Transcript Document

Existing services and the
wraparound challenges
Biba Brand
West of Scotland Regional
Manager
Core Services
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Structured 1:1 work
Structured group work
Substitute prescribing
Medicated detoxification
Community rehabilitation programmes
Needle exchange
Harm reduction
Direct access drug services
Residential rehabilitation (varies by area)
Inpatient detoxification (varies by area)
Wraparound Services
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Primary health care
Child care and parenting support
Housing support and advice
Employment and training support
Financial advice and support
Family planning services
BBV testing, support and treatment
Clinical psychology
Mental health services
Models of wraparound
 Integrated wraparound services based
within frontline drug services, but linked to
mainstream providers
 In-reach from wraparound services - weekly
legal surgeries, mobile crèches, mobile
dental units, college input
 External wraparound services - Money
Advice, P2W, Parenting support services
 Resource Officers
Barriers to wraparound
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Funding
Blockages in services
Overloaded frontline staff
Lack of interagency referrals
Reluctance to close cases or hand over to GPs
Highly supervised prescribing - travel, cost
‘Recovery impatience’
Can drug policy really address other policy
challenges?
(…data…)
Methadone drug & dispensing fee (£)
Scotland’s total = £12.2m
5,000,000
4,500,000
4,000,000
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
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Methadone drug cost + dispensing fee
Cost of methadone supervision (£) + ‘handling
fee’ - Scotland’s total £12.4m (+ £1m for
prisoners)
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8,000,000
7,000,000
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
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Cost for people daily supervised (supervision + controlled drug fee)
Cost for people on take home (supervision + controlled drug fee)
Methadone Dispensing and Drug
Deaths, 2006
12,000
180
160
140
120
100
80
60
40
20
0
10,000
8,000
6,000
4,000
2,000
Ayrshire &
Borders
Dumfries &
Fife
Forth Valley
Gtr Glasgow
Grampian
Highland
Lanarkshire*
Lothian*
Orkney
Shetland
Tayside
Western
0
Numbers on
methadone
Number of DRDs
Lothian Model
 70% of GPs within the enhanced medical services
(90 GP practices)
 2500 stable drug users prescribed methadone
within GP services. 84% are supervised once or
more per annum (usually one 2 week period).
 1000 unstable drug users within specialist drug
services. Higher supervision
 Overall:
20% daily supervised (estimate)
80% take home methadone (estimate)
 No higher rates of drug deaths
Choices
 £25m = Scotland’s spend on methadone
and various fees
 £12.4m cost for supervising and handling a
controlled drug (+ £1m for prisoners)
 methadone alone costs £1.45 = 100ml
(BNF, 2004) …choices…
Wraparound - Employability
 £3.3m pa = New Futures Fund
(employability for all care groups)
 1,100 service users supported annually
 Are we shifting people from benefits to inwork poverty?
 How much of the Incapacity Benefit Reforms
are going on Progress2Work in Scotland?
Wraparound – Housing Support
 Accessing good quality housing
 Maintaining tenancies
 Affordable lets and support for people
‘moving on’
 Supporting People helped 164,000 people in
2005/06 - only 2,500 of this cited drug use
as main problem
Wraparound – Welfare Advice
 SDF survey of 110 drug users – average
council tax debt of £2,000
 Total debt of £220,000 simply due to failure
to complete a form on time
 What are the hidden debt challenges among
the 22,000 on methadone – for mainstream
drug and money advice services in
Scotland?
Wraparound – Parenting Support
 1700 foster homes needed for vulnerable
children currently – Works out at £51m cost,
i.e. £30k per child
 Average Parent Support service working
with 40 families costs £350k (approx)
 £15m would support 1700 families based on
these figures
 Far reaching benefits with this model
What makes wraparound work?
 More effective use of GPs
 Remove blockages in services – reduce
strain on services
 Find resources for wraparound provision
 Fund what makes a difference to drug users
and what’s ‘best value’
 Recommendations about wraparound
support in Scotland’s Drug Strategy