New Strategic Direction for Alcohol and Drugs Phase 2. Third Update Report July PDF

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New Strategic Direction for Alcohol and Drugs Phase 2 Third Update Report July 2015 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 Third Update Report July 2015 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 56 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 This is the third* annual report of progress against the outcomes and indicators set out in that document. For the first time, this annual report also includes progress against the medium and long term outcomes included in the NSD Phase 2. This should help focus action over the next two years of the strategy s delivery. (*the first two update reports are also available online: and The report is structured 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 outcomes in the NSD Phase 2; and Chapter 5 provides a summary and concluding comments Overall, further progress has been made in the third 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 particularly New Psychoactive Substances. In terms of progress against the outcomes within the NSD Phase 2, the majority of the 141 outcomes are on track for achievement within the timescale expected. 15 (11%) of the outcomes have been fully completed, 99 (70%) of the outcomes are classified as being on track for achievement, and 26 (18%) of the outcomes progress 2 is being made but with some delay. At this stage, only one outcome is currently classified as not being on track for achievement and that relates to research in respect of prescription drug misuse. We will continue to monitor progress against the outcomes and indicators on an ongoing basis, and update annually. 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 therefore continue to be recognised as significant public health and social issues in Northern Ireland. New Strategic Direction for Alcohol and Drugs (NSD) 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 NSD Phase In 2010, an update document was published to consider 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 4 directed at front-line services, programmes and interventions. This process also 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 Final Document 1.6 Following a 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 and launched by the then Health Minister in The full NSD Phase 2 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 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 has already been used to inform the current process of tendering and commissioning. Agreement has been reached on the reconfiguration of Tier 4 addiction services and the new model should be operational soon. Further work is now being undertaken to consider Tier 3 addiction services. 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. Anti-Social Behaviour continues to be a target within the Programme for Government. At the local level, we continue to promote joined up work between Drug and Alcohol Co-ordination Teams (DACT), Policing and Community Safety Partnerships (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, the PSNI and local councils. We have also been working with the Home Office to identify and reduce access to new substances of concern. The Department has lobbied for a general ban on the sale of New Psychoactive Substances at the UK level, and continues to work with the Home Office in this regard. DACTs and Independent Sector Forums (ISFs) continue to bring forward issues from local communities, and put in place action and programmes to address these. 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 were developed and contracts awarded to support the delivery of these 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 has been commissioned in light of this work. 8 Harm Reduction approaches Workforce Development We are continuing to support and develop Substitute Prescribing, Needle and Syringe Exchange, Naloxone Provision, and other Harm Reduction approaches. Workforce development is a key part of the Commissioning Framework, and we will support its roll out once finalised. 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 ISFs, 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, drug 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 Binge drinking prevalence Alcohol-related deaths Numbers presenting for treatment Related hospital admissions Alcohol-related crime Drink Driving Public confidence that alcoholrelated problems are being addressed Prevalence Blood Borne Viruses among Injecting Drug Users Drug-related deaths Numbers presenting for treatment Related hospital admissions Drug-related crime Drug driving (including prescription drugs) Number of criminal gangs 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% 73% Drinkers who exceed daily Limit 82% 81% 78% 77% Drinkers who drink above sensible 29% 24% 23% 24% levels Problem Drinking 10% 10% 9% 11% Drinkers who binge drink 38% 32% 30% 31% 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 5,064 5,583 5,846 5,916 8,553 and/or drug misuse In treatment for alcohol-only 3,074 3,476 3,328 3,111 3,891 misuse In treatment for drug-only 1,030 1,118 1,294 1,514 2,617 misuse In treatment for both alcohol and drug misuse ,224 1,291 2,045 Northern Ireland Drug Misuse Database Indicator 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 Individuals presented to treatment services for drug misuse 1,464 1,984 1,755 2,008 2,593 2,999 2,824 2,574 11 First Main Drug of Misuse Second Main Drug of Misuse Cannabis Cannabis Cannabis Cannabis Cannabis Cannabis Cannabis Cannabis Benzodia zepines 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 Hospital Admissions (HIB) Indicator 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 Alcohol- 7,127 7,322 8,267 8,462 8,603 8,652 9,393 10,274 10,486 Only Emergency Admissions Drug-only related admissions 3,160 2,948 3,951 3,880 3,424 3,649 3,256 3,315 3,360 Alcohol and Drug related admissions Deaths (DMB) 1,498 1,308 1,497 1,473 1,663 1,663 1,644 1,556 1,431 Indicator Alcoholrelated deaths Drugrelated deaths Deaths due to drug misuse Blood Borne Viruses (HIB) Indicator (P) New diagnoses of Hepatitis C Reports of both acute and chronic Hepatitis B Data for 2014 are provisional. Figures for earlier years have been revised. 12 Needle Exchange (PHA Needle Exchange report) Indicator 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 Visits to participating pharmacies 8,797 9,997 8,267 13,389 15,828 17,712 20,204 21,220 22,742 Source: 2005/06 to 2009/10 Public Health Information and Research Branch. 2010/11 to 2013/14 Health and Social Care Board. Crime (NIPB and PSNI) Indicator 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 Drug Offences 2,411 2,720 2,974 3,146 3,482 3,780 4,378 4,732 Drug seizure incidents 2,590 2,968 3,198 3,319 3,564 3,920 4,474 4,825 Year No. of persons detected for a drink/drug-driving related offence 4,705 4,657 4,026 3,901 3,606 3,207 3,110 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 or fails to provide 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 were developed. Following the logic model approach, a number of long-term outcomes were initially agreed, and then a number of regional and local short and medium-term outcomes and outputs were put in place subsequently to support the delivery of these long-term aims and to provide the focus for activities and future work The outcomes and the overall success or otherwise of achieving the long-term aim of the NSD Phase 2 are measured by the Key Indicators in Chapter 3. 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 are 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) 1 Short term means within 3 years, and medium to long-term within 4-5 years 14 Community Safety and Anti-Social Behaviour 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 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) Medium/Long Term Outcomes/Outputs 1. Targeted local prevention programmes in place. 2. Reduction in the proportion of adults who have used drugs in the last year. RAG Status Update on Progress The draft Commissioning Framework (outcome 29) sets out the range of prevention initiatives that should be commissioned in Northern Ireland. There has been a delay in completing the tendering for these services which should now commence on 01 July In the interim the existing services have continued to be provided. The proportion of adults using any illegal drug in the last year has fallen from 9.4% in 2006/07 to 6.6% in 2010/11. Future Steps (if appropriate) The effectiveness of the new services to be monitored. New figures will be published in 2015/ Reduction in the proportion of adults who have misused prescription drugs in the last year. 4. Reduction in the proportion of adults who binge drink. 5. Increase in the proportion of adults who drink sensibly. 6. Legislation in
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