Progress Update to Safe and Healthy Select Committee - APRIL 2009

Scrutiny Recommendations

Progress Update

Responsible Officer

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.

Tier one services are by definition non-substance misuse specific services. These can include a wide range services delivered by a range of professionals (e.g. primary care, medical services, generic social workers, teachers, community pharmacists, probation officers, housing officers, homeless persons units). These services work with a wide range of patients/clients including those who misuse substances. Because the list of these service categories is so numerous, it is not practicable to specifically name them. However, the DAAT directory is being modified to provide signposting to generic services via District / Borough information directories.

Sue Wilks

DAAT Manager

3

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

There is a significant knowledge base within the DAAT commissioned services, across all tiers supporting and signposting service users toward an extensive range of locally relevant, front line tier one services as part of the routine assessment and care planning process.

At a strategic level the DAAT Support Team is co-located with and works closely with the Supporting People Team, who are represented on the DAAT, Joint Commissioning Group. The Locality Housing Officers are also managed from within Supporting People. A new work stream, as part of the national drug strategy will see closer working with Jobcentre Plus during 2009/10 as new Job centre Plus Drugs Co-ordinators come into post in every Jobcentre Plus District in England. This will build on the existing links with Jobcentre Plus between tier 2 and aftercare services in Hampshire and the increased activity is anticipated to have beneficial `knock on' effects for those with alcohol issues.

The DAAT and the Health, Personal Development and Wellbeing Strategy will continue to support universal services (Tier 1) to promote alcohol awareness with children and young people through Continuing Professional Development and through the numerous newsletters that are sent to schools on a regular basis which include information about new campaigns and information. We continue to deliver Drugs and Sex and Relationship Education Fora which provides support for practitioners working with young people (and which has a alcohol focus).

In addition, this year (2008-09) a number of alcohol pilot projects have been commissioned by Hampshire DAAT that have focused on the following areas; alcohol information for parents, young people drinking and driving (DVD production with young people), alcohol peer education and first aid awareness, alcohol awareness for young people at risk of offending, a Theatre in Education Production: Last Orders to be delivered in Spring 2009 highlighting the risks associated with binge drinking to pupils in a number of Hampshire Secondary Schools (approx 2-4 schools in each District).

During 2008/09, the PCT have promoted the national `Know Your Limits' (KYL) campaign to 127 GP practices in Hampshire by sending out an information pack and encouraging practice staff to put on a KYL display within the surgery and to send the PCT a photograph of the resulting display. 32 GP practices responded providing information on how they had promoted KYL and their surgery displays.

Universally, tier 1 services should be seen as primary prevention services and it is imperative that these are connected to the DAAT through the wider LAA health & well being agenda rather than through a traditional substance misuse agenda.

This is now taking shape as NI 39 (VSC26 Alcohol-attributable hospital admissions) is set within LAA LI Priority F and will be scorecard monitored via this route as things progress.

Sue Wilks

DAAT Manager

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.

SMART Recovery® (Self-Management And Recovery Training) groups have been developed in Hampshire as an alternative option to Alcoholics Anonymous. During 2008/09, Service User groups in Andover and Winchester have received small grants from the DAAT, in order to help them grow and develop the SMART Recovery® approach.

SMART Recovery®) offers free face to face and online mutual help groups, helping people recover from all types of addictive behaviours, including: alcoholism and alcohol abuse.

SMART Recovery® sponsors more than 300+ face to facehttp://www.smartrecovery.org/meetings/face2face.htm meetings around the world, and 16+ online meetings per week. In addition, they offer an online message board as a forum in which to learn about SMART Recovery®  and seek support.

Sue Wilks

DAAT Manager

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.

The Alcohol Partnership Board continues to meet quarterly, Chaired by Jean Bradlow, Joint Director of Public Health. The 10 Point Plan has been refreshed and traffic lighted to capture progress and appended to this report. In addition, a PowerPoint presentation will be made at the meeting.

It is recognised that following Jean's retirement it will be important to maintain the momentum that has been generated in relation to the delivery of the plan and to identify a new `champion' to lead this work during 2009 and beyond. It is hope that Jean Bradlow's successor will take on this role.

Jean Bradlow

Joint Director of Public Health

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.

The PCT have followed up this issue with the Strategic Health Authority and it now falls within the remit of NHS Education South Central (NESC) who are looking initially at promoting alcohol BI training for NHS public health orientated staff, to expand the training referred to against recommendation 14 below.

Locally a DAAT alcohol in the workplace campaign was carried out earlier this year, with information cards being distributed as follows:

Hampshire County Council - 42,000

Hampshire Fire and Rescue - 2,000

Hampshire Police- 6,000

Hampshire PCT - 2,000

Local Authorities - 4,000

An additional 4,000 cards have been given out to groups that had expressed an interest in locally supporting this project.

A small follow up campaign using HCC pay slips is planned for later on in the year

Ruth Monger

South Central Strategic Health Authority.

Now:

Joanna Chapman-Andrews, NHS Education South Central (NESC)

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.

NHS Hampshire and the Hants CC do not traditionally work in this way around LoD providers and service users, carers and patients. This new cross-cutting approach will need the opening of relations between Hampshire Community Health Care (HCHC), Patient Experience and Engagement leads and HCC Adults Services if headway is to be made here. This would appear premature at this point in HCHC's development? It may be more relevant to established Hampshire Partnership Trust provision and involvement

A Learning and Development Plan is produced annually. This recommendation will be incorporated into the plan for 2009/10

Barbara Evans Learning & Development Advisor Mental Health

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.

A number of alcohol awareness and alcohol brief intervention training opportunities have been developed, by the DAAT and PCT during 2008/09, including 5 training days for Domestic Abuse and Housing staff and 6 training days for generic/front line staff. All of the courses have been fully subscribed and well received and more are being planned for the new financial year. Those working with young people have attended these training sessions, though the focus was not specifically on young people's services.

However, a Development Worker (drug and alcohol training) has been appointed to develop a drug & alcohol learning strategy to equip managers and practitioners with the skills and knowledge to deliver appropriate interventions with the young people with whom they are working. The post holder will be based in the Learning & Development Team, Children's Services. Where appropriate, the training developed will be integrated with that provided by Adult Learning & Development (for example; training on the impact of parental alcohol misuse on the child and/or training on the impact of alcohol misuse on the family).

Sue Wilks

DAAT Manager

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

As part of the alcohol in the workplace campaign (described above), all Adult Services staff should have received an alcohol information leaflet.

Barbara Evans Learning & Development Advisor Mental Health

Additional update arising from the minutes of the Safe and Healthy People Select Committee on 29 October 2008

25

The issue of dual diagnosis was considered at a meeting of the Safe and Healthy People Select Committee on 29 October 2008 and it was agreed that the Committee should receive a further update on the position on dual diagnosis at its meting in April 2009.

The Dual Diagnosis Themed Review Report 2007 was published by the Care Services Improvement Partnership in June 2008. The following recommendations were made:

    1. There is clear designated local responsibility for the strategic development of dual diagnosis services. Ideally this should be a named individual who supports a forum for decision making.

    2. The Joint Strategic Needs Assessment can be a useful process to help raise dual diagnosis issues. Data can contribute to the development of a clear local definition of the target population for services. If the local definition covers only those with severe mental illness plus substance abuse, then the needs of those with less severe mental illness also need to be considered. Clinical and Needs Assessments across the whole age range (including the needs of older people) will provide a more comprehensive service response.

    3. Sensitive and appropriate collection of the views of users as part of needs assessment, strategy development and quality monitoring, to understand satisfaction with services and unmet needs.

    4. Workforce capabilities are strengthened through employing resources such as The Dual Diagnosis Capability Framework and the 10 Essential Shared Capabilities Dual Diagnosis Module.

    5. Joint stakeholder ownership of local strategies, in which the development and training needs (including local health promotion activities) of staff working with dual diagnosis service users are addressed.

    6. Assessment and care coordination includes substance misuse problems and physical health care needs.

    7. The effective recording of user defined outcomes leading to a local outcomes framework for dual diagnosis.

Hampshire Adult Services Mental Health, DAAT and NHS Hampshire commissioners worked together with providers of mental health and substance misuse services, service users and carers to produce a Dual Diagnosis Joint Commissioning Strategy, as required for the mental health National Service Framework Autumn Assessment. This strategy was signed off by the Joint Commissioning Board on 30.3.2009, thus enabling a green rating for the Autumn Assessment. The strategy covers all ages and all levels of substance misuse and mental health.

The next step is to hold a workshop (probably May 2009) with a wider audience of stakeholders to create a Steering Group which will devise an action plan to implement the strategy and monitor its progress.

Liz McGill

Mental Health Commissioning Manager