Agenda item

Report of the Director of Public Health – presented by the Public Health Strategic Manager – Living and Ageing Well.

The Chair welcomed the Public Health Strategic Manager – Living and Ageing Well, Jane Sunter who was in attendance to take Members through the Alcohol and Drug Harm Reduction Group Update 2021 (for copy see file of minutes).

The Public Health Strategic Manager thanked the Chair and Members and noted the report built upon the briefing session held for Members on the topic and linked to other areas of work across the Council and its partners, as highlighted by the previous two agenda items.  She referred to statistics for County Durham and noted that for 2020-21 there had been one-fifth more deaths linked to alcohol harm than in 2019-20, a significant increase. 

It was added that the North East average was significantly greater than the England average, and that the County Durham level was below the North East average.  Members noted that most deaths were associated with long-term dependency, with liver disease accounting for around 80 percent with the bulk being within the most deprived areas.  Members noted the number of seizures had reduced in 2020-21, however, admissions into hospital had increased since 2018-19, and therefore more work was needed with the County Durham and Darlington NHS Foundation Trust (CDDFT) and the Drug and Alcohol Recovery Service (DARS) provider, Humankind.

In relation to drug harm, it was noted that there had been consistent numbers throughout the pandemic, with a hybrid/blended model being operated as a result of the pandemic.  The Public Health Strategic Manager noted figures from the Office for National Statistics (ONS) showed that the North East figure of 9.9 deaths per 100,000 population was greater than the England figure of 5 per 100,000.  It was noted the figure was 8.3 per 100,000 for County Durham, the second lowest in the region, however this was sometime misreported in the press as Durham had the highest number of deaths, albeit also with a large population.

The Committee were informed as regards work relating to Coronavirus vaccine and vulnerable clients, and while those attending the DARS were not classified as vulnerable by the Joint Committee on Vaccination and Immunisation (JCVI), many of the service’s client also fell within identified vulnerable groups such as those that were homeless.  Members were reminded that the that the County Durham Alcohol and Drugs Harm Reduction Plan had been aligned with the SDP Plan and contained 86 actions, of which 61 had been completed, with 25 ongoing.  It was added that the terms of reference and membership of the Alcohol and Drugs Harm Reduction Group (ADHRG) had been updated.

The Public Health Strategic Manager noted the continued work with Balance, the North East Alcohol Office, in relation to alcohol misuse and explained as regards the recent hard-hitting ‘Alcohol - not the answer’ campaign, relaunched in February 2021 in response to concerns as regards increasing alcohol consumption during the pandemic.  She explained as regards other campaigns such as ‘What’s the harm?’ launched in May 2021, aiming to help parents to understand the Chief Medical Officer’s guidance around children and alcohol.  Members learned as regards a successful bid for Contained Outbreak Management Funding of £30,000 to be used to help amplify the Balance alcohol campaigns at a local level and support people in being able to access the DARS.  Councillors noted the continued work with Balance in respect of Minimum Unit Pricing (MUP) for alcohol and the information on the positive MUP had in after introduction in Scotland over the last two years.

In respect of Licensing, it was explained that Public Health worked with the Licensing Teams and while there had been a reduction in terms of capacity during the pandemic, numbers had been increasing, with 63 requests for new, or changes to existing, alcohol licences since March 2021.

With reference to the Holistic Needs Assessment (HNA) for long term opiate users, the Public Health Strategic Manager explained as regards the ongoing work and the increased naloxone supply across the county to help reverse opioid overdose.  Councillors were referred to paragraphs 38 and 39 of the report which related to Substance Misuse Related Deaths (SMRDs) and the statistics for the North East which highlighted an aging cohort for drug users in County Durham, with Humankind looking at the issue as well as targeting those users’ wider health.  The Committee learned of Public Health England Universal Funding, which would further enhance the capacity for naloxone provision.

The Public Health Strategic Manager explained as regards the performance of the DARS, noting good performance during the pandemic period, working on a hybrid model, though maintaining the one-to-one relationships for those at high risk.  It was noted that for Quarter Four 2020-21 there had been 2,866 clients in treatment, a reduction of 149 year-on-year.  Members were referred to the number of successful completions as set out at Table 2 within the report noting opiate and alcohol completions being around the national level, with non-opiate completions being better than the national average.

The Committee were reminded of the work carried out following the Care Quality Commission (CQC) inspection rating of ‘requires improvement’ in February 2018 and noted a further inspection had been scheduled for March 2020, though that had been cancelled as a result of the pandemic.  It was explained that monitoring continued with quarterly contract meeting and that the CQC reported to be happy with progress.  Members were informed of the new DARS centre at Horden, following the closure of the centre at Ridgemount House, Peterlee.  The Public Health Strategic Manager noted the work in relation to the Women’s Recovery Academy Durham (WRAD), with soft launch having took place in February 2020.  The Committee noted funding in the sum of £545,000 relating to helping to reduce crime in relation to drug use in County Durham, with colleagues from the Office of the PCVC, Probation, Humankind, and Public Health all involved in the bid.  It was added the was also a bid for funding from Public Health England’s (PHE) ‘rough sleeper fund’, as well as bid to PHE by Durham County Council on behalf of the LA9 Authorities in respect of commissioning inpatient detoxification beds.

The Chair thanked the Public Health Strategic Manager and asked Members for their comments and questions.

Councillor B Avery noted the impact of drugs and anti-social behaviour in his ward, with Councillor E Mavin agreeing it was a major issue with Police noting they needed more information as regards networks.

Councillor D Boyes noted that the report reflected the good news story in terms of the progress made by the DARS since 2015 from being well below national averages to now being around on par with those averages.  He highlighted that it was an example of where being able to target Public Health grant locally helped to maximise the benefit for the area. 

He noted that the issue of substance misuse was an increasing problem and noted his concern as regards the work of the Public Health Strategic Manager and her team if the Public Health grant was cut.  He added that the impact in terms of both health and crime meant that it must be protected and ringfenced.  He noted that ‘post-pandemic’ statistics would be more useful now in being able to look forward in terms of the service.  The Public Health Strategic Manager agreed as regards having the most up-to-date statistics, though noted there were issues in terms of the most up-to-date figures from sources such as PHE, the Fingertips Database, and Durham Insight and assured Members would be provided with those facts and figures once obtained.

The Chair asked as regards the number of beds for the DARS.  The Public Health Strategic Manager noted that was no longer the primary model, rather community detoxification was used, with staff visiting the clients.  She added that for the most complex clients, there was a commissioning arrangement with a number of external providers, outside of the region.  She explained that in the last year there had been five inpatient requests, and while some would choose to access private treatment, the service could commission and refer to impatient if appropriate.

Councillor D Sutton-Lloyd repeated his previous points as regards how important it was to get the Police involved within communities to tackle what appeared to be a lack of action in terms of drugs as it was having the effect that people were not willing to come forward with information as they felt no action would be taken.  Councillor J Quinn asked if there had been a reduction in drug supply.  The Public Health Strategic Manager noted there had been anecdotal evidence of a reduction during the lockdowns, though statistics would need to come from Durham Constabulary.  Councillor J Quinn asked as regards how to encourage more people to access the DARS, especially in terms of alcohol, as many people may not perceive that they had a problem with alcohol.  The Public Health Strategic Manager noted there were a range of interventions, to encourage people to look at their own alcohol intake, including the work of Balance in awareness raising, including an alcohol intake check when having a health check with GPs, which could include referral to Humankind if appropriate.  She explained to the Committee that there was still a need for an individual to want to access the service and added that there was a ‘drip-drip’ effect of educating children and young people of the dangers of alcohol.  She noted there were a number of other interventions, with reference to an app that showed level of intake and could help fast track referrals.

Councillor J Quinn asked as regards localised numbers for drug and alcohol misuse.  The Public Health Strategic Manager noted that alcohol misuse as the larger issue, with data showing clear links between deprivation and alcohol misuse and poorer health.  She noted she would speak to colleagues in Public Health as regards where people accessing the DARS were from, noting having that information at a postcode level was what had helped identify the need in terms of relocating the DARS to Horden.

The Overview and Scrutiny Officer noted the point raised by the Public Health Strategic Manager in relation to information available via Balance and Durham Insights and would circulate information to the Committee accordingly.

Resolved:

That the annual update on the progress of the Alcohol and Drugs Harm Reduction Group be noted.