Agenda item

(i)            Report of Director of Transformation and Partnerships.

(ii)          Presentation by Jane Sunter, Public Health Portfolio Lead (Drug and Alcohol) and Ted Haughey, DISC, Executive Director of Operations North East and North Yorkshire

The Chairman introduced the Public Health Portfolio Lead (Drug and Alcohol), Jane Sunter and the Executive Director of Operations, North East and Yorkshire, Developing initiatives Supporting Communities (DISC), Ted Haughey who were in attendance to provide and update on Substance Misuse Services for County Durham (for copy see file of minutes).

The Public Health Portfolio Lead reminded Members of the long journey in respect of substance misuse services and noted there was now an opportunity to share good news and also introduce the Executive Director of Operations, DISC, the new service provider working in partnership with Spectrum Community Health Community Interest Company (CIC) and The Basement Project.

Members were reminded of the aim of the Drug and Alcohol Recovery Service in 2015 was: “To provide an integrated model that places the resolution of vulnerability in adults, young people, families and cares at the heart of the recovery process, irrespective of the presenting substance of choice.  Works to break the intergenerational cycle of substance misuse by utilising a holistic approach to family support, regardless of the entry point into health and social care services”.

The Public Health Portfolio Lead explained that in moving forward to a new contract, the key priorities were to have a more integrated and “life course” approach, with focus on families and the people involved, not on the substance.  Members were advised that there was a need to break the intergenerational cycle and noted that Councillors would all be aware of families where there were issues with parents and children.  It was noted that there was a statutory duty for Local Authorities, from the Health and Social Care Act and the Public Health Grant to provide substance misuse services.

Members noted the key priorities were: integration; family focus; outreach support; and reinvigorating of the prevention agenda.  It was explained to the Committee that from consultation it had been shown there was a need to move away from “centres” and to look to have workers out into our communities.  Members were referred to the “four pillars” from the previous model for drug and alcohol services, namely: effective prevention; high quality recovery interventions; recovery rehabilitation programme; and recovery support.  It was explained that the new model would have a robust communication plan and there would be awareness raising within services in terms of referrals.  Members noted this included: GPs, Primary Care, County Durham and Darlington NHS Foundation Trust (CDDFT), Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) and Wellbeing for Life; Adults, Young People and Families Health and Social Care; Self; Community and Voluntary Sector, Educational Settings; and the Police, Crime and Victim’s Commissioner’s (PCVC) Office, Police, Integrated Offender Management (IOM), National Probation Service (NPS), Durham Tees Valley Community Rehabilitation Company (CRC), Prisons Estates, Courts and the County Durham Youth Offending Services (CDYOS). 

The Public Health Portfolio Lead noted consultation had been carried out, including with Members in terms of operational facilities.  Furthermore it was explained that there would be a move to three retained recovery centres located at Saddler House, Bishop Auckland; the Centre for Change, Durham City; and Ridgemont House, Peterlee.  It was added that these would also operate as the bases for staff, however, there would be outreach facilities in the areas of: Newton Aycliffe; Seaham; Consett; Spennymoor; Chester-le-Street and Stanley.  Members noted there was also provision in Teesdale provided by DISC.

The Committee learned that there were several areas for development, including a robust communication plan for external stakeholders.  Members noted another area was in linking prevention training using “Making Every Contact Count” and “Have a Word” for other partners with further development opportunities.  It was explained that there would be the development of the Criminal Justice pathway to include IOM and Checkpoint.  The Public Health Portfolio Lead noted the co-location of Children, Young People and Families Team and the Multi Agency Safeguarding Hub (MASH) with a “Think Family” approach being integrated into local structures, embracing of first contacts (Adults and Children) and safeguarding for no wrong “door” or wrong “person” approach.

Councillors noted a further area for development was the hospital pathway, noting currently there were minimal referrals even though a pathway was in place.  It was highlighted there was requirement for in reach facilities for Accident and Emergency (A&E) and significant wards/departments.  The Public Health Portfolio Lead noted in terms of GPs and Primary Care, GP’s express needed more involvement with the drug and alcohol service.  It was added that further engagement and support was needed to engage alcohol clients and those addicted to prescription medication.  Members noted other areas included: a proactive approach to working with “contracts” given by Police, Health and Social Care; and to increase needle exchange facilities via Pharmacies, highlighting steroid users who may also have other issues such as alcohol misuse and cocaine use.

The Public Health Portfolio Lead asked the Executive Director of Operations, DISC to give an overview of the work DISC.

The Executive Director of Operations, DISC thanked Members for the opportunity to speak to Committee and noted that DISC was established in 1994 and had been delivering services in County Durham for over 30 years.  He explained that DISC operated across the North East, North West and Yorkshire and had a proven track record of partnership working.  It was added that DISC had received a number of awards: Investors in People Silver Award; Investors in Volunteering Award; and the ENE Gold Standard.  Members were informed that DISC operated within a number of quality frameworks, including: Ofsted; Care Quality Commission (CQC); and the Quality and Outcomes Framework (QOF).

The Committee noted that DISC had a multi-thematic offer which included: independent living and registered social landlords; skills, employment and training support; access to opportunities through MoreTime, DISC’s social enterprise; health and wellbeing services including clinical services; and specialist support for vulnerable children, young people and families.  The Executive Director of Operations, DISC explained that DISC’s corporate services were located at Newton Aycliffe and in terms of innovation, there were a number of funding streams which could be accessed for specialist funding for employment training and accommodation provision.

In terms of “Spectrum”, it was explained that it was incorporated in 2011 as a CIC, a non-profit spin out from the NHS, retaining a number of ex-NHS staff and was employee-led and value-driven.  The Executive Director of Operations, DISC noted that Spectrum had a number of contracts which gave an indication of the type of activities they engaged in, including within challenging and complex environments.  It was added that the staff were passionate in terms of making a difference for vulnerable people and were mobile, travelling out to those in need.

The Executive Director of Operations, DISC noted the “Basement Project”, which also operated in Calderdale, looked to mobilise what was already on offer in Durham and helped in terms of supporting “mutual aid”, looking to create a recovery community, working with the Recovery Forum.  It was highlighted that the “Freedom Project” included: steps to recovery, preparation to change; a pre-recovery programme, preparation for detoxification and abstinence; abstinence programme, maintaining and building recovery; compass programme, introduction to 12-step mutual aid; and process group, a personal exploration group.

The Committee noted that DISC would mobilise County Durham’s Drug and Alcohol Service, supported by a comprehensive mobilisation plan covering: finance; performance; workforce; learning and development; premises and resources; IT, communications and data; service user engagement; and operational delivery.  The Executive Director of Operations, DISC noted that there were regular meetings between DISC and Public Health with good communication.

The Public Health Portfolio Lead noted a number of good news stories in terms of performance and referred Members to a number of graphs highlighting successes. 

It was noted in terms of opiate user successful completions, the target had not been met, though there was more work to be done in terms of non-opiate users, with some of these users feeling they were not “taking drugs” as such.  Members were advised that the figures in terms of alcohol had increased slightly and was being looked at.

The Public Health Portfolio Lead noted that staff had transferred to DISC and the key messages were: the new service went live, 1 February 2018; it was business as usual at present; new outreach facilities would be communicated to partners and via the DISC website and contact details for the Drug and Alcohol Service remained the same.

The Chairman thanked the Officers for their presentation and asked Members of the Committee for their questions and comments.

Councillor C Wilson asked how many looked after children were affected by drug and alcohol issues and accessing the service.  The Public Health Portfolio Lead advised she would look to find out this figure and provide a response to the Committee.  In addition, nationally evidence showed drug and alcohol use, or at least in the case of their parents of looked after children, noted issues in terms of supporting those parents, and noted targeted work was needed in this regard.

Councillor L Kennedy noted the Think Family approach and the Council’s One-Point Hubs, and asked how these would be sustained.  The Public Health Portfolio Lead noted that the work in terms of the drug and alcohol service had been carried out over a period where there had also been changes in terms of Children’s Services.  Members were infored that a thematic group had looked to align how services worked and that the services provided via the One-Point hub continued, though they would be looked at in terms of reconfiguring pathways.

The Chairman noted that the regional figures for 2017 showed successes and he asked how DISC would look to ensure that it continued.  The Executive Director of Operations, DISC noted the first step was to ensure that patients transitioned safely, with there being targets for staff for each of the hub areas as well as tracker indicators per client to identify if any targeted work was required.  In addition, Members were advised that there were internal systems within DISC in terms of successful completions and that there was the ability to bring together packages from other services within DISC to be able to help where appropriate in any areas of underperformance.

Councillor H Liddle asked as regards how quickly a response would be given should a person try to access services, and what out of hours provision was available.  The Executive Director of Operations, DISC noted while there was no out of hours provision, contact would be made as soon as possible during operational hours.  He added that in terms of applicants, those with a high risk would be seen that day, and for those with complex needs then staff would travel out to them, noting there were a number of nurses who could proscribe operating on a rota.  It was added that building up the number of community venues available to operate from would help make this easier.

Councillor B Avery noted issues in his Division, that he felt would be mirrored in other areas, of underage drinking and anti-social behaviour and asked was there anything the service could do.  The Public Health Portfolio Lead explained that there was an alcohol seizure pathway, though it was for the Police to identify. 

She added it was a three step approach, looking to identifying the group of young people, identifying which school they attend and target that school, via assemblies and awareness sessions.  It was added that it could be targeted by class or one-to-one support offered should parents be happy to do so.

The Chairman noted that accurate information was important in order to track performance and highlighted that NHS and GP data was not usually up-to-date and asked how we would be getting information from them.

The Public Health Portfolio Lead noted a dedicated team would visit GPs and work in partnership and that in terms of pharma outcomes there would be targeted work where GPs were not seen to being proactive.  The Executive Director of Operations, DISC noted that there would be a single point of contact in terms of clinical and non-clinical, with the Public Health Portfolio Lead adding that it was about building up those relationships. 

Mr AJ Cooke noted concerns in terms of the facility at Teesdale and the large geographical area covered, by Police and other services, and issues such as underage drinking.

The Chief Fire Officer, S Errington asked whether, given the performance concerns that had been raised by the Committee over the years, any consideration had been given in terms of payment by results for the service.  The Public Health Portfolio Lead noted there had not, and added that in her experience such a system would not help if a target was not met then the shortfall would affect the number of staff and this in turn would affect performance and only add pressure to those delivering services.

Councillor L Kennedy asked as regards youth alcohol and drug services and whether these would be via outreach services, for example coming into community venues to explain the consequences of risk taking behaviours.  The Executive Director of Operations, DISC noted this was an element of the work of the young people team, noting an example at a particular park in Gateshead where targeted work in partnership with the Police, Local Authority and other partners looked to tackle hotspots.

The Chairman asked what the definition of success would be in the short and medium term.  The Public Health Portfolio Lead noted in the short term it would be to be engaged with a willing provider and to be more pro-active, and in the medium to long term it would be to increase performance against national figures.  She added she felt positive for the future of the service.

Councillor S Iveson asked when referring young people, what ages were those young people.  The Public Health Portfolio Lead noted in her experience in other Local Authority areas there had been children as young as 8 years old.

Resolved:    

(i)     That the report and presentation be noted.

(ii)    That a further update report be brought to back to the Safer and Stronger Communities Overview and Scrutiny Committee in early 2019.