Scrutiny Review : Access to Services for People with Alcohol Problems

Introduction

Hampshire DAAT is a multi-agency partnership, established in 2001 and responsible for the local implementation of the Government's ten year drug strategy: `Tackling Drugs' (as amended December 2002). The overall aim of the strategy is to `reduce the harm that drugs cause to society - communities, individuals and their families' focusing on 4 key theme areas:

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

Availability: To stifle the availability of illegal drugs in the community

Following the publication of the National Alcohol Harm Reduction Strategy for England published in March 2004, Hampshire DAAT broadened its remit to oversee the implementation of the national strategy at the county level and to lead on the development of a local alcohol strategy for Hampshire.

The DAAT commissions services for people who have drug problems (including those who may have a secondary alcohol problem) from ring fenced budgets for both adults and children/young people. It also has a role in supporting the commissioning of services for people who have alcohol problems, in circumstances where mainstream funding is provided by a partner agency (or agencies), notably the PCT or Adult Services and aligned with the DAAT drugs funding in order to commission services for both drug and alcohol clients.

The DAAT Pooled Budget for adults which is an allocation from the National Treatment Agency (a Special Health Authority) is ring fenced for drug treatment provision only. The has no funding allocation for alcohol treatment provision.

Hampshire DAAT is not a provider of drug and alcohol services.

Issues and Questions Paper : Response

1) How available are early identification services at present, and how are agencies

co-operating to improve on this?

Our perception is that early identification of alcohol problems would tend to be largely reliant upon activity within primary health care services. Predominantly within the GP practice; during routine consultations or specific `well man' or `well woman' clinics when issues such as alcohol consumption would form part of the general health assessment.

The DAAT commissions eight open access shop front services across the county. These services offer information, guidance and support, one to one and group based motivational work and brief interventions, triage assessment (to enable individuals to access more structured treatment services, if required), relapse prevention, needle exchange and aftercare. In six of the services, additional funding has been identified from Adult Services and/or the PCT and in these services, alcohol clients who are drinking at hazardous or harmful levels are able to access a range of the services offered. In Winchester and Andover there is no additional funding. In Winchester, people who present with purely alcohol problems are likely to be referred by the Open Access Service to the Trinity Centre and in Andover they may access services from Two Saints, both of whom are homelessness providers and therefore not appropriate for all sections of the community.

Our perception is that there is a significant gap in provision for people who require additional support, over and above that provided by their GP but are not yet drinking a hazardous or harmful levels. These individuals may not feel able to /or may feel intimidated by the idea of accessing an open access drug or alcohol service, where the behaviour of clients may at times be quite chaotic.

For alcohol clients who require structured treatment services, these services are commissioned by the PCT alongside the structured drug treatment services commissioned by the DAAT and there are six Community Drug and Alcohol Teams (CDATs) across the county offering this provision. Clients may be referred directly by their GP or in six out of the eight Open Access Services described above, triaged using the DAAT Common Assessment Tool and referred to the CDAT's.

However, at the structured treatment level, structured counselling services for people with alcohol issues are particularly lacking at the present time and there are also cost pressures which relate to the provision of domiciliary care and residential rehabilitation provision (which may be `out of county' and high cost)for this client group.

The DAAT has been supporting the development of the 5^th LAA flagship initiative and the 10 point plan, which has been developed along side this initiative, includes reference to the development of services in a number of settings that would offer brief interventions to people for whom their alcohol issues are becoming or have become problematic.

The DAAT remains optimistic that through partnership working via the LAA process resources may be made available to ensure that alcohol issues (which have an impact upon many partners' agendas) will begin to be addressed in a more strategic manner with greater `buy in' and commitment from partners and stakeholders that form part of the LAA process.

3. What multi agency workforce development is in place and what are the workforce planning arrangements for the future?

The DAAT, through its contractual arrangements with all providers requires the provider to be DANOS compliant (DANOS is a National Occupational Standard for Drug and Alcohol practitioners). As part of the contract monitoring arrangements in place, the DAAT has commissioned a DANOS audit of all providers for the past 3 years. From 2008/09 this audit will take place bi-annually due to funding constraints. It is the responsibility of the provider agency to ensure that the workforce delivering DAAT services has the relevant skills and knowledge to deliver the service.

In 2004, the DAAT began work on a project to create a training and development strategy for the Hampshire DAAT. The aim of the project (Tackling drugs? Tackling training!) was to build a competent workforce, supported by a robust training and development strategy to deliver high quality substance misuse services in Hampshire. A strategy document was launched in autumn 2005 with an accompanying action plan. Implementation of the action plan has not been delivered with the drive and focus it warranted due to competing priorities, but there has been progress. A Training Steering Group, historically hosted by the DAAT was disbanded to a lack of support.

The DAAT Alcohol Strategy Co-ordinator has developed and delivered a brief intervention training programme for front line staff during 2007. 8 training sessions have been completed and over 150 front line staff have been trained. Delegates have included officers / practitioners working for Housing providers, Magistrates, Children's and Adult Services and numerous others. It is hoped that the programme will be further developed in 2008 to include a more in depth course of longer duration.

The DAAT is in the process of developing an e-learning package with the support of an external Consultant and Hampshire Learning Centre. The package will include a series of modules which will build and understanding of drug and alcohol issues. All training has been mapped to DANOS standards and early discussion are in place with OCN (Open College Network). It is hoped that the package will be widely available both internally to HCC staff and externally to other stakeholders, their staff and the public. In addition, there are training programmes in place specifically targeted at practitioners working with young people and within the Young Persons Substance Misuse Plan, a DAAT Training Co-ordinator has been identified (although this post has not yet been recruited). All DAAT training is provided free of charge to the participant.

A basic alcohol awareness and an understanding of the options available to patients/clients and the referral routes into more specialist services who have alcohol problems, is considered essential training for front line staff who are regularly accessing people's homes or working with vulnerable people.

3. What improvements could be made to deliver effective support and treatment to the most vulnerable people, including those with mental health problems?

The DAAT has a strong view that there would be significant benefits and reduced duplication of effort if services for adult drug and alcohol clients were jointly commissioned from a single pooled budget for substance misuse, as is the case in many DAAT areas. This would primarily relate to funding from the DAAT (for drugs) and from the PCT and Adult Services (for both drugs and alcohol).

The DAAT Joint Commissioning Group (JCG) made up of key stakeholders, including Health, Adult Services, Probation, Community Safety Partnership's etc. to develop and agree the Adult Drug Treatment Plan and commission against it. However, the commissioning of services relates primarily to those commissioned from DAAT resources. This group already includes those key stakeholders who could jointly lead the commissioning of substance misuse services (drug and alcohol and would be well placed to do this).

Training, improving skills and competencies with in the substance misuse workforce, particularly in relation to diversity issues and underserved groups, including dual diagnosis is key. But, also raising the awareness of frontline workers in other non-substance misuse specific a services to the needs of people who have alcohol problems which may include mental health issues.

Early intervention and preventative work is essential, it is much easier to work with clients before their alcohol use becomes problematic and an entrenched part of their behaviour, potentially causing or exacerbating mental health symptoms.

Currently, mental health services may not be available to clients that are drinking, unless the mental illness is serious such as bipolar disorder or schizophrenia. Clients are being advised that they can't be assessed or worked with until they are sober, if they have common mental health problems such as depression or anxiety, which are very prevalent within this client group.

The DAAT understands that it is a local priority for Health and Social Care 2007/08 to review the Community Mental Health Teams and the role that Primary Care plays in the treatment of common mental health problems. A move towards early intervention and preventative work is integral to this and can only be welcomed.

Clear protocols are required to clarify the roles and responsibilities across the mental health and substance misuse sectors to ensure equity of access and provision of services to clients using both drugs and alcohol. This should be reinforced by further joint training countywide, to establish more effective liaison and support between the sectors for the benefit of dual diagnosed clients.

The DAAT currently provide funding to support dual diagnosis posts within the Community Mental Health Teams, however because of the funding constraints previously described these post are for clients who have a drug problem coupled with a mental health problem.

4. Are there any other matters that you would like to draw to the attention of the review group?

None at this time.

Sue Wilks

DAAT Manager