Transcript Slide 1

Needle exchange: an NTA
perspective
1 July 2009
Hugo Luck
Why NEX?
 It’s effective
 It links us to treatment naïve/resistant populations
 A cornerstone of harm reduction, the leading public health response
to drug use.
The current national picture
 Sharing down to about 25 % of users, though still above the mid-1990s.
 Groin and crack injecting more common, have become more common.
 One third of injecting drug users reporting injecting site infection in the
last year.
 Overall almost half of injecting drug users are now infected with HCV
and about one in 90 with HIV.
 There has been a marked increase in the number of injecting drug
users receiving the hepatitis B vaccine, with two-thirds now reporting
vaccination (how much of this is prison?).
Source : Shooting Up 2008
NEXMS…
 Sorry
 The software has been fixed
 All is not lost
In the meantime…
 The quality of the data we do have seems quite good
 For those DATs who have submitted data we’ll be producing an
initial report as part of the Needs Assessment
 We’re planning to open the system for an ‘amnesty’ to submit
previously unreported data.
For Example
Data are not currently public domain
1) Planning, needs assessment and community
engagement
 Use the existing process
 BUT may need new sources of data
 What are your links with public health?
 Are the Local Authority on board?
2) Meeting need
 Tie directly to needs assessment;
 Economies of scale for disposal;
 Formal and informal needle identification;
 ICPS for all relevant services – what are the gaps and how to fill
them
 Auditing and monitoring – How much do we need to know?
3) Types of service
 What does balance look like?
 All Specialist Treatment services – managing using on top
 Accessibility vs. cost efficiency
4) Equipment and advice
 No limits – what challenges will this present?
 Flexibility of disposal/sharps bins
 Who decides the advice and information given?
 Talking to users
 Encouraging/nagging/facilitating
5) Community pharmacy-based NSPs
 What additional services can pharmacy offer?
 Is it an appropriate setting?
 Confidentiality
6) Specialist NSPs
 Staff competency
 Wound care
 Referral services – on site and off site
More needed
 Are you NICE compliant?
 What isn’t covered by NICE?
 Do we have enough information?
 Does NEX fit well with existing treatment systems?
The role of the NTA
 Built into existing treatment planning/performance management
mechanisms
 Regional teams to work with commissioners and providers to ensure
guidelines understood and implementation process agreed
 Links to the Harm reduction works campaign
 Disseminate good practice
 Get NEXMS right (and use it)
More information
www.nice.org.uk
www.nta.nhs.uk
www.harmreductionworks.org.uk