tag:blogger.com,1999:blog-88034104885102879582024-03-13T12:17:40.018+00:00DrugScope CommentJackie Bucklehttp://www.blogger.com/profile/02256707536603867875noreply@blogger.comBlogger73125tag:blogger.com,1999:blog-8803410488510287958.post-52480824809215828422015-04-01T15:05:00.002+01:002015-04-01T19:07:08.432+01:00DrugScope's closure: thank you for your supportAs you may have read, earlier this week DrugScope <a href="http://www.drugscope.org.uk/Media/Press+office/pressreleases/DrugScope+to+close.htm">announced its closure</a> after fifteen years serving the substance misuse sector, and working on behalf of people facing drug and alcohol problems.<br />
<br />
This has been a terrifically difficult time for all the staff here, but we have been overwhelmed by the response to the news - both from partners and friends that we know well, but also from many others who have appreciated DrugScope's work over its long history.<br />
<br />
We've collected a small sample of these messages, and offer them for what they say about the continuing and vital importance of effective drug and alcohol services and sensible, evidence based drug policy.<br />
<br />
From everyone at DrugScope, thank you for your support over the last 15 years, and your good wishes at this sad time. They are much appreciated. <br />
<br />
<div class="storify"><iframe src="//storify.com/iamsamthomas/end-of-an-era-drugscope-closes-after-20-years/embed?border=false" width="100%" height="750" frameborder="no" allowtransparency="true"></iframe><script src="//storify.com/iamsamthomas/end-of-an-era-drugscope-closes-after-20-years.js?border=false"></script><noscript>[<a href="//storify.com/iamsamthomas/end-of-an-era-drugscope-closes-after-20-years" target="_blank">View the story "End of an era: DrugScope closes after 15 years serving the sector" on Storify</a>]</noscript></div>Anonymousnoreply@blogger.com1tag:blogger.com,1999:blog-8803410488510287958.post-25746808035243936072015-03-31T13:19:00.000+01:002015-03-31T13:19:40.786+01:00Interesting things about alcohol and other drugs you might have missed - April 2015One of the things I've enjoyed about being at DrugScope has been ferreting out fascinating information that is out there about our field.<br />
<br />
This month the slides include information which suggests:<br />
<ul>
<li>Areas with highest levels of need are dis-investing in alcohol services faster than other areas.
</li>
<li>Many fewer teachers are being trained to deliver health education. </li>
<li> That only very small numbers of under-18s are being treated for cannabis psychosis in hospital (but there's been a rise in the last year).</li>
<li>That more people with drug and alcohol issues in receipt of ESA are likely to be sanctioned than would be proportional.</li>
<li>That there are now more people being convicted for drug offences than alcohol ones.</li>
</ul>
<iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/46488223" style="border: 1px solid rgb(204, 204, 204); margin-bottom: 5px; max-width: 100%;" width="595"></iframe>Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-30360881858608654252015-03-26T16:11:00.002+00:002015-03-26T16:11:42.945+00:00Drug Related Deaths Summit 2015<br />
<div class="separator" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;">
<img alt="" border="0" src="http://4.bp.blogspot.com/-pFG04TgLhnY/VRQSmWHsk3I/AAAAAAAAfAM/gpgUwwZksA8/s1600/drd.png" height="320" title="" width="226" /></div>
As we’ve explored previously on this blog, drug users are likely to <a href="http://drugscope.blogspot.co.uk/2015/01/half-picture-beyond-drug-overdose-as.html" target="_blank">suffer health inequalities</a> across a range of domains. However, deaths through overdose remain the most important preventable harm for the health and treatment system to address.<br />
<br />
Last year’s annual report by the Office for National Statistics on <a href="http://www.ons.gov.uk/ons/rel/subnational-health3/deaths-related-to-drug-poisoning/england-and-wales---2013/stb---deaths-related-to-drug-poisoning-in-england-and-wales--2013.html#tab-Key-Findings" target="_blank">drug-related deaths</a> showed a sharp increase in deaths that were recorded as resulting from drug misuse, and we <a href="http://drugscope.blogspot.co.uk/2014/09/sharp-rise-in-drug-deaths-is-cause-for.html" target="_blank">blogged</a> and <a href="http://www.drugscope.org.uk/Media/Press+office/pressreleases/ONS-DRD-sharp-rise" target="_blank">commented</a> on this at the time.<br />
<br />
The number of deaths rose from 1,492 deaths in 2012 to 1,812 in 2013, a 21% rise and the highest number since 2009.<br />
<br />
At the beginning of this year, working with <a href="http://www.nta.nhs.uk/" target="_blank">Public Health England</a> and the <a href="http://www.local.gov.uk/" target="_blank">Local Government Association</a>, DrugScope organised a summit to examine what might be causing the rise and to look at what might be done to reduce overdose deaths in future years.<br />
<br />
The attendees included policy makers from across government, commissioners, clinical and service provider leaders, and service user perspectives. <br />
<br />
The key messages from the summit were:<br />
<ul>
<li>The availability of accurate, timely and easily accessible data is
important in order to make the appropriate adjustments to policy and
practice in order to reduce drug-related deaths; </li>
<li>The majority of drug misuse deaths still involve opiates, in particular heroin and methadone; </li>
<li>Being in contact with a treatment service would appear to be a significant protective factor for drug-related deaths; </li>
<li>Services and practitioners should pay attention to the elevated risk
for those in treatment who are regularly overdosing, are drinking
excessively, live alone in temporary accommodation or are homeless, or
as a result of smoking-related diseases have compromised respiratory
systems; </li>
<li>Policy makers and commissioners should think about
providing timely and accurate alerts to drug users who are not in the
treatment system - including drug users who don't use opiates; </li>
<li>Commissioners and services should look at how they could supply naloxone
more widely in the community to ensure those vulnerable to heroin
overdose (including those not in treatment), their families, peers and
carers are able to access the medicine. </li>
</ul>
Download the report <a href="http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/DRD.pdf" target="_blank">here</a>.<br />
<br />
<h4>
Presentations to the summit </h4>
<br />
<iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/46320092" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> <br />
<div style="margin-bottom: 5px;">
<b> <a href="https://www.slideshare.net/andrewbrown365/drug-related-deaths" target="_blank" title="Drug related deaths"></a></b><br /> </div>
<iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/46320972" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> <br />
<div style="margin-bottom: 5px;">
<b> </b><b><a href="https://www.slideshare.net/andrewbrown365" target="_blank"></a></b> </div>
Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-42021340602102213902015-03-25T14:40:00.001+00:002015-03-25T14:43:57.648+00:00<div dir="ltr" style="text-align: left;" trbidi="on">
<h3 style="text-align: left;">
A fair chance? Sanctions and vulnerability</h3>
<h1>
<o:p></o:p></h1>
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This week saw the release of a significant report by the
House of Commons Work and Pensions Committee - <a href="http://www.publications.parliament.uk/pa/cm201415/cmselect/cmworpen/814/814.pdf">Benefit
sanctions policy beyond the Oakley Review</a>. The report contains a number of
welcome recommendations, including that the next government should conduct a
broad, independent review of the way sanctions are used plus how vulnerable
claimants can be protected and, crucially, identified. DrugScope submitted
evidence jointly with Homeless Link – you can find our submission <a href="http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/DrugScope%20%20Homeless%20Link%20sanctions%20submission.pdf">here</a>.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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We’ve long been concerned that sanctions put vulnerable
people at risk of financial hardship, as my colleague Sam Thomas has <a href="http://drugscope.blogspot.co.uk/2014/08/rise-in-benefits-sanctions-incentive-or.html">blogged
about before</a>, and that some proposed changes may increase that risk, as
DrugScope’s Director of Policy Andrew Brown <a href="http://drugscope.blogspot.co.uk/2015/02/sick-and-sanctioned.html">recently
blogged about</a>. We weren’t able to tell much about people with needs
relating to drug and alcohol misuse from the <a href="https://www.gov.uk/government/statistics/jobseekers-allowance-and-employment-and-support-allowance-sanctions-decisions-made-to-september-2013">official
statistical releases</a>, other than that the number of Employment and Support
Allowance (ESA) and Jobseeker’s Allowance (JSA) claimants sanctioned has
increased substantially over the last few years. What we know from some other
sources gave cause for concern, though.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Several evidence reviews have highlighted the risk of people
with vulnerabilities being disproportionately affected by sanctions. For
example, <a href="http://www.gov.scot/Resource/0044/00440885.pdf">this</a> from
the Scottish Government:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
“The literature suggests that
those who are particularly vulnerable to sanctions are also the most
disadvantaged. This includes people that lack work experience or who face
practical barriers to work, such as not having access to a car; or those with
health problems, including drug and alcohol dependencies; and those with mental
health difficulties.”<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
<a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/323919/ssac_occasional_paper_9.pdf">This</a>
from the Social Security Advisory Committee, writing about conditionality and Universal Credit:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
“The evidence suggests that many
vulnerable claimants do not set out to be noncompliant but they often lead
chaotic lifestyles, have poor organisational skills and frequently forget the
conditions they are supposed to fulfil. A recent study of offender employment
services also referred to the chaotic lifestyles of many offenders and their
inability to understand the sanctioning regime, and questioned the utility of
sanctions as a mechanism for generating behaviour change amongst certain
groups.”<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
The Joseph Rowntree Foundation published an <a href="http://www.jrf.org.uk/sites/files/jrf/Welfare-conditionality-UK-Summary.pdf">evidence
review</a> making similar observations, and the problems faced by vulnerable
groups in particular was highlighted by the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/335144/jsa-sanctions-independent-review.pdf">independent
Oakley Review</a> of communication around JSA sanctions, published in 2014.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So far, so worrying. There is additional evidence that
illustrates the risk to vulnerable groups. A response by the Department for
Work and Pensions (DWP) to a <a href="http://www.benefitsandwork.co.uk/news/2717-dwp-target-mental-health-claimants-for-esa-sanctions">Freedom
of Information Request</a> suggests that while ESA claimants with a primary
medical condition (PMC) of a mental or behavioural disorder make up around 45%
of the ESA caseload, they account for around 60% of ESA sanctions.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="http://www.crisis.org.uk/news.php/957/report-reveals-benefit-sanction-lsquohotspotsrsquo-across-britain">Research</a>
by academics on behalf of homelessness charity Crisis found that while it was
difficult, using administrative data, to make a direct connection between
homelessness and the risk of being sanctioned, there was fairly persuasive
circumstantial evidence that:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
“Homeless people, then, may face
a ‘double whammy’: disproportionally sanctioned by virtue of belonging to
groups overrepresented in the sanctions statistics (young, male), but also more
likely to experience barriers to complying with the new conditionality regime.”<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
They also pointed to <a href="http://www.homeless.org.uk/sites/default/files/site-attachments/A%20High%20Cost%20to%20Pay%20Sept%2013.pdf">research</a>
by Homeless Link which found that sanctioning rates were exceptionally high for
homeless people, with people who misuse drugs and/or alcohol at particular
risk.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
DrugScope’s own <a href="http://www.drugscope.org.uk/POLICY+TOPICS/State+of+the+Sector.htm">State
of the Sector 2014-15</a> found that while some elements of welfare reform had
affected more people, no individual reform had had such strongly negative
impact than the post-2012 sanctions regime:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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<v:imagedata src="file:///C:\Users\PAULAN~1\AppData\Local\Temp\msohtmlclip1\01\clip_image001.png"
o:title=""/>
</v:shape><![endif]--><!--[if !vml]--><!--[endif]--><a href="http://1.bp.blogspot.com/-fbqV1ERG0EA/VRLHBk1oj5I/AAAAAAAAvBU/uI36_GpbxJc/s1600/Welfare%2Breform%2Bupdate.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-fbqV1ERG0EA/VRLHBk1oj5I/AAAAAAAAvBU/uI36_GpbxJc/s1600/Welfare%2Breform%2Bupdate.png" height="432" width="640" /></a><br />
Source: DrugScope, State of the Sector 2014-15<o:p></o:p><br />
<br /></div>
<h3 style="text-align: left;">
ESA, drug and alcohol misuse and sanctions</h3>
<h2>
<o:p></o:p></h2>
<div class="MsoNormal">
A picture is emerging, albeit one informed by somewhat
peripheral evidence. We were keen to learn more. There are problems with some
of the data around drugs, alcohol and benefits. While there is a marker on LMS
(DWP’s Jobcentre IT system), it’s used very inconsistently. On the other hand,
claimants in the ESA Support Group are effectively excluded from
conditionality. That leaves the ESA Work Related Activity Group, or WRAG. As
part of the claim and assessment process, claimants are assigned a PMC, which
for a small number of claimants, can be alcohol misuse or drug misuse. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We submitted a request to DWP in December, which they <a href="https://www.whatdotheyknow.com/request/esa_wrag_claimants_with_primary#incoming-632620">responded</a>
to this week. The numbers provided are illuminating. Firstly, the number of
people with a PMC of drug or alcohol misuse receiving a sanction seems quite
volatile:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-0MMMFmIdsfY/VRLHVJOhVbI/AAAAAAAAvBc/2eLfoITcVoE/s1600/Sanctions.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-0MMMFmIdsfY/VRLHVJOhVbI/AAAAAAAAvBc/2eLfoITcVoE/s1600/Sanctions.png" height="476" width="640" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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o:title="esa"/>
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<div class="MsoNormal">
However, this should be seen in the context of an overall
ESA sanctioning rate that is itself volatile:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-G9P3Ak0Srno/VRLHhYwdEoI/AAAAAAAAvBk/bIwgoRTR24o/s1600/D%2BWebster.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-G9P3Ak0Srno/VRLHhYwdEoI/AAAAAAAAvBk/bIwgoRTR24o/s1600/D%2BWebster.jpg" height="418" width="640" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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<div class="MsoNormal">
Source: Dr David Webster, University of Glasgow<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There’s not very much one can tell from looking at those two
charts. What we have done with the response from DWP sheds a little more light.
We have calculated the proportion of ESA WRAG claimants with a PMC of
drug/alcohol misuse out of all claimants. We have also calculated the
proportion of people with a PMC of drug/alcohol misuse sanctioned out of all
people sanctioned, and have then compared the two figures. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Like people with a PMC of a mental or behavioural disorder,
it appears that people with a PMC of drug or alcohol misuse are disproportionately
likely to be sanctioned, and have been fairly consistently so – the <a href="https://www.gov.uk/government/collections/jobseekers-allowance-sanctions">new
ESA sanctions regime introduced in late 2012</a> doesn’t seem to have made a difference
as far as the proportion of people being sanctioned is concerned:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-TCA5WbxpZXQ/VRLIPRFOeWI/AAAAAAAAvBw/e8p4liN3990/s1600/ESA%2Bsanctions.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-TCA5WbxpZXQ/VRLIPRFOeWI/AAAAAAAAvBw/e8p4liN3990/s1600/ESA%2Bsanctions.png" height="462" width="640" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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<h3 style="text-align: left;">
<br /></h3>
<h3 style="text-align: left;">
Caveats</h3>
<h2>
<o:p></o:p></h2>
<div class="MsoNormal">
As alluded to above, there are several limitations to what
we’ve done. These include:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->Not everyone with needs relating to drug and/or
alcohol misuse will be recorded as having a PMC of drug or alcohol misuse. For
example, an intravenous drug user who has caused themselves nerve damage that
limits their mobility may well be recorded as having a different PMC. The same
might apply to someone with impaired liver function as a consequence of alcohol
misuse, or someone with coexisting mental ill health and substance misuse
needs. <br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->In the context of the overall number of JSA and
ESA sanctions, we’re talking about a relatively small number of people. Seen against almost 900,000 JSA claimants sanctioned between April 2013 and March
2014, the numbers aren’t huge: 8,399 ESA claimants with a PMC of drug/alcohol
misuse sanctioned over 6 years, split pretty evenly between drugs and alcohol.
That is still a large number of people who will have experienced financial
hardship, but due to this and the reason above, we can be certain that we’re
only getting part of the picture.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-size: 7pt; font-stretch: normal;">
</span><!--[endif]-->Finally, while we have long been concerned that
the conditionality and sanctions regime is being used punitively, may not be
achieving its stated aims and may actually be counter-productive, the numbers
alone don’t tell us anything about how fairly these sanctions have been applied,
how proportionate they are, if they comply with policy and guidance and so on. <o:p></o:p><br />
<br /></div>
<h3 style="text-align: left;">
To conclude</h3>
<h2>
<o:p></o:p></h2>
<div class="MsoNormal">
We now have what appears to be some clear evidence that, at
least for Employment and Support Allowance claimants in the Work Related
Activity Group, people with a primary medical condition of drug and alcohol
misuse are at a disproportionate risk of receiving a sanction, much as
claimants with a primary medical condition of a mental or behavioural disorder
are. Couple that with the findings from DrugScope’s State of the Sector,
research by Homeless Link and Crisis and literature reviews by the Social
Security Advisory Committee and the Joseph Rowntree Foundation, and a picture
emerges of a system that appears to not protect the most vulnerable in society
and may, in fact, be placing them at risk of considerable financial hardship.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Work and Pensions Committee appears to think the same
way. Hopefully, whatever the outcome on 7 May, the next government will accept
their recommendations and make addressing them a priority.<o:p></o:p><br />
<br />
Posted by Paul Anders</div>
<br />
<div class="MsoNormal">
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Paulhttp://www.blogger.com/profile/09369260214429541169noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-999095395378038142015-03-09T17:48:00.000+00:002015-03-09T17:48:34.822+00:00What’s happening to funding for drug and alcohol interventions locally?<em>Roberta Silva is a Policy and Public Affairs Intern working at DrugScope. She is currently working on a project looking into local government funding allocations for substance misuse services. This is the first of a series of occasional posts from Roberta, to update you on the progress of this work. </em><br />
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<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.flickr.com/photos/robjewitt/6483424135/in/photolist-aSVf7K-duLXcz-9VMgvz-6v9EwE-8F8WPH-2e3CNo-6SKbxo-bf3WUR-fD86HM-sSdFT-8Wsjqf-7EfUHM-54PzAu-bf42oe-6v5w4T-8pupSi-9V7k1d-5Sus9W-e96NXv-6SKbGu-7W8S5L-2iRkC-59KrpW-fm3dFK-9kMMvL-iQE4JN-9YonaS-7edumw-bA1yAZ-61pCY7-9YUk3i-dZjoUi-8yzYj3-bVuEj-fMCvC8-6LmKkA-4T15Yf-ejJbCa-iqQiCf-o5f2DJ-7kfeYD-i2SMQF-kEoADi-47g9nR-gYTeNM-cjv9Xw-c9g7k1-8rguVz-7e9BDn-6GJn3r" target="_blank">Love Money?</a>, photo by Flickr user <a href="https://www.flickr.com/photos/robjewitt/" target="_blank">Rob Jewitt</a></td></tr>
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Since April 2013, there have been significant changes in the commissioning and funding of drug and alcohol treatment services. The reforms introduced by the Health and Social Care Act 2012 established Health and Wellbeing Boards in every local authority and shifted the responsibility to them to produce Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies (JSNA and JHWS) for every area (see DrugScope’s <a href="http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/PublicHealthReform.pdf">The Public Health Reforms</a>).<br />
<br />
A JSNA is an assessment of the current and likely future health and social care needs of a local area. They are often lengthy documents and the information from them is used to develop a Joint Health and Wellbeing Strategy (JHWS), which forms the basis of health and care commissioning in local areas. However, these vary hugely from one authority to another.<br />
<br />
There has been lots of talk about changes to funding for drug and alcohol treatment in recent years, but relatively little hard evidence. Although the Department for Communities and Local Government produces actual and projected spend on a range of services twice a year, these figures do not really provide sufficient detail for analysis. Last month, DrugScope’s <a href="http://www.drugscope.org.uk/POLICY+TOPICS/State+of+the+Sector">State of the Sector 2014-15</a> revealed a net average reduction of 16.5%, but that was at a service level, which tells us very little about how local systems are being resourced.<br />
<br />
This project is an attempt to shed some light on what’s really happening in terms of funding. It consists of two components. The first is a scan of all 150 or so JHWSs in England, to try to ascertain the inclusion and/or prioritisation of drugs and alcohol. As there’s no standard template – or length – of JHWS, this has involved scanning of each strategy and then assigning the prioritisation given to one of three values for each of adult alcohol interventions, adult drugs interventions and young people’s substance misuse interventions. We should acknowledge that the assignment of prioritisation is inherently subjective – many areas have not marked drugs and/or alcohol explicitly as a priority, but do make a number of references to the issue, for instance referring to substance misuse in the context of the whole population, specialist interventions, the night time economy or a mixture of the three. We’ll consider carefully how best to report these findings.<br />
<a name='more'></a><br />
Secondly, in order to understand the changes in funding allocations, we are obtaining detailed financial and supporting information about the allocation of funding to specific elements of substance misuse treatment. Through Freedom of Information Act requests made to all commissioning local authorities, the plan is to compile a picture of the changes in funding allocations over the years 2013/14, 2014/15 and 2015/16.<br />
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Of the strategies I have looked at so far, it is noticeable how much they vary - not only in style, size and approach, but also in tone. While some are single page documents listing the Council’s priorities for the coming months or years, others give in depth accounts of issues affecting the local area and discuss ways to overcome problems. The need to address substance misuse is recognised in most JHWSs, though approaches vary.<br />
<br />
While there is an emphasis on service provision in some cases, the integration of drug and alcohol services was also observed, either as an amalgamation of the two services, or as integration into wider health areas such as mental health. Understanding alcohol consumption as a population-level concern was common to many strategies. Consequently, these tended to focus on prevention strategies or educational programmes more than on the provision of specialist treatment.<br />
<br />
The same applies (although possibly not to the same extent) to the inclusion of drug misuse in assessments and strategies. Health and Wellbeing Boards are clearly trying to find the right balance between prevention and education and specialist treatment. There are a few strategies that address both acute and “lifestyle” drug and alcohol issues. Further investigation would be required to see if strategies’ priorities and content correlate with the known drug and alcohol issues in an area or region. Public bodies have 20 working days to respond to FOI requests we have submitted. As we’ve started out by making requests to a small number of authorities, to ensure that we get the question right, we’ve had limited responses so far. The ones we’ve received, though, suggest that the question will elicit the information we – and stakeholders in specialist treatment – need.<br />
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The report will be published later in the year. In the meantime, I will be providing occasional updates via this blog. If anyone would like any additional information, please contact me by email at <a href="mailto:robertas@drugscope.org.uk">robertas@drugscope.org.uk</a>.Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-32969420631558259242015-02-23T09:40:00.001+00:002015-02-23T09:40:21.860+00:00Bite-sized Briefing - Take-home naloxone for opioid overdose in people who use drugs<b><i>As part of the support we offer our members DrugScope's policy team send out a monthly round-up and précis of reports which we believe are of interest to the field. The following is offered as an example of the content of our Bite-sized Briefing for January.</i></b><br />
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<tr><td class="tr-caption" style="text-align: center;">Case Study of steps to take to introduce <br />
a take-home naloxone scheme</td></tr>
</tbody></table>
Public Health England have produced a document giving advice to local authorities and others on promoting the wider availability of the overdose medicine naloxone.<br />
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The paper sets out the current position on supplying naloxone saying that it can be prescribed to anyone who is: currently using illicit opiates (such as heroin); receiving an opioid substitution therapy; leaving prison with a history of drug use; those who have previously taken opiates (in order to prevent relapse). Equally importantly, if the person who has been supplied naloxone agrees then it can also be supplied to family members, carers, peers and friends. They do warn that:<br />
<blockquote class="tr_bq">
Regardless of how naloxone is provided locally, information on the risks of overdose and how to respond in an emergency should be available to all those at risk, their carers and families, and staff.</blockquote>
Freedom of Information requests by Release and the National Needle Exchange Forum show that one in three local authorities are currently providing take-home naloxone.<br />
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Changes to the regulations which will make it even easier to make naloxone more widely available are being drafted by the Medicines and Healthcare products Regulatory Agency (MHRA) and will come into force in October 2015. PHE suggest that the new regulations will mean “naloxone is made exempt from prescription only medicine requirements when it is supplied by a drug service commissioned by a local authority or NHS.”<br />
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The paper includes steps that local authorities or others interested in making naloxone more widely available may wish to take, based on the experience of Birmingham which has had a take-home scheme since 2012. There is also: an outline of the issues that need to be covered in training in overdose prevention; advice on recording how naloxone is supplied; and a reminder that naloxone is just one way to reduce drug related deaths.<br />
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Download the paper <a href="http://www.nta.nhs.uk/uploads/take-home-naloxone-for-opioid-overdose-feb-2015.pdf">here</a>.<br />
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<i><b>If you would like to join DrugScope you can do so <a href="http://www.drugscope.org.uk/membership/join.htm">here</a>.</b></i></div>Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-39226963865241435962015-02-20T11:00:00.001+00:002015-02-20T11:12:35.708+00:00What does a good life mean to you?It might mean having a safe and secure home; forming respectful and trusting relationships; or experiencing new places and activities. In fact, I'd be surprised if at least one of those didn't feature in your answer.<br />
<a href="http://4.bp.blogspot.com/-d3V4P7R0rtY/VOcRaqa45gI/AAAAAAAAABM/vWvMHLIIcnk/s1600/good-life%2B(3)_Page_15_Image_0002.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-d3V4P7R0rtY/VOcRaqa45gI/AAAAAAAAABM/vWvMHLIIcnk/s1600/good-life%2B(3)_Page_15_Image_0002.jpg" height="257" width="320" /></a><br />
<div style="text-align: right;"></div>Recently researchers from Revolving Doors Agency asked members of their national service user forum – all of whom have experience of multiple needs, including drug and alcohol misuse – to think about this question.<br />
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They produced collages (right, and below) that represented their ideas of a good life, and then talked through them. A report describing the process was <a href="http://www.revolving-doors.org.uk/documents/good-life/">published yesterday</a>, and makes for a fascinating read. Looking through it, a few things occurred to me.<br />
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Firstly, those basic components of the good life I mentioned earlier are as important to people facing complex situations such as drug dependency as anyone else – and arguably more so.<br />
<br />
This should be obvious, but often our public debate treats people with serious problems as if they can only be defined in terms of what's gone wrong. Ask people what they want to achieve, though, and you get a very different response. For instance, one participant said:<br />
<blockquote class="tr_bq">“That’s just … what I would like, to be able to, sleeping easy at night, not worrying, security, not worrying, just to be able to feel safe in my own house, not having the door banging in or, yeah bailiffs, no police, no dealers, no owing money, just … happy place."</blockquote>Secondly, work is a hugely important part of this picture. One person, talking about their job, said: “I respect myself, I feel good cos I’m one of the workers coming home from work and life’s normal.”<br />
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This echoes the findings of our project with Making Every Adult Matter, <a href="http://meam.org.uk/voices/">Voices from the Frontline</a>. Many people with experience of multiple needs see meaningful work as a central goal - even if they're some distance from full-time employment.<br />
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Finally, it made me think about the role of treatment services. Some people involved in the study felt that an important step towards the life they wanted was ceasing to be dependent on services. However, others recognised the value of the strong, positive relationships that they formed through accessing them.<br />
<br />
The recovery movement rightly acknowledges the importance of creating a supportive community within which people can resolve their challenges. Sometimes, though, this comes with strong expectations about the manner in which people need to change their lives, and at what speed.<br />
<br />
<a href="http://2.bp.blogspot.com/-xzyoCNZiizE/VOcS6NRwlaI/AAAAAAAAABY/DzyX7N3MreU/s1600/good-life%2B(3)_Page_01_Image_0006.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-xzyoCNZiizE/VOcS6NRwlaI/AAAAAAAAABY/DzyX7N3MreU/s1600/good-life%2B(3)_Page_01_Image_0006.jpg" height="255" width="320" /></a>The report concludes (and for what it's worth, I agree) that as far as possible, someone seeking help must decide for themselves what a better life looks like. That requires a support system that can reconcile professionals' views on what’s most important – reducing drug use, getting a home, getting a job – with people's own personal goals.<br />
<br />
(Importantly, it also provides reason to think that coercing people into accessing treatment, <a href="http://drugscope.blogspot.co.uk/2015/02/sick-and-sanctioned.html">as has recently been proposed</a>, is unlikely to help people achieve lasting change.)<br />
<br />
It follows from this that the system mustn't put barriers in the way of success. Through our work on Voices from the Frontline, we've seen how the unintended consequences of government policy can hold people back from realising the kind of life they want to lead. This valuable research helps strengthen the case for why that has to change.<br />
<br />
<i>Sam Thomas is the programme manager for <a href="http://meam.org.uk/voices/">Voices from the Frontline</a>. Follow him on Twitter <a href="http://twitter.com/iamsamthomas/">@iamsamthomas</a></i>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-86211648368453812622015-02-17T11:51:00.001+00:002015-02-17T11:59:42.749+00:00Education Select Committee calls for PHSE to be made statutory<div class="MsoNormal">
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<tr><td class="tr-caption" style="text-align: center;"><a href="https://www.flickr.com/photos/kgnixer/6779226431" target="_blank">Life Lessons</a>, photo by Flickr user <span style="font-size: 12.8000001907349px;"><a href="https://www.flickr.com/photos/kgnixer/" target="_blank">niXerKG</a></span><br />
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DrugScope welcomes the <a href="http://www.publications.parliament.uk/pa/cm201415/cmselect/cmeduc/145/145.pdf">Education
Select Committee’s recommendation</a> to make Personal Health Social and
Economic education a statutory part of the national curriculum.<o:p></o:p></div>
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As we said in <a href="http://data.parliament.uk/WrittenEvidence/CommitteeEvidence.svc/EvidenceDocument/Education/Personal,%20Social,%20Health%20and%20Economic%20Education%20and%20Sex%20and%20Relationships%20Education%20in%20Schools/written/10150.html">our
evidence</a> to the committee, despite sustained and important falls in both the
prevalence and problems that young people face as a result of their drug and
alcohol use, young people in England are amongst the mostly likely to have been
drunk before the age of 13 years old. </div>
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<o:p></o:p></div>
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Addressing these risks in a developmental way is an
important component of an effective preventative response and so we are pleased
to support the call for PSHE to be a mandated part of the school curriculum.<o:p></o:p></div>
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This year <a href="http://www.nta.nhs.uk/uploads/young-peoples-statistics-from-the-national-drug-treatment-monitoring-system.pdf">Public
Health England report that</a> more than a quarter of all those under 18 who
entered drug treatment were identified and referred to specialist services by schools,
colleges and pupil referral units; over half were engaged in mainstream
education and a further one in five were in alternative education. <o:p></o:p></div>
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PSHE education can help support pupils in developing the
values they bring to health decisions, and in developing the resilience that
will allow them to bounce back when mistakes are made.<o:p></o:p></div>
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Earlier this year the <a href="https://www.gov.uk/government/publications/new-psychoactive-substances-review-report-of-the-expert-panel">new
psychoactive substances expert panel</a> made a similar recommendation, for
PSHE to be given statutory status, DrugScope hopes that the government will now
listen to the evidence collected by the Education Select Committee.</div>
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<o:p></o:p></div>
Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com3tag:blogger.com,1999:blog-8803410488510287958.post-62280439865007181922015-02-16T13:58:00.000+00:002015-02-16T13:58:13.267+00:00Sick and sanctionedHow do we best engage people with drug and alcohol problems but who seem unwilling to enter treatment? The debate has been <a href="http://www.bbc.co.uk/news/uk-31464897" target="_blank">re-ignited</a> again this weekend by a proposal by the Conservatives that, should they win the next election, Dame Carol Black will be asked to look at whether those on sickness benefits with drug, alcohol and obesity issues should have those benefits reduced if they refuse treatment.<br />
<br />
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<a href="http://3.bp.blogspot.com/-v5Bcx6s5JJc/VOHNOOG97vI/AAAAAAAAe6Y/6v0F93rbFnA/s1600/sickness.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://3.bp.blogspot.com/-v5Bcx6s5JJc/VOHNOOG97vI/AAAAAAAAe6Y/6v0F93rbFnA/s1600/sickness.png" height="300" width="400" /></a></div>
A recent <a href="https://www.gov.uk/government/publications/statistics-on-ibsda-and-esa-claimants-obesity-alcohol-or-drug-misuse-severe-stress">Freedom of Information request</a> to the DWP indicates that there are about ninety thousand people claiming sickness benefits where drug and alcohol problems are their most significant issue; but it isn't clear how many of those are not engaged in treatment already.<br />
<br />
As <a href="http://www.theguardian.com/politics/2015/feb/14/david-cameron-obese-addicts-accept-help-risk-losing-benefits">the Guardian</a> in their coverage of the proposals makes clear, this isn't the first time these sorts of ideas have entered the political debate. Last year saw <a href="http://www.telegraph.co.uk/news/politics/conservative/10964125/Tories-discuss-stripping-benefits-claimants-who-refuse-treatment-for-depression.html">similar ideas</a> proposed in relation to those claimants with mental health problems though those have not resurfaced in this proposal.<br />
<br />
The Guardian's report points out that DrugScope has been critical of previous moves to introduce benefit sanctions on people with drug and alcohol problems, both <a href="http://www.drugscope.org.uk/Media/Press+office/pressreleases/DS-response-benefit-cut">under this government</a> and <a href="http://www.drugscope.org.uk/events/currentnewspages/White_Paper_joint_letter">the previous one</a>. <br />
<br />
Indeed it has been <a href="http://www.cesi.org.uk/blog/2015/feb/government-got-it-right-drugs-and-welfare-2010-%E2%80%93-where-was-%E2%80%98radical-rethink%E2%80%99" target="_blank">pointed out to us</a> that this government explicitly ruled out the approach they are now proposing, with Lord Freud <a href="http://www.publications.parliament.uk/pa/ld201011/ldhansrd/text/111110-gc0001.htm" target="_blank">telling the House of Lords</a>:<br />
<blockquote class="tr_bq">
First, it mandates claimants to do something, such as being tested for drugs, that is not directly about helping people to approach the labour market. That does not mean that entering treatment is not the right approach to help many claimants who are substance dependent to address their barriers to work, but-and this leads to my second reason-claimants enter treatment for a series of complex reasons, and whether or not they succeed also depends on a series of complex reasons. Forcing claimants to answer, for example, questions about possible drug use, requiring them to attend substance-related assessments about drug use and insisting that claimants enter a mandatory rehabilitation plan if they decline to enter treatment voluntarily would be asking them to do something a large proportion of them would not want to do. If we took the approach of the previous Government, we would create a high risk of those claimants immediately failing these requirements and having to be sanctioned.<a name='more'></a></blockquote>
Changes to the welfare system introduced in this Parliament (including the increased use of sanctions) on those already in treatment is an issue that our <a href="http://meam.org.uk/wp-content/uploads/2013/04/DRGJ2700_MEAM_report_11.14_WEB.pdf" target="_blank">Voices from the Frontline project</a> and recent <a href="http://www.drugscope.org.uk/POLICY+TOPICS/State+of+the+Sector.htm">State of the Sector report</a> suggests has been very detrimental for some. One service manager told us:<br />
<blockquote class="tr_bq">
The welfare reform agenda has hit our service users very hard. The biggest issues are the length of time to process and change benefits, sanctions, capability assessments, appeals etc. People have been left without money for weeks. The demand for food parcels completely outstrips supply.</blockquote>
Another said:<br />
<blockquote class="tr_bq">
These people are being sanctioned – benefit sanctions or their health benefits get stopped or something like their council tax benefit are stopped and then it’s a battle with the DWP to get their benefits back. There’s no doubt – and we do have to examine the figures this year – but our suicide rates are shooting up and the Board is very concerned. They’re getting more serious and untoward incident reports than they’ve ever had. It’s probably the highest ever volume, this year.</blockquote>
DrugScope has consistently <a href="http://www.drugscope.org.uk/Media/Press+office/pressreleases/DS-response-benefit-cut">argued</a> that sanctions raise the risk that people will disengage from support services, potentially worsening their dependency and with additional impacts on their families and communities. We have also argued that they would be against the requirement of informed consent, as set out in the <a href="http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overview.aspx">NHS constitution</a> which makes clear:<br />
<blockquote class="tr_bq">
<strong>You have the right </strong>to accept or refuse treatment that is offered to you, and not to be given any physical examination or treatment unless you have given valid consent.</blockquote>
And reiterated by the current Chair of the Health Select Committee Dr Sarah Wollaston:
<br />
<blockquote align="center" class="twitter-tweet" lang="en" width="800">
I have sent an urgent letter to No10. We absolutely cannot implement coercive consent to treatment because that is NOT consent to treatment!<br />
— Sarah Wollaston MP (@sarahwollaston) <a href="https://twitter.com/sarahwollaston/status/566643905744347136">February 14, 2015</a></blockquote>
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script><br />
The UK Drug Policy Commission in <a href="http://www.ukdpc.org.uk/wp-content/uploads/Article%20-%20Employers'%20readiness%20to%20recruit%20problem%20drug%20users.pdf">a paper on employers’ readiness to recruit problem drug users</a> looked for evidence that, even if the ethical barriers could be overcome, conditionality would be an effective policy option and said:<br />
<br />
<blockquote class="tr_bq">
We were unable to find any convincing examples to demonstrate that making benefits conditional upon engagement with treatment would be effective at improving outcomes.</blockquote>
This is repeated in a JRF paper on <a href="http://www.jrf.org.uk/sites/files/jrf/Welfare-conditionality-UK-Summary.pdf">welfare sanctions and conditionality in the UK</a> which also pointed to evidence that existing sanctions are associated with the rise in the use of food banks and other material hardships and are:<br />
<blockquote class="tr_bq">
associated with negative physical and mental health outcomes, increased stress and reduced emotional wellbeing.</blockquote>
<div>
So if coercion has the potential to damage the chances of treatment succeeding and sanctions may already be leading to those in treatment failing in their attempts to recover from their problems, what might be a more positive agenda for those on sickness benefits?</div>
<ul>
<li>Concentrating on getting the basics right is likely be more effective as introducing new sanctions. We know that where Job Centre Plus and treatment providers work in close cooperation, really strong results can be achieved. For example, one London JCP district achieves more disclosure of substance misuse and also more claimants supported into employment than the other three combined.</li>
</ul>
<ul>
<li>Government should await the evaluation of the <a href="https://www.gov.uk/government/news/pilot-schemes-to-help-people-on-sickness-benefits-back-to-work">ESA healthcare professional led pilots</a>; these might offer a clearer idea of what type of intervention and provider works best in engaging people with treatment and health interventions while avoiding most of the ethical problems referred to above.</li>
</ul>
Whatever the regime it will be important to consider the unintended consequences on the health and wellbeing of those involved.<br />
<br />
As DrugScope highlighted on this blog only weeks ago <a href="http://drugscope.blogspot.co.uk/2015/01/half-picture-beyond-drug-overdose-as.html">some drug users are very vulnerable indeed</a> and further barriers to effective engagement could increase health inequalities for this group.Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com7tag:blogger.com,1999:blog-8803410488510287958.post-82892668057092288802015-02-04T15:17:00.000+00:002015-02-04T15:17:11.617+00:0010 Interesting Things about Alcohol and Other Drugs (February 2015)We scour the data on alcohol and other drugs and here are 10 things we found in the last month that might interest you, including:<div>
<ul>
<li>Deaths amongst opioid users (especially those which are not overdose related); </li>
<li>Children in need and care and substance use problems; </li>
<li>Multiple and complex needs; </li>
<li>Trends in police recorded drug offences; </li>
<li>Gang membership, dependency and mental health problems; </li>
<li>Seizures of synthetic cannabinoids in prison; </li>
<li>Public perceptions of the safety of drug taking </li>
</ul>
<br />
<iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/44263814" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> <br />
<br />
As always any misinterpretation of the data you spot are down to me (and please do let me know so that I can fix them).</div>
Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-65895004623015647252015-01-30T17:36:00.002+00:002015-01-30T17:36:54.957+00:00PHE's Duncan Selbie gives evidence to the Public Accounts Commitee<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">By Richard Clifton</span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">Almost two years ago, Public
Health England (PHE) began operating with a mission to improve wellbeing and
reduce health inequalities across the country. £2.7 billion of ring-fenced
grants were given to local authorities in 2013/14 to improve public health,
including the provision of drug and alcohol treatment and related
interventions. The National Audit Office (NAO) </span><a href="http://www.nao.org.uk/wp-content/uploads/2014/12/Public-health-england%E2%80%99s-grant-to-local-authorities.pdf"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">produced
a report</span></a><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"> in December 2014 evaluating whether intended outcomes and
value for money were likely to be achieved. </span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">On the 20<sup>th</sup> January, the
chief executive of PHE, Duncan Selbie, and three others (Dr Felicity Harvey
from the Department of Health, Michael Brodie from PHE and Dr Janet Atherton
from the Association of Directors of Public Health - ADPH) were called to give
evidence to the Public Accounts Committee. DrugScope provided a short briefing
to the Committee ahead of the evidence session, focusing on key findings from
the forthcoming State of the Sector 2014-15 report and emphasising the breadth
and depth of the contribution made to improved public health by the
drug/alcohol treatment sector.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">The committee voiced concerns
about the allocation of public health resources. The committee cited a survey
conducted by the British Medical Association (BMA) which suggested that some
public health funding had been diverted to support services – not necessarily
public health services as usually understood - that would otherwise have faced
cuts due to reductions in local authority revenue funding. Margaret Hodge
argued that this could potentially lead to a lost opportunity to improve public
health.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"> Duncan Selbie insisted that the grants were
not substitutes for general revenue funding, but that local authorities had
flexibility to spend money where it was most required and the allocations were
best decided at a local level. Importance was placed on authorities using
public health grants to achieve beneficial outcomes at a local level and
assessed against local need. There is a mandate for an equitable service, but
services should be prioritised based on the needs of individual areas.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">Witnesses were asked to
explain PHE’s position in relation to NHS England, local authorities and the Department
of Health. The committee focussed on a number of different aspects throughout
the session: how PHE can work to influence local decisions; how it can
influence national allocations, and around the role of mandation in ensuring
the effective and universal delivery of services and interventions. <o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">The committee also raised the
matter of the ring fence around the public health grant. Having already
expressed concerns about its porosity, members were keen to seek views on the
future of the ring fence, given that is currently only guaranteed to be in
place until the end of 2015-16. Although Selbie has previously </span><a href="http://www.ehn-online.com/news/article.aspx?id=11136"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">called</span></a><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"> for
the ring fence to remain in place beyond 2015-16, on this occasion the
consensus among witnesses was that it was a matter for an incoming government.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">Selbie argued that health and
wellbeing should not be solely conflated with the NHS; and that public health
must be considered within the wider context of both economic and environmental
issues. In his view, economic prosperity was the biggest health driver and Margaret
Hodge agreed that employment, education and housing are all important. However,
the committee was keen to focus on areas PHE directly control and witnesses
were asked about PHE’s influence at both a local and national level.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
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<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">Drug
and alcohol misuse initiatives receive a third of the public health budget, and
so were discussed in a number of contexts during the select committee. While
not being included as prescribed functions for local authorities, there are
grant conditions in place for substance misuse – a matter that was of some
interest to David Burrowes MP, who co-chairs the </span><a href="http://www.turning-point.co.uk/for-professionals/appg.aspx"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">APPG
on Complex Needs and Dual Diagnosis</span></a><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"> with Lord (Victor) Adebowale
of Turning Point. Selbie stated that treatment for substance misuse was not
included as a prescribed function due to the variation in need across different
authorities and that prioritisation must therefore be local. Referring again to
the NAO report, Margaret Hodge observed that when less funding is allocated to
drug and alcohol misuse, outcomes are worse.<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 45.75pt; text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal" style="tab-stops: 45.75pt; text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">There
was discussion about using the health premium to reward local authorities
producing successful results in public health, for which drug treatment is the
only national indicator. Like the grant condition, the health premium is new in
2015-16 and is seen as one of the key
mechanisms to incentivise and maintain investment in treatment.. The committee
expressed concern that the health premium, limited to £5m nationally, might offer
only a modest incentive to improve outcomes. Dr Harvey agreed with the
importance of an incentive programme and stated the premiums available would
increase after a spending review. <o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 45.75pt; text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal" style="tab-stops: 45.75pt; text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">Selbie
was especially passionate about plain packaging for cigarettes and minimum-unit
pricing for alcohol, discussing his desire for a tobacco-free country in the
future. He stated that PHE fully support measures to reduce demand for and harm
from the two substances due to compelling evidence, and it is down to parliament
to pass laws and garner support for harm reduction measures.<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 45.75pt; text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;"><br /></span></div>
<div class="MsoNormal" style="tab-stops: 45.75pt; text-align: justify;">
<span style="font-family: "Arial",sans-serif; font-size: 12.0pt; line-height: 107%;">As
2013/14 was the first full year of PHE, it was too early to identify if public
health outcomes were improving, subsequent years should yield more meaningful
data to compare against the baseline. The Public Health Outcomes Framework was
acknowledged as a key development in this area. Other examples of effective
interventions were provided: PHE’s emergency MMR catch-up vaccinations led to a
reduction in the number of measles cases from 673 in the first quarter of 2013
to 70 in the same period of 2014. The ‘Stoptober’ smoking cessation campaign,
designed and supported by PHE was successful as well, with a University College
evaluation finding it to be cost effective and that it had saved 10,000 years
of life.<o:p></o:p></span></div>
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Paulhttp://www.blogger.com/profile/09369260214429541169noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-86087648985381489342015-01-28T15:49:00.000+00:002015-01-28T16:23:39.054+00:00Half the picture – beyond drug overdose as a cause of death in opioid using peopleThe big rise in heroin and other opioid drug poisonings that the <a href="http://www.ons.gov.uk/ons/rel/subnational-health3/deaths-related-to-drug-poisoning/england-and-wales---2013/stb---deaths-related-to-drug-poisoning-in-england-and-wales--2013.html#tab-Key-Findings" target="_blank">ONS reported</a> last year has been real focus of concern amongst service providers, policy makers and anyone who cares about the lives of vulnerable people.<br />
<br />
But <a href="http://www.drugandalcoholdependence.com/article/S0376-8716(14)01844-4/pdf">new research</a> from the University of Manchester suggests that while overdoses in opioid users remains the largest cause of death (43%) there are other causes which providers, commissioners and policy makers need to be conscious of particularly amongst older drug users.<br />
<br />
Dr Tim Millar who led the research <a href="http://blogs.mhs.manchester.ac.uk/news-hub/2015/01/27/age-concern-in-largest-ever-study-of-heroin-user-deaths/">says</a>,<br />
<blockquote class="tr_bq">
“<i>It is apparent that older users of opioids are one of the most vulnerable groups in society.</i>”</blockquote>
Looking at the paper it’s easy to see why.
<br />
<a name='more'></a><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://2.bp.blogspot.com/-QdyQS9v6g8Q/VMkBUmDcF5I/AAAAAAAAe5U/zI5OJnZdLIo/s1600/opioid%2B-%2Bdeaths.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://2.bp.blogspot.com/-QdyQS9v6g8Q/VMkBUmDcF5I/AAAAAAAAe5U/zI5OJnZdLIo/s1600/opioid%2B-%2Bdeaths.png" height="204" width="320" /></a></div>
The researchers have examined data on 198,247 individuals over 541,891 person years between April, 2005 and March, 2009 and find that there were more than <strong>five and a half times</strong> the number of deaths amongst opioid users than would be expected in the general population.<br />
<br />
Their research suggests that older users are much more vulnerable to both overdose and a number of other diseases than both the general population and their younger peers.<br />
<br />
This research makes clear that 15% of the deaths not categorised as drug-related poisonings were caused by liver disease. The majority were alcoholic liver disease (72%) where the opioid users were <b>7 times more likely</b> to be affected by the disease than the general population.<br />
<br />
Fibrosis and cirrhosis of the liver was also a significant factor in the deaths observed in the study (19% of liver disease deaths amongst the cohort). The researchers found that the chances of being affected by this increased dramatically amongst older opioid users. Younger users (18-34 years) were just under three times more likely to die of fibrosis and cirrhosis of the liver as the general population, but this rose to 6 times for the 35 to 44 year olds, and then to 14 times for the 45-64 year old opioid users captured in the data sets examined by the researchers.<br />
<br />
<ul>
<li>2 in 5 injecting drug users are living with Hepatitis C</li>
</ul>
<br />
There is increasing focus on smoking related diseases by substance use services – for example Turning Point worked with Public Health England on <a href="http://www.turning-point.co.uk/news-and-events/news/turning-point-launches-smoking-cessation-pilots.aspx">smoking cessation pilots</a> in six of their services last year. The data from the Manchester University research suggests that there are higher rates of death amongst opioid users as a result of circulatory system diseases (3.1 times higher), respiratory system problems (8.9 times higher), and cancer (1.8 times higher), which makes this focus an imperative.<br />
<a href="http://2.bp.blogspot.com/-WX0HnDXh8Jc/VMkBb74GE4I/AAAAAAAAe5c/2cR0uEGBhYE/s1600/opioid%2B-%2Bmurder.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-WX0HnDXh8Jc/VMkBb74GE4I/AAAAAAAAe5c/2cR0uEGBhYE/s1600/opioid%2B-%2Bmurder.png" height="204" width="320" /></a><br />
Worryingly the research found that rates of <b>homicide were 12 times higher</b> in opioid users than in the general population, and that was markedly higher amongst older opioid users.<br />
<br />
The rate of homicides in the United Kingdom during the period of the study was <a href="http://data.worldbank.org/indicator/VC.IHR.PSRC.P5">1 per 100,000</a> of population. Younger users (18-34 years) were more than 8 times as likely to be murdered; those between 35 and 44 more than 15 times; and for those between 45 and 64, they were a staggering 27 times more likely to be murdered than the general population.<br />
<br />
Suicide rates were also much higher than might be expected with rates of <b>between three and four and a half times higher</b> than the general population.<br />
<br />
DrugScope’s <a href="http://www.drugscope.org.uk/POLICY+TOPICS/OlderPeople">policy work on older drug users</a> makes the following recommendations:<br />
<ul>
<li>A range of interventions are needed for older people with substance use problems, from age-appropriate, non-time limited treatment and support for those who are drug and/or alcohol dependent, to brief interventions for those who are drinking at risk. Support for those with problems with prescription and/or over-the-counter medications also needs to be available.</li>
<li>Many of the services we visited during the research process for the briefing were delivering positive outcomes but faced a discontinuation of their funding. Independent and statutory funders and commissioners need to recognise the importance of services and interventions for older people and to consider options for sustainable funding going forward, particularly as research indicates increased prevalence and need.</li>
<li>Substance misuse services can implement a range of measures to help ensure the accessibility and relevance of services for older people, including specific groups or times for older people, satellite services operating out of community provision aimed specifically at older people – for instance, local support groups – and home visits.</li>
<li>Older people with substance misuse problems may come into contact with a number of health and social care professionals, including those working in primary care settings, older people’s mental health services, residential services, and for social care providers. With particular reference to alcohol, these professionals should be trained to deliver brief interventions (IBA) and ‘sensible drinking’ advice to those who are not dependent, but are drinking at risk. Links with specialist support should be developed for referral of those with serious substance misuse problems.</li>
</ul>
Read our report <a href="http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/ItsAboutTimeWeb.pdf">It’s about time: Tackling substance misuse in older people</a>Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-82285685473838712082015-01-28T13:46:00.000+00:002015-01-28T13:46:42.320+00:00Bite-sized Briefing - Nations apart? Experience of single homeless people across Great Britain<b><i>As part of the support we offer our members DrugScope's policy team send out a monthly round-up and précis of reports which we believe are of interest to the field. The following is offered as an example of the content of our Bite-sized Briefing for January.</i></b><div>
<b style="background-color: white; color: #666666; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14.3000001907349px; line-height: 20.0200004577637px;"><i><br /></i></b>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-XQ1BYdZ1PG0/VMjnvapsjtI/AAAAAAAAe5E/QDGCONTbwO0/s1600/Crisis%2B-%2BNations%2BApart.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Nations Apart - experiences of single homeless people across Great Britain" border="0" src="http://3.bp.blogspot.com/-XQ1BYdZ1PG0/VMjnvapsjtI/AAAAAAAAe5E/QDGCONTbwO0/s1600/Crisis%2B-%2BNations%2BApart.png" height="320" title="Nations Apart?" width="226" /></a></div>
A new report from the homelessness charity <a href="http://www.crisis.org.uk/" target="_blank">Crisis</a> provides a profile of the single homeless population in Great Britain.<br />
<br />
It draws on Freedom of Information requests to local authorities, a survey of 480 single homeless people across 17 local authorities, as well as detailed follow-up interviews.<br />
<br />
Key findings from the survey results include:<br />
<ul>
<li>48% of homeless people have faced drug dependency and 46% alcohol dependency at some point in their lives (pp. 11-12)</li>
<li>People are more likely to have multiple support needs if they have experienced several homeless experiences (p. 28)</li>
<li>The proportion of homeless people experiencing alcohol dependency increases steadily with age, while drug dependency is consistently high between the ages of 21 and 50 (p. 14)</li>
</ul>
The in-depth interviews also provide evidence that:<br />
<ul>
<li>Where people become homeless when asked to leave accommodation by friends or family, this often follows a “lengthy period of difficulty revolving around their substance misuse” (p. 24)</li>
<li>“Where positive support provision was reported it generally related to provision by the third sector and particularly those involved in addressing substance misuse issues” (p. 44)</li>
</ul>
<a href="http://www.crisis.org.uk/research.php?fullitem=425">Read the full report</a><br />
<br />
<b><i>If you would like to join DrugScope you can do so <a href="http://www.drugscope.org.uk/membership/membershipbenefits">here</a>.</i></b></div>
Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-29911050962393791762015-01-22T17:53:00.000+00:002015-01-22T17:58:50.100+00:00"I might go back to knitting after all" (or: Why innovation isn't always the answer)I was in Westminster this morning for a speech by the incoming Minister for Civil Society, Rob Wilson MP. Charity bosses will have been watching with interest – partly because these are challenging times, but perhaps more because of a handful of tone-deaf comments his predecessor made about the role of charities in public life. Such is politics.<br />
<blockquote align="right" class="twitter-tweet" lang="en" width="250">Charities have ability to tackle disadvantage - Gov needs to make sure they're supported, <a href="https://twitter.com/RobWilson_RDG">@RobWilson_RDG</a> <a href="http://t.co/Bkpqu1dGsl">pic.twitter.com/Bkpqu1dGsl</a><br />
— CentreSocialJustice (@csjthinktank) <a href="https://twitter.com/csjthinktank/status/558223730686824448">January 22, 2015</a></blockquote><script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script><br />
No such provocation from Wilson, who – in a detailed if unremarkable speech – set out his stall. What the third sector needs, he argued, is support for innovative organisations to grow (more on that in a second); better opportunities for charities and social enterprises to bid for public sector contracts; and more action to encourage public and corporate giving.<br />
<br />
Shadow Minister Lisa Nandy and others <a href="https://twitter.com/lisanandy/status/558240287819321344">picked up</a> on Wilson’s reference to a ‘bigger society’ – but this didn’t strike me as much more than a rhetorical flourish. What was more noticeable was his – and the other panellists – repeated stress on ‘innovation’. I’m never exactly sure what people mean by this, but here I took it be “finding new ways of solving old problems”.<br />
<br />
On the face of it, it’s difficult to argue with that – particularly when some of the old ways aren’t that sustainable. Over recent years, the Cabinet Office has introduced initiatives like the <a href="https://www.gov.uk/government/news/major-boost-to-innovations-that-support-social-action">Social Action Fund</a>, a joint venture with NESTA, designed to support new ideas that can grow bigger, or ‘scale’.<br />
<br />
There’s no doubt that this money is welcome to those receiving it, but where does such a focus leave those charities that don’t particularly want to tear up their existing model, or grow beyond the area they already work in? Many highly effective organisations – especially in the drug and alcohol sector – have a long track record and are highly attuned to local need.<br />
<br />
When I asked the Minister about this, he replied that the Social Value Act – currently under review – ought to help smaller organisations to win public sector commissions. (The review is welcome: I took part in a round-table for it organised by NCVO last November, and my impression was that there’s little evidence of the Act playing this role so far.)<br />
<br />
He also said, though, that successful charities should be expected to scale to help more people. This was challenged by the other panellists – Andrew Barnett from the Calouste Gulbenkian Foundation and Danny Kruger from Only connect – who argued that staying small should be a viable option. Wilson clarified he didn’t expect all charities to grow beyond their local area, but his slightly rattled tone suggested tension.<br />
<br />
It’s easy to understand why politicians and policymakers – not to mention many leaders in the sector – want new ideas and big ambitions: they’re facing real challenges and lack money to throw at them. But venture out of Westminster and many small charities aren’t interested in getting bigger: they want to secure the funding they already have (and fear they may lose).<br />
<br />
Last week, at DrugScope’s regular forum of CEOs and senior managers from drug and alcohol services, many expressed concern about the pressures on their organisations to expand rapidly or merge in order to remain competitive. In particular, there’s growing evidence that smaller substance misuse organisations are disappearing without trace, as their contracts are taken over by larger providers.<br />
<br />
Of course, not all small providers are effective, and often charities grow or merge because it makes sense. But when contracts change hands it’s expensive, puts staff under stress and can disrupt services – which poses big risks for people with severe drug dependency. One question is how we can encourage better subcontracting by large providers, allowing smaller organisations to stay put when they’re doing a good job.<br />
<br />
There’s a place for experimentation and growth in all charities, but to imagine these can or should be the driving principles for everything they do strikes me as misguided. I wonder if the efforts of the Minister and his officials might be equally well directed at improving life for organisations who don’t want to be innovative or huge – just effective.Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-1583951349873480072015-01-19T15:37:00.001+00:002015-01-19T23:27:16.461+00:00Putting numbers to faces: a new map of substance misuse, homelessness and offending in England<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><span style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><a href="http://www.lankellychase.org.uk/news_events/501_new_profile_of_severe_and_multiple_disadvantage_in_england"><img border="0" src="http://3.bp.blogspot.com/-yrw6qvBuQ1M/VL0g5ITyvVI/AAAAAAAAAA8/GeV3eRTV2MY/s1600/LANJ2803_Mapping_multiple_d.jpg" height="320" width="226" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.lankellychase.org.uk/news_events/501_new_profile_of_severe_and_multiple_disadvantage_in_england">New research released today</a></td></tr>
</tbody></table>
Statistics can be a limited and limiting way to understand social issues. When we focus on how many people are affected by a problem, or how much the government spends on tackling it, we start to see numbers instead of people. The opposite is also true, though: without statistical evidence, it’s hard to understand the scale of a problem.<br />
<br />
For instance, we know that a small but significant number of people facing serious problems in their lives bounce between different kinds of support – drug and alcohol treatment, supported housing, mental health services, and sometimes prison.<br />
<br />
However, because these services don’t share information at a national level, it’s hard to know where these individuals’ issues overlap and interact. DrugScope is one of four members of the <a href="http://www.meam.org.uk/">Making Every Adult Matter coalition</a>, which is committed to understanding and improving their lives, not least through <a href="http://meam.org.uk/voices-from-the-frontline/">Voices from the Frontline</a>, the project I’m leading. What we’ve lacked, though, is solid data on the national picture – until now.<br />
<br />
<b>Pioneering <a href="http://www.lankellychase.org.uk/news_events/501_new_profile_of_severe_and_multiple_disadvantage_in_england">new research</a> from Heriot-Watt University, supported by the LankellyChase Foundation, has found that over 250,000 people in England experience problems with homelessness, substance misuse and offending in some combination. A smaller subset, estimated at 58,000 people, experience all three at the same time.</b><br />
<br />
The research team spent several years analysing multiple official datasets – including the National Drug Treatment Monitoring System (NDTMS) – and building a composite picture. <a href="http://www.lankellychase.org.uk/news_events/501_new_profile_of_severe_and_multiple_disadvantage_in_england">Their report out today, <em>Hard Edges</em></a>, provides the most detailed data we have yet on the extent and nature of severe and multiple disadvantage in England.<br />
<br />
One thing is clearer than ever before from their findings: substance misuse features in a majority of people’s experiences of complex needs. Their analysis indicates that at least 190,000 people with a substance misuse issue also have problems with homelessness and/or offending: this is almost exactly the same number who have a substance misuse problem without these complicating factors.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-EnRR3viT5VA/VL0gwobZqwI/AAAAAAAAAA0/AYv5-E3cRPs/s1600/smdgraph.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-EnRR3viT5VA/VL0gwobZqwI/AAAAAAAAAA0/AYv5-E3cRPs/s1600/smdgraph.JPG" height="427" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This diagram estimates the number of people in England experiencing each kind of need, and how they overlap</td></tr>
</tbody></table>
<br />
<br />
It’s worth noting that these figures only cover those in treatment – the authors’ estimate including who are receiving no support for a drug or alcohol issues is even higher.<br />
<br />
<b>What’s more, the research cements what we already know about the strong link between substance misuse and mental health problems. People with a drug or alcohol problem who are not also homeless or offenders have the highest prevalence (58%) of mental health problems in the study. And those who are homeless and/or offenders are much more likely to have a mental health problem if they also misuse drugs or alcohol.</b><br />
<br />
The report also provides a useful corrective to commonplace assumptions. Often, when we think of the most vulnerable in society, we focus on single, homeless men with no family connections. However, through an analysis of NDTMS data, the researchers show that of those with the most complex needs – the 58,000 people who have experience of homelessness, substance misuse and offending together – over 60% either live with children or have ongoing contact with them.<br />
<br />
This echoes what we've heard from our Voices from the Frontline: for many people with complex needs, particularly women, the fear of losing access to children looms large. These findings also give us cause to revisit the Advisory Committee on the Misuse of Drugs’ <a href="https://www.gov.uk/government/publications/amcd-inquiry-hidden-harm-report-on-children-of-drug-users">2003 recommendations</a>, which set out the benefits to children of their parents receiving effective drug treatment.<br />
<br />
<b>More widely, what should the substance misuse sector take from this important research? First and foremost, the challenge it poses cannot be tackled by the substance misuse sector working alone. Better mental health, access to housing and effective offender rehabilitation must all figure in our response to complex needs.</b><br />
<br />
All the same, any response must continue to include high-quality treatment for people with drug and alcohol problems. This treatment needs be made accessible to those who, because of the other problems they experience, cannot or will not access services through traditional routes. One model is provided by the <a href="http://www.themeamapproach.org.uk/">MEAM Approach</a>, which focuses on cross-sector partnership and having dedicated co-ordinators for people with multiple needs.<br />
<br />
The <a href="http://www.lankellychase.org.uk/news_events/501_new_profile_of_severe_and_multiple_disadvantage_in_england">findings in this report</a> will not come as a surprise to substance misuse professionals - but understanding the scale of the challenge can help us make the case for better care.<br />
<br />
<i>Sam Thomas is the programme manager for <a href="http://meam.org.uk/voices-from-the-frontline/">Voices from the Frontline</a> at DrugScope. Follow him <a href="http://www.twitter.com/iamsamthomas/">@iamsamthomas</a> on Twitter.</i>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-23070175240561613332015-01-18T15:51:00.000+00:002015-02-16T12:17:49.375+00:00Drugs and Prison - Statistics from the last yearThis weekend there were <a href="http://www.bbc.co.uk/news/uk-30859350" target="_blank">reports in the media</a> about the increased number of drugs being found in prisons. <br />
<br />
This echoes findings in DrugScope's <a href="http://www.drugscope.org.uk/Media/Press+office/pressreleases/Street-Drug-Trends-2014.htm" target="_blank">Street Drug Survey</a>, published last week, where we reported that many respondents were finding that synthetic cannabinoids were readily available in prisons and many people referred into services from jails came out with dangerous levels of use of the drugs.<br />
<blockquote class="tr_bq">
One drug worker said that inmates at a Liverpool prison had become so used to emergency services being called out when people collapsed after taking Black Mamba that ambulances are now known as ‘the Mambalance’.</blockquote>
The last <a href="http://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2014/10/HMIP-AR_2013-141.pdf" target="_blank">annual report</a> from the HMI for prisons found that around 26% of new arrivals at prison had substance misuse and 19% had alcohol misuse needs. The report makes a number of useful points about substance misuse services in prison:<br />
<ul>
<li>Prisons continued to focus on recovery working, which was appropriate, usually with active peer support and service user engagement. </li>
<li>A quarter of inspected prisons were not focused enough on the needs of prisoners with alcohol problems.</li>
<li>In a minority of services, recovery working was undermined by enforced reduction or inflexible prescribing, which did not adhere to best practice guidelines. </li>
<li>Prison substance misuse services offered psychosocial support to prisoners and clinical management of opiate substitution therapy. However, full psychosocial support was not available in a quarter of services and prisoners’ needs were not met. </li>
<li>Clinical management in most prisons was flexible and catered to individual need. However, some options were limited by the refusal of the prison or SMS provider to prescribe buprenorphine, which was contrary to national guidance.</li>
</ul>
DrugScope will have more to say about prison drug and alcohol services as part of our State of the Sector work.<br />
<br />
The following slides are compilation of the statistics that we've seen over the last year which helps describe some of what is going on about drugs and prisons. <br />
<br />
<br /><iframe src="//www.slideshare.net/slideshow/embed_code/43628999" width="595" height="485" frameborder="0" marginwidth="0" marginheight="0" scrolling="no" style="border:1px solid #CCC; border-width:1px; margin-bottom:5px; max-width: 100%;" allowfullscreen> </iframe>
<br />
<b>Update </b>- Channel 4 have <a href="http://www.channel4.com/news/prisoners-on-instagram-reveal-security-crisis-behind-bars-contraband-drugs-knives" target="_blank">uncovered</a> some new information through social media accounts of current prisoners:<br />
<br />
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<li>The number of high risk drug users, </li>
<li>Police estimates of the cost and purity of drugs, </li>
<li>Trends in property crime, and how drug services may have contributed to it's decline</li>
<li>Numbers in treatment in Wales, </li>
<li>Benefit claimants with drug problems in Scotland (and alcohol problems across the UK), </li>
<li>Detection of drugs in prison, and </li>
<li>The support needs of single homeless people</li>
</ul>
<div>
<br /></div>
<iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/43516008" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> <br />
<br />
As always any misinterpretation of the data you spot are down to me (and please do let me know so that I can fix them).Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-48396908563909839842015-01-15T10:12:00.001+00:002015-01-15T11:23:31.923+00:00Briefing - Mental health and substance misuseDrugScope has produced this briefing ahead of a debate on mental health being held in the House of Lords today.<br />
<br />
There is a close relationship between mental ill health and problems with drugs and alcohol.<br />
Where these issues co-exist (often referred to as ‘dual diagnosis’) people experience <a href="http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf" target="_blank">poorer outcomes</a> – including high rates of relapse, hospitalisation and completed suicide.<br />
<br />
A <a href="http://bjp.rcpsych.org/content/183/4/304.full" target="_blank">2002 study</a> found that:<br />
<br />
<ul>
<li>75% of users of drug and 85% of alcohol services experienced mental health problems</li>
<li>Conversely, 44% of mental health service users reported drug use or harmful alcohol use</li>
<li>38% of drug users with a psychiatric disorder were receiving no treatment for it</li>
</ul>
<br />
The Department of Health issued <a href="http://www.rcn.org.uk/downloads/professional_development/mental_health_virtual_ward/treatments_and_therapies/cmhtguidancepdf.pdf" target="_blank">guidance</a> that year establishing that mental health services should lead on providing integrated care, working closely with substance misuse services to establish appropriate processes and training. Progress to date has been limited and inconsistent.<br />
<br />
Through its member organisations on the frontline, DrugScope has learned that:<br />
<br />
<ul>
<li>People are frequently denied access to mental health services on the grounds that their substance use is the cause of their mental ill health or will make treatment impossible</li>
<li>Raised thresholds for statutory mental health services often mean that people are unable to access mental health care and support until they are close to or actually in crisis</li>
<li>People experiencing a mental health crisis while intoxicated <a href="http://www.centreformentalhealth.org.uk/pdfs/Centre_for_MH_review_of_sections_135_136.pdf" target="_blank">are often excluded from health-based ‘places of safety’</a>, which may result in being placed in a police cell</li>
<li>People with drug and alcohol problems have struggled to get appropriate support through the Improving Access to Psychological Therapy (IAPT) programme</li>
<li>Drug/alcohol treatment providers have repeatedly voiced concern about their clients’ access to appropriate mental health support, <a href="http://www.drugscope.org.uk/POLICY+TOPICS/StateoftheSector2013" target="_blank">and see this as worsening</a></li>
</ul>
<br />
This is of concern given that a number of international studies suggest that substance misuse can account for the <a href="http://www.nice.org.uk/guidance/gid-cgwave0619/resources/violence-and-aggression-update-draft-full-guideline2" target="_blank">increased risk of violence amongst those accessing mental health services</a>.<br />
<br />
What’s more, a recent investigation by <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900015-7/fulltext?rss=yes" target="_blank">the Lancet</a> highlighted concern about adequate funding and training for addiction psychiatrists.<br />
<br />
There are specific <a href="http://www.ons.gov.uk/ons/rel/psychiatric-morbidity/psychiatric-morbidity-among-prisoners/psychiatric-morbidity-among-prisoners--summary-report/psychiatric-morbidity---among-prisoners--summary-report.pdf" target="_blank">issues in the prison population</a>, where 70% of prisoners suffer from two or more psychiatric disorders with 75% experiencing dual diagnosis. Lord Bradley’s 2009 <a href="http://www.centreformentalhealth.org.uk/pdfs/Bradley_report_2009.pdf" target="_blank">report</a> found services are organised in a way that ‘positively disadvantages’ this group. These concerns were again highlighted in Lord Patel's <a href="https://www.gov.uk/government/publications/the-patel-report-reducing-drug-related-crime-and-rehabilitating-offenders" target="_blank">report on drug related crime and offender rehabilitation</a>.<br />
<br />
Reviews of the use of Section 135 and 136 of the Mental Health Act have highlighted the problem of intoxication in assessing the mental health of those believed to need a 'place of safety'. In a survey carried out by the <a href="http://www.cqc.org.uk/content/safer-place-be" target="_blank">Care Quality Commission</a> about half of the providers said that people who were intoxicated would be excluded from the places of safety in their local area. Similar findings are reported by the <a href="http://www.centreformentalhealth.org.uk/pdfs/Centre_for_MH_review_of_sections_135_136.pdf" target="_blank">Centre for Mental Health</a> who say:<br />
<blockquote class="tr_bq">
This issue of intoxication was a problem for most areas, and some emergency departments (EDs) and most 136 suites would reportedly not accept a person whom they deemed too incapacitated to assess.</blockquote>
Recently, there have been some positive developments:<br />
<br />
<ul>
<li>The Department of Health is currently engaging with this issue, which is, for example, highlighted in the 'Mental Health Crisis Care Concordat'. This work includes the development of tools and resources to support practitioners and a review of the 2002 guidance on dual diagnosis</li>
<li>The introduction of Health and Wellbeing Boards provides an opportunity to join up mental health and substance misuse care (which are currently commissioned separately)</li>
<li>The continued roll-out of the Liaison and Diversion schemes will place mental health professionals in police stations and courts, covering half the population from April 2015. These have been particularly championed by Lord Bradley, who observes in his report that “no approach to diverting offenders with mental health problems from prison and/or the criminal justice system would be effective unless it addressed drug and alcohol misuse”.</li>
<li>The government’s <a href="https://www.gov.uk/government/consultations/review-of-the-operation-of-sections-135-and-136-of-the-mental-health-act" target="_blank">review</a> of the operation of sections 135 and 136 of the Mental Health Act 1983 has made constructive recommendations on health-based places of safety</li>
</ul>
<br />
While promising, it is not sure that all of these developments will be sustainable and provide the systemic change needed. This is particularly difficult given the division of funding at a local level – with separate budgets for mental health through Clinical Commissioning Groups and substance misuse through Public Health allocations.<br />
<br />
It is vital that the opportunities we have to improve support for this particularly vulnerable group are not missed.<br />
<br />
<a href="http://www.drugscope.org.uk/POLICY+TOPICS/MentalHealth" target="_blank">Further reading on this topic on DrugScope's website.</a><br />
<br />
Download this briefing as a PDF from <a href="http://www.slideshare.net/andrewbrown365/dual-diagnosis-briefing-for-mental-health-debate-public" target="_blank">here</a>.Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-79018220402109343352015-01-08T17:26:00.000+00:002015-01-08T17:26:01.252+00:006 things we've learnt about young people in substance misuse services in England in 2013/14Public Health England have published their annual report on <a href="http://www.nta.nhs.uk/uploads/young-peoples-statistics-from-the-national-drug-treatment-monitoring-system.pdf" target="_blank">young people who accessed specialist substance misuse services</a> in England in 2013-14.<br />
<br />
Here are six things I took from the report:<br />
<br />
<ol>
<li>The numbers in treatment (19 thousand in 2013-14) have been falling since 2008-09, but are <b>still higher than a decade ago</b>.</li>
<li>Most were over 15 years old, but <b>1 in 5 were younger</b>.</li>
<li>Almost half of referrals come from two sources - Youth Offending Teams and mainstream schools.</li>
<li>Cannabis and alcohol remain the two most important substances treated for this age group, but <b>fewer and fewer are presenting with alcohol problems</b>.</li>
<li>Most young people got a psychosocial intervention and three quarters were in treatment for less than 26 weeks.</li>
<li>Substance misuse was likely to be <b>one of a range of problems</b> for the people who accessed these services.</li>
</ol>
<br />
<br />
<iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/43326311" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com1tag:blogger.com,1999:blog-8803410488510287958.post-37120478039947392212014-12-23T18:02:00.000+00:002014-12-23T18:16:38.277+00:00Atul Gawande's Reith lectures: building a system that cares<p>On my wintry walks to work these last few weeks, I’ve been enjoying the <a href="http://www.bbc.co.uk/programmes/b04bsgqn">2014 Reith lectures</a>. Each year, the BBC invites a distinguished guest to give a series of talks on an issue of public interest. This time, surgeon and writer Dr. Atul Gawande has been discussing medicine and public health. I’m grateful to my colleague George Garrad, who suggested they might be up my street.</p>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-JUnFMZNogWA/VJmrsSs9TUI/AAAAAAAAAAk/eOG20KRcTlY/s1600/2494688895_3c1c67e5a3_b.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="http://4.bp.blogspot.com/-JUnFMZNogWA/VJmrsSs9TUI/AAAAAAAAAAk/eOG20KRcTlY/s1600/2494688895_3c1c67e5a3_b.jpg" height="212" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Atul Gawande (photo: <a href="https://www.flickr.com/photos/americanprogress/2494688895/in/photostream/" target="_blank">CfAP</a>, Creative Commons)</td></tr>
</tbody></table>
<p>Firstly, if you have any interest in health (and which of us doesn’t?) I really recommend listening to the four lectures. In them, Gawande makes a passionate yet highly methodical case for how we can improve the health care that people receive throughout their lives, across the world.</p>
<p>He blends stories from his professional and personal life, which are often very moving, with political argument in a way that’s entirely absorbing (I occasionally came close to walking into lampposts). And although his focus is on medicine, I think the issues he discusses are of vital importance for the drug and alcohol sector – and especially its approach to complex needs, which is of particular interest to me through my work at DrugScope with the <a href="http://www.meam.org.uk/">Making Every Adult Matter coalition</a>.</p>
<h3>
Why the system matters</h3>
<p>Gawande’s basic argument, as I understood it, is this: over the last century, we’ve made huge advances in knowledge about the body and how it works. We’ve also developed technology – surgical techniques, medicines – that can help us treat ever more conditions. However, what we haven’t worked out is how to apply this knowledge consistently across every hospital, country and continent. This helps fuel the dramatic health inequalities we see at all of these levels.</p>
<p>In his second lecture, therefore, he focuses on problems with ‘the system’: the interactions between people and organisations that deliver healthcare. As a surgeon, he uses the example of avoidable deaths in the operating theatre and describes work that he and colleagues are doing to introduce simple checklists for basic tasks. A tiny detail like washing your hands takes on huge importance when it’s one of hundreds of tasks that contribute to a successful operation. </p>
<p>Often, Gawande explains, surgeons and other medical professionals resist the idea of following a checklist – until they see the evidence that it saves lives (you can read more about this in a fascinating 2007 <a href="http://www.newyorker.com/magazine/2007/12/10/the-checklist">New Yorker article</a> that he draws on in his talk). However, where his argument gets really interesting is in the final lecture, where he discusses the limitations of this approach:</p>
<blockquote class="tr_bq">
“But just because you have a roadmap does not mean anyone is going to follow it. There are barriers to overcome to execute even the simplest step, and those barriers differ from place to place. In one health centre, staff may not wash hands because they don’t know it’s important; in another, because they don’t have sinks or running water in the delivery rooms; and in another, because they simply have not made it their habit and no one cares.</blockquote>
<blockquote class="tr_bq">
"That last phrase I think is the critical one: if no one cares when someone takes the trouble to do things right, nothing changes. And the overwhelming message to the people who work at the frontlines of care around the world is that no one notices excellence and no one cares. That is the biggest source of burnout and discouragement for health care workers everywhere.”</blockquote>
<h3>What this means for drug and alcohol services</h3>
<p>I think this insight is crucial to how drug and alcohol services approach treatment for those with the most complex needs. We often hear calls for ‘system change’ – the demand that services should be re-designed to work better together. That’s clearly a valuable goal – but it’s also vitally important that we take into account the human beings on whom services depend, who are often forgotten in the rush to reform and restructure.</p>
<p>At <a href="https://storify.com/andrewbrown365/access-all-areas-equality-and-diversity-in-drug-an">DrugScope’s conference</a> in November, I ran a workshop with drug and alcohol practitioners (some of whom also had personal experience of recovery) on their experiences supporting people with complex needs. One substance misuse worker observed – to universal nods of agreement – that they often felt they were “mopping up” problems that other services weren’t resolving in the way they should. </p>
<p>Their personal commitment to the people they work with meant they were willing to compensate for the failures of the system they worked in. It’s one of the great strengths of our sector that, on the whole, it attracts people who care deeply about the work they do, and the lives of those they support. I think to a great extent, this stems from the high number of practitioners who have personal experience of substance misuse. (Incidentally, it’s one the few weaknesses of the lectures that they don’t do more to explore the role of people using, rather than delivering, healthcare services.)</p>
<p>Dr. Gawande’s insight is that in making a system work, you need to do more than simply find the most efficient solution to a problem. You also need to work from the behaviour of people who care, and find out how to build a system that supports them and encourages others to follow suit.</p>
<p>Too often, when looking to reform health and social care, we begin from the assumption that the system can make people better – when actually, the opposite is true. I actually find that idea rather hopeful, and offer <a href="http://www.bbc.co.uk/programmes/b04bsgqn">the lectures</a> – which explore these issues in rich detail – as a diversion over what I hope is a restful Christmas and New Year.</p>
<p><i>Sam Thomas is the programme manager for <a href="http://www.meam.org.uk/voices-from-the-frontline/">Voices from the Frontline</a>. Follow <a href="http://twitter.com/iamsamthomas/">@iamsamthomas</a> on Twitter.</i></p>Anonymousnoreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-56555740157189945482014-12-22T14:21:00.000+00:002014-12-22T14:55:07.364+00:00Bite-sized Briefing - Public Health England’s grant to local authorities<b><i>As part of the support we offer our members DrugScope's policy team send out a monthly round-up and précis of reports which we believe are of interest to the field. The following is offered as an example of the content of our Bite-sized Briefing for December.</i></b><br />
<b><i><br /></i></b>
<br />
<a href="http://4.bp.blogspot.com/-8Io8F_PNGyQ/VJgm3T0bhII/AAAAAAAAe3U/-fdToK1JAmo/s1600/nao.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-8Io8F_PNGyQ/VJgm3T0bhII/AAAAAAAAe3U/-fdToK1JAmo/s1600/nao.png" height="320" width="226" /></a>The National Audit Office <a href="http://www.nao.org.uk/wp-content/uploads/2014/12/Public-health-england%E2%80%99s-grant-to-local-authorities.pdf" target="_blank">have produced</a> an assessment of whether the new public health grant to local authorities is likely to lead to intended outcomes and achieve value for money.<br />
<br />
The report makes clear that despite increases in the overall budget allocated for public health (up by 5.5% in 2013-14) allocations within the overall envelope are changing slowly as local authorities exercise their judgement on local priorities.<br />
<br />
They report that in 2013-14 local authorities had budgeted 54.3% of spending on sexual health, drugs and alcohol services; in 2014-15 this proportion had reduced to 52.8%. They also found:<br />
<blockquote class="tr_bq">
<blocquote>“between 2010-11 and 2012-13 alcohol-related admissions to hospital increased by more than 6% in 26 local authorities. These 26 local authorities spent on average 6% of their public health spending on alcohol services for adults. This was significantly less than the 9% spent by the 26 local authorities where alcohol-related admissions reduced the most.”<o:p></o:p></blocquote> </blockquote>
Other key messages from the report are:<br />
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<ul>
<li>A survey of stakeholders found that three-quarters
of respondents have a good working relationship with PHE, although it is
generally too early to tell whether public health outcomes are improving. That
said, the report points out that PHE prioritised 54 local authority areas for
intensive diagnostic and support work to improve recovery and reduce relapse
rates leading to a 1.3% increase in recovery rates.</li>
<li>The Department of Health has not decided how
long the ring-fence for the public health grant will remain in place.</li>
<li>There have been limitations in the quality of
data, for example, 81 local authorities initially reported not spending anything against
1 or more of the 6 prescribed public health functions, and there are lags of at
least 18 months for publishing much of the public health outcomes data.</li>
<li>Some stakeholders think PHE should display
stronger system leadership. However, the
formal levers available to PHE for securing better public health outcomes are
limited and the autonomy of local authorities gives no guarantee that PHE can
secure improvements in outcomes (and at £5 million, the health premium risks
being too small to bring about significant change).</li>
</ul>
Download the full report <a href="http://www.nao.org.uk/wp-content/uploads/2014/12/Public-health-england%E2%80%99s-grant-to-local-authorities.pdf" target="_blank">here</a>.<br />
<b><br /></b>
<b>If you would like to join DrugScope you can do so <a href="http://www.drugscope.org.uk/membership/membershipbenefits">here</a>.</b></div>
Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-53549930040872101972014-12-19T17:44:00.001+00:002014-12-19T17:44:42.384+00:0010 (more) things - late December editionA final set of slides for the year with 10 more things I saw about alcohol and other drugs and which I thought were interesting.<br />
<br />
This time including: data on drug deaths as a proportion of all deaths of adults 15 - 43; the use of naloxone by ambulance crews in the East Midlands; substances people said they were dependent on amongst people in police cells in London; seizures of drugs and mobile phones in HMP Durham; victims of criminal exploitation; number of people using residential rehab; cultivation or illegal drugs in Scotland; number of possession and possession with intent to supply offences recorded in Scotland; global narcotic seizures by the Royal Navy; and % changes to the ABV of alcohol between 2011 and 2013.<br />
<br />
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<iframe allowfullscreen="" frameborder="0" height="485" marginheight="0" marginwidth="0" scrolling="no" src="//www.slideshare.net/slideshow/embed_code/42876356" style="border-width: 1px; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="595"> </iframe> <br />
<br />
As always any misinterpretation of the data you spot are down to me (and please do let me know so that I can fix them).Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-51826763935211776012014-12-17T21:51:00.001+00:002014-12-17T22:21:00.817+00:00StreetLink celebrates its second anniversary <div dir="ltr" style="text-align: left;" trbidi="on">
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<b>Many happy returns,
StreetLink</b></div>
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Prior to joining DrugScope in 2012, much of my working life
had been spent in homelessness services of one sort or another. Between the
mid-90s and 2010, I worked in hostels, supported housing, outreach and floating
support, before spending two years at Homeless Link, the membership
organisation for the sector. <o:p></o:p></div>
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<br /></div>
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Despite getting to know the homelessness sector pretty well
during that time, I was sometimes perplexed when faced with rough sleeper
outside of work. Identifying the relevant outreach team (having first
established that there <i>was</i> an
outreach team – many areas don’t have one), finding a contact number or email
address and then actually getting through (outreach teams generally work highly
unsocial hours) could be time consuming and complex. If I was away from my
adopted home turf of London, these difficulties were compounded. I thought at
the time that if it was a difficult and time consuming process for me, for
someone unfamiliar with the way the system works, what services work with whom, what they might be called and so on, it would be even more daunting, if not impossible.<o:p></o:p></div>
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<br /></div>
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In December 2012, life was made considerably easier for
anyone worried about someone sleeping rough, including rough sleepers
themselves. Building on the work of the No Second Night Out London hotline,
StreetLink was rolled out across England. Developed and run by Homeless Link
and Broadway (now St Mungo’s Broadway) and funded by the Department for
Communities and Local Government (DCLG), StreetLink provides a single portal
for rough sleepers themselves, members of the public, and members of emergency,
health and support services to get connected to outreach teams.<o:p></o:p></div>
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<br /></div>
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What StreetLink does is in some respects quite simple – it
takes referrals (and self-referrals) from anywhere in England and passes that
information on to the relevant outreach team or local authority. Instead of
having to go through the process of researching provision in any particular
locality, StreetLink provides a single phone number, mobile app and website and
even offers to let people know – in a general sense – what happened to their
referral. In contemporary terms, it ‘hides the wiring’ of what remains a
complex patchwork of services and provision spanning around 150 local
authorities.<o:p></o:p></div>
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<br /></div>
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<b>About rough sleeping
and homelessness<o:p></o:p></b></div>
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The relevance for drug and alcohol services is in the number
of people they support who have housing problems of one sort or another. Around
10% of people starting <a href="http://www.nta.nhs.uk/uploads/drug-treatment-statistical-bulletin-2013-14.pdf">new
drug treatment journeys</a> in 2013-14 had no fixed abode, with a further 14%
having other housing problems. The corresponding figures for those starting <a href="http://www.nta.nhs.uk/uploads/statistics-for-alcohol-treatment-in-england-2013-14.pdf">new
alcohol treatment journeys</a> are 4% and 10% respectively. <o:p></o:p></div>
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As those figures have been pretty constant for some years,
it seems plausible that over 10,000 people in contact with drug and alcohol
services are actually homeless, with around 40,000 having some other sort of
housing problem. Looking at it from the other side, we also know that
‘tri-morbidity’ is commonplace – rough sleepers often have coexisting poor
physical health, poor mental health and problems involving substance misuse.<o:p></o:p></div>
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Nationally, over 2,400 people sleep rough on a typical
night. This number is based on the street counts conducted in winter and <a href="https://www.gov.uk/government/collections/homelessness-statistics#rough-sleeping">reported
by DCLG</a> and represents a continuation of an upward trend visible since
2010, when the street count guidance was changed. In London, the <a href="http://www.broadwaylondon.org/CHAIN/Reports/StreettoHomeReports.html">CHAIN
database</a> used by all the main outreach teams suggests a corresponding
significant increase, with new contacts increasing from 1672 in 2007-08 to 4363
in 2013-14.<o:p></o:p></div>
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These numbers are substantial. Figures recently <a href="http://www.homeless.org.uk/sites/default/files/site-attachments/%23SleepWell%20report.pdf">released</a>
by StreetLink show that in the two years it has been operating, almost 9,000
people have used the service and been connected with support, just over a
quarter of them self referrals from rough sleepers themselves. Of these, almost 1,700 have been supported
into accommodation. <o:p></o:p></div>
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There is a discrepancy between those numbers. Of course, some
of the referrals may have been inappropriate for StreetLink; for example,
people who are street active (begging or drinking on the street, say) rather
than rough sleeping, or people who are already known to services. Some referrals may have been impossible to
find, or may have been reluctant to accept the service offered.<br />
<br />
Simply being referred to StreetLink doesn’t
itself bring any additional entitlement to accommodation. The ‘priority need’ criteria still apply (everywhere apart
from Scotland, although the <a href="http://www.insidehousing.co.uk/journals/2014/07/30/y/d/i/no-going-back-report.pdf">London
Assembly</a> has called for it to be abolished in London too) and the rules around
benefits and public funds (subject to frequent toughening and revision where
non-UK citizens are concerned) can often serve as barriers to services. With
UK nationals making up just under half of the rough sleepers in London, that
means that many people find their options very limited.</div>
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<o:p></o:p></div>
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<br /></div>
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For many foreign nationals, this might mean access to a
reconnection service like the one run by homelessness charity <a href="http://www.thamesreach.org.uk/what-we-do/international-reconnection/london-reconnection-project/">Thames
Reach</a>, but little more. For the rest, StreetLink faces challenges in both
supply and capacity; <a href="http://www.homeless.org.uk/sites/default/files/site-attachments/Pay%20it%20Forward%20-%20help%20more%20people%20leave%20homelessness%20behind.pdf">Homeless
Link suggests</a> that while the number of rough sleepers steadily increases,
the services that can support and accommodate them are facing tremendous
financial challenges as are the local authorities who play such a crucial role.<o:p></o:p></div>
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<b><br /></b></div>
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<b>How you can help</b></div>
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By way of disclosure, I volunteer for StreetLink and from my
experience, many (but by no means all) of the people who make referrals themselves in one way or another work with adults
with complex needs – treatment providers, off-duty
housing and homelessness workers, members of the emergency services and so on.
You may be one of those who have made a referral, but if not, please have a
look at StreetLink’s <a href="http://www.streetlink.org.uk/">website</a> and
save the phone number 0300 500 0914 – the phones are staffed 24 hours a day,
365 days a year.<br />
<o:p></o:p></div>
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<br /></div>
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If you have a smartphone, you can also download the
StreetLink app which makes reporting easier and quicker and also contains links
to information, statistics and other sources of help. It’s available for <a href="https://play.google.com/store/apps/details?id=co.uk.precedent.streetlink">Android</a>
and <a href="https://itunes.apple.com/gb/app/streetlink/id587543230?mt=8&ign-mpt=uo%3D4">iPhone</a>.
If you’re working with someone from central or Eastern Europe who might benefit
from reconnection, the information on Thames Reach’s <a href="http://www.thamesreach.org.uk/what-we-do/international-reconnection/routes-home/">Routes
Home pages</a> might be of interest, although if they're rough sleeping, StreetLink would be the best first point of contact.<o:p></o:p></div>
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<br /></div>
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Finally, while StreetLink has a small, dedicated team of paid
staff, it also relies heavily on a pool of volunteers. If this might be of
interest – and please note that while rewarding, StreetLink is closer to call centre work than
the coal face of rough sleeping – you can contact the team at the following
address: <a href="mailto:volunteers@streetlink.org.uk">volunteers@streetlink.org.uk </a><o:p></o:p></div>
<br />
By Paul Anders, Senior Policy Officer, DrugScope.<br />
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</div>
Paulhttp://www.blogger.com/profile/09369260214429541169noreply@blogger.com0tag:blogger.com,1999:blog-8803410488510287958.post-34291187057413088382014-12-15T10:59:00.000+00:002014-12-18T10:50:22.532+00:00Owen Bowden-Jones: If I had my way the government would...<div>
<em>T<a href="http://2.bp.blogspot.com/-Gf3AxLaYZ_Q/VIcrjU7QndI/AAAAAAAAepE/5sDDVujZyjk/s1600/Owen%2BBowden%2BJones.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://2.bp.blogspot.com/-Gf3AxLaYZ_Q/VIcrjU7QndI/AAAAAAAAepE/5sDDVujZyjk/s1600/Owen%2BBowden%2BJones.jpg" height="180" width="320" /></a>his is a guest blog from Owen Bowden-Jones. </em></div>
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</div>
<div>
<em><br /></em>
<em>Owen is the founder of the </em><a href="http://clubdrugclinic.cnwl.nhs.uk/" target="_blank"><em>Club Drug Clinic</em></a><em>, the current Chair of the Faculty of Addictions at the <a href="http://www.rcpsych.ac.uk/" target="_blank">Royal College of Psychiatrists</a> (2010-2014), a Consultant in Addiction Psychiatry, overseeing alcohol and drug services in the borough of Kensington and Chelsea and an <a href="http://www.imperial.ac.uk/people/o.bowden-jones" target="_blank">Honorary Senior Lecturer at Imperial College</a> in the Division of Brain Science. Owen is also a Trustee of DrugScope.</em></div>
<div>
</div>
<div>
<br />
Invest where the evidence is most robust.</div>
<div>
</div>
<div>
<br />
Develop an inspectorate for scrutiny and oversight of commissioning.</div>
<div>
</div>
<div>
<br />
Move commissioning of drug and alcohol specialist services from local authorities to Clinical Commissioning Groups.</div>
<div>
</div>
<div>
<br />
For both drug and alcohol problems, increase the focus on young people at early stages of harmful use. Early intervention is well established for most illness management and should become a priority for harmful/dependent drug and alcohol use.</div>
<div>
</div>
<div>
<br />
Invest in technology to support recovery. Relapse prevention, motivational enhancement and peer support can all be enhanced with online/mobile telephone interventions.</div>
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</div>
<div>
<br />
Review the workforce to ensure that necessary skills are retained within the sector. We are facing a brain drain, particularly for addiction psychiatry, which is bad news for the whole sector.</div>
Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com2tag:blogger.com,1999:blog-8803410488510287958.post-12955657434184459902014-12-09T16:50:00.000+00:002014-12-09T16:50:47.806+00:00Jan King: If I had my way the government would...<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.angelusfoundation.com/wp-content/themes/replay/framework/extensions/timthumb/timthumb.php?src=http%3A%2F%2Fwww.angelusfoundation.com%2Fwp-content%2Fuploads%2F2012%2F10%2FAngelus-Video-Logo.jpg&w=470&h=441&a=t" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://www.angelusfoundation.com/wp-content/themes/replay/framework/extensions/timthumb/timthumb.php?src=http%3A%2F%2Fwww.angelusfoundation.com%2Fwp-content%2Fuploads%2F2012%2F10%2FAngelus-Video-Logo.jpg&w=470&h=441&a=t" height="300" width="320" /></a></div>
<i>This is a guest blog from Jan King, the Chief Executive of the <a href="http://www.angelusfoundation.com/" target="_blank">Angelus Foundation</a>.</i><br />
<br />
We need the government to take positive steps to ensure young people are better informed of the risks to their mental and physical well-being from new psychoactive substances, the so called ‘legal-highs’.<br />
<br />
We already have a poor commitment to drugs education in this country and the government needs to ensure that all schools cover some key messages. There has been an understandable trend to schools setting more of their own teaching agenda but this cannot be at the expense of our young people’s future health and well-being.<br />
<br />
Compulsory PSHE (Personal Social and Health Education) would be a welcome start and much more proactive means of getting messages to young people. We need well thought out approaches delivered in a range of ways but ideally with young people centre stage saying what works for them.<br />
<br />
The emphasis needs to be on equipping them to withstand the myriad of pressures they may face and not rather pointless enforcement messages around potential penalties.<br />
<br />
At Angelus we have been visiting schools, universities and festivals showing films of what can happen when people experiment with untested substances with little idea of what they are taking let alone what might be a safe dose, assuming such a thing is possible. When they see the outcomes they are often angry they have not been informed by anyone before that there are new forces at play trying to take advantage of their potential vulnerabilities.<br />
<br />
While we are committed to working with young people and their parents so that young people can take informed decisions we need the Government to be taking a much clearer stand on what schools should be doing to stem this pernicious trend.<br />
<br />
The Government’s review into NPS goes some way in the right direction but the new Administration will need to ensure that its recommendations are pursued vigorously if we are really to keep our young people safe.<br />
<br />
There will be no time to rest on any laurels as we know the industry that knocks out these substances will already be cooking up new ways to get around any changes in the law. Andrew Brownhttp://www.blogger.com/profile/10763753671606930383noreply@blogger.com0