APPENDIX A 16/05/13

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APPENDIX A

Drug and Alcohol Services in

Leicester

Joanne Atkinson, Consultant in Public Health

Kate Galoppi, Head of Drug and Alcohol Action Team

19th June 2012

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Aim of presentation

• To introduce members to the issues of drug and alcohol misuse in Leicester including:

– The extent of the problem

– Existing services

– Gaps in service provision

• Drug and Alcohol needs assessment recently undertaken – presented to SLP 12th June which forms basis for much of the presentation

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Aims and objectives of needs

assessment

• Provide a clear and accurate statement of

needs re: substance misuse in Leicester by;

– Collecting and appraising data

– Reviewing evidence base

– Reviewing current system

– Engaging stakeholders

– Disseminate findings

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National Policy

• 2010 Drugs strategy

– Reduce use

– Increase recovery

– By reducing demand, restricting supply & building recovery into communities

• 2012 Alcohol strategy

– Reduce excess drinking

– By behaviour, crime, binge drinking, alcohol related deaths, young people drinking

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Local Policy

• Safer Leicester Partnership provides the oversight re: substance misuse and includes a range of partners

• Relevant sub-groups of SLP:- Alcohol Delivery Group- Drug and Alcohol Commissioning Group

• Local strategies and plans include:– Adult drug treatment strategy

– Young peoples substance misuse plan

– Alcohol harm reduction strategy

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Demographics

A young and growing population

6% 4% 2% 0% 2% 4% 6%

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Leicester Population structure, 2010 and 2020

England Females 2010 Leicester Females 2020 Leicester Males 2020

Leicester Females 2010 England Males 2010 Leicester Males 2010

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Demographics II

High levels of deprivation

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Drug use

• Estimated 2,539 OCU (Opiate/ Crack Users) in Leicester

• 6% report taking drugs in last 12 months, (Leicester Lifestyle Survey) v 8.8% England

• Majority cannabis followed by cocaine/coke

• Higher usage in males, 16-24 year olds and white groups

• Nationally 18% of 11-15yr olds reported taking drugs in the last year

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Alcohol

• In Leicester it has been estimated that: – 63,000 adults (26.2%) drink above recommended levels

– almost 13,000 (5.3%) drinking at harmful levels and

– almost 9,000 (3.6%) dependent on alcohol

• Leicester Lifestyle Survey backs this up – 27% reported drinking above the recommended levels

• However we have a relatively low proportion of people that drink alcohol – just under half of the adult population report that they do not drink

• More males than females report drinking above recommended levels (32% v 23%), highest in 16-24 yr olds (33%) and white populations (36% v 12% in Asian groups)

• Young people (11-15 yr olds) TellUs4 Survey (2009)– 20% reported ever having an alcoholic drink (42% - England)

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Vulnerable groups

• Clear association between mental illness and drug/ alcohol dependence.

• Estimated that 33% psychiatric patients with serious mental illness have a substance misuse problem (dual diagnosis)

• In Leicester 9% of new drug treatment journeys had dual diagnosis v 14% nationally

• 10% of new alcohol treatment journeys had dual diagnosis v 16% nationally

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Health outcomes: Drugs

0

10

20

30

40

50

60

Ra

te p

er

10

0,0

00

Hospital admission rates for drug poisoning (primary diagnosis),

2010-11

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Health outcomes: Drugs II

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Health outcomes: Alcohol

395 405 419 430535 537

652 676 676

952

203 189 148 211 220 210 267 261 250403

0

200

400

600

800

1000

1200

Ag

e-s

tan

da

rd

ise

d r

ate

pe

r 1

00

,00

0

Alcohol-specific hospital admissions for Males and Females, 2009-10 Age

standardised rate per 100,000

Males

Females

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Health outcomes: Alcohol II

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Deaths: Alcohol

35.9

14.9

34.7

15.5

55.7

20.4

13.16.1

12.36.1

19.9

7.90

10

20

30

40

50

60

Eng Males Eng Females EMids Males EMids Females Leicester Males Leicester

Females

Ag

e-s

tan

da

rdis

ed

ra

te p

er

10

0,0

00

Alcohol-specific and alcohol-attributable mortality for Males

and Females, 2007-2009

Alcohol attributable mort rate Alcohol specific mort rate

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Treatment

Tier 4

Tier 3

Tier 2

Tier 1

Non-substance misuse specific services requiring

interface with drug and alcohol treatment (e.g. primary

care/ A&E/ housing/ police)

Open access drug and alcohol treatment centres (e.g.

Drop-in clinics - Leicester Community Projects Trust LCPT)

Structured care planned

community-based treatment

services (e.g. Community Drug

and Alcohol Teams, LPT)

Inpatient/ Residential services for drug

and alcohol clients (e.g. inpatient detox,

LPT/ residential rehab)

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Current Treatment Services

LCPT (Leicestershire Communities Projects Trust)

• Public front door

• Drugs/Alcohol

• Drop-in and phone advice

• Assessment

• Needle exchange

• Baseline (Crack Cocaine)

• Casework

LPT (Leicestershire Partnership Trust - NHS)

• Referrals from LCPT and other agencies e.g. GPs

• Drugs/Alcohol

• Assessment

• Casework

• Subsitute Prescribing

• Screening & vaccination for blood borne viruses

• Referral to detox

• Primary Care Support to GPs

QoL (Quality of Life Service)

- provided by Leics & Rutland Probation Trust

• Referral from other agencies and some public access

• Drug/Alcohol

• Recovery services

• Group work

• Peer Mentors

• Parents/Carers services

CJDT (Criminal Justice Drugs Team)

- provided by Leics & Rutland Probation Trust

• Integrated treatment pathway for offenders

• Drugs/ Alcohol

• Alcohol Arrest referral

• DIP (Drug Intervention Programme)

• Structured treatment

• Community orders

• Treatment within HMP Leicester

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Other related services

• Alcohol liaison workers in UHL (tier 2)

• Substance misuse midwife in UHL

• Alcohol Locally Enhanced Service with GPs

(brief interventions)

• Alcohol worker based in the Dawn centre

• Anchor Centre (wet day centre working

predominately with street drinkers)

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Adult Treatment: Drugs

Referral

• Criminal Justice - 319 (52%)

• Self - 81 (13%)

• GP - 56 (9%)

• Drug Services - 141 (23%)

• Other - 24 (3%)

Treatment

• CJDT - 596 (35%)

• LCPT 120 (7%)

• CDT - 960 (56%)

• Inpatients - 34 (2%)

Discharge

• Planned - 155 (32%)

• Referred on - 194 (40%)

• Unplanned - 138 (28%)

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Adult Treatment: Alcohol

Referral

• Criminal Justice - 85 (18%)

• Self - 14 (3%)

• Health and Mental Health Services - 255 (54%)

• Other - 118 (25%)

Treatment

• Tier 3 and 4

• Other structured treatment - 580 (79%)

• Inpatient - 78 (11%)

• Structured day programme 65 (9%)

• Other - 14 (1%)

Discharge

• Planned Occasional user - 123 (29%)

• Planned Alc/Drug Free - 111 (26%)

• Referred on - 27 (6%)

• Unplanned - 166 (39%)

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Treatment: Young people

Referral

• YOT - 36 (51%)

• Children / Family Services 24 - (34%)

• Family and Friends 6 - (8%)

• Other - 5 (7%)

Treatment

• Psychological - 89 (86%)

• Harm Reduction- 9 (9%)

• Other - 5 (5%)

Discharge

• Planned - 42 (70%)

• Referred on - 10 (17%)

• Unplanned - 8 (13%)

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Funding Available 2012/13

Department of Health £3.6m

Home Office/ Ministry of

Justice

£1.9m

Leicester City Council £0.35m

NHS £1.8m

TOTAL £7.7m

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Recommendations from

needs assessment

• Greater understanding of needs within specific communities is required e.g. South Asian & Somali

• More analysis required regarding whether service provision matches need (Health Equity Audit)

• Further development of dual diagnosis services

• Improved marketing of treatment services

• Further work needed to explore needs of children whose parents are substance misusers

• Better access to support and information at times of crisis

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Recommendations – cont’d

• Further exploration of why proportion of referrals from criminal justice is so high

• Improve uptake of vaccination to reduce blood borne viruses

• More exploration re: needs of those using legal highs and steroids

• Improved recording within treatment services

• Increase proportion of dependent drinkers accessing treatment

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Next Steps

• Refresh plans:

- adult drug treatment strategy/ plan

- young peoples’ substance misuse plan

- Alcohol Harm Reduction Strategy/ plan

• Procurement process – from October 2012,

new services in place from 1st July 2013

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