Agenda item

The Committee considered a report of the Director of Public Health, Adult and Health Services that provided Members with an update on the County Durham Drug and Alcohol Service (DARS) delivery.

The Chair introduced the Public Health Strategic Manager who was in attendance to give an update on DARS and share progress made to date since the last report that was presented in January 2019. The Public Health Strategic Manager informed the committee that the new contract that commenced in September 2017 had embedded well. Members were informed that in the last 18 months the DARS had established many new pathways that had transitioned more outreach workers to provide a more accessible, fully mobilised service.

The Public Health Strategic Manager notified the committee that the performance of DARS was reviewed on a quarterly basis by the Drug and Alcohol Strategy Group that reported to the Safer Durham Partnership.  She explained that the service had formed pathways with Humankind that worked alongside Spectrum Community Health Community Interest Company (CIC) to deliver services. 

As part of the new contract, the Public Health Strategic Manager explained that they had decommissioned three recovery centres but had kept three centres located at Whinney Hill, Consett and Stanley.  The remodelled service included outreach provision to clients in the community rather than clients coming to them and the service was built around the family and young children.  She added that a Health Needs Assessment (HNA) had also been carried out to look at the further needs of long-term opiate users. 

The Public Health Strategic Manager noted that an inspection had been carried out by the Care Quality Commission (CQC) in 2018 that had ranked the service ‘as requiring improvement’. Members noted that at the time of the inspection, the service was only four months into the new contract and still in the infancy stage. Members were informed that an action plan had been implemented and the next inspection was expected in March 2020.

The Public Health Strategic Manager informed the Committee that there were 3,035 clients by the end of quarter two and the number of successful completions was stable with several clients getting into recovery leading fulfilling lives.  In addition, there were now 40 outreach workers across the County and clinical intervention covered areas that had no provision in the past.

The Public Health Strategic Manager advised the Committee that there had been pathways established with the Criminal Justice Network, prison service, the police and children and family services through the Youth Justice Service and had created better integration and partnership working.  Members were advised that there were 121 clients being supported through the Criminal Justice Team which was a huge increase from the previous 35. In addition, 311 children and families had access to the service through the multi-agency safeguarding hub (MASH). 

The Public Health Strategic Manager supported the significant developments within hospital settings in both the Lanchester and North Durham hospitals with recovery workers gaining access to hepatology, maternity services and paediatric wards with 100 new referrals made to the drug and alcohol team.  In addition, there had been developments within the Primary Care Trust with the increase in prescriptions for gabapentin and in GPs offering flu vaccinations for clients with respiratory diseases and long-term conditions.

The Public Health Strategic Manager explained that a new Housing Solutions Outreach Worker had been employed to engage with people who were sleeping rough in Durham City that had led to them liaising with Housing Solutions for help. She noted that a harm reduction death group had been established to aim to prevent and reduce the number of deaths from substance misuse. Naloxone kits had been rolled out to vulnerable services to include families, carers and custody suites to counteract the effects of drugs when people overdosed. She added that a programme had been recognised for pharmacies to also give them out.

Councillor Charlton asked if there was capacity within the budget if the service engaged with more and more clients.

The Public Health Strategic Manager responded that the new model of working had enabled better provisions for the service to engage with service users but it had not brought in many more extra clients.  She added that although the budget remained the same for this year and next, it was unclear how it would be funded in the future.

Councillor Bainbridge asked if the Outreach Worker was focused on working with rough sleepers in the Durham City area.

The Public Health Strategic Manager informed the Committee that the Outreach Worker was part of a bigger programme regarding rough sleepers that involved Housing Solutions that had success in getting people into homes.  She added that the service had received funding from housing providers and the Outreach Worker reacted to specific work in Durham City but the programme looked at County Durham as a whole. She highlighted that the service also looked at people at risk of homelessness and not just those known to be rough sleeping so issues were picked up earlier and potentially referred to the Drug and Alcohol team if needed.

Councillor Boyes enquired as to what work was carried out with people in or coming out of prison who had drug and alcohol issues.

The Public Health Strategic Manager notified the Committee that Humankind had won the contract with prisons across the region to carry out work with people with drug and alcohol issues within the prison system.

The Service Manager, Humankind stated that Humankind and Spectrum Community Health CIC were integrated to interface better with people in and out of prison so that treatment was seamless and there were no gaps.

The Public Health Strategic Manager noted that the prison outreach worker worked with the health worker to ensure there were strong links into the prison.

Councillor Turnbull was disappointed that due to GDPR a Councillor could not find out the progress or outcomes of a person who they had referred to housing.  He noted good work undertaken by the Drug and Alcohol Recovery Service but was concerned at the number of needles and drug paraphernalia that was dumped in villages.  Cllr Turnbull asked how this could be prevented. 

The Service Manager, Humankind responded that if the problem areas were reported, the service could respond by examining how things could be done differently like adding additional bins or needle exchange sites.  He added that through partnership working, education could also be provided to users in those areas to the dangers of dumping needles.  He noted that this multi-pronged approach would take time but could be achieved.

Councillor Boyes requested some form of update to be given to Councillors on people who were rough sleepers that were helped by Councillors.

The Public Health Strategic Manager stated that an update for Councillors may be difficult due to GDPR as they did not set regulations on this area.  She agreed to forward concerns raised by Members to the services involved and explore if options were available within regulations to provide feedback to Councillors. 

Councillor Temple praised the good work that had been covered in the report and said that the North East had some of the highest rates of deaths from drug misuse in the country which were roughly double the national average. He asked when we would see improvements in this area and were there any national initiatives that we could learn from.  He was aware that things were done differently in other parts of the country and knew that poverty played a part in the amount of drug and alcohol misuse.  He noted that Ron Hogg, former Police, Crime and Victims’ Commissioner was a great believer in changing behaviour and policing towards drug users and asked if there would be any safe spaces created for people to inject.

The Public Health Strategic Manager stressed that the rates of deaths related to inequalities in the North East and County Durham. She noted that there were positive engagement rates with Naloxone being rolled out that counteracted the effects of drugs in the case of overdose.  In addition, it was highlighted that work had been carried out around safer consumption as part of the Health Needs Assessment but would cost over £1million to undertake.  She emphasised that the new model of working had been effective with safer consumption.

Councillor Temple requested further information to when the number of completion rates would reflect the decrease in deaths. The Public Health Strategic Manager could not give an exact date as there were a lot of factors that would have to be considered. Councillor Boyes stated that this could be followed up at a future Committee meeting.

Councillor Crathorne commented on the positive work and engagement undertaken by the service and asked if the figures reflected people who had successfully completed treatment and were without drug and alcohol.

The Public Health Strategic Manager stated that in the report the successful completion rates measured people that had been in the service for 5 years to be completely free of drug and alcohol.  She added that within that time they may have come back into the service numerous times but the more they came back the greater the chance of recovery.  Members were referred to the graph within the report that showed that opiate users in the County were higher than some of the national targets for England.  She noted that people had gone into completion if they did not represent themselves within six months.

Councillor Crathorne stated that more need to be done on the ground targeting drug dealers to stop the vicious circle.

The Public Health Strategic Manager stated that there were improved relations with the Police and Prison Service that had made progress but more needed to be done. 

Resolved

That the report be noted.