Alcohol Scrutiny Review: Responses to scrutiny report recommendations.

21 July 2008

General:

    a) Responses received from:

      - Neil Luckett on behalf of the Hampshire Alcohol Partnership Board (reflects the views of the Hampshire PCT and Hampshire DAAT)

      - Cllr. Kirk, Executive Lead Member for Children's Services (Education)

      - Ruth Monger, NHS South Central SHA Head of Workforce Strategy

      - Cllr Perry, Executive Member for External Relations and Communications

    b) No responses received to date from Executive Members for Adult Services and Human Resources

Recommendation

Response

1) That the DAAT and partners, as part of  the reassessment of population requirements across Hampshire, recognise the importance of, and promote, self help support

Hampshire Alcohol Partnership Board: The Alcohol Board recognised the importance of communication and health education regarding the delivery of the Hampshire Alcohol Strategy including promoting information, awareness and health promotion alongside the opportunities for people to effect their own behaviour change. All front-line and primary care services will be encouraged to play a part in providing access to self-help support on alcohol.

An important example is Alcoholics Anonymous (AA) having a local representative who attends both the Alcohol Partnership Board and the Alcohol Service User Group, the HAAG. This has led to the promotion of the work that AA does among treatment providers and other services within Hampshire, e.g. including a letter being sent out to all treatment providers outlining the work that AA does locally. It is important that as any new services are established, they are linked in with AA. This has been agreed by the Alcohol Board.

2) That the DAAT works with partners to develop the Hampshire and Isle of Wight Substance Misuse Services Directory to include reference to categories of tier one services in Hampshire

Hampshire Alcohol Partnership Board: The Service Directory currently gives an overview of existing treatment services within Hampshire. It is being updated and will include an overview of the different types of tier one services that can be accessed.

We recognise the benefits of neighbourhood links on alcohol; as have proved beneficial to the overall delivery of smoking interventions in Hants & IoW over recent years.

3) That the DAAT  works with tier one organisations to establish a way to connect them to the work of the DAAT

Hampshire Alcohol Partnership Board: The Hampshire Alcohol Partnership Board's 10 Point Plan has set delivery objectives to promote health education and alcohol awareness across a range of settings, including commissioning services that will engage the public and specific groups at tier one level.

The DAAT has delivered a variety of tier one training over the past 12 months; this has included Alcohol Brief Intervention Training delivered by the Alcohol Strategy Co-ordinator to 150 front line staff. It is planned to continue the delivery of training to front line workers on alcohol misuse. Packages will be developed to include a section on how appropriate clients will be referred effectively to specialist levels of alcohol treatment.

Children's Services Department:

a) Hampshire CC Health, Personal Development and Wellbeing Team1 will continue to encourage schools to follow the guidance and service level agreement (SLA) for use with external agencies working with pupils around drug and alcohol.

b) Hampshire CC PRISM Network will continue to support schools to increase social inclusion and promote improved educational outcomes for vulnerable pupils who may be involved in drug and alcohol misuse

Hampshire CC Health, Personal Development and Wellbeing Team will;

c) map external agencies delivering alcohol (and drugs) interventions in schools and create an up to date database of agencies details

d) work with the PRISM network to support drug and alcohol co-ordinators in Hampshire schools

e) review guidance and polices for Hampshire SfYP to undertake early interventions with young people at risk of developing drug and alcohol problems

4) That commissioners of tier two services emphasise the  importance of access to tier one services, encouraging service users and their families to access self help groups, such as AA, and influence the piloting of an alternative model of self help to the AA Twelve Step Model in order to promote choice across the county

Hampshire Alcohol Partnership Board: This approach will be raised with commissioned tier 2 drug service providers in Hampshire via the DAAT. As alcohol treatment services continue to develop, it will be important that they are aware of the role that AA plays locally and are informed as to how best to get in touch with them. Better communication of the AA `offer' is required to maximise the potential of this resource.

5)  That the Safe and Healthy People Select Committee draws the attention of the Department of Health and the Home Office to the local inequities in access to drug and alcohol services associated with ring fenced funding streams and levels of funding

Hampshire Alcohol Partnership Board: This situation has been recognised by the Alcohol Board, DAAT and PCT and this funding has been diverted by the PCT into the alcohol flagship to allow new pilot investment in alcohol brief intervention services, with the aim of testing and establishing models of useful delivery and impact on alcohol.

6) That consequences of the impact of cutbacks in national funding for younger people's alcohol interventions should be monitored by the DAAT and reported back to the Safe and Healthy People Select Committee in October 2008

Hampshire Alcohol Partnership Board: Alcohol incident data involving young people is being collected. The DAAT Young People's Strategic Coordinator is charged with relaying accurate information and intelligence to the Alcohol Board regarding young people's alcohol misuse in Hampshire.

Children's Services Department: The DAAT can confirm that the YP substance misuse grant which came to Hampshire CC via the Area Based Grant has been released to the DAAT for 2008-09. The DAAT are currently working with providers to review the services delivered and to extend the service contracts until March 31st 2009.

7) That the PCT continues to play the lead role in ensuring that adequate resources are available to implement the Ten Point Plan, and that outcomes from commissioned services are reviewed

Hampshire Primary Care Trust: The PCT is committed to the 10 Point Plan and its lead approach although cannot guarantee resources on an on-going basis currently. The PCT will adopt `principles of commissioning' and the `commissioning cycle' in order to provide efficacious and cost-effective alcohol services.

It is intended that the pilot projects will be operational from October 2008. A review of the current alcohol treatment services is currently being considered.

8) That the LAA Executive Group should:

(i)  prioritise the work on developing effective joint commissioning of services for people with alcohol problems, as stated in the  Alcohol Flagship Initiative Ten Point Plan

(ii) give high priority to the Brief Intervention Training elements within the Ten Point Plan

Cllr Perry:

As member of LAA Board, will encourage its adoption.

Hampshire Alcohol Partnership Board:

i) This process has been initiated, although without new allocations designated against `alcohol' it remains unclear how joint commissioning will unfold and be delivered.

ii) This issue is being addressed over 08/09 and Alcohol Concern will be commissioned to deliver a range of training packages to specific front-line workers.

Children's Services Department:

i) The Health, Personal Development and & Wellbeing Team are members of the Hampshire CC Lead Commissioners Group and are exploring opportunities for pooling (some) budgets and joint commissioning services for children and young people in the future.

ii) Hampshire YOT staff have received alcohol and brief intervention training Jan-June 2008 funded by Comic Relief/Hampshire DAAT and Wessex YOT.

Hampshire DAAT Drug & Alcohol Strategy Manager (Young People) to consult the evaluation findings from the alcohol and brief interventions training and to consider whether the training could be rolled out to other practitioners working with children and young people.

9) That the LAA Alcohol Lead be invited to provide an update to the Safe  and Healthy People Select Committee, twelve months after the publication of the review report, on progress with the implementation of the Ten Point Plan

Hampshire Alcohol Partnership Board:

This will be accommodated by Jean Bradlow (PCT/HCC) Director of Public Health, or other lead officer.

10) That the DAAT Support Team promotes DANOS to all agencies with an interest in alcohol harm reduction, including tier one services, to ensure that continuing progress is made to embed the standards into the care and support provided to people in Hampshire with alcohol problems

Hampshire Alcohol Partnership Board:

The DAAT support team currently promote DANOS to all services that it currently commissions and will continue to ensure that all services are provided by well trained and competent staff. This approach will be applied to any services that are delivered through the 10 Point Plan.

Children's Services Department:

NB: While DANOS cover most of the generic competencies required in the substance misuse field, other national occupational standards and competencies may be required for staff working in more specialist roles including those working with children and young people.

Hampshire DAAT has commissioned the production of a strategy on the 'Development of Modular Substance Misuse Training for Staff Working with Children and Young People'.

Hampshire DAAT Youth Substance Misuse Strategy Group will explore opportunities to implement the Hampshire DAAT Strategy on the 'Development of Modular Substance Misuse Training for Staff Working with Children and Young People'

As a priority for DAAT YP Strategy partners to ensure through the children's workforce development team that adequate training is in place for PAs attached to schools and members of the youth support service around alcohol misuse

11) That the DAAT reviews the balance of attention given to alcohol issues within DARGs and, where necessary, seeks to influence groups to redress any obvious imbalance

Hampshire Alcohol Partnership Board: Alcohol has always been an issue in DARGs, however the `balance' has been a reflection of ring-fencing. New commissioning and initiatives around the 10 Point Plan will provide impetus and added value within these networks if alcohol allocations become a feature.

Members of the Alcohol Partnership Board will continue to work with colleagues at the DAAT and with local DARGS to ensure that issues relating to alcohol receive sufficient attention.

Children's Services Department:

The Hampshire Drug & Alcohol Strategy Manager (Young People) will work with colleagues at the DAAT (including the Alcohol Strategy Co-ordinator) and local DARGS to review the balance of attention given to alcohol.

12) That the SHA ( workforce planning, education and training), PCT and Hampshire County Council explore how they can work more closely together to support  workforce strategy development in respect of multi agency staff groups responding to the needs of adults with alcohol problems

SHA (workforce planning, education and training):

The SHA is fully supportive of recommendation 12 and will discuss with both HPCT and HCC the best way to take this forward.

Hampshire Alcohol Partnership Board: This approach can work in parallel with the brief intervention training packages commissioned over 08/09.

Support from South Central NESC (C/o Joanna Chapman-Andrews) would be useful for working this through.

13)   That the PCT and Hampshire County Council ensure that their approaches to learning and skills development providers include a consistent  approach to working  in partnership with service  users, carers and parents

Hampshire Alcohol Partnership Board:

This inclusive approach in respect of learning and development deliveries is embedded as a feature in terms of: consultation, needs assessment, service design, access, best value and the commissioning cycle.

Children's Services Department:

The HPD and W team will include learning and skills development providers in training opportunities and invite them to attend SRE and Drug fora and conferences

14) That the DAAT Strategic Partnership Board provides assurances to the Safe and Healthy People Select Committee-

(i)    that all that can be done, is being done to implement the Hampshire DAAT training and development strategy in respect of alcohol

(ii)   that any separate adult and young people's workforce initiatives are integrated to avoid duplication and to aid the best use of resources

Hampshire Alcohol Partnership Board:

i) DAAT Board to reply via Sue Wilkes or Chair.

ii) This will be consistent with delivering the alcohol strategy.

Children's Services Department:

i) The HPD and W team seeks to appoint a training coordinator for drug education who will influence the training provided by the new training team. Alcohol awareness and strategies will form part of the programme for all staff working with young people across a range of settings

ii) Joint commissioning and planned work around prevention and intervention will seek to ensure more efficient services

15) That Hampshire County Council reviews its workforce substance misuse Health and Safety policy as it relates to alcohol, with a view to strengthening its implementation

Hampshire Partnership Board:

This will be co-ordinated via HCC Occ.Health Service

16) That Hampshire County Council's Occupational Health Department -

(i) builds DANOS into its staff IPP appraisal process, in order to strengthen its ability to deliver tier one interventions to staff with alcohol problems

(ii) explores opportunities for joint training with NHS staff on alcohol issues and the use of evidence based screening tools such as AUDIT

(iii) reviews its role in facilitating access to tier two services for those in the workforce that it identifies as needing additional support

Hampshire Alcohol Partnership Board:

i) This will be led by Sue Wilks the DAAT Team Manager.

ii) This will be led by Helen Wright, HPCT and linked to (i).

iii) A HCC Occ. Health lead is required to progress this.

17) That Adult Services increase the number of its staff who access alcohol awareness training, and include DANOS  within its appraisal process for appropriate staff groups

Hampshire Alcohol Partnership Board: This will be initiated via the training packages commissioned via Alcohol Concern over 08/09.

18) That Adult and Children's services consider  whether volunteers and carers would benefit from Alcohol awareness training and, if so, how this might be accessed

Hampshire Alcohol Partnership Board: This cannot be supported currently until new finances around alcohol are secured or diverted from other sources.

19) That the `invest to save' work on transition services includes work on the transition between Children's and Adult's Alcohol Services, and between Children's and Adult's Mental Health Services

Children's Services Department:

Hampshire DAAT will re-commission the Tier 3 YP Treatment Service in 2008-09 and will ensure that the intent of this recommendation is built into the service specification.

20) That evidenced based examples of good practice with regard to diversionary activities for young people who drink, be communicated County wide via Hampshire County Council Children's Services and the Alcohol Flagship communication strategy

    Hampshire Alcohol Partnership Board: The Alcohol Communication Strategy has been drafted and a working group that will oversee the implementation of the strategy is in the process of being set up.

    A variety of campaigns will be carried out in the next 12 months, linking closely with the Health, Personal Development and & Wellbeing Team

The Alcohol Board has requested information from Chief Executives and community safety managers regarding district level commissioning and provision aimed at addressing alcohol and youth etc (01 April 08). 5 from 11 districts have replied.

Work that has been taking place within the county, for example the STAR project, will continue to be supported and any learning outcomes will be shared with other areas.

Children's Services Department:

    · The annual Rock Challenge 2009 programme is being supported by Hampshire CC 2008-09. The main aim of the Service is to engage young people from schools and youth settings in a performing arts competition as an alternative to drug and alcohol use.

    · The HPD and W team is currently working with The Be Your Best Foundation (organises RC) to extend the Rock Challenge event to include Education Centres, YOTs and youth club settings. The information day is 16th July and the event will take place in March 2009.

    · The HPD and W Team has commissioned the making of an advert which will be shown in shopping centres linking alcohol and teenage pregnancy. This will also be available on disk for all schools with an accompanying teaching pack.

    · The Health, Personal Development and & Wellbeing Team will deliver 3 `Making The Links Events' in November 2008 aimed at staff working with young people in schools and youth settings to consider ways of raising the aspirations of young people leading to less risky behaviour. This will include young people led workshops which provide young people the opportunity to show the programmes and projects that they have been involved in e.g. youth arts, peer education, peer mentoring.

    · The HPD and W team will continue to work with all support services for young people to encourage activities to reduce risky behaviour

    · A peer design project is taking place in the New Forest over the summer (2008) for young people to receive awareness on alcohol use and the associated risks. Young people will be given the opportunity to design postcards, posters and a DVD to educate their peers. These materials will be used in a campaign in the approach to Christmas

21)  That Children's Services:

(i)    work to encourage Hampshire Schools to review how well embedded alcohol awareness is in their Personal Social & Health Education curriculum and the Healthy Schools initiative.

(ii)   ensure that staff in Locality Teams are trained in alcohol problem identification, including awareness of the potential for a child's problems to be related to parental drinking, with a view to mainstreaming substance misuse tier two services

Hampshire Alcohol Partnership Board:

i) Hampshire HS Inspector & Adviser (Glyn Wright) is a member of the Alcohol Board. Feedback will be requested on this.

ii) Assurances will be sought to establish this practice. The mainstreaming of tier 2 services is a separate aspect and this would require further comment from the DAAT, YP Strategic Coordinator (Tina James).

Children's Services Department:

    · A drug education package for Primary Schools, developed in consultation with primary school teachers, and in line with the Hampshire Personal Development Guidance has been issued to all Primary Schools and has been highlighted at training and network events

    · To continue with our SRE and Drug Fora which brings together teachers and agencies that are prepared to go into school and deliver on drugs education including alcohol

    · To continue to deliver Personal Development Learning Network events for co-ordinators of personal social and health education

    · To continue to encourage schools to achieve Healthy Schools status which requires them to address Alcohol and Drug Education within PSHE

    · To continue to promote school based health services and ensure they provide support around drug and alcohol misuse

    · To continue to raise awareness with schools tried and tested resources available for them to use in the PSHE programme e.g. The Drinkaware Trust has recently produced 'Streetwise', a free alcohol education resource for 11 to 16 year olds.

    · Schools attending the SRE and Drug For a have already been given and trained in the resource `Drunk in Charge of a Body' which links alcohol and unwanted pregnancy

    · Hampshire DAAT Youth SM Strategy Group have agreed to commission training in 2008 for staff working with families and children affected by substance misuse (see also detail under recommendation 17.10 above)

    · A drug education package for secondary schools has been developed in consultation with secondary school teachers and in line with Hampshire PD Guidance will issued to all secondary schools next term. This will be highlighted in training events, network meetings and SRE and Drug forums.

    · For the Health, Personal Development and Wellbeing Team to encourage schools to complete the 'Are You Getting It Right' Audit around whether young people believe they are receiving quality SRE and to extend this to include other aspects of PSHE - particularly alcohol and drug education

    · For the H,PD and Wellbeing Team to lead four consultation and training events with young people using the audit (above) to ascertain the quality of PSHE in their schools in the four high Teenage Pregnancy areas of Gosport, Havant, Rushmoor and Basingstoke

    · To provide Tier 1 and Tier 2 training for drug coordinators in school to improve knowledge and strategies for coordinators to use

    · To ensure through the Quality Standards for IAG that schools and consortia are giving good advice and information to young people around the dangers of alcohol and drug misuse

    · To work with the Parenting Strategy team to ensure high quality information for parents and carers around alcohol awareness and legislation around alcohol

    · To work with schools to ensure that messages around alcohol are shared with parents

    · To promote the Children's Society materials around supporting the children of substance misusing parents through working with Young Carers

    · To work more closely with Children's Centres and Extended Schools to promote school based health services available to young people, their parents, carers and wider community to provide information, advice and guidance around substance misuse including alcohol.

22) That commissioners of alcohol and domestic violence training for staff ensure this covers awareness of the inter relationship between alcohol problems and domestic violence, and that frontline staff can signpost clients to appropriate sources of help

Hampshire Alcohol Partnership Board:

Effective links have been developed within the County Domestic Violence Coordinator, who has been invited to join the Alcohol Board. It is hoped that this will lead to the development of a number of joint proposals. These include the potential that the A+E Brief Intervention work will give the opportunity for screening for Domestic Violence to take place within an A+E setting and the opportunity to deliver training to Domestic Violence staff around alcohol and vice versa.

23) That the LAA Executive Group:

(i)    prioritise the possible expansion of the arrest referral scheme to other parts of Hampshire as appropriate, depending on the outcome of the evaluation of the Andover area scheme in March 2008

(ii)     prioritise the work of the proposed alcohol worker in Winchester prison on hazardous and harmful drinkers

Cllr Perry:

As member of LAA Board, will encourage its endorsement.

Hampshire Alcohol Partnership Board:

i) The evaluation report has not been presented to the Alcohol Board although initial findings suggest the scheme has been useful in Andover. Learning from this has influenced thinking regarding new pilot investments in brief interventions services and settings over 08/09. The next stage will be to identify funding for the expansion of the arrest referral scheme across the county.

ii) This provision has been prioritised and commissioning of services in HMP Winchester is being initiated (start date Sept. 08).

24) That when the Hampshire wide alcohol needs assessment is reviewed and updated by the DAAT, that consideration is given to:

(i)    the need in Hampshire for extended outreach to enable alcohol workers to reach vulnerable groups, including homeless people,  who are unlikely to be connected to mainstream services

(ii)    the need in local areas for `wet' services for people with alcohol problems

Hampshire Alcohol Partnership Board:

i) This is recognised via Supporting People inputs to the Alcohol Board and some targeted commissioning via specific providers. Closer working links are being established between Supporting People and the APB, looking at service availability for those who are using substances in supported accommodation

ii) `Wet' services may be useful within specific settings. This will require further discussion as to whether it is a useful priority within the first round of limited pilot commissioning.

25) That progress on actions following the 2007 mental health and substance misuse Dual Diagnosis review be reported by Adult Services to the Safe and Healthy People Select Committee during 2008

Hampshire Alcohol Partnership Board:

This review report should also be fed to the Alcohol Board when available. Mike Webb to follow-up.

1 Hampshire CC Health, Personal Development and Wellbeing Team consists of the County Inspector for Personal Development Learning, Healthy Schools Coordinators, Teenage Pregnancy Strategy Manager, Teenage Pregnancy Training Coordinator, Drug and Alcohol Strategy Manager (Young People), Accreditation Officer, Drug Development worker and Information and Guidance Development worker