

ACHIEVEMENTS

To ensure the workforce are adequately trained in line with professional competencies and developed in line with guidance from Assembly Government

    All service provider job descriptions now mapped to professional competencies

    A budget is allocated to each provider to ensure that training needs are met and this is monitored via quarterly service performance meetings.

PLANNING AND PERFORMANCE MANAGEMENT

This priority area is focused on ensuring transparency of service planning and adequate performance management of services

AIMS

ACHIEVEMENTS

To ensure robust, transparent and co-ordinated processes and procedures for the commissioning of all substance misuse services

    The Substance Misuse Joint Commissioning Group meets on a bi monthly basis and oversees all decisions relating to service development and commissioning for substance misuse.

To ensure all commissioned services have in place contracts or service level agreements which specify integrated care pathways and output and outcome requirements

    Complete

To monitor service performance on a regular basis

    Performance reports from all funded projects are considered on a quarterly basis via the Substance Misuse Joint Commissioning Group.