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

The Addaction service manager gave a presentation which provided a service update following the update provided to committee on 21 September 2017, the main points being that:

·         There had been significant improvements and this was set to continue, both in terms of organisational performance and outcomes for service users

·         Improvements in outcomes for services users was supported by focusing on recovery and making use of support networks including volunteers, peer mentors and local communities

·         The council had reviewed the contract, effective from April 2018, which would mean some challenges to staff capacity, focused working such as time-limited and structured care, clearer pathways and use of group work. Although the outreach programme would be reduced, there would be increased information and signposting for referrals and more service advertising.

·         Addaction had listened to recommendations from the last meeting regarding publicity and this was being developed. 

The chairman welcomed the improvements and asked how people were accepting new approaches to treatment.  The service manager explained that service users understood and preferred having more contact and more on offer, particularly group work, to support recovery. There were some long-standing users who had resisted engagement but this was being addressed with the support of a key worker.

A member asked for more clarity on the groupings of types of substance misuse, and it was clarified that Public Health England had introduced a fourth primary group where there was combined use of alcohol and non-opiates. 

The member welcomed the group work approach, commenting that there should be more group work. He asked what was in place to enable support groups such as AA and Al-anon to continue, and whether the Stonebow Unit was being used for people with mental healthcare needs as well as substance misuse treatment needs.  The service manager confirmed that dual diagnosis clinics were being explored with 2gether NHS Foundation Trust and there was support to help upskill staff to refer into the service. As part of this work, it was recognised that mental healthcare needs could be addressed alongside substance recovery support and so the use of pathways was being reviewed so that people did not need to complete one care pathway or achieve recovery before accessing other care.  Addaction had clinical psychologist input but referred people to other support for one to one counselling.

The vice-chairman thanked Addaction for the opportunity for members to visit to the Leominster base, and asked what progress had been made in Leominster regarding group provision on offer and how the co-production panels were helping to increase engagement and community involvement with Addaction.  It was recognised that there was more that could be achieved around increasing Addaction’s presence in Leominster and the appointment of a new team leader would support development in this area. It had been found that the Leominster service was better suited to smaller groups of 4 or 5 people but the plan was to have a core user group each for cannabis, stimulants and low-level alcohol followed by an opiate user group.  ...  view the full minutes text for item 41