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Agenda item

Rotherham CGL Drug and Alcohol Treatment and Recovery Service

-               Lucy Harrison, CGL, Anne Charlesworth, RMBC and partners to present

Minutes:

Lucy Harrison, CGL, and Anne Charlesworth, RMBC, Matt Pollard, RDaSH, gave the following powerpoint presentation:-

 

Successful Opiate completions

Defined by Public Health England as:-

-          Drug free, alcohol free or occasional user (not opiate/crack) discharges in the previous 12 months as a proportion of all clients in treatment in that period (latest treatment journey used)

Representations defined by Public England as:-

-          All drug free, alcohol free and occasional user (not opiate/crack) discharges 6-12 months ago who have re-presented within 6 months as a proportion of all drug free, alcohol free and occasional user (not) discharges 6-12 months ago (latest treatment journey used)

 

Rotherham’s Performance

Since April 2018 – contract commencement

 

Month

Opiate successful exists

Representations

April

5

2 (June & September)

May

7

0

June

1

0

July

4

0

August

1

0

September

2

0

October

9

0

 

Our Approach: Evidence based optimised prescribing

-          Staff training and education events – using data and service information

-          Medication dose review for all Service users – highlighting those on 30 ml Methadone or less daily or 6 mg Buprenorphine or less daily and not using illicitly on top

-          Reduction and detox options discussed with Service users

-          A number of models of detox and reduction – Service user lead and clinically  safe – our primary detox offer is a 2 week front loaded Buprenorphine detox with intensive wraparound PSI and clinical support – detox takes 12 weeks from commencement to completion

-          Engagement with Shared Care Practices – same offer with GPs offering the detox or a reduction (less than 12 weeks) this is supported by the Shared Care Worker in the practice

-          A clear offer for sustained recovery through Foundations of Recovery and support from peer mentors, Mutual Aid and the recovery service

 

Our Target

-          To continue to support Service users through a range of clinical and psycho-social interventions aimed at supporting individuals to successfully exit patterns of addiction and ongoing prescribing into sustained and positive recovery and abstinence from opiates and medication

-          To deliver on Rotherham’s ambition to pull the rate of recovery from opiate dependence up to that in comparable areas of England – 1.5% year on year is the improvement needed to do this but starting from a challenging position

 

Discussion ensued with the following issues raised/clarified:-

 

·           CGL had found that some of the users were on an suboptimal dose i.e. they were on a dose of Methadone of 50-45 ml which meant that they were buying Heroin illicitly on top of their Methadone prescription.  This stopped them from engaging in treatment, they may be committing crimes and it was quite unsafe and could actually contribute to the risk of drug related death.  Those Service users were not detox or reduction ready because they were still using opiates illicitly on top of a prescription so their Methadone dose had been increased.  There was a clinical intervention where their use on top of their prescription was discussed, review their dose and look to increase that to a dose that helped that person physically so they would not need to use Heroin on top. When the Service was confident that that person was stable they would be reviewed and look to reducing the prescription to 30 ml

 

·           There were a number of different clinical approaches depending upon the Service user and where they were on their recovery journey i.e. whether they had an illicit dose on top, health needs etc. and discussed with a clinician as to whether they were detox appropriate

 

·           There were a large number of users on 40 ml or less and not using illicitly so they would be the next cohort of Service users to be worked with

 

·           The targets in the CGL contract with regard to waiting times were the same as those in the previous contract i.e. to see someone within 21 days of presenting to the Service.  The contract record had always been excellent.  If there was a dip in performance when analysed it was usually due to a couple of people who had not kept their appointment due to holidays etc.  There was the ability to drill down in the numbers in more detail

 

·           The availability of Service had increased to include 2 late nights a week and a Saturday morning to ensure there were less barriers for those who worked being able to access the Service 

 

·           The issue of Spice usage was known across South Yorkshire but was more prevalent in Doncaster and Barnsley than probably Rotherham and Sheffield.  It was something that was monitored with the Service provider regularly, however, there was no visible Spice issue and users were not coming into the Service at the moment nor had it been seen through the Community Safety elements.  CGL had a package in place for Spice users with different interventions workers could offer and a clinical prescribing package

 

·           The use of Spice was most prevalent in prison and rough sleepers.  It was felt that, due to Rotherham having a smaller cohort of rough sleepers, this was partly why the numbers were not being seen as they were in the bigger cities

 

·           The transition of Service to CGL had been extremely smooth, facilitated by RDaSH, and had picked patients up very quickly.  The contract was now 6 months in.  There was still concern regarding the number of opiate exits to meet the annual target, however, it was acknowledged that it had to be a safe service and that it took a little longer.  CGL had responded by offering a quicker detox package

 

·           CGL had had an unannounced CQC inspection the previous week.  A meeting was taking place later to discuss the initial feedback

 

·           The performance report demonstrated the level of detail that could be achieved with the Service.  All Drug Services across the country had to feed into the National Drug Treatment Monitoring System (NDTMS).  If a Service user presented themselves to any Service in the country/prison service it would be seen through the NDTMS as all the systems were linked up across the country.  It was a very complex system where you could see patterns.  There were persistent areas that had performed really well under RDaSH, some of the reds were quite arbitrary and the figures not as bad when drilled down.  It was known what the key areas were e.g. more work requiring on making sure Service users had their vaccinations for Hepatitis, waiting times for non-opiate users and those Service users who had been in receipt, of treatment for a long time

 

·           There was a lot of fear in the opiate using population that if they left treatment and the treatment offer on the table 5-10 years ago they would never get the same treatment offer again.  This was a real fear and driving force in people not leaving treatment

 

·           CGL also included a narrative report which gave more of the Service user voice.  This could be shared with the Select Commission

 

·           The Service User voice was really important and would be in the CQC feedback.  They interviewed 18 Service users during their inspection.  Service users were spoken to, feedback mechanisms for Service users and they get feedback from Service Manager.  It was a peer-led service so if someone went to the front door they would be met by  Service users that had been through the system and who were really helpful in gathering feedback and giving a warm welcome and removing any stigma

 

·           A client’s mental capacity was assessed at assessment where they would be asked questions and given the opportunity to disclose anything that had impacted on them.  It was not measured but there was anecdotal evidence and national figures around the number of female users that had been sexual abused as children and Adult Service users that had been through the care system at some point.  All workers had worked in substance misuse for a number of years and knew how to ask the questions and refer to the relevant support systems

 

·           The manager was a member of the Suicide Prevention Working Party and the service had a toolkit that could be used to support service users

 

·           Deaths of Service users was closely monitored and fed in through Adult Safeguarding.  The outstanding feature of the deaths since the previous report in September had been a number of people that died in Rotherham Hospital of a number of long term conditions many of which related to alcohol.  There had been one incident of a Service user’s suicide

 

·           CGL offered predominantly urine screening as part of the Service offer but could offer oral testing and Spice could be included

 

·           There was a national alert system around strong, weak or contaminated batches of drugs.  Over the past 2 years there had been an increase in incidences of Heroin mixed with Fentanyl which had been the cause of a number of drug related deaths in the North-East of the country.  There was a Fentanyl approach within the organisation and it would be reported through the system

 

·           Clear pathway for those with substance misuse issues and mental health issues following from the recommendations of the scrutiny review

 

·           RDaSH and CGL had been working to ensure the pathways were correct between the Services.  A significant number of those who presented to substance misuse services would have additional mental health and physical health needs and a number who presented to secondary care mental health services used substances.  There was a very clear responsibility for mental health services provided by RDaSH where people had significant mental health needs to be the lead agency in supporting users and care planning

 

·           If someone was in contact with Mental Health Services and subject to a Care Programme Approach (CPA), they would have a whole plan of care around them including contact numbers for emergency services, Crisis and, if were being encouraged to access CGL Services, CGL staff would be encouraged to support them in that process.  It was part of the role of the Care Co-ordinator to hand hold

 

·           Rotherham also had involvement of GPs through the Shared Care approach for opiate use treatment and clear pathways for referral or self-referral to IAPT.  They were still working on the front end part and would have a joint training programme for staff to bring everything together

 

·           As part of the initial risk assessment process and ongoing risk assessment review for Mental Health Services was to ask questions about domestic relationships/any difficulties with relationships.  Often tactfully phrased but the point was to find out whether there were any immediate risks both in terms of safeguarding and whether there was historical stuff that needed to be dealt with.  This would link to with work on suicide prevention and impact of past trauma or abuse

 

·           CGL asked questions regarding domestic abuse and perpetrators but in a very tactful way and they did have perpetrator programmes that could be delivered if they had the numbers.  The data was not reported on the scorecard but was collated on the system

 

·           CGL was also a member of the  MARAC. 

 

Anne, Lucy and Matt were thanked for their presentations.

 

Resolved:-  (1)  That the presentation and supporting information be noted.

 

(2)  That a monitoring report be submitted to the Select Commission in June 2019.

Supporting documents: