Good practice for commissioning substance misuse

Good practice prompts

Public Health England has just (26 August 2016) updated its good practice prompts for planning adult prevention, treatment and recovery services for drugs and alcohol (a major revision for 2017/18 is also currently under way).

Given the very substantial reductions both in commissioning resources and in funding for local substance misuse services, this advice is likely to be even more important than usual.

Adult drug prevention, treatment and recovery

Here is PHE’s introduction:

An estimated 300,000 people in England are dependent on heroin and/or crack. There are also reports of more people having problems with other drugs, including new psychoactive substances (so-called ‘legal highs’), image and performance-enhancing drugs, and growing concern about dependence on prescribed and over-the-counter medicines. Added to this, an individual’s drug use or dependency can significantly affect the people around them, including their families, friends, communities and society.

Investing in effective prevention, treatment and recovery interventions is essential for tackling the harm that drugs can cause, helping users overcome their addiction, reducing involvement in crime, sustaining their recovery, and enabling them to make a positive contribution to their family and community.

Planning is key. Successful plans will be based on the local needs and community assets assessment, and will reflect evidence of what is known to work in addressing the root causes and wider determinants of drug dependence.

Effective local systems are those that provide welcoming, easy to access, flexible services that can cater for the needs of a broad range of people and their different drug problems. They raise their recovery-orientated ambitions and improve the progress of service users while continuing to protect them from the risks of drug misuse (and are seen to do so by providers and users). They will encourage more service users to complete their treatment but will not put at risk any who are benefiting from their existing treatment.

The guidance outlines six key principles that local areas might consider when developing plans for an integrated alcohol and drugs prevention, treatment and recovery system:

  1. Drug misuse and dependence are prevented by early identification and interventions
  2. There is prompt access to effective treatment
  3. There are interventions to address the health harms of drug use
  4. Treatment is recovery-orientated, effective, high-quality and protective
  5. Treatment supports people to sustain their recovery
  6. Local authority public health commissioners work closely with all relevant partners to commission high-quality, evidence-led alcohol and drug services based on outcomes

Each principle is followed by two sub-sections:

  1. A list of what you will see locally if you are meeting the principle
  2. The questions you should ask to check you are following the evidence and best practice which supports that principle.

time to plan

Adult alcohol prevention, treatment and recovery

PHE follows a similar format for its advice on planning alcohol services:

Alcohol is the leading risk factor for deaths among men and women aged 15-49 years in the UK and the harm from alcohol impacts on a range of other public health outcomes. In England, over nine million people (22% of the population) drink at levels that increase the risk of harm to their health. Of these, 1.6 million adults show some signs of alcohol dependence.

Alcohol has been identified as a causal factor in more than 60 medical conditions, including circulatory and digestive diseases, liver disease, a number of cancers and depression. The increase in risk for these conditions is greatest among those 2.2 million people in England drinking at harmful levels (ie, in excess of 35/50 units per week, female/male). However, even increasing-risk drinkers (those regularly exceeding the lower risk guidelines) are at significantly increased risk of these conditions. Binge drinking can lead to injuries, anti-social behaviour and other societal harm.

Because this range of drinking behaviour leads to such a wide variety of harm, evidence points to a multi-faceted and integrated response, aimed at individual drinkers, at-risk groups and whole populations.

Alcohol-related harms fall disproportionately on the poorest in society. According to the local alcohol profiles for England (LAPE) for the most deprived tenth of the population, hospital admissions, where the main reason for admission was alcohol, are 55% higher and alcohol-related deaths 53% higher, than the least deprived tenth of the population.

Effective local systems will be those that are coherently planned by local government, NHS and criminal justice partners to provide clear, integrated policies and pathways through levels of intervention based on identified need.

Planning is key. To address the harm, costs and burden on public services from alcohol misuse, successful plans will take into account local needs and community assets assessments, and will reflect evidence of what is known to work in terms of: effective interventions for those at risk; treatment and recovery services for dependent drinkers; and action to reduce binge drinking and reduce the harm caused by binge drinkers.

For alcohol services, PHE identifies give principles (again followed by a series of practice prompts):

  1. Effective population-level actions are in place to reduce alcohol-related harms.
  2. There is large scale delivery of targeted brief advice.
  3. There are specialist alcohol care services for people in hospital.
  4. There is prompt access to effective alcohol treatment.
  5. Local authority public health commissioners work closely with all relevant partners to commission high-quality, evidence-led alcohol and drug interventions based on outcomes.

 

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