New Strategic Direction for Alcohol and Drugs Phase 2. Second Update Report June PDF

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New Strategic Direction for Alcohol and Drugs Phase 2 Second Update Report June 2014 Contents Chapter Page No. Executive Summary 2 1. Background to the NSD Phase NSD Phase 2 - the revised Approach
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New Strategic Direction for Alcohol and Drugs Phase 2 Second Update Report June 2014 Contents Chapter Page No. Executive Summary 2 1. Background to the NSD Phase NSD Phase 2 - the revised Approach 6 3. Update on NSD Phase 2 Indicators Progress on Outcomes Conclusions 39 Annex A Statistics Update Section 1 Numbers Presenting for Treatment Section 2 Hospital Admissions Section 3 Alcohol and Drug Related Deaths Section 4 Alcohol and Drug Prevalence Section 5 Blood Borne Virus and Injecting Drug Use Section 6 Personal Expenditure on Alcohol Section 7 Alcohol and Drug Related Crime Section 8 Drink/Drug Driving Section 9 Disruption of Drug Supply Markets Section 10 Public Perception of Alcohol/Drugs as a Social Problem Section 11- Views on Alcohol and Drug Related Issues Executive Summary The cross-departmental strategy to reduce the harm related to substance misuse in Northern Ireland, known as the New Strategic Direction for Alcohol and Drugs (NSD) Phase 2, was launched in early This is the second annual report of progress against the outcomes and indicators set out in that document (the first report is available at the following link: _nsd_phase_2_update_report-_march_2013.pdf). The report is structures as follows: Chapter 1 sets out the background to the development of the strategy; Chapter 2 summarises the revised approach taken in the NSD Phase 2; Chapter 3 provides an update on the key indicators available since the last report; Chapter 4 shows progress on the short-term outcomes in the NSD Phase 2; and Chapter 5 provides a summary and concluding comments Overall, further progress has been made in the second year of the NSD Phase 2 s implementation. Since the original strategy was published in 2006, we have seen some encouraging signs in relation to reductions in the levels of binge drinking and the percentage of young people who drink and get drunk. Prevalence of illegal drug misuse has largely plateaued and we are seeing more people access treatment and support services for alcohol and drug misuse. However, levels of alcohol and drug related hospital admissions and deaths are still high, and there is increasing concern about the misuse of prescription drugs and New Psychoactive Substances. In terms of progress against the short-term outcomes within the NSD Phase 2, the majority of the 86 outcomes are on track for achievement within the timescale expected. 8 (9%) of the outcomes have been completed, 60 (70%) of the outcomes are classified as being on track for achievement, and in 18 (21%) of the outcomes progress is being made but with some delay. At this stage, no outcomes are identified as being not on track for achievement. 2 We will continue to monitor progress against the outcomes and indicators on an ongoing basis, and update annually. We will also seek to identify and address emerging issues. For example, we have initiated actions on prescription drug misuse and progress against these have been included in this year s report. 3 1. Background to the NSD Phase 2 Introduction 1.1 Alcohol and drug misuse, and their related harms, cost our society hundreds of millions of pounds every year. However, this financial burden can never describe the impact that substance misuse has on individuals, families, and communities in Northern Ireland. Alcohol and drug misuse are therefore significant public health and social issues in Northern Ireland. 1.2 In 2005, the Department of Health, Social Services, and Public Safety (DHSSPS) led the development of a cross-sectoral strategy that sought to reduce the harm related to both alcohol and drug misuse in Northern Ireland. DHSSPS launched this strategy, entitled the New Strategic Direction for Alcohol and Drugs (NSD), in Update 1.3 In 2010, an update document was published to see how effective the NSD was in terms of delivering on its aims and objectives. This document (available online at: looked particularly at the progress against the NSD s key priorities, completion of the NSD outcomes and progress against its indicators. 1.4 Overall, the update was positive and it highlighted much progress in key areas. It also raised a number of areas in which not as much progress had been made as originally anticipated and which would require further work. The report highlighted that a number of the strategic drivers had changed during the period and that a number of new issues had emerged that were not originally a high priority within the NSD. 1.5 Accordingly, it was agreed that, rather than undertaking a full new strategic development process, the existing NSD would be reviewed, revised, and extended until This decision was taken to ensure a consistent approach on the issue over a ten-year period and to ensure that resources continue to be directed at front-line services, programmes and interventions. This process also 4 allowed the NSD Phase 2 to reflect new trends and re-direct effort to where it is most needed or to where new issues/concerns are emerging. NSD Phase 2 Consultation 1.6 The NSD Phase 2 was issued for public consultation on 04 March 2011 and the process ran until 31 May individuals and organisations were involved in the consultation. Direct consultation was also undertaken with children and young people through the Participation Network and the development of a young person s version of the consultation document. NSD Phase 2 Final Document 1.7 Following the consultation, the NSD Phase 2 was revised and refined to take on board the issues raised. The final document was then approved by the Northern Ireland Executive in December 2011 and launched by the Health Minister on 26 January The full document is available online at: ase_ _ 5 2. NSD Phase 2 the Revised Approach The Five Pillars 2.1 The NSD Phase 2 identifies five supporting pillars, and these pillars provide the conceptual and practical base for the NSD. The five pillars are: Prevention and Early Intervention. Treatment and Support. Law and Criminal Justice. Harm Reduction. Monitoring, Evaluation and Research. Themes 2.2 Two broad themes, Children, Young People, and Families and Adults and the General Public, are also identified to enable an integrated and co-ordinated approach to tackle the issue. In delivering on the NSD, organisations are encouraged to focus on specific sub-groups within these themes. Values and Principles 2.3 The values set out in the NSD Phase 2 are the basic tenets on which the strategy, and its implementation, is built. These values are: Positive, Person Centred, Non-Judgmental and Empowering; Balanced Approach; Shared responsibility; Equity and Inclusion; Partnership and Working Together; Evaluation, Evidence and Good Practice Based; Consultation, Engagement, Transparency; Addressing Local Need; Community-based; Long-Term Focus; Value for Money and Invest to Save; Built on Existing Work; and Access to information. 6 Overall Aim 2.4 The overall aim of the NSD Phase 2 is to: reduce the level of alcohol and drugrelated harm in Northern Ireland. Long-term objectives 2.5 The NSD has a set of overarching long-term objectives to: provide accessible and effective treatment and support for people who are consuming alcohol and/or using drugs in a potentially hazardous, harmful or dependent way; reduce the level, breadth and depth of alcohol and drug-related harm to users, their families (including children and young people), their carers and the wider community; increase awareness, information, knowledge, and skills on all aspects of alcohol and drug-related harm in all settings and for all age groups; integrate those policies which contribute to the reduction of alcohol and drug-related harm into all Government Policy; develop a competent and skilled workforce across all sectors that can respond to the complexities of alcohol and drug use and misuse; promote opportunities for those under the age of 18 years to develop appropriate skills, attitudes and behaviours to enable them to resist societal pressures to drink alcohol and/or misuse drugs; continue to effectively tackle the issue of availability of illicit drugs and young people s access to alcohol; and to monitor and assess new and emerging illicit drugs and take action when appropriate. Key Priorities 2.6 Although the NSD Phase 2 seeks to address a wide range of issues, a number of Key Priorities were identified. These form the cornerstone of work over the life of the Strategy and reflect those issues that have been identified to be of crucial importance through the Review and the extensive pre-consultation exercise. The Key Priorities, and some very high level updates on progress against these, are set out in the following table: 7 KEY PRIORITY Developing a Regional Commissioning Framework Targeting those at risk and/or vulnerable Alcohol and drugrelated crime including anti-social behaviour and tackling underage drinking Reduced availability of illicit drugs Addressing community issues Promoting good practice in respect of alcohol and drugrelated education and prevention Harm Reduction approaches Workforce Development UPDATE The Alcohol and Drug Services Commissioning Framework, which covers all tiers of service, was issued for consultation on March The document will be finalised in the near future, but is currently being used to inform the next process of tendering and commissioning. A further consultation on Tier 4 inpatient detoxification was launched in October 2013 and proposal are now being finalised. The strategy, and its implementation, continues to target those at risk and/or vulnerable this is on the basis of local needs assessment and prioritisation. Key links have been made between NSD Phase 2, the Community Safety Strategy, the Strategic Framework for Reducing Offending, and alcohol licensing. At the local level, we continue to promote joined up work between DACTs, PCSPs, and local councils. Key links have made between NSD Phase 2, the Organised Crime Task Force, the Community Safety Strategy, and the Strategic Framework for Reducing Offending. At the local level, we continue to promote joined up work between DACTs, PCSPs, and local councils. DACTs and ISFs remain in place to bring forward issues from local communities, and put in place action and programmes to address these. Policing and Community Safety Partnerships (PCSPs) also play a role in identifying problems within communities and seeking local solutions to local problems. The Alcohol and Drug Services Commissioning Framework looked at the role of Community Support Services, and specifications are being developed to support commissioning of services on a more consistent basis across the region. The Alcohol and Drug Services Commissioning Framework sets out the evidence base for what works in alcohol and drug education and prevention, and a range of services will be commissioned in light of this work. We are continuing to support and develop substitute prescribing, needle and syringe exchange, naloxone, and other harm reduction approaches. Workforce development is a key part of the commissioning framework, and will support its roll out once finalised. 8 Emerging Issues 2.7 The NSD Phase 2 recognised that, since publication of the original NSD, a number of issues had emerged. These issues were identified, noted and considered by the NSD Steering Group and the relevant Advisory Groups. This process was also informed by the Independent Sector Forums, the Advisory Council on the Misuse of Drugs, the British-Irish Council Drug Misuse Sectoral Group, and recent research. These emerging issues include: prescription or over-the-counter drugs; new psychoactive substances; families and hidden harm; recovery; mental health, suicide, and drugs and alcohol misuse, sexual violence and abuse, and domestic violence; a population approach to alcohol misuse; local funding; and the review of public administration. 9 3. Update on NSD Phase 2 Indicators 3.1. To measure the extent to which the overall aim of reducing alcohol and drugrelated harm is being met, the NSD Phase 2 established a set of Indicators that can be used for this purpose. These are set out below: Alcohol Drugs Prevalence Prevalence Binge drinking prevalence Alcohol-related deaths Numbers presenting to treatment Related hospital admissions Alcohol-related crime Drink Driving Public confidence that alcoholrelated problems are being addressed Blood Borne Viruses among Injecting Drug Users Drug-related deaths Numbers presenting to treatment Related hospital admissions Drug-related crime Drug driving (including prescription drugs) Number of gangs (criminal) dismantled, disrupted or frustrated Public confidence that drug-related problems are being addressed Progress against these indicators is reported as the information becomes available. It should be noted that for the majority of these indicators we are seeking a reduction in the figures. However, in respect of some of the areas particularly those presenting for treatment and public confidence an increase in the numbers is actually positive as it means more people are seeking help for their misuse and this should lead to long-term reduction in related harm. When reporting against these indicators, where possible and appropriate, figures will be broken down by Section 75 groups and particularly in terms of age, gender, and geographical area The tables below set out data information that has been published since the last report: 10 Prevalence Alcohol Adults (Adult Drinking Patterns Survey) Indicator Prevalence 73% 72% 74% Drinkers who exceed daily Limit 82% 81% 78% Drinkers who drink above sensible levels 29% 24% 23% Problem Drinking 10% 10% 9% Drinkers who binge drink 38% 32% 30% Young People (Young Persons Behaviour and Attitude Survey) Indicator Ever taken an alcoholic drink 60% 55% 46% 38% Drink in the week prior N/A 19% 13% 7% Drink and been drunk 34% 30% 24% 14% Drugs Adults (Drug Prevalence Survey) Indicator 2002/ / /2011 Lifetime use of any illegal drugs 20% 28% 27% Last year use of any illegal drugs 6% 9% 7% Last month use of any illegal drugs 3% 4% 3% Young People (Young Persons Behaviour and Attitude Survey) Indicator lifetime use of any drugs or solvents 23% 19% 15% last year use of any drugs or solvents 18% 13% 11% last month use of any drugs or solvents 12% 7% 7% Treatment Census of Drug and Alcohol Treatment Services in Northern Ireland Indicator In treatment for alcohol and/or 5,064 5,583 5,846 5,916 drug misuse In treatment for alcohol-only 3,074 3,476 3,328 3,111 misuse In treatment for drug-only misuse 1,030 1,118 1,294 1,514 In treatment for both alcohol and drug misuse ,224 1,291 Northern Ireland Drug Misuse Database Indicator 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 Individuals 1,666 1,464 1,984 1,755 2,008 2,593 2,999 2,824 presented to treatment services for drug misuse First Main Drug of Misuse Cannabis Cannabis Cannabis Cannabis Cannabis Cannabis Cannabis Cannabis 11 Second Main Drug of Misuse Benzodia zepines Benzodia zepines Benzodia zepines Benzodia zepines Benzodia zepines Benzodia zepines Benzodia zepines *A compliance exercise was carried out in 2011 which partially would explain an increase in the number of forms completed and returned at this time Benzodia zepines Hospital Admissions Indicator 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 Alcohol-Only 7,127 7,322 8,267 8,462 8,603 8,652 9,393 10,274 Emergency Admissions Drug-only related admissions 3,160 2,948 3,951 3,880 3,424 3,649 3,256 3,315 Alcohol and Drug related admissions Deaths 1,498 1,308 1,497 1,473 1,663 1,663 1,644 1,556 Indicator (p) Alcoholrelated deaths Drug-related deaths Deaths due to drug misuse Data for 2012 are provisional Blood Borne Viruses Indicator (p) New diagnoses of Hepatitis C Reports of both acute and chronic Hepatitis B Data for 2012 are provisional. Figures for earlier years have been revised. Needle Exchange Indicator 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 Visits to participating pharmacies 8,797 9,997 8,267 13,389 15,828 17,712 20,204 21,220 Source: 2005/06 to 2009/10 Public Health Information and Research Branch. 2010/11 to 2012/13 Health and Social Care Board. 12 Crime Indicator 06/07 07/08 08/09 09/10 10/11 11/12 12/13 Drug Offences 2,411 2,720 2,974 3,146 3,482 3,780 4,378 Drug seizure incidents 2,590 2,968 3,198 3,319 3,564 3,920 4,474 Year No. Drink/Drug-driving related 4,700 4,645 3,994 3,889 3,590 3,168 offence All figures have been revised since last update. Figures are provisional and are subject to change. Any person who is required to submit to an evidential test is counted as a drink/drug driving detection. 13 4. Progress on Outcomes 4.1 In order to deliver the overarching long-term aims of the NSD, a series of outcomes has been developed. Following the logic model approach a number of long-term outcomes were initially developed. A number of regional and local short and medium-term outcomes and outputs have subsequently supported these and will provide the focus for activities and future work. (Short term means within 3 years, and medium to long-term within 4-5 years). 4.2 Outcomes will be measured, and the overall success or otherwise of achieving the long-term aim will be measured by the Key Indicators previously described. The outcomes were structured in a manner that not only demonstrated their sequential nature across the five years of the NSD, but also their relationship with the Themes, Long-Term Aims and Key Priorities. 4.3 The outcomes were grouped within the themes based on certain issues or topics as follows: Adults and the General Public - 1 (Treatment and Support) Adults and the General Public - 2 (Prevention and Early Intervention) Children, Young People and Families - 1 (Treatment and Support) Children, Young People and Families - 2 (Prevention and Early Intervention) Community Safety and Anti-Social Behaviour 14 Monitoring, Evaluation and Research Workforce Development 4.4 The outcomes set out the overall direction of travel. The Public Health Agency was asked to continue to develop local and regional plans that support the achievement of the NSD outcomes, and identify and address local needs. 4.5 The short-term outcomes are set out in the following table along with an indication of progress against these deliverables using a red (not on target for achievement), amber (on target for achievement but with some delay), or green (on target for achievement) designation. Outcomes that have been completed are outlined in blue. 15 Adults and the General Public 1 (Prevention & Early Intervention) Short Term Outcomes/Outputs 1. An integrated and targeted programme undertaken to raise awareness of the health impact of drinking above the relevant guidelines messaging must be clear and consistent. 2. Improved understanding of the social norms associated with alcohol misuse, and work undertaken to challenge these and those factors driving the drinking culture; also work undertaken to challenge these norms 3. Local community support services reviewed and consideration given to increasing consistency across Northern Ireland. RAG Status Update on Progress The Commissioning Framework has indicated that DACTs should play a more active role in the development of a local integrated education and prevention plan. It is recommended that a service in each HSCT area will be commissioned to ensure that the outcomes listed here are addressed. A workshop was undertaken with the DACTs on the 17 September 2013 to inform the development of these services. A review of the community support services was undertaken as part of the Commissioning framework consultations. The findings have contributed to the redesign of tier 1 services which will come into effect under the new contracts. Future Steps (if appropriate) 4. Health professionals, particularly within Primary Pare and A&E, trained and encouraged to undertake brief alcohol advice/intervention programmes across Northern Ireland. 5. Review of the role and capacity of alcohol liaison nurses,
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