City of York Council (Logo)

Meeting:

Decision Session - Executive Member for Health, Wellbeing and Adult Social Care

Meeting date:

15/11/23

Report of:

Peter Roderick, Acting Director of Public Health

Portfolio of:

Cllr Jo Coles, Executive Member for Health, Wellbeing and Adult Social Care


Decision Report:

Investment of 2023/4 council budget growth money - Substance Misuse


Subject of Report

 

1.        The report will give an overview of how the council will allocate resource from the 2023/24 Council Budget growth funding, which allocated funding to the public health team to support those living with substance use disorder issues. 

2.        It will also set the context for the investment in terms of York’s Drug and Alcohol Partnership priorities and programme.

 

Pros and Cons

 

3.        This new investment, if directed to the right programmes, will improve the health and wellbeing of some of the city’s more vulnerable residents, and further embed the recovery model which is an evidence-based approach to reducing the personal and societal harms of substance use.

 

Policy Basis for Decision

 

4.        These proposals support the ambitions of the Council Plan 2023-2027, in particular the core commitment around health and health inequalities, and specifically the action ‘Support more people on their journey of recovery from addiction, including through smoking cessation services and our recovery-based drug and alcohol model’.

 

Recommendation and Reasons

 

5.        The Executive Member is asked to approve the use of £75k contained in the 2023/24 Council Budget growth funding for:

 

a.   £50k funding for York in Recovery, a peer-led recovery charity working with those in recovery to maintain abstinence-based social and community participation.

b.   £25k funding for the Alcohol Care team at York and Scarborough Teaching Hospitals Foundation Trust.

 

Reason: These investments are in line with partnership and council priorities, and constitute a strong level of additional support from the council to support those with substance use disorder and tackle health inequalities

 

Background

 

6.        The government’s 10-year strategy ‘From Harm to Hope’ (2021) lays out several aspirations which aim to reduce the harm caused by drug and alcohol use nationally. The Supplemental Substance Misuse Treatment & Recovery Grant (SSMTRG) has been provided from central government to assist with the implementation of the plan.

 

7.        Local delivery of this strategy has been in progress since its publication, including the establishment of a Combatting Drugs Partnership for the city, reporting to the government’s Combatting Drugs Unit, including Police, Probation, Prison Services, OFPCC, treatment providers, the VCSE, education, health, people with direct experience of substance use disorder, and other partners, with the SRO being York’s DPH.

 

8.        This partnership, which we have called the York Drug and Alcohol Partnership, has oversight over the:

 

·        development of a Health Needs Assessment for drugs and alcohol

·        additional resourcing of the prevention and treatment system through the Supplemental Substance Misuse Treatment and Recovery Grant

·        Local Plan of Action, with three key aims to

o   Break drug supply chains

o   Deliver a world-class treatment and recovery system

o   Achieve a generational shift in the demand for drugs

 

9.        There are a number of targets the government expect us to meet within this work, including a focus on reducing drug and alcohol related deaths, for 2% of all people in treatment to access residential rehabilitation services, a national target for treatment capacity to increase by 20% (with an agreed 3 year trajectory locally that will contribute to the national ambition), and improving quality – including by reducing caseloads and increasing the professional staff mix across many agencies.

 

10.    Locally, our data suggests that:

 

·          In 20/21 there were 810 opiate/crack users, 41% not accessing treatment. In York, 21.4% drinking at above low risk levels (approx. 32,000 people), of which 2,458 are possibly dependent.

·          In 20/21 there were 108 hospital admissions for drug poisoning, a rate of 51.18 per 100,000, and 1,480 alcohol specific admissions (771 per 100,000), significantly higher than both England and region. Over the last 10 years there have been 186 drug poisonings resulting in death in York, of which 148 (80%) were drug misuse related. In 2021, there were 65 alcohol related deaths in York, of which 20 were alcohol-specific deaths.

·          All major drug types are readily available across York, particularly heroin, cocaine, cannabis, amphetamines, and benzodiazepines. There was an increased demand for benzodiazepines, the majority of which was related to diazepam. Cannabis edibles have also been identified as an increasing threat, with data indicating offences have tripled.

·          There are a number of organised crime groups (OCGs) relating to drugs in the city. At the time of the Drugs and Alcohol Health Needs Assessment 2022, there were 40 of these OCGs, and 20 county lines were known to traffic and exploit local juveniles with 18 having links to firearms and five with links to weapons and five with links to sexual exploitation. Crime related to alcohol peaks in the city centre, particularly during the night time hours and over the weekend, especially during the summer and December. The main crime types are ASB nuisance and violent crime.

·          Around 21% of the adult population in York drink above the recommended levels, and around 2,500 people are estimated to be dependent on alcohol, of whom only around 16% are in treatment.

11.    Through the SSMTRG grant York was allocated £325,566 in the first year, rising to £450,444 in year three, to support achieving these outcomes through, for instance, employing extra criminal justice workers within Changing Lives, expanding harm reduction work such as peer-to-peer naloxone training, and funding third sect family support and advocacy.

 

12.    Through engagement with the York Drug and Alcohol Partnership a Local Plan of Action has been drawn up in line with the expectations of the Combatting Drugs Unit National Outcomes Framework. This was discussed by Health and Adult Social Care Policy and Scrutiny Committee in February 2023 (see background paper).

 

13.    The council’s main contributions to this action plan is to oversee the ‘delivery of a world-class treatment and recovery system’, using SSMTRG resources. The 3 year treatment plan drawn up by public health for our commissioned services is summarised below:

 

 

Increased treatment and harm reduction capacity, including inpatient

detoxification and residential rehabilitation

Years 1 and 2 to focus on pathways and JSNA, building a strong foundation of information and evidence to support further plans for increasing treatment places towards end of Year 2 and into Year 3.

Enhanced treatment quality 

Year 1 and 2, review caseloads and training options.

Year 2/3, consider training needs and the ascertain number of workers across the system required to support reduction on caseloads.

Year 3 focus on recruitment to ensure reduction of caseloads and support quality of service provision

Expanding and developing the workforce

Year 1 and 2 explore training needs and develop plan to support training plan.

Year 3 plan to expand workforce to support increase in treatment placements and consider specialist workers in other organisations

Reducing drug related deaths and improving access to mental and physical health care

Year 1 to undertake DARD review, look to explore pathways with secondary care for inpatients/outpatients to ensure prompt referrals.  Undertake review into Alcohol Care Team model.  Develop IBA and online alcohol reduction programme. Year 2 look to review findings and build on recommendations and continue to strengthen pathways. This will assist with Year 3 plans.

Recovery orientated system of care, including peer-based recovery support services

Year 1 focus on mapping/reviewing current services and ensure those with lived experience, including family/carers/friends feed into future plans to shape relevant initiatives. This will ensure by Year 3 there is a wide recovery offer for individuals.

 

Consultation Analysis

 

14.    Discussions have taken place with many partners across York that support individuals who are affected by their drug and alcohol use, through a partnership del which includes those with direct experience. These regular conversations have led to the production of the Local Plan of action and the 3-year treatment plan, on which these investment proposals are based.

 

Options Analysis and Evidential Basis

 

15.    It is proposed that in line with the above aspirations and strategic objectives, the one-off 2023/24 growth monies allocated to ‘substance misuse’ should be used to fund two discrete and complementary pieces of work.

 

16.    Firstly, £50k funding will be granted to York in Recovery, a peer-led recovery charity working with those in recovery to maintain abstinence-based social and community participation. There is an established and growing programme of work around recovery in the city, which is highly beneficial to statutory services and in line with best evidence around long-term, sustained recovery and minimisation of harm from substances. It also aligns to the asset-based community development approach, and the personalised care agenda within health. Through recovery cafes, peer-led groups, training and distribution of naloxone, emerging social enterprises, support for Alcohols anonymous (AA) and Narcotics Anonymous (NA) groups, and the physical space of York Recovery Hub at York CVS launched in 2023, York in recovery occupies an essential part of the system, but as a recently constituted charity needs stability and resource to build strong foundations. This money will fund salary costs for a coordinator or two years, as well as bringing in support around funding/bid-writing to enable a sustainable approach in the longer term.

 

17.    Secondly, £25k funding will be given for the Alcohol Care team at York and Scarborough Teaching Hospitals Foundation Trust. This is in addition to resource the council has given through the SSMTRG grant to establish this team and will enable the Trust to expand its work to identify patients with alcohol issues in A+E and on inpatient wards, enable safe detoxification and facilitate discharge with community support in place. This approach has demonstrated significant Length of Stay reductions in other parts of the country and contributes to the aspirations of council and health partners around improving flow in the health and care system; it is therefore hoped that in the period where public health funds this team, partners can build a business case to make this a cost-neutral service from the perspective of the Trust.

 

Organisational Impact and Implications

 

18.     

·       Financial

Funding has been provided for these schemes as one-off growth money in the 2023/24 budget, earmarked for substance misuse.

 

·        Human Resources (HR)

There are no HR implications of this report.

 

·        Legal

There are no legal implications of this report.

 

·        Procurement

This investment will involve a grant agreement with York in Recovery and is as such subject to a Best Value assessment. The investment in York Hospital will be through a contract variation.

 

The council’s current Contract Procedure Rules (January 2023) includes at clause CPR 4 - Grants conditions for the award of Grants, where the value of a Grant is less than £175,000 over 3 years, the Director shall have the discretion to conduct a competitive application process for the award of that Grant if doing so demonstrates best value for the Council. If a Director is not conducting a competitive application process then the Best Value Form must be completed to capture the rationale for the decision.

 

The Best Value Assessment to be completed for the use of the £75k contained in the 2023/24 Council Budget growth funding will fulfil the requirements of CPR 4 where the Director is required to explain the reasons for the decision to directly award this Grant funding without inviting competition for these Grants as follows:

 

a.      £50k funding for York in Recovery

b.      £25k funding for the Alcohol Care team at York and Scarborough Teaching Hospitals Foundation Trust

 

Public Health team colleagues have confirmed that the £50k Grant to be awarded direct to York In Recovery is due to this provider being the only suitable one that can deliver what the council requires and this will be evidenced within the Best Value Form to be completed and submitted by the Director of Public Health to Commercial Procurement team in accordance with CPR 4.4.

 

The £25k Grant to be awarded direct for the Drug Alcohol Care Team funding to York and Scarborough Teaching Hospitals Foundation Trust is in addition to resource the council has given through a previous SSMTRG grant with this current grant value of £106,405 + £25,000 = £131,405 and therefore CPR 4.4 requires that a competitive Grant applications process if this is deemed Best Value otherwise the Best Value Form would need completing  and submitting to evidence and justify the rationale behind this decision.

 

Once the relevant approvals, delegated authority to award these Grants have been obtained then a formal Grant Agreement should be prepared and then awarded to the Grant funding providers and signed by all parties to these Grants and the signed copy shared with Commercial Procurement and Legal.

 

·        Health and Wellbeing

This investment will have a positive effect on treatment and recovery efforts in York, as set out in the Drug and Alcohol Local Plan of Action, and because of the demographic characteristics of those living with substance use disorder in York, this investment in treatment and recovery in the city will have a net positive effect on decreasing health inequalities.

 

·        Environment and Climate action

There are no direct environment and climate action implications as a result of these proposals.

 

·        Affordability

Drug and alcohol issues, which can be accompanied by other complex mental and physical health problems from trauma, impose a significant financial burden on, and financial complications for, those who suffer them, including problem debt and housing issues.  These proposals will have a net positive effect on financial inclusion in some of our most vulnerable communities in the city.

 

·        Equalities and Human Rights

An Equalities Impact Assessment has been completed and is attached as an annexe to this document. In summary, it finds that because of the demographic characteristics of those living with substance use disorder in York, this investment in treatment and recovery in the city will have a net positive effect on increasing equality; the EIA has therefore not prompted any amendment to these plans.

 

·        Data Protection and Privacy

This proposals in this report do not require any changes in the handling or transfer of data not already covered by existing data protection arrangements.

 

·        Communications

There are no communications implications of this report.

 

Risks and Mitigations

 

19.    There are no known or anticipated risks associated with the divestment of these resources in the way outlined above. Both proposals will be monitored through existing contract-monitoring arrangements to ensure performance and quality.

Wards Impacted

 

20.     All wards are affected by this decision.

 

 

Contact details

 

For further information please contact the authors of this Decision Report.

 

Author

 

Name:

Ruth Hine

Job Title:

Public Health Specialist Practitioner (Advanced)

Service Area:

Public Health

Telephone:

07983 951 103

Report approved:

Yes

Date:

30/10/23


Co-author

 

Name:

Peter Roderick

Job Title:

Acting Director of Public Health

Service Area:

Public Health

Telephone:

07511160283

Report approved:

Yes

Date:

30/10/23


Background papers

 

National 10 year Drug Strategy Harm to Hope - https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1079147/From_harm_to_hope_PDF.pdf

 

Health and Adult Social Care Policy and Scrutiny Committee 21 February 2023 - Local Plan of Action for Drugs and Alcohol in York

https://democracy.york.gov.uk/documents/s165565/Report.pdf


Annexes

 

Annex A: Equalities Impact Assessment (EIA)