AGENDA ITEM

REPORT TO CHILDREN AND YOUNG PEOPLE’S HEALTH AND WELLBEING COMMISSIONING GROUP

3 JANUARY 2018

REPORT OF DIRECTOR OF PUBLIC HEALTH

Integrated Alcohol Servicefor adults and young people

SUMMARY

  1. This report to theChildren and Young People’s Health and Wellbeing Commissioning Group (CYPHWCG)
  • presents an overview of the Alcohol Service
  • proposes a24 month extension of the service contract (April 2018-March 2020)

In order to realise the opportunities for efficiency of systems and structures and to maximize the benefits for clients with co-occurring drug and alcohol issues, it is proposed that a 24 month extension be approved, bringing alcohol and drugs contracts into the same timeline for re-procurement. During this period we will be reviewing our strategic approach to how we address alcohol and substance misuse; the service we design for procurement in 2020 will be a part of the response to this review (which will include understanding the changing demography of our community).

RECOMMENDATIONS

  1. The Group is asked to note the detail contained within the report and
  1. To endorse the 24 month extension of the Alcohol Service contract for adults and young people with Change Grow Live (CGL).

DETAIL

Context

  1. Alcohol related harm places significant costs not just to health services but spans crime and antisocial behaviour, loss of productivity in the workplace, social services and wider problems experienced by those who misuse alcohol and their families. Alcohol related harm estimates for the North East[1] show alcohol related harm costs the region a total of £1.01 billion.
  2. For Stockton-on-Tees this cost is estimated as £79.6 million (including £15 million cost to the NHS and healthcare), with alcohol harm costing Stockton-on-Tees £408 per head of population, which is higher than the regional (£386) and national average cost (£363). Costs to the NHS place Stockton in the top 10% of LA’s with the highest cost per head nationally, with costs to the workplace placing Stockton-on-Tees in the top 10-20% of LA’s. Costs to children and adults’ social services and substance misuse services in Stockton total £9million.
  3. A multiagency alcohol strategy and action plan to reduce alcohol harm across the borough is currently under development involving Trading Standards, Licensing, Police, Public Health and the CCG. The plan will focus on alcohol harm prevention, treatment and control, with identification of at risk drinking and brief advice training delivered as part of the preventions strand of the strategy.
  4. Admission episodes for alcohol-related conditions in Stockton-on-Teesremain significantly worse than those in England (see figure below). The rate of alcohol admissions increases with deprivation.

  1. Surveys into perceptions of alcohol behaviour for Stockton-On-Tees indicate that 95% of increasing / high risk drinkers think they are drinking at moderate or light levels. 39% of the population surveyed was drinking at increasing / higher risk levels (Balance Stockton Alcohol Dashboard 2015).

Current Service Provision

  1. The Stockton on Tees Alcohol Service is an integrated model for adults and young people. The services provided include the Adult’s Alcohol Treatment and Recovery Services and the Young PeopleDrug & Alcohol service.
  2. During 2017/18 our contracted provider Lifeline Project Ltd collapsed nationally. As a result, the Alcohol serviceshave been through the process of contract novation, with services transferring from Lifeline to Change Grow Live (CGL).

9In order to realize the opportunities for efficiency of systems and structures and to maximize the benefits for clients with co-occurring drug and alcohol issues it is proposed that a 24 month extension be approved, bringing alcohol and drugs contracts into the same timeline for re-procurement. During this period a review of our strategic approach to drug and alcohol misuse will be undertaken to inform service design for procurement in 2020.

  1. This contract is a separate contract from the adults’ drug treatment contract with the same provider.
  2. Lifeline Project Ltd was awarded the contract for the integrated service in January 2014. The contract was initiallyover 2.3 years, with the option to extend for 3x1year extensions (until 31st March 2019). The annual contract value for the integrated Young People’s Drug and Alcohol Service and Adults Alcohol Treatment Service is £766,969.00 p.a.
  3. The service is a hub and spoke model, with a fixed base at Skinner Street, Stockton, with workers based across GP Practices, University of North Tees Hospital and hubs in Billingham, Thornaby and Roseworth delivering:
  • Clinical intervention and aftercare: Currently sub-contracted to the Fulcrum Medical Practice. The clinicians offer clinically supported alcohol reductions, relapse prevention prescribing, community detox, hospital to home detox continuation, inpatient assessment/referral and clinical aftercare support, delivery of screening for hepatitis B, C, HIV, chlamydia and other sexually transmitted infections and delivery of immunisations including hepatitis B.The 2 Nurses are also responsible for health and wellbeing programmes – smoking cessation, sexual health and improved mental wellbeing/suicide prevention.
  • Hospital in-reach: An assessment and unstructured treatment service based within the University of North Tees Hospital, working with acute staff to target and engage patients who have attended and been admitted to hospital on multiple occasions, as a result of alcohol misuse.Offering screening, identification and open access via hospital in-reach and into the community offering brief and extended interventions, with onward referral to into appropriate services.
  • Assertive community outreach:An open access model offeringspecialist evidence based interventions including psychosocial interventions (cognitive behavioural, motivational interventions and family interventions), structured counselling, recovery planning encompassing multiagency working, recovery goals, physical, mental and psychological functioning, harmminimisation, identification and brief advice and referral into specialist and/or residential in-patient services.
  • Wraparound interventions:An holistic approach to individual needs.Facilitating access to social services, education, training and employment, support and advocacy with housing, support with benefits/debt advice, developing self-help skills and offering therapeutic activities (walking groups, peer support group,women’s group, relapse prevention and art therapy).
  • Enhanced access via GP Surgeries: offering support to 21 practices via the GP Locally Enhanced Service (LES) for Alcohol, providing extended brief interventions and supporting GP’sto establish effective processes to identifyand support patients with alcohol issues.
  • Working with criminal justice partners: providing community based treatment elements of Alcohol Specialist Activity Requirements (ASAR’s) and Alcohol Treatment requirements (ATR’s); working together on three-way recovery focused care plans and reporting back to Probation and the courts as required.
  • The young people’s service consists of 1 senior practitioner and 2 recovery workers co-located and integrated within Youth Direction Services. The service delivers an open access model of support, delivery of evidence based psychosocial interventions and the provision of pathways for pharmacological support.

Care Quality Commission (CQC) Review December 2015

  1. The CGL Manager for Stockton on Tees is about to become a registered CQC Manager and will be reviewing governance frameworks for the service in line with best practice guidance.

Adult’s Alcohol Service Review

  1. Contract Management and performance monitoring meetings take place on a monthly basis. A summary of performance at quarter 2 2017/18 is detailed below.
  2. SBC Public Health undertook a full review of the service during 2015/16. This included a survey of clients, 114 of who responded, as well as assessing service delivery against the service specification. In combination the results from these resulted in production and full delivery of a development plan (reported March 2016 and January 2017 respectively).
  3. A further extensive review will be undertaken during the proposed extension period (April 2018- March 2020) to ensure that the service model meets the needs of clients and stakeholders; is fit for purpose; is efficient and effective.

Overview of Adult’s Alcohol ServicePerformance (Year to date at Q2 2017/18)

  1. During the first two quarters of 2017/18:
  2. 289 referrals were made to the alcohol service
  3. A snapshot of adult caseload during September revealed that:
  4. 318 clients were receiving psychosocial interventions (cognitive behaviour; motivational support)
  5. 48 pharmacological (primarily relapse prevention)
  6. 66 recovery support

Clients receive multiple interventions depending on their individual care plan. The number of interventions delivered therefore is likely to be more than the case load.

  1. The highest proportions of referrals continue to be received from Stockton Town Centre (12%), Newtown (8%) andParkfield/Oxbridge (6.5%). In contrast, the ward with the least referrals during this period wasHartburn (0.3%).The vast majority of referrals are made as self-referral/by a family member (41%). The service continues to gain a significant proportion of referrals from GPs (34%)
  2. During the first two quarters of 2017/18 155 clients were discharged from the service. 32 people were discharged as alcohol-free and 48 as occasional users; 57 (36%) dropped out of the service.
  3. On-going reassurance of performance will be gained through consideration and revision of reporting methods and regular performance monitoring meetings in discussion with the Service Manager; the contracts support officer and public health as commissioner of the service.

Overview of Young People’s Drug & Alcohol Service Performance

  1. Service performance has been reviewed for the previous 12 months of the contract. During the last 12 months (September 2016-September 2017) 84 young people were in treatment with the service. In line with national trends this represents a slight drop in numbers in treatment when compared to the previous 12 month time period. In line with national trends cannabis is the most commonly cited substance that young people receive treatment for (84% from April – September 2017), followed by alcohol (32% from April – September 2017).
  2. In March 2016 a service development plan was put in place with the service to address the following areas:
  • Identifying vulnerable groups and delivering targeted outreach
  • Reviewing service systems and their impact on service delivery
  • Improving marketing and stakeholder engagement
  • Care planning and assessment processes
  1. Service improvements that have taken place during the period of the SDIP include:
  • Successful completions of treatment remaining sustained at 94% since October 2016, compared to 64% during 2014/15
  • Young people experiencing larger reductions in use of cannabis (average days used) during treatment compared to the national average. Young people report using cannabis for 17 out of 28 days prior to beginning treatment. This drops to 7 on treatment exit
  • Young people experiencing larger reductions in the amount of alcohol units consumed during treatment, compared to the national average. During quarter 4 of 2016/17 reporting, on entry to treatment young people drink on average 18units on an average day, this reduces to 7.3 on treatment exit. Nationally the figures are 13.3 and 10 respectively.
  • Young people reporting improvements in their wider wellbeing on exit from treatment, on average young people feel less anxious, more worthwhile, and happier and feel their relationships with family and friends have improved.
  1. Consultation surveys have been embedded with young people involved with the service on a quarterly basis. During quarter 1 of 17/18 consultation was carried out with 30 young people, out of the number surveyed all young people were happy with where they were seen for treatment, and felt that the service involved the right people in their treatment. Comments from young people included:
  • “A service you can trust”
  • “I’m listened to & respected, most of my life I’ve been judged”
  • “Class service”
  • “Sound team”
  1. In October 2017, the outcomes of young people accessing the service over the last 3 years were reviewed. The analysis led to the identification of missed opportunities to address wider aspects of wellbeing. Sexual health, including chlamydia testing, and smoking were of particular note.

Conclusions

  1. The integrated alcohol service for adults and young people continues to deliver to the service specification
  2. The integrated alcohol service for adults and young people implements best practice and is flexible and adaptable to delivering service improvement recommendations
  3. The reporting methods and performance monitoring systems will be considered and revised
  4. Reassurance of governance arrangements has been provided and will continue to be monitored throughout the contract period, should the extension be approved
  5. Should the extension be approved, a comprehensive review of service model will be performed in a timely fashion prior to procurement for services beyond March 2020.

FINANCIAL AND LEGAL IMPLICATIONS

Service budget will remain static over the 24 month contract extension

RISK ASSESSMENT

Risk will be considered as part of any service development or future commissioning.

COUNCIL PLAN IMPLICATIONS

Continued development of the service will have a positive impact on the Joint Health and Wellbeing Strategy outcomes to improve the health and wellbeing of adults and their families.

CONSULTATION

Consultation with clients as part of the novation is currently in process.

Exploratory work and consultation will take place going forward to ensure that the service is fit for purpose; and is efficient and effective in its delivery.

Name of Contact Officer:Mandy MacKinnon

Post Title:Early Intervention Manager, Public Health

Telephone No:01642 52 8478

Email address:

1

[1] The Cost of Alcohol to Stockton Local Authority 2013/14. Balance Northeast.