Transcript Adfam*s Outcomes Project

Policy update
PLUS PROJECT: SUBSTANCE
MISUSE FORUM
Oliver Standing
Director of policy & communications
[email protected]
@AdfamUK @OliverStanding
Overview
1.
2.
3.
4.
5.
Home Office Drug Strategy 2016
ACMD priorities 2017
Modern Crime Prevention Strategy
Clinical Guidance (Orange Book)
State of the Sector 2015
Overview
6. Dame Carol Black review
7. Psychoactive Substances Act 2016
8. Life chances strategy
9. Q and A and discussion
Drug Strategy 2016
• Strategy is overarching policy document – important but not
binding
• Drug policy is owned by Home Office but lots depts. have
interest – DH, DCLG, DWP
• Indications new strategy will be similar to 2010 version
• Indications that it may be published in July – after noise from
referendum
• Some issues v politicised – eg methadone
• ‘Recovery’ disputed concept – what does it mean to you?
Drug Strategy 2010
• “We are determined to protect the public from the harms that
drugs can cause to individuals, their families and society as a
whole by reducing demand, restricting supply and supporting
individuals to lead lives free of dependence.” Home Sec
• 3 priorities:
– Recovery
– Restricting supply
– Reducing demand
Drug Strategy 2010
1. Recovery
• “being drug free is now the clear end goal”
• PbR
• Recovery wings in prisons
• Importance of treatment
2. Restricting supply
• Temporary Class Drug Order (cf NPS)
• Anti trafficking
3. Reducing demand
• Troubled families
• FRANK
• PHSE (?)
ACMD priorities 2016
• ACMD has had a bit of back-and-forth with Home Office over
the Psychoactive Substances Bill
• Nerochemistry working group
• Polysubstance working group
• Social harms beyond D&A user
• Older drug users
• PIEDs
• Drug related deaths
Modern Crime Prevention Strategy
‘We will develop a modern crime prevention strategy
to tackle the key drivers of crime’
Conservative Manifesto 2015
Focus on: drivers of crime – drugs. alcohol, the
effectiveness of the CJS, character, opportunity and profit
Focus on: technology – as a creator of new criminal
opportunities, and of new ways to prevent crime
Focus on: working with a wide range of partners – including
law enforcement, academia, the private sector, the voluntary
sector and the public
Modern Crime Prevention Strategy
• Drugs feature:
• “Treatment – getting users into treatment is key, as being in
treatment itself reduces their levels of offending – and the
Criminal Justice System offers a number of routes in.”
• “Full recovery from dependence should be the aim of
treatment and evidence suggests that recovery is more likely
to be achieved and sustained if users are given support to
improve their ‘recovery capital’ – particularly around housing
and meaningful employment.”
Crime is falling...
Crime Survey shows
crime down 66%
since mid-1990s
Factors include:
- Fewer heroin and
crack users
- Car, home, mobile
phone security,
and Chip and Pin
- Partnership
working, e.g. IOM
- New police
tactics, e.g.
hotspots,
forensics
- Young people
behaving better
And it is also changing
We are seeing rises in
police recorded
violence and sex
offences as more
victims come forward
and as crime recording
practice improves
We are getting a better
picture of the scale of
fraud and cyber crime –
experimental ONS data
suggests there may be
5m frauds per year, and
2.5m cyber crimes
Crime prevention must change too
Offender
Victim
Crime
Location
This ‘triangle’ has been at
the heart of crime
prevention thinking – take
away one side, and the
crime can’t happen
But we need to recognise
that changing crime
means different victims,
different offenders and
different locations (e.g.
online or in the home)
And preventing it will
require new approaches,
with new asks of the
public, industry, law
enforcement and govt.
Drivers of crime
 Drugs – strongly linked to acquisitive crime, organised crime, gangs and
violence;
 Alcohol – strongly linked to violent crime;
 The effectiveness of the Criminal Justice System – in terms of whether
the individual believes they are likely to be caught, the speed of the system
in delivering justice and also the effectiveness of the system in rehabilitating
offenders and preventing further crime;
 Character - parents, friends, schooling and neighbourhood all have a
significant impact on an individual’s identity, perception of what is ‘normal’
and their propensity to offend;
 Opportunity – for those who are disposed to commit crime, the more
opportunities they have (e.g. unlocked windows, or unattended bags in
bars), the more offences they are likely to commit;
 Profit – organised criminals will exploit new, illicit commercial opportunities
more quickly and systematically than other criminals.
Understanding these drivers can help us work out which part of
the victim-offender-location triangle to target
Working with partners
Law
enforcement
College of
Policing
HMIC
National
Policing Lead
Police Federation
Jill Dando
Institute
Police
Foundation
Academia
VCSE
Victim
Voluntary
Forum
Support
members
Sector
Mentor
Crimestoppers
UK
Early
NCA
Google
Intervention
MIND
Foundation
Alcohol
Apple
Superintendents
industry
Association
N’hood Watch
Society for
evidence-based
policing
ADS
KPMG
MTC-Novo
CUCI
MoJ
DfT
PCCs
Academic
institutions
DfE
APCC
ABI
Tech UK
IBM
Catch 22
Public
Private Sector
British Retail
Consortium
Behavioural
Insight Team
DCLG
DH
Other
Government
Clinical Guidance (Orange Book)
• Current version published 2007
• intended for all clinicians, especially
those providing pharmacological
interventions for drug misusers as a
component of drug misuse
treatment.
• Assessment should include
“Identifying social problems,
including housing, employment and
domestic violence, and offending.”
• Newer issues such as NPS and
naloxone will be covered more
extensively in new doc.
State of the Sector 2015
• Third annual State of the Sector Project:
 ‘Health check’ for the drug and alcohol sector as it has
entered a new landscape post April 2013
 Wide scope – funding, commissioning, staffing, service
user need, partnership working
• Contributes to a wider body of work looking at how the sector
is faring
• Survey of adult community and residential drug/alcohol
services in England
State of the Sector 2015
1. Commissioning and contracts
As a result of recent retendering or
recommissioning...
Services recommissioned or contracts
renegotiated since September 2014
Agree
1%
Disagree
Yes - retendering or
recommissioning
38%
Yes - contract
renegotiation
40%
44%
38%
20%
20%
24%
Services better reflect
local need
Services better reflect
good practice
Service quality has been
prioritised
55%
No
6%
n = 142
Don't know
n = 73 - 82
“Service users are fed up from the
changes.” Survey comment
State of the Sector 2015
2. Funding
Changes to funding - community and
residential services
40
33
Community
services
18
17
12
Residential
services
7
4
3
Increase
Decrease
community services n = 105
Residential services n = 33
No change
Not sure
“Increasingly we are being told
commissioners can only fund for 12
weeks. We’re commissioned by
about 23 local authority areas, and
more and more are saying, ‘we’ve
only got money for 12 weeks.’ We
still have a proportion that will pay
the 26 weeks – we’ve just won 3
recent tenders 2 for 26 weeks and
one for 12 + 12, but my worry is
that this will be a trend.” Wendy
Dawson, Ley Community
State of the Sector 2015
Impact of changes to funding
Positive impact
Negative impact
20%
10%
0%
10%
20%
30%
40%
50%
60%
n = 73 - 82
6%
15%
16%
16%
15%
9%
19%
18%
14%
55%
51%
43%
38%
35%
30%
26%
23%
14%
State of the Sector 2015
“We have tried very hard to ensure the cuts do not affect the
people who use our services. However we are creaking with not
enough management, admin time or fit for purpose IT.”
Service manager
“Case Managers have seen a doubling of caseloads and loss of
certain outlying locality sites has reduced local access points.”
Service manager
State of the Sector 2015
3. The delivery of services
Changes in number of people accessing service
35%
26%
21%
10%
8%
Large increase
(>10%)
n = 125
Small increase About the same Small decrease Large decrease
(<10%)
(< 10%)
(> 10%)
• Most commonly cited reason
for increase is higher
numbers accessing services
with novel psychoactive
substances (NPS) and alcohol
related needs.
• 63% felt confident that their
service had the skills,
knowledge and support to
engage with NPS – a modest
reduction compared to last
year (71%)
State of the Sector 2015
Access to: housing
“It is harder to get to see a
housing worker, most
houses/flats are private lets
and are expensive and often
unsafe/shoddy.” Survey
comment
“We have one member of our
team whose expertise is
housing. We have no funding
to help people get private
rented accommodation. But
we can help and offer advice
and information.” Survey
comment
Has availability of
housing/resettlement
services changed?
Do you provide/can service users
access housing/resettlement
55%
37%
27%
22%
18%
5%
Yes Yes - joint
Yes - in
referral to working house (own
an external with an
staff)
agency
external
agency
n = 109
No
6%
1%
Not sure
No change Worsened Improved
since
since
since
September September September
2014
2014
2014
State of the Sector 2015
Naloxone
• 61% of respondents were
confident that their service
has the skills, knowledge
and support to engage with
the new naloxone legislation
which came into force in
October 2015.
• 18% were not confident in
the above
“We are engaging with naloxone.
Last year we had none! Since
October it’s so much easier…We
are paying for it, we are being
pragmatic, so it comes out of our
prescribing budget. If we get to
the point where I’ve exceeded
certain moneys allocated then
we’ll have to talk to public health
and the CCG.” Service Manager
State of the Sector 2015
Themes across the three years: funding
Funding increase in year
preceding survey
Funding decrease in year
preceding survey
YEAR ONE
19
34
YEAR TWO
23
71
YEAR THREE
15
58
IMPACT: Delivery of core services, worker caseload, reliance on volunteers and
impact on workforce development emphasised across the three years
State of the Sector 2015
Themes across the three years: commissioning
cycles
Retendering /
renegotiation year
preceding survey
Anticipate retendering /
renegotiation in year
preceding survey
YEAR ONE
57%
63%
YEAR TWO
54%
44%
YEAR THREE
44%
35%
State of the Sector 2015
Themes across the three years: mental health
Access to mental health
services improved during
year preceding survey
Access to mental health
services worsened during year
preceding survey
YEAR ONE
3%
23%
YEAR TWO
4%
22%
YEAR THREE
9%
20%
Dame Carol Black review
• “An independent review into the impact on employment
outcomes of drug or alcohol addiction, and obesity”
• “Long-term conditions such as drug addiction and alcohol
dependence, or obesity, can seriously affect people’s chances
of taking up and remaining in rewarding employment.”
• “7. What are the legal, ethical and other implications of
linking benefit entitlements to take up of appropriate
treatment or support?”
• NHS constitution: patients can “accept or refuse treatment
that is offered to you, and not to be given any examination or
treatment without valid consent.”
Dame Carol Black review
• Indications are it may be published around same time as Drug
Strat - July
• “A great deal of the media coverage has focused on proposals
to make benefits conditional on accepting an offer of
treatment…It is important that the review acknowledges the
many other factors that prevent people with substance
misuse problems from returning to work, such as mental and
physical health problems, homelessness and offending.
Together these issues demand long-term, joined-up support.
(MEAM)
Psychoactive substance act 2016
• Brought in in response to “legal highs” / Novel psychoactive
substances (NPS).
• The law defines as a "psychoactive substance" anything which
"by stimulating or depressing the person’s central nervous
system ... it affects the person’s mental functioning or
emotional state".
• Exemptions made for alcohol, tobacco etc
• Criticised for definition above and for breadth ‘ “banning
pleasure”, un-enforcability
Psychoactive substance act 2016
• Postponed from April 1 due to confusion over definition –
ACMD pointed out was unworkably broad, and often
impossible to prove psychoactivity
• New definition adds “qualitatively identical to substances
[already] controlled under the Misuse of Drugs Act 1971” – ie
an analogue of existing drug
• Coming into effect May 26 – tomorrow!
Psychoactive substance act 2016
Life chances strategy
• PM’s speech in Jan 16 launched the idea, 4 priorities
–
–
–
–
Early neurological development
Development of character and resilience
Social connections
Specific drivers of poverty such as D&A, mental health
• “It starts with that fundamental belief that people in poverty
are not liabilities to be managed, each person is an asset to be
realised, human potential is to be nurtured.”
• Written and oral testimony being submitted to inquiry to
inform the strategy
Life chances strategy
• Lots of things to think about / related issues
– How are girls’ experiences different?
– What role does insecure/poor quality housing play for children in the
development of resilience ?
Questions
1.
2.
3.
4.
What impact does all this have on your role on the frontline?
What would you like to see covered at future forums?
How good are your links with substance use services?
How have changes to commissioning affected you?