Download Copy herewith - Wrexham County Borough Council

AGENDA ITEM NO.
1.
REPORT TO:
Joint Meeting of Social Affairs, Health and Housing
Scrutiny Committee and Children and Young People
Scrutiny Committee
REPORT OF:
Clare Field - Chief Prevention & Inclusion Officer
Rebeccah Lowry – Divisional Manager, Social
Inclusion
REPORT NO:
EDM/19/09S
DATE:
30 November 2009
CONTACT OFFICER:
Vicky Jones (Tel: 317023)
Jonathan Miller (Tel: 317696)
SUBJECT:
Tackling Substance Misuse in Wrexham County
Borough – National Context and Local Action
PURPOSE OF THE REPORT
To provide an overview of the national and local agenda for substance misuse,
including the strategic context in which substance misuse is considered and the
delivery mechanisms for tackling the issue in Wrexham County Borough.
2.
SUMMARY
2.1
This report provides Members with:

an overview of the national strategic context for substance misuse;

an outline of actions being taken to tackle substance misuse locally and
how decisions are made to prioritise these actions; and

information on significant changes to substance misuse structures for the
future.
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3.
RECOMMENDATIONS
Members are requested to:

consider the report and note national and local context for tackling
substance misuse;

note local Substance Misuse Action Team (SMAT) function and
progress;

note robust governance of SMAT funding and investment processes;
and

note structural changes for the future.
4.
INFORMATION
4.1
Wrexham Community Safety Partnership (CSP) is a statutory organisation that
was established in 1998 as a result of the Crime and Disorder Act. The Home
Office guidance requires Community Safety Partnerships to formulate and
implement a strategy to tackle local crime and disorder, including action to
reduce substance misuse.
4.2
The responsibility for providing the strategic co-ordination to the work to tackle
and reduce substance misuse in Wrexham has been delegated by Wrexham
CSP to the SMAT.
(a)
NATIONAL CONTEXT
4.3
Although overall crime and disorder matters are governed by the Home Office,
matters of substance misuse, which includes the misuse of both drugs and
alcohol, are devolved. The strategic context in which it sits is therefore set by
the Welsh Assembly Government (WAG) through their National Strategy
“Working Together to Reduce Harm: 2008-2018”.
The National Substance Misuse Strategy for Wales: Working Together to
Reduce Harm 08-18
4.4
The new strategy sets out the agenda for SMATs to tackle and reduce harms
associated with substance misuse in Wales and outlines 4 key action areas:
(1) Preventing Harm - helping children, young people and adults resist
reduce or delay substance misuse by educating them about the damage that
substance misuse can cause to their health, their families and the wider
community
This section concentrates on the importance of education and information on
the harm substance misuse can cause to health, families and communities.
Early intervention is also highlighted as important for tackling onset of
substance use and stresses the importance of all agencies having a
responsibility for identification and prioritisation of children and young people
with substance misuse problems.
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(2) Support for Substance Misusers - to reduce the harm they cause to
themselves, their families and their communities through provision of effective
treatment and other services
This section sets out a wide range of actions which will further improve the
support and treatment offered to substance misusers and remains the
cornerstone of the new strategy. It is well evidenced that for every £1 spent on
drug treatment at least £9 is saved in costs to the criminal justice system,
treatment helps to break the cycle of offending behaviour by treating the
underlying cause of the drug habit. This saving equates to more if we were to
consider further social costs.
(3) Support for Families - to reduce the risk of harm to children and adults as
a consequence of a parents, partners or child’s substance misuse. It
emphasizes the need to support carers and the burden of care that can be
placed onto children by parental substance misuse
This action area describes the impact of substance misuse on children and
families and recognises the clear links between substance misuse and
domestic abuse, child poverty and homelessness, crime and anti-social
behaviour. The needs of significant others and not just the substance user is
highlighted as well as the support to be offered to children and families.
(4) Tackling Availability and Protecting Individuals - reducing the harm
caused by substance misuse related crime and antisocial behaviour by tackling
the availability of illicit drugs and the inappropriate availability of alcohol and
other substances
This section refers to the continued success of the Drug Intervention
Programme. This is a Home Office funded, regionally managed, programme
which focuses on bringing drug using offenders into treatment to break the
cycle of drug use and offending behaviour as a result. It also encourages
partner agencies to take a more holistic approach to the management of the
‘Night Time Economy’ and tackle traders who persistently sell or supply alcohol
to children. Finally the section refers to the importance of the local
communities in identifying those involved in the illicit drugs trade and the
importance of neighbourhood policing teams.
(b)
LOCAL CONTEXT
4.5
The responsibility for providing the strategic co-ordination to the work to tackle
and reduce substance misuse in Wrexham has been delegated by Wrexham
CSP to the SMAT. The diagrams at Appendix 1 illustrate Wrexham SMAT’s
local delivery mechanisms and structures for both the commissioning of adult
(Appendix 1a) and children and young people (Appendix 1b) substance misuse
services. The diagrams show key relationships with other local partnerships
and regional groupings.
4.6
The purpose of the SMAT is to implement the National Substance Misuse
Strategy at a local level. The SMAT’s function is to make informed joint
decisions on the commissioning of substance misuse services (for both adults
and children and young people) against WAG priorities for spend. For 09/10
the WAG priorities are:
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
improving the access, availability and quality of children and young
peoples’ substance misuse services;

addressing waiting lists for treatment;

tackling alcohol misuse;

commissioning appropriate detoxification and rehabilitation services; and

to assist CSPs in responding to the Healthcare Inspectorate Wales 1 st
Review of Prescribing Services which was undertaken in 2008.
(c)
Identifying Priorities/Local Commissioning Strategies
4.7
WAG require all SMATs to have local commissioning strategies which outline
priority areas for investment of the Substance Misuse Action Plan Funding
(SMAPF). In Wrexham the commissioning strategy also provides the strategic
framework for interventions funded from sources in addition to the SMAPF.
4.8
The first commissioning strategy (2005-2008) marked a major review of
substance misuse services and resulted in re-configuration and development
within adult and young people’s substance misuse services in Wrexham.
4.9
Wrexham SMAT is currently working on the recommendations of its second
commissioning strategy, both were commissioned from the Institute of Public
Care who undertook detailed needs assessments and interviews to determine
priorities for development.
4.10
Identifying service needs and priorities cannot be determined by the prevalence
of substance misuse in an area as the target audience is largely unknown and
by its nature is a hidden problem.
4.11
As accurate figures of substance misusers are not available to identify service
priorities a variety of other methods are used to influence the service needs in
Wrexham. This includes:
-
service user feedback;
monitoring of demand for services;
performance management of each of the commissioned services; and
anecdotal information from partners.
4.12
The second commissioning strategy identifies the positive performance that has
been achieved against the recommendations of the previous commissioning
strategy and the positive state of substance misuse provision in Wrexham. It
also highlights future investment requirements based on local need analysis,
market mapping and performance management information. This forms the
basis of SMAT planning and commissioning in line with the WAG stated
priorities referred to in paragraph 4.6.
4.13
The Executive Summary of Wrexham SMATs second Joint Commissioning
Strategy is attached at Appendix 2. The priorities for 2008-11 are contained
within this document; progress is ongoing against each one of the priority areas
listed.
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4.14
Whilst the Wrexham priorities contribute to achieving the WAG priorities as
detailed in paragraph 4.6 the focus of the interventions in Wrexham are based
on the information gained at a local level.
(d)
Investment
4.15
The WAG invest in services to tackle and reduce substance misuse through the
Substance Misuse Action Plan Fund (SMAPF) this fund has increased from
£385,289 in 2006/07 to £794,380 in 09/10. Other funding streams that are
used to finance services to tackle and reduce substance misuse are sourced
from: the Local Health Board; Social Care (WCBC); Home Office Drug
Intervention Programme funding; and Probation. In addition there is a SMAPF
Capital fund which is managed regionally. Appendix 3 provides a complete list
of the services and interventions funded through two WAG sources, SMAPF
and the Safer Communities Fund (SCF).
4.16
The following paragraphs provide examples of some of the services/initiatives
commissioned by Wrexham SMAT and/or partners in responding to the issues
of substance misuse locally, these include interventions and services funded
from SMAPF and other sources:
4.17
Adult Treatment and Support services:
4.18

Drug Intervention Programme - Home Office funded programme
ensures people arrested for specific offences (related to drug use) are
drug tested and channelled into treatment services to break the cycle of
offending behaviour.

The Elms local treatment centre - mainstream investment providing
multi disciplinary team offering treatment and support to drug and alcohol
users to help them overcome their problems and work to more fulfilling
futures.

Alcohol Liaison service - based within Wrexham Maelor hospital
ensures alcohol misusers are identified and treated to prevent further
hospital admissions or presentations for alcohol related conditions. The
service aims to reduce pressure on health systems and prevent further
anti social behaviour and violent crime on our streets as a result of
ongoing drunken behaviour. It identifies problematic drinkers who
normally would be difficult to reach.

Harm Reduction Outreach service - supports and lessens impact on
communities by engaging with hard to reach substance misusers through
outreach work.
Children and Young People Prevention, Education, Treatment and Support
services:

Drug and Alcohol Education awareness programmes - in schools,
youth centres, colleges and universities to prevent todays’ children and
young people from becoming problematic drug and alcohol users of the
future.
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4.19
4.20

Peer Education programmes - for young people to educate one another
and act as role models

In2 Change Children and Young Peoples substance misuse team multi disciplinary team to work with young people who are at risk of or who
have developed substance misuse issues. The team work with young
people between the ages of 11 and 19 years. The Council take the overall
lead for the team in line with youth service provision and wider structures.
See Appendix 4 for operational management structure and team
breakdown.

Family Support Project - Council provided project working with families
where there is parental substance misuse to lessen the impact and
improve outcomes for children.
Initiatives to tackle availability of drugs and alcohol and for enforcement
purposes:

Police Intelligence and Operations - in addition to general police
operations the SMAT invested in two specific drugs operations last year
which were successful in seizing substantial amounts of illicit drugs.

CCTV to combat drug related litter - units placed in hot spot areas
where discarded needles have been an issue to deter and enforce against
repeat offenders.

Trading Standards Underage sales enforcement officer - targeting off
and on licence premises with the police to reduce availability of alcohol to
underage youths and enforce against irresponsible retailers. Also
promotes proof of age schemes and developing work to tackle proxy sales
(whereby adults purchase alcohol for young underage youths).

Rapid Response - Joint police and ambulance patrols over the Christmas
periods to prevent violent crime and keep the Maelor Accident and
Emergency Department free for the most needy by treating minor alcohol
related incidents/injuries on the street.
There is a significant amount of activity in relation to tackling substance misuse
locally and this continues to be developed into the future. In addition to the
previously outlined projects further SMAT Achievements include:

A well established primary care treatment provision a partnership between
GPs and the North East Wales NHS Trust (NEWT) in delivering drug
treatment;

Year on year increases in the investment of treatment places (£385,289 in
2006/07 to £794,380 in 09/10);

Good performance against waiting times targets (92% of appointments fall
within the target waiting time, the remaining 8% are largely attributed to
the fault of the service user);

Secured capital funding for refurbishment of the former Maes Y Dre
Community Centre to facilitate a night shelter; and
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
A Health Inspectorate Wales review (commissioned by WAG) of
substance misuse has highlighted Wrexham SMAT as demonstrating
good practice.
(e)
Measuring Performance
4.21
WAG has established 8 Key Performance Indicators (KPI) to measure the
performance of the SMAT across Wales these focus largely on the support/
treatment element of the national Substance Misuse Strategy.
KPI1 - Increase local service capacity for people who misuse drugs, alcohol
and other substances in line with stated priorities.
KPI2 – Reduce the number of incidences of unplanned ending of contact with
services. (clients who do not respond to follow up and have been out of contact
for more than 6 weeks).
KPI3 – Achieve a waiting time of not more than 10 working days between
referral and assessment.
KPI4 – Achieve a waiting time of not more than 10 working days between
assessment and beginning of treatment.
KPI5 – All young people referred from a YOT to receive an appropriate
assessment within 5 working days of referral.
KPI6 – All young people referred from YOT to have commenced an agreed
care plan no later than 10 working days from completion of assessment.
KPI7 – Reduce the number of incidences of serious acquisitive crime.
KPI8 - All clients who are injecting drug users to be offered information,
counselling, screening and where appropriate immunisation against Hepatitis B.
4.22
WAG has developed a Welsh National Database to record achievements
against the KPI’s. However, there are currently difficulties regarding data
quality which result in inaccurate data, therefore it is currently not possible to
get a national assessment of SMAT performance across Wales.
4.23
Each project identified through the SMAT Commissioning Strategy is
performance managed at a local level this information is assessed by Wrexham
SMAT to monitor performance and achievements. This system does not allow
for comparisons with other SMATs in Wales.
(f)
Future Changes/Developments
4.24
There are currently some significant changes underway to substance misuse
planning and delivery mechanisms which will culminate in the formation of Area
Planning Boards (APBs) in each region in Wales.
4.25
The establishment of the APBs is in response to the NHS reconfiguration and
also the findings of the Healthcare Inspectorate Wales review of substance
misuse.
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4.26
The Ministers for Social Justice and Local Government and Health and Social
Services have agreed to establish a pooled budget that brings together Social
Justice and Health and Social Services resources for substance misuse. The
discretionary allocation (0.4%) plus the declared LHB substance misuse spend
of the existing 22 LHB budgets will be top sliced from the funding for the 7 new
LHBS and allocated to 7 new APBs for substance misuse from 2010-11
onwards. The SMAPF capital budget will also be pooled at the new APB level
as will Home office resources for the Drug Intervention programme. Further
discussions are being held with regard to inclusion of the Probation Service
substance misuse funding in the budget to be managed by the APB.
Subsequent consideration may be given to the inclusion of social care and
other funding streams.
4.27
SMAPF revenue will remain with local CSPs, however, there will be a strong
expectation that some will be aligned with regional APB resource for structured
treatment and residential services that are common across the region.
4.28
The APBs will involve a range of partner organisations and agencies currently
involved in planning, funding and delivering substance misuse services. The
WAG will be represented on the Boards and Public Health will also have a key
advisory role.
4.29
The APBs will facilitate the development of regional and sub-regional planning
and implementation for substance misuse strategies, in particular in relation to
structured treatment and residential services and services for people with
complex needs. The APB regional plans must complement the local CSP
strategies for substance misuse. Detailed guidance will be subject to
consultation from October 2009, with a regional consultation event planned for
January 2010. It is however anticipated that the APBs will be established
during November 2009, becoming fully operational from April 2010.
4.30
It is important to note that the focus of the new APBs for substance misuse
services will be on adult services initially, with a longer term view to the
inclusion of children and young people services.
5.
EQUALITIES IMPACT ASSESSMENT
Each service commissioned through the Wrexham SMAT Commissioning
Strategy is subject to an Equalities Impact Assessment. The overall SMAT
Commissioning Strategy will be impact assessed this year 2009/10.
6.
RESOURCE IMPLICATIONS
No additional resource requirements as a result of this report.
7.
LEAD MEMBER COMMENT
The Lead Member for Children (Additional Learning, Families & Support) said
that he welcomed the joint approach between the CSP and Children & Young
People on this issue.
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The Lead Member for Community Safety has suggested that at some point it
would be helpful for Members to be given some indication of the scale of the
local problem set in the context of the scale at national level.
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