To review the quality and performance of the substance misuse service commissioned by Herefordshire Council and delivered by Addaction.

A presentation was given by officers of Addaction.

In his introduction, the chief officer of Addaction thanked council officers for their frank feedback and noted concerns raised about service delivery which he had taken up with Addaction’s trustees.  An action plan had been discussed with the public health team and it was recognised that the service had not started-off well and that the resulting concerns were understood. It was accepted that the level of cultural change was underestimated, and with support, the service had now identified what was required to make the transition from a medical model of care to one that was more peer and community focused.  Much had been learned from this and there was confidence that the team was in place to take the service forward.  The motivation was to ensure the best possible service for Herefordshire, regardless of who provided the service. 

In answer to a member’s question about what the challenge was in taking on the Herefordshire service compared with other areas that Addaction covered, the chief officer explained that there were demographic challenges in Herefordshire with implications for an available workforce.  A possible comparative area was Norfolk but in Addaction’s experience there were very few close comparators to draw upon. Other factors were that the shift in service model was greater than had been seen with other services whilst ensuring continuity for service users.  There had been much learning taken from this area and a different approach was being taken to recruitment and training.

Members welcomed the invitation to visit Addaction again and for the opportunity to hear from a service user about their experience of the service.

A member asked about cultural changes, staff transfers and recruitment in terms of how long it would now be expected to take, with the benefit of lessons learned, to make the transitions required and embed the new model of provision.  In response, it was estimated that this would take 6 to 9 months.   In terms of preparation for re-tendering within a 3 year contract, it was believed that the best approach was to ensure the service continued to evolve right up to point of re-tendering and that the next transition for the new contract would be smoother as the most challenging aspects of service development had been overcome.  Contracts tended to be of 3 years’ duration typically although longer terms were emerging nationally, and recent research had shown how contracting could affect service delivery.  It was noted by the Director of public health that the new drugs strategy recommended longer contracts although this could be a challenge for funding with the public health grant ending in 2019 and arrangements thereafter remaining unclear.

A member asked about patterns of substance use. Officers suggested that patterns were linked to changes in the drugs market and how the supply chain operated within rural areas compared with urban areas. The impact of police intervention was known to interrupt supply which then resulted in a down turn in use of particular  ...  view the full minutes text for item 15