Client Liaison Programme ­ Draft Paper

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					Briefing for the Public Petitions Committee
Petition Number: PE1113 Main Petitioner: Peter McCann on behalf of the Castle Craig Hospital Subject: Calls on the Parliament to urge the Scottish Government to increase the availability and provision of residential and abstinent treatment for those who are alcohol and/or drug dependent. Introduction Drug and alcohol services such as those referred to in the petition are organised through 22 Alcohol and Drug Action Teams 1 (ADATs), which are based on either local authority or NHS Board boundaries. Their role is to coordinate local efforts to tackle substance misuse at both a strategic and operational level. They consist of senior officials from local statutory and nonstatutory bodies, including the core partners of health, social work, police, prisons, education and the voluntary sector. The most comprehensive data available concerning services comes from the ADATs themselves. The current National Drugs Strategy 2 requires ADATs to prepare and submit to the Scottish Government annual plans for tackling drug and alcohol misuse in their areas. The most recent of these Corporate Action Plans 3 have been prepared for 2007-08, and provide data for 2006-07 and projections for the current year. As regards abstinence services, only four ADATs (East Lothian, Edinburgh, Greater Glasgow and Clyde and Lanarkshire) discuss them in their most recent plans. In the main, these relate to the roll out or development of such services that each ADAT has planned for 2007-08. However, Lanarkshire ADAT describes a non-residential abstinence service that was being used in 2006-07 for people with both drug and alcohol problems. The ADAT plans also detail the residential services available in each area, providing information such as the number of beds available and admissions data. Appendix 1 contains two tables - Table 1 pulls together residential service data for 2006-07 from each of the individual ADAT plans, and Table 2 outlines waiting times data for residential drug services. From Table 1 it can be seen that 13 out of the 22 ADATs have some form of residential service available, though the number of beds available differs greatly across the country. It is also interesting to note the admissions to services outside each ADAT area. These include admissions to services in all
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parts of the UK. It should be noted that whilst in some cases residential services cater for either drug or alcohol misuse, there are many services that cater for both given that, in many cases, individuals have both drug and alcohol problems. Whilst all ADATs that have residential services in their area have provided some details, not all have outlined what treatment interventions are available. Table 2 outlines waiting times data for drug rehabilitation residential services for the first quarter of 2007. It should be noted that ADATs collect data from services within their area. Therefore, information on residential rehabilitation is only collected from those ADAT's with residential services located within their area at the time of the data being collected. ISD Scotland has been asked to provide an update of this table, which will be forwarded when it is made available. Equivalent data for alcohol services is not available. Scottish Government Action General In July 2007, Mary Scanlon MSP asked a Parliamentary Question 4 regarding the commissioning of in-patient and residential rehabilitation drug and alcohol treatment interventions. In response the Cabinet Secretary, Nicola Sturgeon, said that the Scottish Government had commissioned an update of ‘Integrated Care for Drug Users’, which was first published by the Effective Interventions Unit in 2002. She stated that the new document would cover planning and delivery of treatment for both drug and alcohol misuse. The update is currently being considered by the Scottish Government. Drugs In terms of drugs specifically, the Scottish Government published its ‘Review of Drug Detoxification and Rehabilitation Services in Scotland’ 5 in July 2007. For this ADATs were asked to provide information on the availability, decisionmaking process, use and cost of existing residential detoxification and rehabilitation services. The aim of the review was to develop a picture of the then position and help inform future policy and funding decisions. The review was largely based on data for 2005-06, thus the data on residential beds and waiting times, above, is more up-to-date. However, it did provide analysis of spending and referrals to services. The review (2007, p 3) found that a total of £9.08m was spent on residential detoxification and rehabilitation services in 2005-06. Of this, 68% came from local authorities and 32% came from NHS Boards. The review noted that residential treatment is considerably more expensive than community-based interventions, and points to work undertaken by Aberdeen ADAT, which estimated that the average package of care for residential rehabilitation per person per year was £20,000, compared to £3,000 for community rehabilitation. As regards referrals, the review (2007, p 4) found considerable variation across the country as to who ultimately refers and authorises funding
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for a client to enter residential drug treatment. However, the review found that, almost universally, clients access a residential intervention only after the failure of all community based options. In addition, previous evidence of abstinence, even brief, and a belief in one’s own responsibility to change behaviour, were also cited as criteria in some areas. The Scottish Government is also reviewing current strategies for tackling drugs misuse and is seeking to launch a new strategy during 2008 6 . Alcohol As discussed above, many residential services support both those with alcohol and drug addictions. However, specific alcohol residential rehabilitation data is not available. The Scottish Government has announced the development of a new long term alcohol strategy with stakeholders to tackle what it considers to be a significant problem across the whole population and has advised 7 that a strategy consultation will be announced in the spring of this year. Budget The Scottish Government ‘Scottish Budget Spending Review 2007’ 8 (BSR) details the Government’s proposals for spending on both drugs and alcohol misuse. The budget for drugs misuse is handled through the Justice portfolio, whilst alcohol misuse is handled through the Health and Wellbeing portfolio. However, whilst the BSR provides detail of specific drugs and alcohol misuse programmes, much spending occurs within generic budgets of health boards, local authorities and others. As regards drugs, the BSR (2007, p 122) states that funding for drugs misuse would be £29.5m in 2008-09, £30m in 2009-10 and £32.8m in 2010-11. It explains that this funding would go to ADATs, through Health Boards, to tackle drug misuse at a local level. The Scottish Government commits itself in 2008-09 to “continue to provide financial support to increase access, capacity and quality of drug treatment and rehabilitation services”. In terms of alcohol, the BSR (2007, p 104) proposes to invest £20.1m in 200809, £30.1m in 2009-10 and £35.1m in 2010-11. The BSR (2007, p 27) explains that this would back the new strategy in alcohol and “introduce a radical range of measures to reduce alcohol-related harm and encourage sensible and healthy consumption.” Scottish Parliament Whilst there has been no recent deliberation of the particular issues raised by the petitioner, the Health and Sport Committee published its ‘Report to the Finance Committee on the draft budget 2008-09’ 9 on 16 January 2007. As
6 7 Personal communication 15 January 2008 8 9


part of its scrutiny of the proposed budget it reflected on drugs and alcohol. It discussed the cross cutting nature of tackling both issues and obtained figures from the Scottish Government concerning specific and generic spending on alcohol and drugs misuse. The Scottish Government provided figures to the Committee identifying that, in 2006-07, £106.1m of expenditure was specific to alcohol misuse, which compared to £431.5m for drug misuse. However, the Committee found the figures to be incomplete in some cases, eg the Scottish Government had not provided figures for generic programmes spend on alcohol. This highlighted the difficulty in obtaining accurate figures on the expenditure for each, which the Committee recommended be improved. The figures received by the Committee indicated that 10% of expenditure on alcohol misuse was dedicated to prevention, with the rest spent on treatment and rehabilitation. However, the Committee noted that this could be explained by a lack of information on alcohol health promotion spending. In terms of drugs misuse, figures received indicated that 11% was spent on prevention, 41% spent on enforcement and 48% spent on treatment and rehabilitation. The Committee was also made recommendations concerning increased use of research and evaluation as a basis of future treatment services development. It also called for national outcomes indicators for drugs and alcohol misuse services.

Jude Payne Senior Research Specialist January 2008

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APPENDIX 1: DATA ON RESIDENTIAL REHABILITATION SERVICES Table 1: Residential Services available in each ADAT area 2006-07
Number of residential services in area 2 1 2 1 3 1 3 1 1 Admissions 2006-071 Total Number of beds 18 13 40 12 138.5 4 32 4 1 Apr-Dec 2006 483 129 118 935 371 17 431 17 13 Jan–Mar 20072 131 39 31 122 11 147 6 4 Number of services from outside ADAT area used 2006-073 5 7 0 0 2 5 2 0 6 8 2 3 Number of clients admitted to outside services 2006-074 35 52 0 0 1 14 8 0 173 27 8 6


Aberdeen City Aberdeenshire Argyll & Bute Ayrshire & Arran Angus Borders Dumfries & Galloway Dundee City East Lothian Edinburgh City Fife Forth Valley Greater Glasgow and Clyde Highland Lanarkshire Midlothian Moray Orkney Perth & Kinross Shetland West Lothian Western Isles
1 2

27 4 1 1 -

644 77 19 3 -

1255 969 3 5 -

404 292 1 0 -

9 3 3 5 2 1 0 4 7 1

243 7 7 99 4 1 0 6 108 2

Total admissions, including those from outside ADAT area. May be projected if no actual figures were available at the time of reporting. 3 Includes, in some cases, only projected figures for part of the year. 4 Includes, in some cases, only projected figures for part of the year. 5 Unclear whether data is for 2006-07 or whether it is a 2007-08 projection.

Table 2: Drug Treatment Waiting Times - longest wait for a date to be offered for residential rehabilitation, Jan-Mar 2007
Clients offered an appointment date Longest Wait (no. of clients) Drug Action Team Aberdeenshire Argyll and Clyde Borders Glasgow 13-26 wks (1) <7 days (4) 27-52 wks (1) 52+ wks (1) Source: Parliamentary Question SW3-1467 10

Clients still waiting for an appointment date as at 31 March 2007 Longest Wait (no. of clients) 52+ wks (3) 27-52 wks (1) 52+ wks (9) 52+ wks (2)