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Hampshire County Council Safe and Healthy People Select Committee Item 4 Alcohol Scrutiny Panel 24 October 2007 Written Evidence Report of the Chief Executive |
Contact: David Pryke Ext. 7342 [email protected]
1. Summary
1.1. To give consideration to written evidence received following the launch of the review on access to appropriate services for people with alcohol problems including mental health.
2. Recommendations
2.1 That consideration be given to the written evidence received to date
3. Written Evidence
3.1 Following the launch of the review, to date, written evidence has been received from:
· The Alcohol Focus Group (Appendix 1)
· Drug Rehabilitation Centre -Simon Gunn, Service Manager (Appendix 2)
· Hampshire Constabulary (Appendix 3)
· CLEMS Winchester (Appendix 4)
· Basingstoke and Deane Borough Council (Appendix 5)
· Alcoholics Anonymous (Appendix 7)
The closing date for the receipt of written responses is 19 October 2007 and any further written evidence received will be tabled at the meeting.
LINK(S) TO CORPORATE STRATEGY | ||
Yes |
No | |
Hampshire safer and more secure for all |
x |
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Maximising well-being |
x |
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Enhancing our quality of place |
x |
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Section 100 D - Local Government Act 1972 - background documents
The following documents discuss facts or matters on which this report, or an important part of it, is based and have 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
Appendix 1
Alcohol Focus Group Response to Alcohol Scrutiny
Overview
The response from the Alcohol Focus Group centres upon a couple of key points from each question. These are:
Question 1 - The need for a county wide adult Open Access Tier Two service. Currently service provision for alcohol misuse is not complete in Hampshire, with particular gaps being in Winchester and Andover.
Question 2 - The Alcohol Strategy Co-ordinator has delivered alcohol and brief intervention training to over 100 front line staff this year, with more training days planned.
Question 3 - One of the most underserved groups is prisoners within Winchester Prison. A recent survey highlighted that, prior to entry, prisoners drink at a high level and that this has a strong link with their criminal activity.
Question 4 - Alcohol has recently become a flagship priority issue within the Local Area Agreement, building upon the Hampshire Alcohol Strategy. A Ten Point of Action has been developed, however it is crucial that funding is identified in order to be able to carry out the actions.
1. Early Identification services
Develop adult open access Tier 2 Services
In order to be able to meet the needs of those within the community drinking at a hazardous or a harmful level, it is essential that Tier Two Services are available Hampshire wide.
Tier two interventions include the provision of open access facilities that give alcohol specific advice, information and support; extended brief interventions and the referral of those with more serious problems to structured services. (Models of care for Alcohol Misusers, DOH2006) Structured services operate at Tier three and would be more appropriate for those physically or emotionally dependant on alcohol.
By developing the provision of services at Tier Two, this will enable clients to be seen at an appropriate level and will prevent inappropriate referrals to Tier Three, thus preventing bottle necks in the treatment system. Currently no alcohol specific service is available within Hampshire at this level.
These open access services are often the first point of contact for those seeking treatment for alcohol misuse. These services offer work for both drug and alcohol clients. Within Hampshire, funding for the drug services is provided by the Drug and Alcohol Action Team, this is ring fenced for drug clients only and alcohol can only be seen if it is a secondary substance. The funding for the Alcohol side of the service is provided by the PCT and this varies considerably across the county.
Currently Hampshire has 8 open access services and only 6 of these are able to work with Alcohol clients. The services in Winchester and Andover have no funding to work with alcohol clients.
In other services, the funding for alcohol is limited, with drug related clients often receiving treatment in a shorter space of time.
The breakdown of hazardous /harmful drinkers and dependant drinkers in each Local Authority area of Hampshire is enclosed below. It is estimated by Alcohol Concern that Hampshire has 116,975 adults drinking at hazardous or harmful levels, that is one in eight adults, with the distribution as follows:
Population over 16 |
Drunk over 6/8 units on at least one day in the last week | |
Basingstoke and Deane |
120,227 |
14,427 |
East Hampshire |
86,982 |
10,437 |
Eastleigh |
91,773 |
11,012 |
Fareham |
86,813 |
10,417 |
Gosport |
60,673 |
7,280 |
Hart |
66,470 |
7,976 |
Havant |
93,479 |
11,217 |
New Forest |
138,512 |
16,621 |
Rushmoor |
71,515 |
8,581 |
Test Valley |
86,742 |
10,409 |
Winchester |
87,278 |
10,473 |
Alcohol Concern also estimate that the number of people who are drinking at a level that would mean that they are either physically or psychologically dependant on alcohol is 65,311 adults in Hampshire, or one in fifteen adults.
Population over 16 |
Number of people dependent on alcohol | |
Basingstoke and Deane |
120,227 |
8,055 |
East Hampshire |
86,982 |
5,827 |
Eastleigh |
91,773 |
6,148 |
Fareham |
86,813 |
5,816 |
Gosport |
60,673 |
4,065 |
Hart |
66,470 |
4,453 |
Havant |
93,479 |
6,623 |
New Forest |
138,512 |
9,280 |
Rushmoor |
71,515 |
4,791 |
Test Valley |
86,742 |
5,811 |
Winchester |
87,278 |
5,847 |
Within the current LAA process, alcohol has been identified as a flagship priority issue. One of the issues that is being looked at is the need to develop services at this level. One of the proposals is to allow for 1 worker to be based within each area, this would cost approximately £330,000.
If work was carried out with this the potential benefits to existing services would be:
Health: It will allow those misusing alcohol to access treatment sooner. The recent UK Alcohol Treatment Trial (2005) estimated that for every £1 spent on alcohol treatment, £5 is saved by the public sector. That is to say, that if £300,000 was spent on alcohol treatment services, the public sector Hampshire could expect to save £1,500,000. These costs would be saved through improved health and thus not needing to access health care so often, reduced negative social impact and less interaction with the criminal justice services.
Local Authority Area: A higher number of residents would be able to access timely treatment services. This would also help to prevent local tenancy breakdown, of which 30-40% is estimated to be alcohol related.
2. Workforce development
Brief Intervention Training
The Alcohol Strategy Co-ordinator has been involved in delivering training for front line staff around alcohol and brief interventions.
To date, 6 training sessions have been carried out to over 100 front line staff, with a further two fully booked for late October. Those attending have included workers from local treatment services, housing providers, the police, mental health teams and local magistrates. It is hoped that by training up front line staff, this will would enable more services to be able to work with clients that might be drinking at harmful or hazardous levels.
Feedback from the training has been very positive and further training sessions are planned. It is also hoped to be able to develop further training that will be relevant to existing service providers.
3.Responding to vulnerable groups
A number of vulnerable groups misuse alcohol on a regular basis, one of the key groups being prisoners prior to entering Winchester Prison.
A survey carried out within Prison in 2006 highlighted the strong link between alcohol misuse, the amount that prisoners were drinking prior to entering prison, and criminal activity. This work has been recognised nationally.
One of the key local gaps is the lack of alcohol services within Winchester Prison. The prison drug service is not able to work with alcohol clients, they can only be seen if an illicit drug is also involved. When prisoners were asked if they would use an alcohol service, 198 (49%) said they would. However, of this group 67 (37%) were not eligible to access the service.
An alcohol service would allow prisoners to receive help before they are released back into the community. The Probation Service cites evidence of the effectiveness of brief interventions and the potential usefulness of this form of intervention when working with offenders. (National Probation Service Strategy for alcohol misusing offenders, 2006)
46% of prisoners stated that alcohol was linked to their criminal activity, with violent crime accounting for half of these offences. The highest percentage within each crime group who believe that their offending was related to alcohol consumption is as follows:
Robbery - 71% Violence Crime - 68% Theft - 46% Burglary - 42%
Compared with data from the National Alcohol Strategy, Winchester Prison has 10 times as many hazardous / dependant drinkers than the general population. The average consumption among those who said they did not have a drinking problem was 43 units per week; among those who say that they do the average consumption was 157 units. 50 Units a week is taken to be the point at which a man starts to drink at a dependant levels. 35% of prisoners believe that they have a drinking problem.
Currently funding is being sought for a full time worker within Winchester Prison, which will cost approximately £40,000.
4. Any other matters
It is important that this work links in with the ongoing development and implementation of the Hampshire Alcohol Strategy (2006-2009) and of Alcohol as the fifth Local Area Agreement Flagship priority issue.
Work with the LAA has led to the development of a 10 Point Action Plan, that has been provisionally agreed by the LAA Executive Group. However, as no specific alcohol budget currently exists, it is crucial that funding is identified in order to be able to deliver actions within plan. The total cost of these actions is £750,000.
If required, the background to these actions and a business case for each point is available.
The Ten Point Plan
1. Develop adult Tier 2 services (advice, information, brief interventions, group work etc), building on existing countywide provision across 8 open access bases for drug services, providing best value and economies of scale.
2. Support enhanced Tier 2 services within Winchester Prison to provide support services to the prison population.
3. Develop a county wide, family focused interventions team at a Tier 2 level. This would work with young people and their families, encouraging services to screen for alcohol use and make referrals.
4. Develop schemes with Accident & Emergency Departments for accurate data collection and the development of alcohol worker posts to provide screening, onward referral and opportunistic brief interventions. Additional workers to work with Young People who are admitted to A+E for alcohol related issues.
5. Develop a county wide Arrest Referral Service which will identify individuals whose offending is a consequence of alcohol and which delivers brief interventions.
6. Develop and deliver `Brief Intervention' training for front line staff across all partner agencies, for both Young People and Adults.
7. Develop opportunities to jointly commission substance misuse services (drug and alcohol).
8. Develop a Communications Strategy around alcohol activity which involves all LAA agencies - Health, Police, Adult Services Department, Probation.
9. Promote effective linkages between alcohol services and Supporting People services, tying in housing and support in order to maximise outcomes.
10. Review and update the Hampshire Alcohol Strategy, ensure that the Alcohol Flagship Initiative is embedded within DAAT governance structures and establish performance indicators to be monitored by LAA..
Appendix 2
From: Simon Gunn [mailto:[email protected]]
Sent: 08 October 2007 15:01
To: Howlett-Marsh, Ben
Cc: David Price
Subject: RE: Hampshire County Council - Scrutiny of Access to Services for People with Alcohol Problems
Hi Ben
Thanks for the e mail.
We are a new drug rehabilitation centre. We have been operating for only 5 months. In terms of local need I am afraid I have little to offer.
Your council will only fund placements in CSCI registered units so will not refer local clients to us as we are not yet registered. We have tried to become involved with some local authority panels but to no avail. It seems that as we are a private organisation we are unable to be involved. One of my managers was recently asked to leave the Rushmoor Housing Panel for this reason.
Much as we would like to be involved all our clients are from outside the area and, it seems, will continue to be for the forseeable future.
If you can think of any way we could be more involved in the future please do not hesitate to contact me.
Regards
Simon Gunn
Services Manager
01252 514111
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Dear Philippa,
Hampshire County Council Scrutiny Review: Access to services for people with alcohol problems.
Please find a response from Hampshire Constabulary to the above scrutiny. Should you have any questions or require further clarification please do not hesitate to contact me.
Yours sincerely,
Alistair Nichols
Inspector
Community Safety Department
Hampshire County Council Scrutiny Review: Access to services for people with alcohol problems.
1 How available are early identification services at present, and how are agencies co-operating to improve on this?
1.1 How available are early identification services for people who need them, from your point of view?
There are a variety of situations where Hampshire Constabulary personnel will come into contact with those with alcohol problems. The principle ones are when dealing with individuals who are allegedly the victim of crime or an offender. Other scenarios are chiefly encountered in more general community involvement and responsibilities, such as mental health issues, missing person enquiries or simply people contacting the police as being the most visible and accessible source of support available.
With all these points of contact police officers and staff will be chiefly concerned with signposting the individual to such services and, indeed, alerting the services to the potential needs of individuals and encouraging further contact. In brief there appear to be few services available, if any. At present, other than giving the generic advice for the person to contact their GP, there appears to be little, readily identifiable, option available to our staff. This is in marked contrast to the availability of such services for drug misusers, for whom custody referral schemes are widely encountered examples in the policing environment (in Portsmouth the scheme has just been expanded to include `harmful and dependent' drinkers).
1.2 How does your agency/group identify people at an early stage of their drink problem, and what interventions do you offer?
There are no specific means to identify people at an early stage of their drink problem. The means that may do so are, for example, the child at risk reporting systems, for those involved in crime or otherwise at risk; custody risk assessments, which unless dealing with overt signs of drunkenness rely on self-reporting, and other risk assessments (e.g. missing persons).
As has been described above there are few options available in the way of services to refer people to.
1.3 What kind of agency co-operation is happening at present to improve on services that are available currently, and how are you involved in this?
Following an approach from Alcoholics Anonymous I have acted as a facilitator so that some of their awareness material has been made available at one of our custody suites and this has been backed up by custody staff knowing how they can point anyone expressing an interest in AA in their direction. This will be made available across the Force area.
Staff have made use of the Brief Intervention Training that has been made available by Hampshire DAAT - Mike Webb.
A further development is the Service User Group with Mike Webb's support is preparing material for use in Hampshire Constabulary's initial training package for Custody Officers.
2 What multi agency workforce development is in place and what are the workforce planning arrangements for the future?
2.1 What progress can you see being made to develop the workforce, including volunteers and informal carers, who respond to people with alcohol problems?
I do not feel able to remark on workforce development of those specifically working in this field.
However as far as Hampshire Constabulary workforce is concerned there is a need for those initially encountering people with alcohol problems to be able to recognise that this is an issue and confidently direct the latter onto service providers appropriate to their needs.
2.2 Which aspects of the above e.g. joint recruitment, joint training, growing the workforce, developing new ways of working, achieving a representative workforce etc. happen on a joint basis, and how?
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3 What improvements could be made to deliver effective support and treatment to the most vulnerable people, including those with mental health problems?
3.1 What, in Hampshire, is proving most effective in responding to the vulnerable groups you know about?
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3.2 Can this be improved on, and, if so, how?
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3.3 What are the barriers to making improvements?
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4 Are there any other matters that you would like to draw to the attention of the review group?
No further to the above.
Appendix 4
CLEMS Winchester Response to Alcohol Scrutiny Review October 2007
CLEMS is a Tier 2 Open Access Shop Front Drug Advice Drop In service. It is funded by the Hampshire DAAT and is run by a charity called CRI. CLEMS is the only service of its kind in Winchester therefore it is responsible for all the triage assessments of drug clients who wish to attend Spencer House for some form of treatment for their drug use.
Due to the nature of our service it is very common for us to see clients who have considerable alcohol dependence issues as well as some form of drug use. If it is apparent that alcohol is the main form of substance misuse we would encourage that person to attend The Trinity Centre in Winchester as they deal with Alcohol as a sole issue. If the person is in need of a triage then we would do this however we would only do this if they had a drug misuse issue as well.
In order to do a triage we would use the Common Assessment Tool which is a DAAT commissioned tool and is used for both drugs and alcohol assessments. This then is sent to Spencer House whom would then deal with the client directly.
My knowledge of the alcohol resources in Winchester are as follows, a person who wants to address their alcohol issues would need to attend their G.P and then they would be directly referred to Spencer House for assessment. I understand that the waiting list for such an assessment at times can be long due to the demand for the service and the fact that there is no intermediate service such as CLEMS whom do the triage assessments for alcohol.
We have 27 clients who we consider our "core" group who use our service daily and we would suggest that 10-15 of them have alcohol issues as well as drug dependency problems. However these people have a more serious drug issue that needs to be addressed and that is what we deal with in CLEMS.
We would always advise people of where they can obtain assistance for alcohol issues, as well as going to The Trinity Centre we have information on local AA meetings and we would support clients in attending such meetings as these. Our project has strong links with The Trinity Centre and we seek to do good quality partnership working with them on clients that cross both projects.
In Winchester the availability of services does seem to be sparse and although services such as Trinity and CLEMS fill in some of the gaps a service which is for people with different levels of alcohol dependence that can offer advice and support, harm minimisation messages and deal with issues that are surrounding the alcohol usage is missing.
Appendix 5
Basingstoke & Deane Council Response
Scrutiny Of Access to services for people with Alcohol Problems
1) How available are early identification services at present and how are agencies co-operating to improve on this?
1.1) How available are early identification services for people who need them, from your point of view?
For young people I feel that the services for young people are good although this isn't echoed in adult services. Although more work needs to be carried out with young people from an earlier age.
1.2) How does your agency/group identify people at an early stage of their drink problem, and what interventions do you offer?
As a Local Authority we don't provide any treatment services, however through general awareness work if a young person is identified then we can sign post them on to the appropriate treatment service. Some officers are also trained as health trainers or are those that have Tier 2 trained in substance misuse.
1.3) What kind of joint agency co operation is happening at present to improve on services that are available currently, and how are you involved in this?
I chair the drug and alcohol reference group for the Borough of Basingstoke & Deane which is a multi agency group that meets every other month and is represented by agencies such as probation, housing, treatment providers, connexions amongst others. This meeting provides an ideal opportunity for people to network and address local issues and find solutions to problems within our Borough.
2) What multi agency workforce development is in place and what are the workforce planning arrangements for the future?
2.1) What progress can you see being made to develop the workforce, including volunteers and informal carers, who respond to people with alcohol problems?
I belief that they play a major role in future planning. There should also be more support for carers both in terms of respite and support groups.
2.2) Which aspects of the above e.g. joint recruitment, joint training, growing the workforce, developing new ways of working, achieving a representative workforce etc. happen on a joint agency basis and how?
Unsure of this although it would be good to have more involvement from carers, especially when going into schools.
3) What improvements could be made to deliver effective support and treatment to the most vulnerable people, including those with mental health?
3.1) What, in Hampshire, is proving most effective in responding to the vulnerable groups you know about?
I feel that the service for young people is a pro active organisation and willing to work with other external agencies.
3.2) Can this be improved on, and if so, how?
3.3) What are the barriers to making improvements?
There doesn't appear to be fair spilt in funding available when it comes to alcohol, drugs seems to be more of a priority. Housing is also a problem for those people who drink both in terms of maintaining a tenancy and for those trying to obtain housing.
4) Are there any other matters that you would like to draw to the attention of the review group?
Southdown Intergroup Appendix 6
Philippa Smart, Scrutiny Team
Chief Executives Department
Elizabeth 11 Court
The Castle
Winchester SO23 8UJ
REFERENCE: SCRUTINY REVIEW: ACCESS TO SERVICES FOR PEOPLE WITH ALCOHOL PROBLEMS
Dear Philippa
We are very please to be invited to take part in this exercise however as an organisation we do not wish to engage in any controversy by either endorsing or opposing any causes. Therefore we would have feel uncomfortable about offering an opinion on the state of service provision for people with Alcohol Problems in Hampshire.
We are delighted to respond to question 4 with some background information on Alcoholics Anonymous which we hope will help the review group to determine the state of the service provision that Alcoholics Anonymous provides.
4. Are there any other matters that you would like to draw to the attention of
the review group ?
· Latest estimates show there are over 2 million AA members worldwide. For the past 60 years AA has been the world's largest organisation offering help to alcoholics.
· There are over 3,000 AA meetings in the UK every week. AA is self funding there is no charge, and no-one has to speak or declare themselves alcoholic to attend. Anyone who is concerned about their drinking is welcome.
· AA was founded in America in 1935 when two chronic alcoholics met and helped each other get sober and stay sober. AA came to Britain in 1947.
· AA evolved a 12-step programme that provides the framework for recovery from alcoholism. Its success has led to many other organisations adapting AA's programme to deal with all forms of addiction.
If you have any questions or require more information then please contact me.
Mark
Tele:- 07950 231870
Public Information Liaison Officer - Southdown Intergroup
Alcoholics Anonymous
C/o
Amesbury Cottage
High Pitfold
Hindhead
Surrey GU26 6BN