Public Health performance report quarterly information as at end

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                  Quarterly information as at end of August 2008

See appendix 1:

                                                     PUBLIC HEALTH PERFORMANCE REPORT

                                                              Indicators and their meanings

Indicator title                       Meaning of indicator                                                       Positive direction of   Time lag from
                                                                                                                 travel                  quarter end
All age all cause mortality           Total number of deaths and age standardised death rate per 100,000         Decreasing death rate   6 months
(males and females)                   population.
Cardiovascular disease mortality      Number of deaths from cardiovascular disease for people aged less          Decreasing death rate   6 months
under 75 years                        than 75 years and age standardised death rate per 100,000
Cancer mortality under 75 years       Number of deaths from cancer for people aged less than 75 years and        Decreasing death rate   6 months
                                      age standardised death rate per 100,000 population.
Smoking during pregnancy              Percentage of women known to be smokers at the time of delivery.           Decreasing percentage   1 month
Breastfeeding initiation              Percentage of new mothers known to have initiated breastfeeding.           Increasing percentage   1 month
Childhood immunisation uptake         Percentage of children immunised with MMR vaccine by their 2               Increasing percentage   2 months
Smoking quitters at 4 weeks           Number and percentage who had successfully quit at 4 week follow-up        Increasing percentage   2 months
Cervical screening uptake             Percentage of eligible women, aged 25-64 years, recorded as being          Increasing percentage   3 months
                                      less than 5 years since their last adequate result.
Alcohol related admissions to         Number and rate of hospital admissions for alcohol related conditions      Decreasing admission
hospital (males and females)          per 100,000 population.                                                    rate
Drug users in treatment               Number of drug users in treatment year to date.                            Increasing number       3 months
Drug users in sustained               Percentage of drug users sustained in treatment for 12 weeks.              Increasing percentage   3 months
Prescribing of cost-effective         Prescribing of cost effective statins (simvastatin and pravastatin) as a   Increasing percentage   2-3 months
statins                               percentage of all statin items prescribed. Statins are used to prevent
                                      cardiovascular events such as stroke and heart attacks.
Prescribing of ACE inhibitors         Prescribing of ACE-inhibitors as a percentage of drugs acting on the       Increasing percentage   2-3 months
                                      rennin-angiotensin system. Drugs in this class are used to treat heart
                                      failure and hypertension.
Generic prescribing of proton         Prescribing of generic omeprazole and lansoprazole capsules as a           Increasing percentage   2-3 months
pump inhibitors                       percentage of all drugs in the class of proton pump inhibitors. This
                                      class of drugs is used in treating dyspepsia and use of generic
                                      capsules represents the most cost-effective choice of agent.
Prescribing of cost-effective anti-   Prescribing of dispersible aspirin tablets (75mg) as a percentage of all   Increasing percentage   2-3 months
thrombotics                           antiplatelet drugs. These drugs are used to reduce the risk of
                                      cardiovascular events such as stroke and heart attack.

                            Public Health Performance Report

This commentary concentrates on those indicators for which information has been
updated since the last report to the Board and are showing red.

New targets

This report presents data on the first quarter of 2008/09 for many of the indicators. The
targets have been updated with new trajectories set for Vital Signs. Areas to note where
changing targets affect performance are:

   Cardiovascular disease mortality under 75 years – a more ambitious target has been
    set as the PCT was performing very well against the previous trajectory. This has
    moved the PCT position from green to amber. However, it should be noted that the
    target is for 2007-09, but the latest data is for July 2007-June 2008.
   Smoking during pregnancy – this is no longer a national indicator but a local target has
    been set to continue a 1% reduction per year.
   Breastfeeding initiation – this is no longer a national indicator but a local target has
    been set to continue a 2% increase per year. This will be replaced by the new
    indicator for breastfeeding at 6-8 weeks in future performance reports.
   Childhood immunisation for MMR at 2 years – new trajectories have been set for year
    on year improvements, rather than the national target of 95%.

Smoking during pregnancy & Breastfeeding Initiation

The target for smoking during pregnancy is to achieve a 1% reduction by the end of each
year. Therefore, there is still potential to achieve this target by March 09.

21% of women are know to be smokers at time of birth in compared to 12% in Liverpool
Women’s Hospital (LWH) S&O, which in terms of health inequalities reflects that women
in more deprived wards are more likely to smoke in general, but particularly during
pregnancy. In relation to reducing health inequalities this is a key priority as it impacts on
child mortality rates and was identified as key issue in the Public Health Annual Report.
We do need to focus on LWH and those women in deprived wards as a key priority to
reduce health inequalities.

Breastfeeding shows a similar picture around health inequalities, with lower rates in LWH
(47%) than S&O (59%), so again we need to focus on reducing that inequality. These
issues will be picked up in renegotiating the maternity core offer, i.e. what services the
LWH provide and how they link to support services across Sefton.

Childhood immunization uptake (MMR at 2 years)

Childhood immunisation for MMR at 2 years – new trajectories have been set for year on
year improvements, rather than the national target of 95%.

A small improvement in MMR uptake has been seen following the media campaign
conducted by the PCT. Work continues with primary care to improve uptake and to ensure
data completeness as there has been some under reporting.

The DH has announced a catch up campaign for MMR for children and young people from
13 months to 18 years. The national campaign has been prompted by a rise in the number
of cases of measles nationally. In Sefton a cluster of mumps cases has occurred in

The PCT is establishing a programme with local GPs to deliver the top up programme for

Smoking Quitters at 4 weeks

Numbers of successful quitters is generally low in the first quarter of the year and should
get back on trajectory in future quarters.

The quarterly target for smoking quitters has not been met. Whilst the numbers of quitters
is usually lower in this quarter than the January to March quarter, this underperformance
is a significant concern and is being actively pursued with provider services. The
introduction of new services through pharmacies and community based organisations
using health inequalities funding will increase access and choice and should help improve
overall performance later in the year. Planned social marketing work should also help to
boost the number of referrals into the service.

Cervical screening coverage

Sefton’s coverage rate (73.9%) is still well below the national target of 80%. However, the
decreasing coverage is a national issue and neighbouring PCTs are also below target.

Sefton PCT has accepted an invitation to join an Improvement Foundation programme to
improve uptake of cervical screening in women aged 25-34 years. We will be one of five
participating sites working with about 10 general practices to identify barriers to cervical
screening, seek ways of overcoming them and share best practice and new ideas which
can be adopted by other practices and areas. Ahead of this programme, focus groups are
currently being held to understand why women do not attend screening appointments.


The percentage of cost-effective statins continues to increase albeit slowly and at broadly
the same rate as in other PCTs. This has meant that although the overall performance
has improved there is still considerable work to do. For the prescribing of ACE-inhibitors
performance actually reduced over two quarters but has improved subsequently. The
Public Health performance report for May included in it a paper Prescribing Performance
Action Plan aimed at addressing this area. Progress on delivery of this paper will be
monitored through the Medicines Management Committee and Governance Committee.
The red-lighted prescribing indicators have been included in a Prescribing Quality Scheme
for PBC consortia as mandatory areas of work meaning that challenging targets will need
to be achieved by consortia in order to retain freed-up prescribing resources. This should
act as a significant incentive to practices and consortia to achieve these targets.

                      Tackling Health Care Associated Infections
                           An update report for Sefton PCT

Appendix 2


Sefton PCT and local NHS Trusts are committed to significantly reducing all avoidable
health care associated infections (HCAI) including MRSA and Clostridium Difficile and
have adapted a zero tolerance approach.

Over the past year the PCT has been working closely with Aintree Foundation Trust,
Southport District General Hospital, Walton Neurological Centre and primary care to
reduce such infections. The PCT continues to work closely with the Department of
Health’s MRSA/Cleaner Hospital Task Force and the North West SHA to ensure that the
local health economy is taking all appropriate measures to reduce HCAI.


The attached graphs for Aintree, Southport and Walton illustrate the progress being made
by local hospitals to reduce MRSA. The graphs include the cumulative figures for
2006/07; 2007/08 and 2008/09 (until August).
All three trusts are showing a steady year on year reduction in the number of bacteraemia
being reported.

The current national reporting system requires trusts to report Pre 48 hour and Post 48
hour cases. This distinction is intended to reflect those bacteraemia that have occurred
after admission to a hospital from those cases that occurred before admission to hospital.
MRSA is a relatively common bacterium, with national surveys showing that over 20% of
care home residents being colonised. (Colonisation: MRSA is found on the skin of a
patient usually located in places such as the nose or auxilla. A Bacteraemia occurs when
MRSA has entered the blood stream of a patient and caused a system wide infection.)
The figures presented in the attached graphs include both Pre 48 hours and Post 48
hours’ cases.

This is best illustrated by the data for Southport where between April 08 and August 08
three bacteraemia have occurred. As each trust conducts a detailed Root Cause Analysis
(RCA) for every bacteraemia identified, Southport has a good understanding of how each
of these bacteraemia occurred. For the three Southport cases two were shown to be Pre
48 hours. Seton PCT’s infection control team conducted a detailed RCA for each case
with the assistance of the Health Protection Agency. This analysis identified that the two
community cases were linked and that the source of the infection was as a result of
exposure to MRSA whilst travelling outside Europe. Such cases illustrate the challenge
facing the NHS as it has little control of an individual’s risk of exposure to MRSA outside
of hospital. However such cases also highlight one of the potential challenges to
interpreting data when using the national reporting system. As each local hospital trust
must report both Pre 48 and Post 48 hours cases, this can give the impression that
hospitals have more cases of MRSA than they actually do.

Trusts are now required to provide weekly reports to the PCT and the SHA as part of the
national monitoring system.

MRSA Screening

The Department of Health has announced changes to the MRSA Screening protocols in
England. At present national guidance requires hospital trusts to carry out a risk
assessment procedure to identify which admissions to its wards should be screened. The
focus of this procedure has been elective admissions to hospital, and in particular
admissions to surgical wards. Such guidance has meant that there are variations in
screening practice across the country. Over the next three years the Department of
Health intends to introduce a universal screening programme for all patients being
admitted to hospitals.

Financial implications of the new screening procedures.

Implementation of the latest national guidance will have a significant implication for the
work load and budgets of Hospital Trusts. It can be anticipated that there will be a
doubling of the number of screening tests carried out once the new standard is fully
implemented. Work has begun with each hospital trust to assess the costs of
implementing the new guidance across the timetable set out by the Department of Health.
A report will be prepared for the Executive Team setting out the resource implications for
the PCT.

Clostridium Difficile (C Diff)

The attached graphs show the current levels of C Diff in local hospitals. The national
reporting system for this infection is not as well developed as that for MRSA, hence the
lack of data for 06/07. The Department of Health has also widened its surveillance system
from cases reported in individuals aged 65 years and above, to include all cases between
2 years and 65 years old.

Aintree Foundation Trust has a target of 250 cases for 2008/09. Whilst the Trust shares
the PCT’s aspiration of no avoidable infections, this target represents a near 20%
reduction compared to the 292 cases in 2008/09. At present the trust is running over its
monthly target. Aintree has tightened its infection prevention and control procedures
further and introduced new directorate based performance monitoring systems.

Southport is also running slightly above the target set for it. The trust has also increased
its measures to reduce the number of cases. Its target for 2008/09 is 118 cases. Earlier
in the year Southport received an inspection from the Health Care Commission. The
Commission’s inspection team gave a high rating to the hospital for its standards of
cleanliness and procedures.

Walton Neurological Centre has a very different patient profile to the two district general
hospitals and had only 17 cases of C Diff last year. Whilst it is currently running slightly
over target Walton has levelled out the number of cases in the last month.

All local trusts including Sefton PCT are reviewing their anti-biotic prescribing patterns to
ensure effective use of such drugs. Sefton PCT has led the way in its information
campaign to clinicians and in the parallel campaign for patients. The campaigns will have
longer term benefits to patients and the NHS by lowering the chances of C Diff occurring
as well as ensuring that bacterial infections are treated properly.
Sefton PCT has also strengthened its infection control team to enable it to meet the
requirements of the Hygiene Code and to assist local care and nursing homes to reduce
the risk of community based infections.

Joint work with the Department of Health

Sefton PCT and Aintree Hospital continue to work closely with the Department of Health’s
MRSA/Cleaner Hospitals Task Force. The Task Force has recently completed two
inspections of Aintree Hospital and commented favourably on the progress the trust is
making. This inspection programme has been complemented by the North West SHA’s
collaboration with a US hospital.

Collaboration with Johns Hopkins Hospital, Baltimore, USA.

The North West SHA has established a partnership with Johns Hopkins Hospital (JHH),
the USA’s top performing hospital for the last 17 years. Johns Hopkins had experienced
similar problems to UK hospitals in relation to HCAI. Over the past five years it has
reduced its infection rates significantly for MRSA, C Diff and other such infections to below
UK and other European hospitals. At the core of the JHH approach is the concept of
patient safety and reducing the consequent cost of litigation if the hospital failed to protect
its patients.

The UK end of this Trans Atlantic partnership consists of Liverpool PCT, the Royal
Liverpool & Broadgreen University Hospital Trust, Aintree Foundation Hospital Trust,
Sefton PCT and the North West SHA. A small team from JHH has recently visited the
Aintree and the Royal Liverpool Hospitals to review their current protocols and
procedures. The team commented favourably on the systems Aintree have in place and
believe the trust is on the right path to reduce its infection rates further.


The overall picture in relation to reducing HCAI is mixed. Whilst all local NHS trusts are
making good progress in reducing MRSA, levels of Clostridium Difficile are above the
targets set for them. External assessment of the two hospitals serving Sefton’s population
indicates that both trusts are taking the necessary steps to reduce HCAI. Sefton PCT
continues to work with local trusts and to take measures to improve its own performance.
The Department of Health has issued new guidance in relation to MRSA Screening. Over
the next three years all local trusts must introduce universal screening of patients admitted
to their wards. This new guidance will require additional investment over the next three
years to ensure its implementation.

Prof. Rod Thomson           Consultant in Public Health         15/09/08

             Aintree Foundation NHS Trust - MRSA Cumulative figures for 2006-07, 2007-08 and 2008-09 (to date)

          Target 06/07 = 28, Actual = 40
          Target 07-08 = 19, Actual = 33
       40 Target 08-09 = 23, Actual = 12 (to date)








               Apr        May        Jun         Jul   Aug     Sep      Oct       Nov      Dec       Jan         Feb   Mar
MRSA 06-07      2          8          11         16    18      23        25       30        32        33         36    40
MRSA 07-08      5         10          14         16    16      17        20       20        26        28         31    33
MRSA 08-09      6          7           8         12    12

                     Aintree Foundation NHS Trust - C.Difficile cumulative cases 2007-08 and 2008-09 to date
                                                (Target 250 cases for 2008-09)








               Apr       May       Jun       Jul       Aug      Sep       Oct       Nov       Dec       Jan    Feb   Mar
C.Diff 07-08   72         84        92       107       115       128      151       170       201       248    270   292
C.Diff 08-09   36         64        86       121       146

                     Southport & Ormskirk NHS Trust - MRSA cumulative cases 06-07, 07-08 and 08-09 (to date)

             Target 06/07 = 19, Actual = 15
             Target 07-08 = 10, Actual = 13
             Target 08-09 = 9, Actual = 3 (to date)







                Apr         May         Jun           Jul   Aug   Sep      Oct       Nov      Dec       Jan    Feb   Mar
MRSA 06-07       1           2            4           4      5     5        6         9        11       13     13    15
MRSA 07-08       3           5            6           10    10    11        11       12        13       13     13    13
MRSA 08-09       0           0            0           2      3

                 Southport & Ormskirk NHS Trust - C.Difficile cumulative cases 2007-08 and 2008-09 (to date)
                                           (Target 118 cases for 2008-09, 30%)








               Apr      May       Jun       Jul      Aug       Sep       Oct       Nov       Dec       Jan     Feb   Mar
C.Diff 07-08   14        22       28        40        52        62        72        80       87        100     113   132
C.Diff 08-09   17        29       37        46        58

                         Walton - MRSA cumulative cases 2006-07,20 07-08 and 2008-09 (to date)










             Apr   May       Jun        Jul       Aug        Sep        Oct       Nov       Dec      Jan   Feb   Mar
MRSA 06-07   1      2         3          3         4          5          6         7             8   8      8     8
MRSA 07-08   2      3         3          3         3          3          3         4             5   5      5     5
MRSA 08-09   1      1         1          2         2

                      Walton - C.Difficile cumulative cases 2007-08 and 2008-09 (cases to date)










               Apr   May      Jun       Jul      Aug       Sep       Oct       Nov       Dec      Jan   Feb   Mar
C.Diff 07-08   2      3        3         5        5         5         6         6         7       11    16    17
C.Diff 08-09   1      4        5         6        6

                               Sefton Drug Action Team
                        Co-ordinator’s Report to the PCT Board
                                   September 2008

Appendix 3

Developmental Priorities July – December 2008

Within the time frame July – December this year we must make substantial progress in
each of the following areas if we are to continue to improve our performance as a DAT.

1. Fully Establish CDT at 8 Church Street

At the time of writing I have a realistic expectation that the required refurbishment will
commence in September. A September start will result in a December completion. The
PCT will work with DAT on the lease agreement for the premises.

2. Co-location of DAT Commissioning Team

Co-location of the whole team will contribute greatly to its efficiency and effectiveness.
Our lease in Burlington House is held by the PCT and expires on 27th March 2009.

Three options are available to us:

   1) Co-location with the PCT commissioning arm.
   2) Co-location with the PCT provider services.
   3) Secure an independent office base

Following discussions with the PCT and the Health & Social Care Directorate options 1
and 2 have been ruled out as impractical or unaffordable therefore option 3 has been
pursued. Following a brief property search officers wish to recommend that the DAT enter
into an agreement with Sefton Carers Centre and locate the DAT commissioning team on
the 1st floor of the Centre from February next year.

This is an affordable option with several advantages not least an existing connection to
the Council’s IT system which is already installed at the Centre.

Subject to further negotiation a recommendation will be made to the JCG that the team be
relocated to the Carers Centre no later than the 27th February 2009.

3. Award of new DIP Contract

Following a competitive tendering process the contract for the provision of criminal justice
treatment services has been awarded to Crime Reduction Initiatives (CRI). DAT Officers
are currently working closely with CRI in order to effect an efficient handover of these
services from Monday 29th September.

The major issues involved in this service transfer include:

      TUPE issues
      Staff structures
      Data migration
      Contract negotiation
      IT & phone installation
      Agree new office layout with Carers Centre (including a separate entrance)
      Accommodation at 8 Church Street
      Introductions to partner agencies
      Service budget
      Informing service users of changes

4. Undertake annual needs assessment

The DAT has formed an ‘Expert Group’ to undertake the assessment. Below I describe
the process and timetable that we will follow:

Questions posed re needs assessment


What ? - NTA chosen definition of Needs Assessment is

‘A systematic method of identifying unmet health and healthcare needs of a population….
And making changes to met these unmet needs ‘

Why ? - The NTA expect our treatment plans to be informed by a robust needs
assessment. The DAT must submit its treatment plan for 09/10 in Jan 09.

When ? – July – November so that it is completed in time to inform next year’s plan.

How ? - Needs Assessment Core Group to over see the process.
        Carers representation required
        Others to join the group as required
        This group will devise the process, oversee the research and
        produce a needs assessment report by end of November

Key questions at this stage:

It is expected that our scope will broaden as the process develops and further issues
emerge. This is not an exhaustive list of questions/issues.

             What is the prevailing pattern of substance misuse?
             What’s the estimated size of the problem?
             How important is alcohol as an issue?
             Which groups are not in service (BME. gender, age, migrants, international
              workers etc)?
             What prevents some people entering services?
             Are some geographical areas of need under represented in services?
             Are services adequately publicised?
             Why do some people fall out of services (unplanned discharge)?
             What is the quality of services currently delivered?
             How satisfied are service users and carers with these services?
             What is the BBV status of those not known to services?
             Demand for abstinence services and support?
             How can we best develop a recovery model?
             What are the key workforce development issues?
             What implications are there for our commissioning priorities?

What sources of information already exist to inform the assessment?

             User satisfaction surveys
             Stimulant study
             NDTMS
             Complaints to service providers
             Other JMU research
             Women’s Group findings
             35ys plus study group
             Sefton Equalities Partnership
             Neighbourhood Planning Unit
             PCT
             DAT Drug Audit
             Healthcare Commission service improvement reviews

Other sources of information – available to us in the near future:

             Sefton Cocaine web-site
             Women’s Group minutes
             Alcohol needs assessment for HMP Kennett (JMU)
             Alcohol, Public Health Partnerships’ needs assessment
             Healthcare Commission inspection report (Diversity & Tier4)

Research methods available to us:

            Questionnaires
            Focus groups
            Outreach
            Semi-structured interviews

Financial rewards to be considered.


We should consider bench marking our local needs against those of other DATs.

The next stage


      Needs assessment is an ongoing process but for the purposes of this piece of work
      the timeline is July – November.


      Mid October - review process and material gathered

      Late October – November begin drafting the document

      Mid November – circulate draft for comment

      December – present to JCG

Capture varying perspectives

Jo Christensen – Service User Advocate
John Hill – DAT Co-ordinator
Ronnie Murrell – DAT Clinical Lead
Colin Ashcroft – HMP Kennet
Mhairi Doyle – Jobcentre Plus
Rod Thomson – Sefton PCT
Jane Williams – Sefton Carer’s Centre
Liz Gray – Housing Development Manager

            Perspectives                      Lead          Progress

Users of community drug services        Jo Christensen   Scoping
Users of criminal justice services      Jo Christensen

Provider of community drug services     John Hill
                                        Ronnie Murrell
Provider of criminal justice services   John Hill
                                        Ronnie Murrell
Other providers                         John Hill
                                        Ronnie Murrell
Carers                                  Jo Christensen   Scoping
                                        Jane Williams    underway
Individual DAT officers                 All
Treatment naïve                         Jo Christensen
Communities                             John Hill        Meeting with AL
Police                                  John Hill        Meetings
PCT – Alcohol                           Rod Thomson      Info requested
Probation                               Ronnie Murrell
Prison - IDTS                           Ronnie Murrell
                                        Colin Ashcroft
Housing                                 Liz Gray
Education, Training & Employment        John Hill        Meeting arranged
                                         Mhairi Doyle

Resources available to support the work:

Allocated budget of 5k
DAT Data Performance Manager
DAT Business & Admin Manager

Actions to take now

      Each lead to identify key questions, methods of enquiry and timescales within the
       July – November timeframe.

      Report progress back to the next meeting of Needs Assessment Core Group in

      John to arrange regular meetings with each lead

      Sarah to identify the data that is available to support the needs assessment.

5. Develop equality & diversity plan

This is a piece of work that is closely allied to our needs assessment. Sefton Equalities
Partnership (SEP) has been invited to oversee our work in this area and our first agreed
action is the completion by the DAT of an equality self-audit which will be submitted to
SEP for comment in September. Following the audit SEP will work with us to develop any
action plan that might be necessary to help us address any areas of identified weakness.

6. Joint NTA/Health Care Commission inspection

The joint NTA/Healthcare Commission review of diversity & Tier 4 is running alongside the
development of our equality planning. The Commission has recently released the
provisional inspection results for 2007/08.

Their chosen scoring key is;       1 = weak
                                   2 = Fair
                                   3 = Good
                                   4 = Excellent

The DAT has scored 3 – Good, for both diversity & tier 4 services. These provisional
scores will be ratified and our final scores reported to us in November. A full national
report will be published in January next year.

7. Establish green for all NTA and DIP Compact Targets

See figures below

                                                           Sefton DAT Performance Indicator Report
                                                                     YTD Sept 09 JCG

Numbers in EFFECTIVE treatment                        Q1                Q2                 Q3                Q4                 Year End
New presentations                                                                                                               + 5%
Number PDU in Effective Treatment YTD                 Not Available                                                             1245.3
                                                      until Sept end
Number 18+ in Effective Treatment YTD                 Not Available
                                                      until Sept end
Total Number in Treatment                             1397

Effective Treatment Year to Date                                                                                      Target
Number presented April 07 – March 08                                                            456
Number in treatment over 12 weeks                                                               369
Number planned discharge prior to 12 weeks                                                      10
Percentage in Effective Treatment                                                               83%

Comments: Sefton has out performed this target for 07/08. This year Sefton must concentrate on the number of Problematic
Drug Users into treatment. For Apr, May & Jun it is not possible to ascertain the 'No. over 12 weeks', 'No. Completed' or 'Percent
in Effective Treatment' until the first 6 months of the year have elapsed.


Retention Year to Date                                                                       07/08 Year end         Target
Percentage retained                                                                          87%                    85%

Comments: The final target for 07/08 was above target using the new retention calculation.

Overall Waiting Times First Tier 3 Treatment Intervention                           Target
99%                                                                                 83%
Overall Waiting Times First Tier 4 Intervention                                     Target
100%                                                                                83%
 Comments: Waiting times for first presentations to all treatment were excellent.

Overall Waiting Times Subsequent Tier 3 Treatment Intervention
]                                                                                   Target
95%                                                                                 83%
Overall Waiting Times Subsequent Tier 4 Treatment Intervention                      Target
64%                                                                                 83%

Comments: An investigation is now taking place to identify 4 clients who waited over three weeks to access Tier 4 treatment.

Treatment Type                 % Planned Discharges          % Unplanned                 Target planned discharges
                                          35%                        65%                                        66%

 Comments: Planned Discharge data is disappointing. A full review of all discharges needs to take place to understand why
 performance is low. The target agreed for 08/09 looks unrealistic and I would suggest it may be worth entering into a
 conversation with the NTA to lower the target to give the DAT something achievable to work towards.                           22
Month           Apr    May       June       July       Aug      Sept       Nov       Dec      Jan       Feb      Mar       Year End
Target          10     10        10         10         10       10         10        10       10        10       10        110
Actual          8      9         16         18                                                                             51

Comments: In order to achieve the year end target, Sefton DRR has set itself a target of 10 new commencements per month.
Performance in July was above target.

Successful Completions

Successful completion target for year                                                                       38

Total year to date                                                                                          16

Drug Intervention Programme

Compact Target 1; 95% of all adults arrested for a trigger offence to be Drug Tested

Responsible Agency: Merseyside Police

                                               June                                           July (prov)
Sefton Actual                                  217/219
Sefton %                                       99%
North West Average %                           96%                                            100%
National Average %                             98%                                            99%

Compact Target 2 95% of adults who test positive and have an Initial RA served to attend and remain at the RA

Responsible Agency: Merseyside Police and Lighthouse Project

                                                            June                                       July (prov)
Sefton Actual Performance                                   73/81                                      44/80
Sefton Actual %                                             91%                                        55%
Northwest Average %                                         77%                                        70%
National Average %                                          82%                                        80%
Sefton Performance – Out of Area / Out of Hours             73/78

Sefton %                                                    94%

Reason for Final Gap                                                                                       June
Out of Area / Out of Hours                                                                                   2
Police Data Error                                                                                            1
Did not attend and remain
LHP did not see the client                                                                                   3
Disputed Test, not seen in 28 day period                                                                     1
    Comments: Performance against this target for last two months has moved into the Amber zone.
    Although Sefton is not green on this target, steady progress is being made towards achieving a green
    status and performance is above the Northwest and National Average.

Compact Target 3; 85% of all adults who are assessed as needing further intervention to have a care plan drawn up and agreed.

Responsibility; Lighthouse Project, Sefton DIP Team
Month                                                     June                                                      July (prov)
Sefton Actual                                             24/29                                                     21/24
Sefton %                                                  83%                                                       88%
Northwest Average %                                       71%                                                       61%
National Average %                                        82%                                                       82%

Comments: Performance against this target dropped slightly in June. An investigation was conducted and it was concluded that
a person who was inappropriate for treatment was assessed as appropriate in error. This issue has been dealt with on a one to
one basis with the key worker involved. July performance is above target.
Compact Target 4 95% of adults taken on to the caseload to engage in drug treatment

Responsible Agency; Lighthouse Project, Sefton DIP Team

Month                                            June                                            July Provisional
Sefton Actual                                    33/33                                           40/40
Stretch Target                                   21                                              21
Sefton %                                         100%                                            100%
North West Average %                             95%                                             93%
National Average %                               86%                                             95%

Comments: Performance remains excellent on Compact Target 4.

8. Recruit to Joint Commissioning Manager’s Post

This post has been revised and will be advertised during September.

9. Implement Carers Action Plan

The full implementation of this plan is dependant upon the appointment of an Advocacy
Worker by the Carers Centre. Interviews were held earlier this month and an appointment

10. Full development and implementation of Accommodation Strategy

Our Accommodation Strategy was written in August 2007 and has served us well by
clearly demonstrating to partners the importance of housing issues to our client group. As
a result we have been able to develop appropriate client pathways and support treatment
outcomes. Because the strategy and its accompanying action plan are now more than 12
months old they will be subject to review. A refreshed strategy paper and an updated
action plan will be presented to the JCG later this year.

11. Roll out of MOVE ON Project

The post of Development Manager has been advertised and interviews will be held in
early October. The post has been created in order to develop service user pathways to
education, training and employment which is an essential requirement of the new drug
strategy, Drugs: protecting families and communities.

12. Digest latest unit cost info & commence financial planning for 09/10

The NTA is currently collecting all the required data from service providers and the
relevant information will be fed back to the DAT later this year.

13. Develop IDTS in local prisons & ensure effective interface with DIP, community
   treatment and aftercare services.

IDTS Implementation plan is currently under development and we are on course for full
implementation from the 1 April 2009.

14. Development of a treatment system based upon a recovery model, person
   centred care and social re-integration

The new National Drug Strategy calls upon DATs to take a new approach to tackling drug
use based upon the concept of recovery. Recovery is defined as;

‘a process through which an individual is enabled to move – on from their problem drug
use towards a drug free life and become an active and contributing member of society’

Moving to an approach that is based on recovery will mean a significant change in both
the pattern of services that are commissioned and the way that practitioners engage with
individuals. It will require a significant culture change on behalf of some service providers
to develop an approach which raises service user expectations considerably higher than
they may be at present, we must engender a culture of hope and progress. Discussions
are currently underway with providers to establish their ability to deliver the new model
and to identify any barriers that must be overcome. The model will be presented to the
JCG in October and will address the full range of our client’s needs and allow for the
development of packages of person-centred care that go beyond just the clinical
stabilisation of physical symptoms.

15. Developing a quality improvement plan 2009/11

This plan will bring together all of the work outlined above. At its heart will be the recovery
treatment model and it will explain in some detail how we will achieve the objectives and
desired outcomes of the new National Drug strategy Drugs: protecting families and

Other issues

New NTA Commissioning Guidance 2009

The DAT’s profile within the NTA has risen, in part due to our successful conference in
May. As a consequence I have been invited to join an Advisory Group established by the
NTA to help oversee the drafting of new commissioning guidance that will be published
next year. The first meeting was held in August and four further meetings have been

New guidance is considered necessary in order to better reflect the following

      The New Drug Strategy
      The suite of clinical guidance published in 2007
      World Class Commissioning

Department of Work and Pensions Green Paper – ‘No one written off’

This paper presents the Government’s proposals for welfare reform. There is a clear
expectation that drug users on benefits take appropriate steps – such as engaging in drug
treatment or employment provision that supports a return to work. This approach is
consistent with the objectives of the new drug strategy which has a focus on reintegration.
None of the proposals will affect service users immediately because a change in the law
would be required to alter the benefits regime.

The earliest any changes could be implemented is 2011. The NTA are inviting service
users to register their views on the proposals by 22nd October, Sefton Service User Forum
might wish to present its views.

John Hill
DAT Co-ordinator
September 2008