Leicestershire Drug
and Alcohol Team
Strategic Summary-
Adult Drug Treatment Plan 2008-09 (DRAFT)
Leicestershire Partnership Strategic
Direction for Drug Treatment
Purpose
The purpose of this document is to describe
the overall direction and purpose of the Leicestershire DAAT strategy
for drug treatment. As well as summarising the key findings of the Leicestershire
DAAT Partnership Needs Assessment, it will highlight the unmet needs
and key priorities for the coming year.
Introduction
Leicestershire is a county with seven
district authorities and a population of approximately 635,100 individuals,
(according to mid 2006 estimates). The University of Glasgow study from
2004-05 into problematic drug using populations indicates an estimate
of 1772 problematic drug users of opiates and/or crack cocaine in Leicestershire
with a 95% confidence interval. The stretch target for 2007-08 was to
have 1670 in treatment. At November 2007 numbers in treatment stood
at 1202 which represents 68% of the PDU estimate, an increase on the
figure for 2005/06 of 1069 (60%).
A needs assessment has been conducted
in accordance with the National Treatment Agency guidance. The process
has examined the demographics and performance of the treatment system
from NDTMS data for 2006-07 and to date for 2007-08, outlined the treatment
map for tier 3 and 4 services and estimate the possible treatment naïve
cohort through the bulls-eye toolkit.
Strategic Direction
It is the strategic aim of Leicestershire
DAAT to increase the numbers of problematic drug users engaged in treatment
by end of March 2009. Leicestershire’s aim is not only to increase
the numbers accessing treatment services but also improve on the numbers
sustained in treatment, and successfully exiting the treatment journey.
Drug treatment services need to be responsive and appropriate to the
diverse range of drug using populations across the county and their
demography.
Treating drug misuse is a complex issue
that requires a range of responses and interventions, and as such requires
the collaboration of a range of partner agencies including criminal
justice, health, and local authorities
Key findings from the Needs Assessment.
i)Prevalence Levels
There is evidence of increased national
prevalence of powder cocaine use from 1998 to 2007 (particularly between
1998-2000).
During this time there has been a large
increase in seizures across Leicestershire Police Force with heroin
and powder cocaine the main Class A drugs seized. However, the most
recent data on Class A seizures for the first quarter of 2007/2008 shows
an increase in Ecstasy seizures (up to 27% from 19% in 2005) with a
corresponding decline in heroin seizures (down from 34% in 2005 to 27%
in 2007/2008).
East Midlands has comparable rates of
drug use with London, but estimates of problem drug use (opiate and/or
crack use) for Leicestershire suggest the second lowest prevalence rate
in the region.
High prevalence of problematic drug use
is strongly associated with high-risk groups - with evidence of acute
dependencies with those engaged through the criminal justice system.
It is a working hypothesis of this report
that due to methodological limitations, the problematic drug user (PDU)
prevalence estimates provided by the Home Office for crack-cocaine
and injecting are inflated and subject to wide confidence levels.
Therefore, previous analyses and interpretation from the ‘treatment
bull-eye’ should be treated with caution.
ii) Penetration Rates
The ‘penetration rate’ (extent to
which the whole opiate and/or crack using population are engaged in
Tier 3 or 4 treatment) for Leicestershire is estimated to be around
75%.
The numbers engaged in structured Tier
3 and 4 treatment programs has increased during 2006/7, including greater
reports of stimulant use (mainly
powder cocaine). It is unclear whether
this reflects increased prevalence or an artefact of enhanced reporting.
Stimulants such as crack and cocaine
comprise a fifth of all reports of drug use (taking main and secondary
drugs into account). Research by colleagues at NDTMS suggests that this
figure is predicted to increase over time.
A fifth of Leicestershire treatment clients
report housing as an issue, with 5 per cent in no fixed abode (NFA)
and 15% stating housing as a pressing concern.
The treatment rate (proportion of PDU
in treatment weighted for resident population) is highest in Loughborough
Lemyngton, Loughborough Hastings
and Coalville wards.
The treatment rate of those ‘new’
to Tier 3 or 4 treatment (also known as the ‘treatment naïve’)
shows a similar pattern with highest prevalence in Loughborough Lemyngton
and Coalville wards.
As at 31/3/07, 80 per cent of clients
have been retained in treatment at the 12 week mark, reflecting a stable
cohort of problem drug users.
Retention levels into treatment may have
declined this year due to possible interactions between client characteristics
(age, gender, ethnicity), drug profiles (poly-drug use, injecting behaviour)
and referral routes (criminal justice, self etc).
Anecdotal and research evidence suggests
that attrition and unplanned treatment discharges may reflect a chaotic
lifestyle amongst a cohort of PDUs.
Forty one per cent of referrals into
treatment services during 2006/7 come from ‘other’ sources. Further
work is required to clarify the nature of these ‘other’ referral
routes.
Tier 4 services face increased demand
via referrals from the criminal justice system.
Tier 4 services report increased poly-drug
use, variable length of stay and childcare issues are also suggested.
Further robust analysis (due to concerns over the small numbers) is
required to examine the interplay between retention, successful outcomes
and demographic characteristics (such as
gender and childcare issues). It is suggested
that this is picked up through qualitative research with service users.
iii)Access
According to the 2001 census data BME
groups (as defined by all non white groups) is 5.3% in Leicestershire
and the male to female split is 49% to 51%. In the NDTMS data at the
end of quarter 2 for 2007-08 BME groups accounted for only 4% and the
gender split was 73% male to 27% female. Age groups were represented
at 18 to 24 20%, 25-34 52% and 35-64 28%.Treatment services would not
appear to be representative of population figures and ensuring equality
of access to treatment services is a key priority.
iv)Quality & Performance.
The quality and performance offered by
the treatment services are a commissioning priority to be addressed
via a revised performance management framework to be introduced with
effect from April 2008. Meeting the key targets of the NTA will be monitored
through this framework. The release of the NICE Guidelines and technical
appraisals along with the revised Clinical Guidelines (Orange Book)
lead to there being clear priorities to ensure appropriate Clinical
Governance Structures are in place and to undertake an audit of practice
against the guidelines.
v)Service user, Parent & Carer
involvement.
The NTA and HCC have priorities in relation
to the involvement of Service Users, Parents & Carers in the care
of the Service User and in the service planning and commissioning processes.
Leicestershire is committed to exploring and improving methods by which
these priorities can be achieved.
vi)Workforce.
Leicestershire has invested in a training
consortium to ensure that the treatment system workforce is appropriately
trained and competent to work in this field. The competence of the workforce
is further under pressure with the requirements of the NICE and Clinical
Guidelines. Leicestershire DAAT needs to continue to address workforce
training.
Unmet need
There is evidence (via DIP) of a younger
cohort of predominantly stimulant users who are less likely to access
treatment services. Stimulant users were
less likely to attend treatment services
as their use did not warrant medication. However, evidence suggests
that this cohort is more likely to access primary care services for
minor health related issues.
The extent and nature of problematic
drug use within minority groups across the county warrants further exploration.
Some evidence of unmet need within
the younger (under 25) refugee and asylum
seeker population, with particular regard to poly drug use (inc alcohol).
There is also evidence of ‘pockets’
of problematic drug use in particular wards across the county (DIP data).
Key Priorities
Key treatment priorities for the Leicestershire
DAAT partnership identified by the 2008/09 needs assessment are
Improve access to treatment
–
Improve methods to engage
stimulant users
Improve methods to engage
minority groups
Ensure access for drug using
offenders
Further develop T1/Primary
Care access/referral routes
Improve retention in treatment
–
Further develop model of Shared
Care provision/delivery
Explore appropriate initiatives
to retain clients once in treatment inc assesertive outreach, mentoring
support, locality/community based teams
Ensure harm reduction
initiatives are delivered within all tiers of treatment system
Further develop work with
partners to improve throughcare and aftercare opportunities for substance
users, with particular regard to secure housing options, training and
employment opportunities
Further to this, the partnership will
continue to deliver on priorities identified last year , including ;
continue to improve on key
identified targets (inc waiting times)
continue to support the development
of an effective, competent workforce
increase access to, and improve
quality of Tier 4 services
increase service users and
family/parent participation.
Conclusion
Whilst these priorities have been identified
through the needs assessment process undertaken throughout Oct-Dec 2007,
it is acknowledged that the process of undertaking the needs assessment
should be prioritised throughout the year as part of the strategic approach
to data analysis.
To this end there is a need for developing
a more robust method to enable the strategic use of information
and data to enhance the treatment planning process.
DRAFT
DRAFT
F:\SHARED\LLR DAAT\3. Treatment\Annual
Planning\Annual Planning 2008-09\Treatment Plan Masters 2008-2009\Leicestershire\Strategic
Assessment Leicestershire08-09.doc