Agenda item
Substance Misuse Service
This report provides an account of substance misuse services in Brent. It covers the Integrated Treatment, Recovery, Wellbeing and Substance Misuse service model and the commissioning arrangements by Brent Council Public Health. The performance of the provider, Westminster Drugs Project (WDP) with Central North West London (CNWL) NHS Foundation Trust as the clinical partner, is described. The work of B3, the service user council for Brent entirely run for and by local residents who have been directly affected by problematic drug and alcohol misuse, is described.
Minutes:
Councillor Hirani (Lead Member for Public Health, Culture and Leisure) introduced the report on the Substance Misuse Service from the Director of Public Health. The report provided details of: the Integrated Treatment, Recovery, Wellbeing and Substance Misuse service model; commissioning arrangements; provider performance; and, the work of B3, the service user council for Brent run by and for local residents directly affected by problematic drug and alcohol misuse. Councillor Hirani advised that the responsibility for Public Health had been transferred to local government following the Health and Care Act 2012. Despite year on year reductions to the public health grant, Brent’s Substance Misuse service was considered to be an example of best practice, particularly in relation to the inclusion of peer support.
Andy Brown (Head of Substance Misuse) provided a brief overview of the key themes of the report, advising that data provided via the National Drug Treatment Monitoring System (NDTMS) estimated that there were: 2,310 opiate and/or crack users; 1,752 opiate users; 1,331 crack users; and 3,169 problem alcohol users in Brent. This data suggested that approximately only a third of active drug users and a fifth of problematic alcohol users were engaged with treatment services in Brent - this was broadly in line with national figures.
Discussing ‘The New Beginnings service’, Andy Brown advised that this new service model had been developed in conjunction with B3, responded to areas of local new or under met need, and rebalanced the divide between clinical services and non-clinical support such as outreach, criminal justice services and recovery support. The new service model had been fully mobilised by 1 April 2018. With the change in service provider there had been a transfer of staff, clients and case files from across five organisations into a single performance management and reporting system led by the new provider, Westminster Drugs Project (WDP). As was expected the transfer led to a temporary drop in performance, in part due to data cleansing through the bringing together of records from different organisations, but this was improving and remained higher than the national averages across a number of areas.
Radha Allen (Project Co-ordinator) and Amina Gariba (B3 Volunteer), then delivered a short presentation to the committee on the work of B3, which as previously highlighted, was an entirely peer-led service, designed and run by service users, and funded directly by Brent Council. B3 provided peer-led support and opportunities for service users and volunteers to develop new skills and qualifications. B3 also operated an out-of-hours’ weekend drop-in service for people struggling with substance misuse issues. Moving forward, B3 had recently established an outreach programme to help sign-post individuals not engaging with treatment services.
The Chair thanked the Lead Member, officers and representatives of B3 for the introduction and invited questions from the committee.
In the subsequent discussion, the committee queried how the council was assured that the key objectives of the substance misuse service were being met. Members queried the strategy for engaging hard to reach cohorts and questioned what the barriers existed for accessing services. Queries were raised regarding the protocol for prescribing substitute drugs or drugs which reduced the urge to misuse substances. Further comment was sought on performance of the new service model against the previous model and members requested clarification regarding treatment completion rates. In concluding their questioning, the committee queried what the emerging challenges were for the service going forward.
In response to the committee’s queries, Councillor Hirani explained that the Cabinet received quarterly performance statistics which included key indicators for the substance misuse service. Furthermore, Andy Brown measured performance as part of the contract management. Tom Sackville (Interim Head of Services WDP) advised that a monthly meeting was held between WDP, the Council and B3 to discuss performance and allow the service to be held to account by service users. With regard to engaging hard to reach cohorts, the committee was informed that WDP had an outreach service, through which relationships were built with communities to help broaden awareness of the services available. WDP also worked with a range of council services and the criminal justice service to identify and engage potential service users.
Ruben Seetharamdo (Sector Manager, CNWL NHS Trust) highlighted that Central North West London NHS Foundation Trust was the clinical partner within the New Beginnings Service. Based at the Willesden Centre for Health and Care, the clinical element of the service undertook a holistic assessment of service users, encompassing physical and mental health needs. This assessment included whether there was a need for medication to be prescribed and whether in-patient services were needed to support a service user to detox. Brent had a very good community detox pathway, supported by a 12-week recovery day programme. Dr Melanie Smith (Director of Public, Brent Council) emphasised that there were no barriers in terms of policy or funding to the prescription of necessary clinical treatments. Ruben Seetharamdo advised that such treatments included campral acamprosate and antabuse (disulfiram). In response to a further query, Ruben Seetharamdo explained that the NHS was not able to prescribe implants as these were not licensed but could prescribe oral medication.
Andy Brown confirmed that performance had reduced when the substance misuse services were integrated under the new service model. This had been expected, in part due to the amalgamation of case-loads across which removed the potential for duplication of figures. There had been a focus on raising performance in line with key performance indicator targets. Tom Sackville confirmed that no service users had been prevented from accessing services as a result of the change of service model. Dr Melanie Smith emphasised that all parties had been acutely aware of the risks in recommissioning the service under the new model and this had therefore been monitored very closely. Public Health England had been interested to note the speed at which Brent had been able to raise performance following the implementation of the new model.
Andy Brown advised that effective treatment was usually measured as the completion of the 12-week programme, but often service users continued to access services for a longer period, reflecting the reality that this was often a longer process. The numbers of service users re-engaging with services within a six-month period was measured. Councillor Hirani advised that moving forward, outreach remained an ongoing challenge for the service.
The Chair thanked everyone for the contribution to the discussion and noted that during the discussion the committee had requested that the following be provided:
- an estimation of when service performance models would return to pre-service integration levels.
The committee subsequently RESOLVED to note the treatment and recovery services available to residents with problems of drug and alcohol misuse.
Supporting documents: