To provide an overview of performance of substance misuse services (provided by Addaction) across Herefordshire in order to provide assurance.

The public health representative introduced the item and explained that the service had been recommissioned and was making the transition from a treatment maintenance model to a recovery model which was a more demanding approach.

The manager of Addaction Herefordshire presented the update, making the following points:

·         the contract had been running for 14 months and represented a significant culture shift for services users and staff, and this was now starting to be reflected in performance figures.

·         There were over 700 service users presenting a varied caseload within which the county’s older population was reflected. 

·         The service was working closely with commissioners and had developed a service improvement plan to encompass changes to treatment programmes in the move towards supporting recovery rather than maintaining a prescription for life. 

·         Steps to increase service user engagement and contact had taken service attendance to 85% attendance, with clearly identified goals for treatment and being clear with services users about reaching the end goal from the outset of treatment.

Members raised a number of questions and comments in response to further points covered during the presentation, with the following responses:

·         In answer to a question about performance compared with other areas, it was clarified that the service was at the top end of the lower quartile and was improving. The services was seeing more clients who had stopped engaging with the previous provider. It was expected that there would be a decline in completed casework because of adjustment to the new recovery where service users were required to be more accountable within their recovery plan and changing behaviour. Having more boundaries in place supports this but it is a challenge for service users. Staff use a case management tool which records substance use, state of health and social factors.  This information is reviewed every three months as required by the Care Quality Commission, and there is a plan in place to improve performance significantly.

·         Herefordshire had been identified as one of three sites for the roll-out of a new pathway for service users which would mean quicker assessment at the first point of contact with a new service user. The assessment would look at the whole service user’s circumstances and produce a risk assessment. A further appointment for a recovery choices session would then be offered, and a clear explanation given of expectations and a timetable of activities offered which help to promote recovery. There were good links with a range of providers that could be accessed for activities; these were client-led activities so there was a choice to attend or not. 

·         Regarding service development, there had been some recruitment activity to manage a vacancy and add a recovery worker to the team. It was a challenge to recruit into Herefordshire but there was a robust national recruitment system and national press would be used if required. Specifically regarding Leominster, the site was now open and this service was developing gradually. It was hoped that with some staffing issues being resolved and additional administrative support, that the Leominster service would be available over 5 days. The centre at Ross was also being developed.

·         In response to a member’s concerns that the service gave the impression that it was not on target in delivering the contract within its remaining period, the service manager explained that there was progress being made although this was gradual. He recognised the staffing issues and believed that with these being resolved improvements would continue.  He added that there had been a need to challenge some of the treatment programmes for individual service users and to support staff to work on relapse prevention as well as working with people to reduce methadone dosage.  The service manager would give some consideration to how recruitment could be addressed with the help of the council.

·         The public health commissioner responded to a comment about the relationship between contract monitoring and procurement roles by confirming that there was a new contract monitoring officer in place which would help to address any concerns about conflict between roles. The member suggested that it was essential that the contract monitoring officer be present during scrutiny to hear their views on how contracts were being conducted. 

·         Members emphasised that the current criticisms were not a reflection on the current service manager as it was recognised that the quality of information and presentation was much improved, as was the management of the service in general. The service manager recognised the previous problems within the service and the impact it had on morale, and affirmed his commitment to the remainder of the contract.

·         In terms of local patterns of drug use, it was confirmed that there had been no confirmed reports of Spice usage which had been reported elsewhere, although there were reports of NPS (neuro-psychoactive substance).

·         There had been no reports of dealers frequenting the vicinity of popular premises, and the service maintained vigilance and close links with services where they prevailed, and people were being asked to move on.

·         There was a new team member in post working on developing community engagement across the county. With specific reference to Leominster, this would include making links with Leominster Football Club, and the service manager welcomed the suggestion to attend Leominster Town Council to say more about Addaction’s work.

·         There were many steps towards improvement in response to CQC inspection finding in October 2016 including: maintaining good links with service user groups; managing safeguarding; daily checking of clinical equipment; improved confidentiality improved; review of lone working arrangements; reduced waiting times for access to the service; access to foreign language speakers. 

·         A member expressed concern about limitations to information sharing between organisations and a lack of confidence in the compatibility of systems to enable this.  The need to share information was acknowledged, noting that the service was confidential unless there were safeguarding or welfare concerns. Within these parameters, there were clear protocols to manage information sharing.  Commissioners were assured that the system would enable appropriate information sharing when required.

·         Work with veterans had increased and the service was establishing a veterans group and making links to national resources to support this. 

·         The need for outreach workers was recognised in order to maximise points of contact and this included hospital liaison workers. The suggestion of looking laterally at other groups such as young farmers and ketamine use was noted.

RESOLVED

That:

(a)  the performance of the substance misuse service be noted;

(b)  the following recommendations be offered to the service for the delivery of improved performance:

o   robust staff supervision and service user reviews to support culture change towards the recovery model

o   undertake and review risk assessment regarding information sharing and system compatibility

(c)  the contract monitoring officer be requested to attend committee for service reviews;

(d)  consideration be given to regular briefing notes for members to include performance data; and

(e)  a service update be presented to scrutiny in 6 months’ time