Sheffield Future Commissioning of Drug & Alcohol Community Treatment Magdalena Boo, Joint Commissioning Manager www.sheffielddact.org.uk
Scope of the Plan • IN SCOPE • Adults 18+ (young people’s services are separately commissioned) • Publicly funded services only • Drug and alcohol harm reduction, treatment and recovery services • Community services only (not residential or inpatient) • Pharmacological and psychosocial interventions • Service user involvement and carer support services • OUT of Scope: • Drug Interventions Programme • Contracts under £50k total value www.sheffielddact.org.uk
What is the plan based on? • National strategy HM Government (2010) Drug Strategy: Reducing Demand, Restricting Supply, Building Recovery: Supporting people to live a drug free life HM Government Alcohol Strategy (2012) • National Good Practice Guidance Strang (2012) Medications in Recovery: Re-orientating drug dependence treatment, NTA NTA (2010) Routes to Recovery: Psychosocial Interventions for drug misuse Nat Cen (2012) Drug System Change Pilots Evaluation Final Report DH (2009) Signs for Improvement commissioning interventions to reduce alcohol related harm Models of Care for Alcohol Misuse & Models of Care for Drug Misuse (2006) NTA (2012) Club drugs, emerging trends and risks • National and local data and soft intelligence Alcohol & Drugs JSNA Support Pack, PHE Sheffield Needs Assessments – drugs & alcohol Sheffield Performance Monitoring Frameworks DOMES reports, Public Health England Core Data Set J • National Clinical Guidelines DH (2007) Drug Misuse & dependence: UK guidelines on clinical management www.sheffielddact.org.uk NICE guidance
Local Need (Drugs) Which local drug users does the plan aim to support through commissioning services? • 4017 opiate and crack users of which: • 2,200 heroin users are already in treatment and need ongoing treatment (prescribing interventions) and recovery support • <2,000 heroin users not yet in treatment who require harm reduction interventions including needle exchange, hepatitis screening and immunisation & wound care; and motivational interventions to choose a drug free life • Opiates include heroin, opium and some over the counter and prescription drugs e.g. codeine based preparations • Non opiate users , sometimes called ‘recreational drug users’ who require harm reduction interventions including needle exchange, hepatitis screening and immunisation & wound care; psychosocial interventions and motivational interventions to choose a drug free life. • Non opiates include: Cannabis and synthetic cannabinoids, Crack cocaine and powder cocaine, Club drugs including ketamine, ecstasy and new psychoactive substances, Khat, Steroid users www.sheffielddact.org.uk
Local Need (Alcohol) • 47,000 higher risk drinkers of whom we should commission interventions for 10-15% (4,700-7,050) including: • ‘Binge’ drinkers (more than 175ml wine or 1 pint of beer for women per day or 1.5 pints and 250ml glass of wine for men per day, drunk quickly in order to get drunk) • People drinking at increasing and higher risk (above DH guidelines of 14 units per week/2-3 per day for women with 2 drink free days and 21 per week/3-4 per day for men with 2 drink free days) • Dependent drinkers • Vulnerable drinkers including street drinkers • Most individuals do not require “treatment but identification that they are drinking at increased risk and brief advice on behaviour change. • Dependent drinkers will usually require treatment interventions in order to cut down or stop drinking • This plan aims to provide services both for people who wish to drink safely, socially and sensibly within Department of Health unit guidelines as well as for those who require total abstinence. www.sheffielddact.org.uk
Proposed Service Re-design • Just under £5m investment (£4.95m comprising contract values + additional variable costs of medical waste, drug testing, needle exchange paraphernalia, prescription costs, vaccines) • Investment of circa £2,000 per drug/alcohol user per year – a typical heroin user spends £1,400 per month on drugs so this is good value for public money • End to end services • Opiates, non-opiates, alcohol • Specialist needle exchange separate from treatment and recovery services for drugs • Alcohol not co-located with any drug service • < 3 weeks waiting time targets for all interventions • Per capita funding model so capacity can be increased or decreased according to need/demand • National unit costs and regional benchmarking used to set a ‘fair price’ • Flat rates paid for premises and non clinical pay rather than a % management fee • 25% cost savings on current contract values over 2 years • 3- 5 year contract terms with a “break clause” at year 3 www.sheffielddact.org.uk
Proposed Services (Opiates) • 1,000 assessments • 2,450 prescribing places, of which • 950 secondary care • 1,500 primary care • 900 psychosocial interventions places • Aftercare: Personal Recovery Budgets (400 per year across drug treatment system) • £2.7m + additional costs for prescriptions, vaccines, drug tests of circa £700k • Harm reduction and vulnerable adults nurse led service including blood borne virus, woundcare and venous care, home supervision of substitute prescribed medication, very vulnerable service refusers with mental capacity www.sheffielddact.org.uk
Proposed Services (Non Opiates) • 800 ‘Tier 2’ places including 400 needle exchange + 400 open access/assertive outreach caseload (unique individuals can’t be on both caseloads and can’t also be on DIP or Tier 3 caseload) • 400 Psychosocial interventions places (non opiates only) • Aftercare: Personal Recovery Budgets (400 per year across drug treatment system) • £733k + £70k additional variable costs of paraphernalia and medical waste • Pharmacy training • Cross Sheffield roll out of drug screening tool and referral pathway • Learning schemes for service users and carers including ‘Ambassadors Scheme’ www.sheffielddact.org.uk
Proposed Alcohol Service • 2,400 Identification and Brief Advice assessments using AUDIT • 1,000 pharmacological/medical treatment places including community detoxification and prescribing to prevent relapse • 500 Psychosocial Interventions places • Nurse Support Services – primary and secondary care liaison nurses in- reach into GP and hospital settings • £930,000 + prescription costs • Criminal Justice alcohol interventions likely to move under the DIP Service from 2015: - Fixed Penalty Notice Waiver - Alcohol Conditional Bail - Alcohol Treatment Requirements www.sheffielddact.org.uk
Timetable • Public & Stakeholder Consultation (8 weeks) – 27 th December 2013 • Cabinet – 18 th December 2013 or 15 th January 2014 • Round 1 tender begins January 2014 (Q4) • Round 2 tender begins July 2014 (Q2) www.sheffielddact.org.uk
Consultation Questions • Sheffield DACT has provided a series of questions on which we wish to consult the public and stakeholders. • You do not need to answer all the questions. • We would also like any other comments or views on the proposed services and have provided a comments box as Q16 for this purpose. • We will use this information to inform our planning, including the service re-design, the service specification and questions asked as part of the tender. • Sheffield DACT will, where possible, provide further clarification and answer your questions as part of this consultation process. • Please respond by 27 th December 2013 – we are able to take your comments today. www.sheffielddact.org.uk
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