Contact: Mary Robertson Ext: 7260 email: [email protected]

Sue Wilks (01962) 826028 email: [email protected]

1. Summary

1.1 Background

1.1.1 The DAAT is a multi-agency strategic partnership of Local Authority, Health, Criminal Justice and community bodies with a primary responsibility for the local implementation of the Government's 1998 ten year drug strategy, `Tackling Drugs' (as amended December 2002).

1.1.2 The overall aim of the `Tackling Drugs' strategy is to `reduce the harm that drugs cause to society - communities, individuals and their families' and within this context it focuses in on the four key theme areas of:

Young People - to help young people resist drug misuse,

Treatment - to support people to overcome their drug problems

Communities - to protect communities from drug related crime & anti-social behaviour

and Availability - to stifle the availability of illegal drugs in the community

1.1.3 The DAAT reports to the National Treatment Agency (NTA), a special health authority, created by Government in 2001, with a specific remit to increase the availability, capacity and effectiveness of treatment for drug misuse in England.

1.1.4 The DAAT partnership are funded through the Drug Pooled Treatment Budget, a pooling of various agencies drug service funding in 2001, in order to get better co-ordination of resources and to prevent duplication and waste. Adult Services, Primary Care Trusts and other partnership agencies also provide other limited funding.

1.1.5 The Treatment Plan, drawn up locally in line with national service frameworks is submitted to the NTA annually and details how the Pooled Treatment Budget will be spent for the financial year.

1.1.6 The Pooled Treatment Budget can only be spent on treatment services for people with drugs, not alcohol, as their primary substance of misuse. The Pooled Treatment Budget does not contain any resources allocated for the provision of alcohol treatment services, which are in the main being funded through Social Services and the Primary Care Trusts. However as alcohol and drug misuse are closely associated joint drug and alcohol services are provided wherever possible to ensure effective use of both DAAT Pooled Treatment and Adult Services and Primary Care Trust funding.

1.1.7 Hampshire County Council host the DAAT support team who implement the strategic aims of the DAAT partnership and manage the delivery of the operational Treatment Plan as agreed by the Joint Commissioning Group of the DAAT, commissioned through Hampshire County Council contracts.

1.2 The national framework for services

1.2.1 Services are delivered under the NTA's framework for developing local systems of effective drug misuse treatment in England 'Models of Care 2002'. This breaks down treatment services into four tiers, linked through integrated care pathways and care planning and co-ordination.

1.2.2 the four tiers are:

1.2.2.1 Tier 1 - Non-substance misuse specific services requiring interface with drug treatment. These are services that work with drug users, but their sole purpose is not drug treatment and includes all generic services, including, but not limited to health (primary and secondary) care, social care, housing and vocational services.

1.2.2.2 Tier 2 - Open access drug treatment services. Accessible and low threshold services with limited requirements on drug users to receive services, with the aim of engaging drug users, providing information and support, especially around harm reduction, providing brief interventions and providing a gateway to more structured treatment services.

1.2.2.3 Tier 3 - Structured Community based drug treatment services. Treatment services provided within structured programmes of care that are planned and co-ordinated with clients following a comprehensive assessment of their needs. Services include psychotherapeutic interventions, counselling, substitute and maintenance prescribing, community detoxification and structured day services and programmes.

1.2.2.4 Tier 4 - Residential services. Services delivered at Tier 4 include inpatient drug detoxification or stabilisation services and drug residential rehabilitation services.

1.3 Local Delivery - The Treatment Plan

1.3.1 The Treatment Plan is written as prescribed by the NTA and is broken down into nine "grids" or areas.

1.3.2 Grid 1 - Tier 1 services

The DAAT recently undertook a needs analysis of training requirements throughout the drugs sector, including what is needed to provide professional in generic Tier 1 services with the skills and confidence to provide services to drug users. A training programme will be rolled out by the end of this financial year to include input from service users. Other priorities include providing tools to Tier 1 services to allow them to interact with drug treatment services with a "Directory of Services" published detailing all drug services available in Hampshire and the development of a common referral form to ease communication and referrals between Tier 1 and treatment agencies.

1.3.3 Grid 2a - Open Access Services

The DAAT has currently commissioned six static tier 2 open access services throughout Hampshire (Lymington, Eastleigh, Winchester, Andover, Basingstoke and Aldershot) with two new services in Fareham and Havant commissioned from April 1st 2006. In addition three Mobile Needle Exchange / Outreach services cover approximately three quarters of Hampshire with a new fourth service to fill the gap to be commissioned in 2006. The DAAT are also currently looking at how Pharmacists can be used to provide Tier 2 services, especially in rural areas.

1.3.4 Grid 2b - Criminal Justice Intervention Programme (now Drugs Intervention Programme (DIP))

Additional funding was provided to the DAAT to provide a coordinated approach to services specifically for drug users committing crime. During 2005 the DAAT commissioned, following a lengthy tender process, Cranstoun Drug Services to provide all it's criminal justice based services, including providing treatment services in partnership with Probation for offenders sentenced to a Community Order with Drug Rehabilitation Requirement, providing enhanced arrest referral services through engaging with offenders in police cells and providing throughcare services by continuing to engage with clients as they move through the criminal justice system. In addition some additional funding will go to the Tier 2 Open Access services to provide "aftercare" services, that will give drug users, following treatment or on exiting the criminal justice system, the opportunity to receive relapse prevention support and to learn or rediscover "life skills" including training, finance skills and social skills.

1.3.5 Grid 3 - Structured community based services

The DAAT currently commission three local Trusts, Hampshire Partnership Trust in the South West, Central and North of the County, Portsmouth City PCT in the South East of the County and Surrey Border Partnership Trust in the North East of the County to deliver Tier 3 medical and therapeutic services. In addition, Structured Day Services operate in three areas of the County although it is hoped this will be expanded during the remainder of this year. Another important area is the development of GP (Primary Care) prescribing and the DAAT has made funding available for workers to take this work forward and for contracting GP's to deliver drug treatment services. The DAAT has also recently funded two Royal College of General Practitioner training events for GP's to enhance and develop their skills, to work with drug users.

1.3.6 Grid 4 - Residential and Inpatient Services

The DAAT is providing additional funding this year to allow more drug users to access Inpatient detoxification services and is working with Adult Services by providing some funding for additional residential rehabilitation placements.

1.3.7 Grid 5 - Workforce development

In addition to the Training Strategy drawn up following the recent training needs analysis, the DAAT are directly funding three drug treatment modern apprentices on a two year course. The DAAT are also working closely with all providers to ensure that all human Resources and training policies and practices are in line with the NTA endorsed Drug and Alcohol National Occupational Standards (DANOS) guidelines.

1.3.8 Grid 6 - Underserved groups

The DAAT are looking at how best to provide services to underserved groups including parents and children, travellers, Black and Minority Ethnic groups, homeless drug users and crack and cocaine users, to ensure that their needs are met through the existing framework of services.

1.3.9 Grid 7 - Systems / Infrastructure

The DAAT are working with service providers, in consultation with service users, to provide common tools for assessment and outcome monitoring to ensure that users receive a consistent approach to their care whichever service they approach. Service providers are also being audited against Quality in Alcohol and Drug Services (QuADS) national standards, again, to ensure that their care is consistent and of a high quality.

1.3.10 Grid 8 - Users and carers

The DAAT has worked to ensure that service users are involved throughout its work and have user representation on both the DAAT Strategic Group and DAAT Joint Commissioning group. Through the employment of a service user / carer worker and funding the DAAT are supporting the creation of independent service user groups throughout Hampshire. Currently their are four local groups and the Hampshire User Federation where users meet on a pan Hampshire basis. Service users have been actively involved in the writing of service specifications, assessment and evaluation of tenders, overdose prevention training and continual feedback on service effectiveness and user issues to the DAAT. For carers and concerned others the DAAT is providing a 24 hour support line that it is hoped will lead to the development of peer led support groups throughout the County.

1.3.11 Within the Treatment Plan the DAAT also sets out its plans for treatment services for Young People. These include a new Tier three Service for young people opened on 1^st July `05. The service is configured as two teams - North and South, comprising a Team Leader, Youth Offending Team (YOT) and Communities Workers and Administrator. The provider is intending to set up an 0800 phone line as a single point of telephone contact for the service as soon as practicable. The DAAT is also looking at how to provide Tier 4 inpatient services for Young People.

1.3.12 It is important to note that whilst the NTA funding does not apply to services for Alcohol misuse, the DAAT has been tasked with the co-ordination and development of an Alcohol strategy for Hampshire. The initial draft of the Strategy has been completed and presented to the Alcohol Focus Group. Feedback from the group was largely very positive, however an amended initial draft and action plan will be circulated to stakeholders from late October. Stakeholders will be asked to highlight actions that they feel to be the most urgent and this will guide future work and the development and delivery of an action plan.

1.4 Local delivery - funding

1.4.1 A summary of Treatment Plan Pooled Treatment Budget funding and expenditure is given in Annex 1.

1.4.2 The DAAT in previous years have had slippage funding that has been rolled forward, however, last year the strategic decision was taken to invest all slippage into recurring services and commitments. It is anticipated that this year the total slippage will be approximately 4-5% of the overall budget and this has already been allocated to bringing some funding decisions in 2007/08 into the next financial year 2006/07.

1.4.3 The Government in the last spending review announced that there would be large increases in funding for drug treatment over the next two years as detailed below:

1.4.4 Through using accrued slippage for treatment services this year the DAAT have already committed a large proportion of the 2006/07 uplift.

1.5 Local delivery - performance against Key Performance Indicators

1.5.1 The DAAT is performance managed by the NTA against nationally prescribed key performance indicators and locally agreed targets that reflect local need as identified in the Treatment Plan.

1.5.2 The three Key Performance Indicators are

1.5.2.1 Numbers in Treatment

The national target, under the 1998 `Tackling Drugs' strategy is to double the number of drug users in treatment within 10 years, this was split into a 55% increase from the 1998/99 base line by 2003/04 and then a further 45% increase by 2007/08. However in 2003/04 the NTA reset the baseline for the 45% increase target to 1500 clients in treatment

1.5.2.2 Percentage of clients retained in treatment for 12 weeks or more

This is a relatively new target, from April 2004, which the NTA have set as 55% of clients entering treatment must be retained in treatment for greater than 12 weeks. Some evidence shows that this is the critical period for retention of clients and improved outcomes. The DAAT's current retention rate is 61%.

1.5.2.3 Waiting Times

The NTA have set waiting times targets for different treatment modalities or types. The service providers themselves have provided the following waiting times to us.

Modality	NTA 2005 target	Average wait (at end September 2005)
I/P Detox	2 weeks	5.2 weeks
Residential Rehab	3 weeks	0.9 weeks
Specialist prescribing	3 weeks	2 weeks
GP Prescribing	2 weeks	1.9 weeks
Day Service	3 weeks	0 weeks
Counselling	2 weeks	0.8 weeks

2. Impact Assessment

The DAAT Treatment Plan for 2005/6 will provide the structure of local service development under the national `Tackling Drugs' strategy in Hampshire.

3. Consultation with Local Members

Local Members representing communities that will benefit from services resulting from the Treatment Plan will be briefed by letter about service developments as they arise.

Recommendation(s)

This report is received and its contents noted

Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1 Published works

2 Documents which disclose exempt or confidential information as defined in the Act

None

Annex 1 - Summary of Treatment Plan Pooled treatment Budget funding and expenditure