delivering recovery through sustainable change adp strategy.pdf · this will be inclusive of...

Delivering RecoveryThrough Sustainable

Change

2009-2011

Moray’s Strategy for Substance Misuse 2009 – 2011

Published by:

Moray Alcohol and Drug Partnership (MADP)252 High Street

ElginMoray

IV30 1BE

Other documents that support this Strategy:

MADP Constitution

Strategic Assessment

Moray Delivery Plan

Commissioning Plan

Best Practice – Interagency working with Children Affected by ParentalSubstance Misuse

M o r a y A l c o h o l a n d D r u g P a r t n e r s h i pD e l i v e r i n g R e c o v e r y T h r o u g h S u s t a i n a b l e C h a n g e

C o n t e n t s

Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Moray Alcohol and Drug Partnership . . . . . . . . . . . . . . . . . 9

The Picture in Moray. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Key National and Local Guidance . . . . . . . . . . . . . . . . . . 17

Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Key Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Funding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Appendix 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Appendix 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Appendix 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Appendix 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Appendix 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Index of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52


Foreword - ChairI am delighted to present the Moray Alcohol and DrugPartnership’s (MADP) first Strategy which comes at animportant point in the journey that local agencies have beenundertaking to strengthen services.

Alcohol and drug misuse is a complex issue which severelyimpacts on the lives of individuals, families and communities.How we reduce the risk of serious preventable ill-health iscritical to improving the life circumstances andlife expectation of those who live in Moray.

The Government’s strategic approach to alcohol and drugs issues has beenset out in two landmark documents: The Road to Recovery published in May2008; and Changing Scotland’s Relationship with Alcohol: A Framework forAction, published in March 2009. Moray moved quickly, building on the workundertaken by the Moray Drug and Alcohol Action Team, to review andrestructure its arrangements to form what was believed to be Scotland’s firstAlcohol and Drug Partnership on 1 May, 2009. The MADP formally links toMoray’s Community Planning Partnership and this new structure serves toclarify roles, responsibilities, accountability arrangements, priorities andresources between partner organisations.

This Strategy forms part of a suite of documents which includes a StrategicAssessment, a Delivery Plan and a Commissioning Plan, which taken together,provide a strong foundation on which to improve how substance misuse will betackled locally.

We remain committed to turning rhetoric and general direction of travel intoreality by way of services that deliver better outcomes for the people of Moray.This is a challenge which requires us to not simply organise ourselves to reactto the present, but instead to work closely to invest in all our futures.

Sandy RiddellChair, Moray Alcohol and Drug Partnership


Executive SummaryIn line with recent national guidance from the Scottish Government, Moray wassuccessful in developing the first Alcohol and Drug Partnership in Scotland.This is a unique strategic partnership which will consider substances, (alcoholand drugs – including illegal drugs and volatile substances), as part of its remit.

Effective action to address drug and alcohol misuse remains one of thegreatest challenges facing Scotland today. Although Moray is a safe place tolive and is seen as offering a high quality of life, like most regions in Scotlandthere is growing concern surrounding alcohol and drug misuse. This Strategyreflects the growing commitment of all the partners involved in the MADP totackle these issues in targeted, imaginative and co-ordinated ways throughservices, education, campaigning and supporting enforcement.

The Strategy behind the MADP should be viewed as a programme for changethat fully embraces the Scottish Government’s national strategies in relation toalcohol and drug issues but in ways which provide solutions for addressinglocal priorities and concerns. Through shared priorities, the Strategy isdesigned to bring practicality and reality to our collective vision to ensure thatpeople affected by substance misuse get the help they need, when they needit.

The MADP has developed a structure based on need, encompassing:Management and Performance;Finance and Commissioning; andWorkforce Development.

The previous work undertaken by the Moray Drug and Alcohol Action Team,together with this Strategy, will provide an excellent basis to fulfil the followingremits outlined in the National Alcohol and Drug Framework1.

All local alcohol and drug strategies should:Provide a clear assessment of local needs and circumstances, includingboth met and unmet needs;Consider issues such as workforce development and ensure that theworkforce is equipped with the skills to deliver;Identify key outcomes relating to alcohol and drug misuse, their place withinthe wider framework of priority outcomes contained within the SingleOutcome Agreements, and how their achievements will be measured;Set out an outline of the services to be provided and/or commissionedreflecting the local assessment of need, including developing a service mapwhich identifies all services available locally;Set out clearly and openly the total resource that each partner is directing tothe pursuit of alcohol and drug outcomes; andSet out an approach for the commissioning and delivery of services,including preventative interventions, in pursuit of the outcomes identified.


The Challenge in Moray

The challenge facing Moray is not a new one with substance misuse being aproblem across all levels of the population and a change in culture required toaddress, in particular, the alarming rise in alcohol related problems.

Alcohol misuse is a bigger problem than drug misuse2 with 1 in 20 deathsbeing alcohol related and the cost in dealing with alcohol related use standingat £2.25billion nationally3. Data collected in 2006/07 suggests that alcoholdependence in Moray was a significant problem4, with the rate of dependencebeing twice that of the national average.

With the exception of Eilean Siar and Orkney, Moray has the lowest estimatedprevalence of problematic drug misuse at 0.53% (95% CI 0.53 – 0.85%)5.Heroin remains to be the drug of choice. However there is concern that the useof other types of drugs, including cocaine and crack cocaine for example; anda greater tendency for individuals to use more than one drug and/or alcoholsimultaneously, with the range and type of drugs used, coupled with the effectsand associated disease, proves to be a huge burden on the resources availablein Moray. This ensures that a large percentage of the population is affected insomeway by substance use.

What do we need to do?

Our strategy is designed around the key priorities (combining Children andFamilies and Family Support) identified in the National Strategy ‘The Road toRecovery’, which also encompasses the alcohol agenda, and are:

1. Prevention - Better prevention of drug problems, with improved life chancesfor children and young people, especially those at particular risk of developingan alcohol or drug problem, allowing them to realise their full potential in allareas of life;

2. Recovery - To see more people recover from problem alcohol or drug use sothat they can live longer healthier lives, realising their potential and making apositive contribution to society and the economy;

3. Law Enforcement - Having communities that are safer and stronger placesto live and work because crime, disorder and danger related to alcohol anddrug use have been reduced;

4. Children and Families and Family Support - Ensuring that childrenaffected by a parental alcohol or drug problem are safer and more able toachieve their potential and supporting families affected by alcohol and druguse; and

5. Service Delivery - Improving the effectiveness of delivery at a national andlocal level.

We will express in section 6 how we will work towards providing lastingsolutions for the above priorities and a complete list of the outcomes andtargets are listed in Appendix 1.



Multi Agency Inspection of Substance Misuse Servicesin Grampian

The Social Work Inspection Agency (SWIA) completed a multi-agencyinspection of substance misuse services in Grampian. This was a pilotinspection across Moray, Aberdeenshire and Aberdeen City. As a result of theinspection, recommendations were made to encourage change. In early 2009,SWIA carried out a follow-up inspection. There were no recommendationsarising from the follow-up inspection and there are no plans to repeat thisexercise in the future.

SWIA commented on the progress made by MADP and the fact that we werenow in a position to develop services in a structured way. The report hasprovided us with outcomes in order to move forward with sustainable changesin managing the performance of service delivery in Moray.

This Strategy aims to:Provide a vision for a safer, healthier and happier Moray;

Accentuate the need to work in partnership with the people who areaffected by alcohol and/or drugs in Moray to ensure that we are providingneeds-led services and interventions;

Promote partnership working and accountability;

Briefly outline national drivers;

Identify key strategic priorities;

Start to address the need for a change in culture;

Provide a vision of the solutions required to meet the key priorities identifiedand in doing so provide hope; and

Report on the current financial position.

Moray Alcohol and DrugPartnershipThe Moray Alcohol and Drug Partnership (MADP) is a multi-agency partnership,accountable directly to the Moray Community Planning Partnership through theHealthier Strategic Group. The MADP has been established to respond tonational strategies on alcohol, drugs and volatile substances. An organisationalstructure of MADP can be found at Appendix 2.

The purpose of the MADP is to reduce the impact of problematic alcohol anddrug use on individuals, families and communities by co-ordinating the work ofthe statutory and third sector agencies and by developing and implementingstrategies for tackling alcohol and drug problems at a local level.

Aims:Provide leadership on strategic and planning issues that arise in the deliveryand on-going review of the Moray Delivery Plan;Provide direction at Chief Officer Level across agencies on servicesensuring that they are focussing on both local and national priorities and tomake strategic and planning recommendations to the Healthier StrategicGroup; andEnsure that active strategic links are made with other planning structures, inparticular, the Community Safety Partnership, the Northern CommunityJustice Authority, the Grampian-wide Alcohol and Drug/Public Health forumand the Committees and Boards of constituent bodies.


Objectives:Ensure that all development is consistent with the strategic direction set outin the Moray Delivery Plan;Undertake tasks delegated/remitted by the Healthier Strategic Group;Provide guidance and direction to the sub-groups who will have specificdelegated responsibility for supporting the delivery of the MADP strategicpriorities; Discuss and respond proactively to significant challenges or issues whichhave implications for the delivery of the Moray Delivery Plan; and Develop operational links with the wider Community Planning Partnershipand engage appropriately with key services and partnerships e.g. Housing,Employment, Criminal Justice Social Work, Education and Public Health.

Role of Members:Members must demonstrate effective leadership; Members must engage in communicating relevant information to the MADPregarding outcome delivery, including major organisational/budgetarychanges or developments in legislation in order to create a proactiveenvironment in influencing outcome development;Members must champion the MADP outcomes within their ownorganisation and develop ways of increasing awareness of the MADPoutcomes with respective organisations within the Community PlanningPartnership;Members should, where appropriate, facilitate change in order to deliverMADP outcomes. This will be inclusive of training, aligning and poolingbudgets and integrating service planning processes; andMembers must actively participate in MADP events, seminars and othervehicles of engagement.


The Picture of Moray

Tackling alcohol-related and drug-related harm is one of the ScottishGovernment’s key public health priorities. Recent research into drug misusesuggests that there are 52,000 problem drug users in Scotland; 40-60,000children are affected by the drug problem of one or both parents; and therewere 455 drug-related deaths in 2007, double that of 10 years previously. Theeconomic and social cost of Scotland’s drug problem is estimated at £2.6billion per annum.

The Scottish Government have published a new strategy for dealing with thosesuffering from a drug-related problem entitled ‘The Road to Recovery’6 andthey are providing £94 million over the next 3 years to tackle the drug problem,which represents a funding increase of 14%.

Recent public reports including the Scottish Government’s report ‘ChangingScotland’s Relationship with Alcohol’7, have highlighted the significantescalation and negative impact excessive drinking is having on Scotland as awhole. The question now is how best to use resources to enable services at alocal level to provide help to those who are affected and to counter theincreasing trend in the numbers misusing alcohol and drugs.

The MADP commissioned a full Strategic Assessment of drug and alcoholservices in Moray and this was published in September 2009. This Strategygives a brief summary of the problems identified in the Strategic Assessment.


Alcohol misuse is a bigger problem than drug misuse in terms of the number ofpeople misusing and the harm caused to health. The number of acute inpatientdischarges in Moray largely mirrors the national trend. Moray has seen an 8.9%increase in numbers since 2003/04, with a discharge rate of 625 per 100,000(2007/08).

In the under 15 year age category, the rate of discharges in Moray (80 per100,000) was twice that of the national average (38). Data suggests that thereis an increasing trend in the number and rate of alcohol misuse among middleand older age groups, which may be due to the larger population in that agegroup.

In Moray, 74.1% of alcohol-related discharge patients were diagnosed with amental and behavioural disorder due to the use of alcohol. This ranked Moraytenth highest of all local authorities, and above the Scottish average of 70.9%.These figures suggest that alcohol dependence might be a significant problemin Moray, with the rate of alcohol dependence over twice that of the nationalaverage.

Moray recorded a relatively high percentage of inpatients with an alcoholic liverdisease ranking Moray seventh highest of all local authorities in Scotland, andabove the Scottish average. The actual proportion of serious alcohol-relateddiagnoses is one of the highest in Scotland. Also the rate of alcoholdependence has continued to remain well above the national average andwhile there has been a slight drop nationally and in Moray from 2005/06, Moraystill has a rate over twice that of the national average.

The number of deaths in Moray where alcohol has been attributed as theunderlying cause has remained relatively static over the last 7 years with a totalof 28. In Moray a significantly higher proportion of males die due to alcohol-related causes. A report published in 2007, comparing all alcohol-relateddeaths from 1998 – 2004, placed Moray 14 out of the 426 local authority areasin the UK, and 11 in Scotland. Of the 20 worst local authority areas in terms ofalcohol-related deaths over this period, 15 were in Scotland.

Grampian Police statistics for the period 2005/06 to 2007/088 show that mostof the alcohol related crime was found to take place mainly in the larger townsin Moray. On average 58.5% of crimes committed between 2005 and 2008found the accused were either drunk or had been drinking and of the offencescommitted, serious assault was recorded as the highest crime type with 85.5%of the accused found to have been drinking prior to carrying out the assault.

Within Moray there is a wide range of premises operating liquor licences acrossthe area, the majority of which are on-sale9. When comparing the proportion ofon-sale and off-sale licences in Moray with the national average10, Moray has alarger number of licences in force per 10,000 (population aged 18 and over) onboth counts. Moray has the eighth highest number of on-sale licences with 34(per 10,000) compared with the other Scottish local authorities, and well abovethe national average of 26. Moray is ranked even higher in off-sale licences,


with 21 licences per 10,000 population aged 18 and over. This ranks Morayfifth highest out of all the Scottish local authorities, and well above the nationalaverage of 15.

The 2006 SALSUS11 reports that 65% of 13 year olds and 90% of 15 year oldshave had an alcoholic drink at some point in their lifetime, higher than thenational findings and also higher than Aberdeenshire and Aberdeen City. Whilethere appears to be a slightly higher rate of young people having had analcoholic drink in Moray than nationally, the actual levels of consumption arewell below the national average.

The SALSUS report suggested that young people in Moray feel their parentsare more accepting of them drinking alcohol at home compared with thenational average. Also the survey found that a significant proportion of youngpeople in Moray think their family ‘don’t mind’ if they had a drink.

Audit Scotland highlighted in their report (2009)12 an example of good practicein tackling underage drinking in Moray through partnership working withOperation Avon. All schools in Moray are registered as Health PromotingSchools, where schools take an active role in promoting healthy activity as wellas mental and social well-being.

While the SALSUS survey identified that Moray young people tend to drink lessthan the national levels, on average however more Moray young people havehad a drink at 13 and 15 years of age than nationally. This would suggest thatalcohol education should be being targeted at the later stages of primaryschool and continued to be addressed throughout secondary education.

In 2004, a report was published(i), which provided estimates of the national andlocal prevalence of problem drug use(ii) within Scotland in 2003. It is thesecond report of its kind, the first being published in 2001. The research usesseveral data sources and statistical methods to obtain estimates of problemdrug use at various levels within Scotland, focusing on 15-54yr olds. Thereport also provides estimates of the prevalence of drug injecting(iii)13.

The research suggested that in 2003 there were 310 problem drug users inMoray (95% CI: 182 – 1627), a prevalence rate of 0.66% (95% CI: 0.39 – 3.48).The report further estimates that there were 111 injecting drug users in Moray,a prevalence rate of 0.24%, the sixth lowest in Scotland. Between 2002/03 and2006/07, the number of new clients reported to the SDMD rose steadily from56 to 115, an increase of 105%. However, 2007/08 has seen a drop to 93making a net increase of 66%.

(i) the results of research funded by the Substance Misuse Division of the Scottish Executive and carriedout jointly by the Centre of Drug Misuse Research at the University of Glasgow and the Scottish Centrefor Infection and Environmental Health

(ii) For the purposes of the study, problem drug use is defined as opiate and/or benzodiazepine use (whichincludes the prescribed use of methadone and assumes that all illicit use of those drugs or the use ofmethadone is considered problematic)

(iii) defined as the injecting of any drugs, not necessarily opiates or benzodiazepines (but excluding theinjecting of steroids)


The rate for Moray for all new clients tends to be around half that of Scotlandsuggesting that the problem in Moray is not as severe as nationally.

Data regarding the employment status of new clients indicate a similar picturein Moray to nationally. The vast majority of new clients are unemployed withthe remainder reporting their status as either employed or otheriv.

In both Moray and Scotland, around 80% of new clients report living in ownedor rented accommodation and around 12%-15% report being homeless.

By far the most commonly reported illicit drug is heroin, reported by around76% of new clients in Moray and 68% nationally. There has been virtually nochange over the last 3 years. The next most commonly used drugs arediazepam and cannabis, each reported by around 30-35% of new clients. InMoray the proportion of new clients reporting combined usage of diazepamwith heroin has increased by 17% between 2005/06 and 2007/08.

A proportion of clients are prescribed drugs for the treatment of drug misuse ordependence. In 2005/06 the proportion in Moray was almost half the nationalfigure, 23% compared with 45%. Over the next 2 years, an increase in Morayand a reduction nationally have brought these proportions almost in line, at34% and 39% respectively. Methadone is the main prescribed drug thoughthe proportions both in Moray and nationally that have been prescribed thisdrug have reduced over the last 3 years.

There was a larger proportion of new clients reporting having injected in theprevious month in Moray than nationally, while smaller proportions thanScotland report either having injected in the past but not in the previous monthor never having injected. Similarly, a larger proportion of new clients fromMoray inject heroin than do nationally. Data regarding the sharing ofneedles/syringes reveals a worrying trend in Moray. The proportion of newclients who report sharing needles/syringes in the previous month has nearlydoubled over the last 3 years, from 17% to 30%, while the proportion thatreports never having shared needles/syringes has reduced from 61% to 47%.Nationally, the situation is reversed.

There are 9 facilities offering a needle exchange service in Moray, 7 communitypharmacies in various locations throughout Moray, the Integrated Drug andAlcohol Service and Studio 8. Noticeably there is no needle exchange facility inKeith.

(iv) Other includes: school, excluded from school, long-term sick/disabled, in prison,housewife/househusband/childcare and retired


Data is collected on blood-borne viruses to monitor the incidence of thesediseases, specifically Hepatitis B, Hepatitis C and HIV / AIDS. However, data isonly published at Grampian level.

Data for drug-related deaths is available from 2 sources, Grampian PoliceSudden Death reports and the Scottish Drugs Misuse Database (SDMD), DrugMisuse Statistics Scotland. Grampian Police have recorded 15 drug-relateddeaths in the last 3 full fiscal years in Moray, 2 in 2005/06, 8 in 2006/07 and 5 in2007/08. The majority are the result of heroin overdose.

The situation in Moray with regard to waiting times for an assessment differs tothe national picture. Over the last 2 years, of those clients offered anassessment within each quarter, an average of 36% were offered anassessment within 14 days(v), nearly half the Scottish average of 67%.

Figures for homelessness due to an alcohol/drug problem, prior to April 2007do not provide an accurate reflection of the problem. Post April 2007, 44individuals have been identified as having support needs relating to alcohol ordrug dependency and were referred to the Integrated Drug and Alcohol Serviceand 39 individuals have lost their accommodation because of alcohol and/ordrug problems14.

The SALSUS report identified that 7% of 13 year olds and 30% of 15 year oldsindicated that they had used or taken drugs at some point. Of those who hadused drugs, 48% reported that they were drinking alcohol at the time.

Over the last 6 years, the rate per 100,000 population of all drug-related crimehas remained steady both locally in Moray and nationally. The rate in Moray isconsistently around half the national rate. In contrast to possession offences,the trend for drug supply crimes is slightly increasing. The average number ofcrimes recorded each year over the last 5 fiscal years is 59 and numbers forthe last 2 years have been above this average15.

Unlike alcohol, the vast majority of drug-related crime relates to the illegality ofthe drugs themselves rather than the drugs being a contributory factor to theoffender’s behaviour. However, there are those whose offending is the directresult of their drug misuse and although a custodial sentence is an availableoption, it is not always the most effective.

Whilst a parent/carer’s alcohol or drug misuse should not automatically lead toa child protection enquiry or increased levels of intervention, there is increasingevidence of the negative effects in parental problem substance use on thewelfare of children. In particular, problem substance use is associated with anincreased risk of child abuse and neglect.16

(v) Time between date referral received / first date of contact and first appointment date offered forassessment (for those offered an assessment date during the reporting period)


Furthermore, there is a strong link between parental substance misuse anddomestic violence. In a study of 54 children, 36 of who were on the ChildProtection Register, 81% of parental substance misuse cases also involveddomestic violence17.

As the current picture above describes, alcohol and drugs pose a major threatto the health, wellbeing, safety and wealth of Moray and we aim to design andcreate a structure in Moray that will provide sustainable solutions to theseproblems.

As is evidenced in this section, alcohol and drugs are a blight on ourcommunities and too many people are ruining their, or someone else’s, life. Asdirected by the National Strategy, we aim to base our solutions to the aboveproblems firmly in the recovery agenda and ensure that they are person-centred and outcome-focused.


Key National and Local GuidanceAlcohol and drug abuse have become increasingly important themes in thenational and local policy agenda. Addressing the consequences of drugproblems has been a priority of the British and Scottish Governments for sometime but this is now met with a recognition that the scale and impact of alcoholmisuse across the whole of the population requires for the profile to be raisedsignificantly. The national and local guidance on alcohol and drug issuescomes from:

‘The Road to Recovery’The Scottish Government's national drugs strategy that focuses on recoverybut also looks at prevention, treatment and rehabilitation, education,enforcement and the protection of children.

This national guidance promotes cultural change in dealing with drug use andpromotes the fact that drug treatment services should provide hope, socialreintegration and be outcomes-focused.

‘Changing Scotland’s Relationship with Alcohol:A Framework for Action’This adopted a new and visionary approach, recognising the need to changeScotland's relationship with alcohol so that the people of Scotland can realisetheir potential as individuals, families, communities and as a nation.

The Framework for Action outlines the actions which the Scottish Governmentwill be taking forward to rebalance Scotland’s relationship with alcohol. Someare specific legislative measures designed to effect change in the short term.Many others focus on creating cultural change over a much longer period. Thehealth service, local government, the alcohol industry, the police and the thirdsector all have crucial roles to play in helping to develop and implement whatwill be a rolling programme of work over the coming months and years.

‘Audit Scotland: Drug and Alcohol Services inScotland’The Audit Scotland report says a coordinated effort is needed across the publicsector to deliver services that meet the needs of both people with substancemisuse problems and of communities. The report states that the ScottishGovernment needs to work with the NHS, Councils and other partners toensure all public bodies are clear about their individual and collectiveresponsibilities.


Last year the public sector in Scotland spent £173 million directly on drug andalcohol services for prevention, treatment and enforcement activities. Thewider costs to society are estimated at £5 billion a year, including costsassociated with drug and alcohol-related crime, hospital admissions, andworkplace absences. The key recommendations from the report were that:

The Scottish Government should set clear national minimum standards fordrug and alcohol services; The Scottish Government should clarify governance and accountabilityarrangements for the delivery of services in Scotland; That public sector bodies ensure that drug and alcohol services are basedon an assessment of need and are regularly evaluated;That public sector bodies ensure that service specifications are in place;That public sector bodies set clear criteria for expected outcomes; andThat public sector bodies utilise an audit checklist to improve delivery andimpact of drug and alcohol services.

The MADP is accountable locally through the Community Planning Partnershipand specifically through the Healthier Strategic Theme Group. In order toprovide accountability, the MADP must ensure that they work within the SingleOutcome Agreement (SOA) and the Health, Efficiency, Access and Treatment(HEAT) Targets.

‘Single Outcome Agreement’The purpose of the SOA is to detail strategic priorities, identify the outcomeswhich will be delivered and show how the outcomes contribute to the ScottishGovernment’s National outcomes.

The MADP meet 2 Priority Issues from the SOA 2009/10 which are:Key Issue 1: HealthKey issue 2: Alcohol

The MADP will work towards the following National Outcome:Outcome 6: We Live Longer Healthier Lives


The MADP will achieve this by working towards Local Outcomes:Local Outcome 13: The impact of alcohol and substance misuse in Moraywill reduce

Evaluate clinical/social outcomes for service users Full evaluation of all alcohol and drug servicesMeasure pathways for service usersPerformance management structure

Implementation of Substance Misuse Strategy Develop StrategyDevelop Moray Delivery Plan

Review and Re-Design Local Substance Misuse Services Evaluate alcohol and drug servicesProvider consultationService user consultationResource allocationDevelop Strategy

‘Health, Efficiency, Access and Treatment (HEAT)Targets’HEAT Targets allow the NHS to set out key areas for achievement whichoptimise the contribution of health-related activities to the Government’spurpose and National Outcomes.

The MADP will achieve this by working within the following targets:

H4: Achieve agreed number of screenings using the setting appropriatescreening tool and appropriate alcohol brief interventions, in line with SIGN74 guidelines by 2010/11; and

A11: To offer drug misusers faster access to appropriate treatment tosupport their recovery.

Although the MADP will be accountable through National Outcome 6, NationalOutcomes 8 and 9 will be used to identify specific operational accountability.

A list of other relevant strategies can be found at Appendix 3.


QualityIt is imperative that in delivering on the Strategy, we provide quality and bestvalue. Responsibility for planning, evaluating and delivering in relation to theStrategy lies with the MADP. In order to be efficient, robust and effective, theMADP has restructured and now incorporates a Strategy Group which issupported by three sub-groups:

Finance and CommissioningWorkforce DevelopmentManagement and Performance

The aims and objectives of these groups and the full governance arrangementsare detailed in the MADP Constitution.

The MADP will be held accountable through the Community PlanningPartnership by the Healthier Theme Group and will report annually onperformance. The MADP will also be held accountable through the SOA andthe HEAT Targets outlined on pages 18 and 19.

Given the importance of the SOA and HEAT Targets in the delivery frameworkand the role for partners in the identification, pursuit and achievement ofshared outcomes, it is critical for the MADP to be equipped to operateeffectively within an outcomes based environment. The Scottish Governmentcommissioned the Delivery Reform Group to develop a toolkit to assistPartnerships in working with outcomes. The MADP has used the OutcomesToolkit18 to develop outcomes for Moray, which are at the heart of everythingwe now do. A full list of the outcomes can be viewed at Appendix 4.

In order to provide long term sustainable treatment and recovery services, wehave developed a Commissioning Plan to ensure that we are transparent in ourdecision making and are providing value for money.

Workforce development will be an ongoing priority and we will take ourdirection from Health Scotland and the Scottish Government through theirWorkforce Strategy when developed. The MADP recognises the importance ofbuilding a good competence level for staff which will be consistent across allregulatory bodies. The MADP will look at developing a skills audit to ensureappropriate levels of learning are made available. The MADP will also provideall staff with a forum to further their learning and development within the field ofsubstance misuse.

In managing performance, the MADP will use the Moray Delivery Plan (MDP) toensure that we are meeting the targets set and providing quality. The MDP willallow the MADP to monitor and evaluate the delivery of services, engage inbest practice through sound financial management and design throughdelivering needs-led services.


To further enhance the quality of services being provided, the MDP willencompass self assessment for individual services and the MADP to improveefficiency and further enhance accountability.

We will ensure that all services are managed appropriately and that servicespecifications are in place to ensure accountability and quality of delivery.


Key PrioritiesSince the launch of the national drugs strategy ‘Road to Recovery’ in 2008 andthe whole population approach in dealing with alcohol through ‘ChangingScotland’s Relationship with Alcohol’ in 2009, a lot of changes in the field ofalcohol and drug misuse have taken place.

MADP has restructured in line with the ongoing challenges and a StrategicAssessment of alcohol and drug service delivery has been completed. Withinthis section of our Strategy, we will outline the direction of travel we are drivingtowards to ensure that Moray remains a healthier, safer and happier place tolive. This is in line with the key priorities set out in the National Alcohol andDrug Framework.

To provide operational goals to ensure we deliver on the direction of travel wehave identified, a complete list of the goals and targets are listed in Appendix 1.


6.1 PreventionPreventing alcohol and drug use is more effective than dealing with theconsequences of established problems. The MADP recognises that people willabuse alcohol and drugs and we will strive to ensure that no one will do thiswithout knowing the consequences of their actions. We will ensure thataccurate information is delivered to the people of Moray both within andoutwith the education environment.

We have added an Information and Health Improvement Officer to the MADPSupport Team and will now provide accurate information in a number of waysto support people to make informed choices.

We continue to support information campaigns such as Alcohol AwarenessWeek and Know the Score and look at using these as vehicles in furtherproviding information and advice to the public. Both whole population andtargeted campaigns allow the MADP to get the right message across to theright audience.

Early years experiences, family relationships and parental attitudes andbehaviours are factors related to people, especially young people,experimenting with alcohol and drugs. We will look at improving lifelonglearning, skills and wellbeing in order that those who choose to live in Morayhave choices in the direction they take.

We will look at the approach we offer in early years and ensure that adequateinterventions are available. This will be offered through improved Health andSocial Work services, better partnership working with Public Health, GrampianPolice, the third sector and Education and through improved workforcedevelopment.

The MADP will also work in partnership with Grampian Police and CommunitySafety, identified below in 6.3, to ensure that we are dealing with antisocial andcriminal behaviour.

We will create better strategic links around mental health and will implementstronger and more efficient assessment protocols with mental health services.The MADP are working in partnership with Housing and have been fullyinvolved in the development of a new Homelessness Strategy for Moray whichidentifies the needs around alcohol and drug use.



6.2 RecoveryRecovery is the process in which a service user moves from having a problemwith alcohol or drugs to a life free of substances in which they can contributeto society. In order to fully support this ethos, services must be delivered in aperson-centred way.

In reality, recovery is very individualistic and will mean something different toeveryone who enters on a journey from abusing substances to becomingsubstance free or maintaining their use to a level where their life is improved.

Recovery is about assisting an individual to achieve their full potential. We aimto provide the foundation to change the culture of service delivery in Moray, tothat of hope and progress, which is driven forward by a partnership approach.We aim to provide a range of services including harm reduction, stabilisationand abstention in order to support those who access them on a route torecovery. In doing so, we aim to empower service users to seek recovery.

The MADP aims to redesign services to ensure a more integrated approachthat offers more effective and shared assessment. This approach will also offera structured pathway, where recovery journeys don’t end with abstinence,engaging with health, social work, housing, employability, mutual aid andcounselling, through a commissioning process involving the NHS, LocalAuthority and the third sector.

Embedding recovery at the heart of service delivery is not a new approach andhas been used successfully in the treatment of mental health for a number ofyears. It is however a major change in the delivery of alcohol and drug services.Recovery builds on the strengths and allows for the growth of recovery capital(the resources available to someone to allow them to recover) and moves theservice user and their family to centre stage.

Recovery is a new way of managing the process in alcohol and drug servicesand this has forced MADP to look at new solutions. We will develop ourworkforce to ensure that they have the skill base and tools in order to engagewith service users to promote meaningful goals.

Through the Moray Delivery Plan and Commissioning Plan, we willcommission, develop and manage the performance of services in Moray toensure that outcomes are met and allow the opportunity for action to be takenwhere outcomes have not been met.

We will ensure that the ethos of recovery is ingrained throughout our strategicdirection and that we are able to provide new ideas that lead to lastingsolutions.

6.3 Law EnforcementThe MADP will stay at the forefront of law enforcement through ourpartnerships with Grampian Police, Community Safety, The Scottish PrisonService, Local Licensing Forum (LLF), the Northern Community JusticeAuthority and the third sector. Each of the partners will form part of the MADPand engage in joint work to promote support to those who are engaged inantisocial or criminal behaviour that affects themselves and the localcommunities throughout Moray.

We will work with partners to support alternatives to custody and also to thosewho have no other option than to serve a custodial sentence.

We will support efforts to reduce:

Supply: Using enforcement, disruption and diversion to make a difference in theavailability of drugs on the streets of Moray and to penalise those responsibleand also working with LLF;

Demand: Through joint efforts and activities with Grampian Police, the third sector andCommunity Safety such as Operation Avon, education and information toproviding interventions aimed at reducing dependency; and

Harm:By supporting statutory and third sector partners to provide services aimed atharm reduction.

We will continue to work in partnership with the Criminal Justice DrugTreatment Service in promoting effective measures such as Drug Testing andTreatment Orders and Antisocial Behaviour Orders.

Partners in Moray are committed to joint working and sharing of information totarget crime and antisocial behaviour. This is now further evidenced throughthe commitment of all services to use the Single Shared Assessment.

MADP will engage in strategic development to provide safer streets with theimplementation of taxi marshals and will explore new ways of safeguardingboth individuals and communities from the effects of both alcohol and druguse.

MADP will further develop Arrest Referral Schemes currently commissionedwith both Grampian Police and the third sector.


6.4 Children and Families andFamily SupportChildren living with parents who misuse alcohol and/or drugs are within themost vulnerable in society. The MADP must build on the success of GettingOur Priorities Right (GOPR) and Hidden Harm. It is estimated that 40-60,000children in Scotland are affected by parental drug use with effects of this beingneglect, emotional and physical abuse and poor mental/physical health.Growing up in this environment can have severe consequences for anindividual’s life chances.

Children and young people who find themselves in this situation requirespecialist support to ensure that they share the same high aspirations andoutcomes as all of Scotland’s children. MADP will work with Health, SocialWork and the third sector to ensure that services are available to meet theneeds of those unfortunate to be in this position.

‘Getting it Right for Every Child’ is a national Government Programme whichprovides an overarching framework to ensure that public agencies work toaddress each child’s needs. The MADP will work in partnership with otheragencies to support children affected by parental alcohol or drug use.

MADP will work with the North East Scotland Child Protection Committee(NESCPC) to ensure that all services have in place GOPR action plans and thatappropriate action is taken when children are identified. This will be monitoredthrough the Moray Delivery Plan.

All services operating within the remit of MADP will work within the SingleShared Assessment (SSA) Management Protocol that will incorporate a riskassessment and check list. This will be forwarded to the Integrated Alcohol andDrug Social Work Manager to minimise risk to child welfare.

NESCPC will deliver learning and development based on the GOPR packswhich will provide staff in Moray with the skills to work with families wherealcohol and drug misuse has been identified.

MADP will publish guidance for professionals working with children who areaffected by parental substance misuse in April 2010.

MADP will work strategically with the Community Planning Partnership’sSmarter Theme Group to ensure the safety of all children in Moray affected byparental substance misuse. We will also provide additional social work servicesto build on the capacity to improve assessment, recording and planning forchildren at risk in Moray and in so doing, provide additional support services. Inachieving this MADP will look to commission the most appropriate servicesfrom health, social work and the third sector.



Families and Carers will play a major part in the recovery journey of those whohave an alcohol or drug problem. The MADP Support Team will work with theScottish Network for Families Affected by Drugs (SNFAD) to provide a networkof support for families and carers in Moray. This will be supported through theCarers Strategy.

Applying the research by the Princess Royal Trust for Carers, it is estimatedthat there could be as many as 2,000 young carers in Moray. If this were to bethe case then there could potentially be over 100 young carers in Moray whoare caring for an adult with a substance misuse problem.

In May 2009, there were 1682 adult carers registered with the Moray CarersProject. Of these 34 were caring for someone with an alcohol and or drugproblem. This is probably a significant underestimation of the real number ofpeople who have had to take responsibility to help care for a person who issuffering from substance misuse.

We recognise that many families and carers may not seek help and supportdue to the embarrassment of the situation they find themselves in. We will offersupportive networks to assist in helping family members through difficultperiods of their lives. The MADP will provide support to service users, familiesand carers to develop self-help and recovery groups, as well as continuing toprovide more valued one to one support through those services commissionedthrough Health, Social Work and the third sector.

6.5 Service DeliveryTo ensure that we are delivering the appropriate services in Moray, the MADPhave commissioned a full Strategic Assessment of alcohol and drug services inMoray. This Strategy will give direction in how we deliver our strategic prioritiesas a result of this. Alongside the Strategic Assessment, we have listened toservice users through consultation.

We will endeavour to provide services focused on recovery in education,enforcement, harm reduction and treatment based on intelligence. The MorayDelivery Plan sets out our priority outcomes and this will be supported in thecreation of services through the Commissioning Plan.

MADP will be supported in delivering services through a range of differentstrategic partners and groups, all of which are listed in Appendix 5. The MADPsee an important role for the third sector in planning and delivering servicesand this will be reflected in the membership of the Partnership and associatedsub-groups.

We aim to provide sustainable treatment and recovery services and in order todo this we will build a network of intelligence to ensure that we can provideservices which are needs-led. In monitoring this we will implement the MorayDelivery Plan, use the data collated by SMR 25 submissions and engage inongoing consultation with service users. We also aim to engage with carersand the communities that are most affected by alcohol and drug misuse.

We will engage with national organisations, in particular the Scottish DrugsForum and Scottish Network for Families Affected by Drugs, to engage withthose not already accessing services and look at how we can meet their needs.


We will continue to evaluate services which are tailored to specific needs andlook to provide resources to ensure these continue. In particular families whoare caring for children, including pregnant women, those who are homelessand older alcohol and/or drug users.

We will use national guidance, including the pathways model promoted byHealth Scotland in providing a recovery journey and mapping progress throughservices. We aim to create a single door access into services, comprehensiveassessment and care management through to planned discharge and ongoingself-help.

The rural aspect of Moray creates a real challenge in being able to offerservices where they are needed. We aim to look at the gaps identified in theStrategic Assessment and provide better service provision in these areas.

Through improved intelligence and commissioning structures, we aim to delivercomprehensive tier 1 to tier 4 services in Moray. Access to tier 4 residentialservices will be purchased outwith Moray. The tier structure provides fordiffering levels of need and these are evidenced in Appendix 6.


7 FundingFinancial governance arrangements for work in relation to substance use areparamount. The Government and other partners contribute resources to thealcohol and drug agenda. The MADP will ensure that the resources madeavailable are used appropriately and the Chair of the Finance andCommissioning Sub-group will ensure that these are used to provide servicesin a needs-led, intelligence based way.

The table below gives the projected income and expenditure for alcohol anddrug activity in Moray. This is the resources that will be available to ensure thatMoray is providing solutions in the key priority areas identified in the strategy.

Income Recurring Expenditure Recurring

National Alcohol Funding £334,000 MADP Support £93,500National Drug Funding £108,000 Treatment £1,159,000

Service User Support £62,000Provided by: Enforcement £92,000

NHS Grampian £497,000 Education & Prevention £69,500Grampian Police £129,000

The Moray Council £408,000

Total £1,476,000 Total £1,476,000

Notes:National Alcohol Funding: Provided by the Scottish Government through the

NHS – This money is ring-fenced.

National Drugs Funding: Provided by the Scottish Government through theNHS – This money is ring-fenced.

MADP Support: Operational Management of the MADP SupportTeam.

Treatment: Case Management, counselling, direct access,clinical, medical, etc.

Service User Support: Family, social, housing, employability, information,etc …

Enforcement: Licensing, Police and Community SafetyOperations.

Education and Prevention: Education, diversionary, training etc.


8 ConclusionThe problem we have in Scotland around alcohol and drug misuse isconcerning and it is anticipated to get worse. The approach taken by theScottish Government to look at the whole population is providing a baseline fora shift in culture.

We have set out in our Strategy how we aim to provide solutions to currentproblems being encountered with alcohol and drugs in Moray and we verymuch aim to focus more on outcomes and recovery. It is vitally important thatthose with a dependency on alcohol and/or drugs have the opportunity tomove forward with their life and become substance free.

We have made a commitment to provide adequate services which providequality and best value to service users and commissioners and do so in asupportive and constructive way.

We have identified the priority areas for Moray and have provided ideas on howwe will attempt to create solutions that will be sustainable.

The Moray Alcohol and Drug Partnership will strive to support the change inculture required in Scotland to assist in reducing the severe health and financialimplications through the misuse or overuse of alcohol.



Appendix 1National Outcome 6 – We live longer healthier livesLocal Outcome - The impact of alcohol and substance misuse in Moray willreduce

PreventionNo MADP Outcome Lead Officer Target Resources

6.1.1 Implementation of Tracey Gervaise, Achieve agreed ADPHEAT H 4. Public Health number of screenings NHS Grampian

Lead, NHS using the setting-appropriatescreening tool andappropriate alcoholbrief intervention, inline with SIGN 74guidelines by2010/11

6.1.2 Increased number of Tracey Gervaise, Increase in life ADPpeople in Moray who Public Health expectancy The Moray will be active in Lead, NHS Baselines on Life Councilimproving their own Expectancy, NHS Grampianhealth Healthy Life

Expectancy andHealthy LifeExpectancy(Self Assessed) inplace

6.1.3 Intelligence led Tracy Gervaise, Development of ADPperformance Public Health baselines. NHS Grampianmanagement Lead, NHS Development and The Moraysystems and implementation Councilstructures to of robustmonitor and report intelligenceMADP activity performance

management systemsand structures

6.1.4 Increased level and John Campbell, Co-ordination, ADPquality of substance Moray Alcohol implementation The Moraymisuse prevention and Drug and evaluation of Councilinformation, advice Partnership substance misuse NHS Grampianand support Support Team prevention,

information, adviceand supportprogrammes andcampaigns

6.1.5 Implementation of Mike Perera, Achieve agreed ADPHEAT A11 Manager, NHS timescales for NHS Grampian

Integrated Service The Morayaccess to alcohol Counciland drug services


RecoveryNo MADP Outcome Lead Officer Target Resources

6.2.1 Increased number of Mike Perera, Increase in clients ADPthose undertaking a Integrated Service undertaking arecovery programme Manager, NHS recovery programme,accessing education, accessing education,employability and/or employment and/training or training

6.2.2 Increased number of George Gartly, Increase in clients ADPthose undertaking a Housing Support undertaking a recovery The Morayrecovery programme Manager, The programme sustaining Councilaccessing and Moray Council a tenancy or temporarysustaining a tenancy accommodationor temporaryaccommodation

6.2.3 Approved MADP Mike Perera, Co-ordination and ADPclient pathway(s) Integrated Service implementation of The Moray

Manager, NHS client pathways for Councilall clients accessing NHSalcohol and drug External partnership services funding

Law Enforcement

6.3.1 Streets in Moray are Adrian Moar, Co-ordination, Communitysafe and free from Community implementation Safetyharm Safety, Grampian and evaluation of CPP

Police Safer Streets ADPprogrammes andcampaigns

6.3.2 Reduction in the Adrian Moar, Co-ordination, Community impact of alcohol Community implementation Safetyand drugs related Safety, Grampian and evaluation of CPPdomestic violence Police domestic violence NCJA

prevention ADPprogrammes andcampaigns

6.3.3 Reduction in the Blair Dempsie, Co-ordination, NCJAimpact of alcohol Operations implementation and The Morayand drugs within Manager, Criminal evaluation of Drug Councilthe criminal justice Justice, The Testing, Treatment ADPstructure Moray Council Orders and Anti

Social BehaviourOrders

6.3.4 Increased April Charlesworth, All those taken into ADPproductivity Service Manager, custody who are Grampianthrough arrest Turning Point under the influence Policereferral Scotland of alcohol and/or

drugs are informedand supported onhow to gain accessto specialist services


Children and Families and Family SupportNo MADP Outcome Lead Officer Target Resources

6.4.1 Improved assessment Blair Dempsie, Critical review of ADPand risk assessment Operations existing assessment The Moraysystems and Manager, and risk assessment Councilstructures. Criminal Justice, systems and structures.

The Moray Implementation ofCouncil critical review

recommendations

6.4.2 Improved services Jean Sinclair, Co-ordination and ADPfor children and Social Work implementation of The Morayyoung people who Manager, client pathways for Councilare living with parental Integrated children and young NHS substance misuse Alcohol and people who are living Grampian

Drug Service, with parental substanceThe Moray misuseCouncil

6.4.3 Children and young Tracey Gervaise, Co-ordination, ADPpeople have an Public Health implementation The Morayimproved knowledge Lead, NHS and evaluation of Counciland understanding of Health Promoting NHS substance misuse. Schools/ Curriculum for Grampian

Excellence/Health and GrampianWellbeing in Schools/ PoliceMIB and SMS substancemisuse prevention andinformation programmesand campaigns deliveredin schools and youthsettings

6.4.4 Evidence-based John Campbell, Development and ADPguidelines for Moray Alcohol implementation of The Morayprofessionals working and Drug evidence-based Councilwith children and Partnership guidelines for NHSyoung people Support Team professionals Grampianaffected by parental working with childrensubstance misuse and young people

affected by parentalsubstance misuse


Service Delivery

No MADP Outcome Lead Officer Target Resources

6.5.1 Established John Campbell, Co-ordination, ADPpartnership working Moray Alcohol implementation SDFwith services users and Drug and evaluation of SNFADso to inform and Partnership service usersupport the Support Team consultationdevelopment and programmes anddelivery of services activity

6.5.2 Development and Sharon Milton, Critical review and ADP delivery of evidence- Divisional redesign of MADP Partnerbased MADP Commander, services contributionsservices Grampian Police External

funding

6.5.3 MADP performance Tracey Gervaise, Co-ordination and ADPmanagement Public Health implementation ofreporting systems Lead, NHS performanceand structures fit management systemsfor purpose. and structures that

support the development, implementation andevaluation of the MADPDelivery Plan

6.5.4 Robust financial Sharon Milton, Critical review of ADPmonitoring and Divisional financial monitoring,control Commander, recording and reporting

Grampian Police systems and structures

6.5.5 Robust Sandy Riddell, Critical review of ADPaccountability and Chair Moray accountability andgovernance systems Alcohol and governance systemsand structures. Drug Partnership and structures


National Outcome 8 – We have improved the lifechances for children, young people and families at riskLife chances for children, young people and families at risk in Moray willimprove Child Protection services in Moray will improve


6.4.5 Improved outcomes Blair Dempsie, Development and The Morayfor LAAC affected by Operations implementation of a Councilsubstance misuse Manager, Criminal client pathway for NHS Grampian

Justice, The LAAC affected byMoray Council substance misuse

6.4.6 Carers who support: Pauline Knox, Co-ordination The MorayIndividuals with Carers Strategy implementation and Councilsubstance misuse and Development, evaluation of a NHS Grampianproblems/habits or, The Moray training needs ADPthose affected by Council assessment andsubstance misuse are of training andbetter informed and information, advicesupported. and support

programmes andactivity


National Outcome 9 – We live our lives safe from crimeLocal outcome - There will be a reduction in alcohol related offending


6.3.5 Reduction in alcohol Sharon Milton, • Reduction in Grampianrelated offending Divisional alcohol related Police

Commander, offendingGrampian Police • Reduction in

alcohol relatedjuvenile offending• Reduction inalcohol relateddomestic abuse

The above targetswill be assessed incomparison toestablished baselines

6.3.6 Reduction in the Hugh Mackie, • Reduction in the Grampian availability of alcohol Chief Inspector, level of underage Policeto young people Grampian Police drinking collated ADP(under 18 years) by SALSUS SALSUS

• Reduction in thepercentage of youngpeople spoken to bypolice officers duringOperation Avon underthe influence of alcohol,in possession of alcoholor in the company ofsomeone in possessionof alcohol

The target wouldincorporate the numberof Operation Avon’staking place to providean average per operation

6.3.7 Increase level and Hugh Mackie, Co-ordination, Grampian quality of drink Chief Inspector, implementation and Policedriving programmes Grampian Police evaluation of drinkand campaigns driving programmes

and campaigns

6.3.8 Reduction in drug Hugh Mackie, • Reduction in Grampianmisuse Chief Inspector, needle disposal/ Police

Grampian Police exchange statistics. NHSThis would The Morayincorporate not only Councilneedle bins but thosecollected by Landsand Parks staff• Reduction in the percentage of peoplewho having come intocustody for any offencewere found to be inpossession ofcontrolled drugs

Appendix 2Organisational chart for the Moray Alcohol and Drug Partnership within theMoray Community Planning Partnership.



Appendix 3Other Guidance relating to Substance Misuse:

Strategy Brief DescriptionADAT Review A complete review of all Alcohol and Drug Action

Teams structure and function

Tackling Drugs in Scotland: Set early direction nationally for work onAction in Partnership drugs

Essential Care Commissioned by SACDM, it focused on the supportthat is needed to address problems in areas of serviceusers lives

Plan for Action on Alcohol Sets out a comprehensive programme ofProblems: Update 2007 action for the next three years to change drinking

cultures and reduce alcohol-related harm throughgovernment action, partnership working, andencouraging individuals to take personal responsibility

Health Promoting Health Action in Acute Care SettingService: Offers a significant opportunity to improve health and

reduce inequalities, complementing action in othersettings

Hepatitis C Action Plan for Scotland – Is the culmination of a process of consultation thatPhase I: September 2006 – has followed on from the publication of a report byAugust 2008 the Scottish Needs Assessment Programme ( SNAP)

in 2000 and the recommendations and key messagesin the Consensus Statement which emerged from theConference in the Royal Colleges of Physicians ofEdinburgh in 2004

Hepatitis C Action Plan for Scotland – Intervention on an industrial scale; an investment inPhase II: May 2008 – March 2011 the public health of Scotland that should, over the

longer term, significantly reduce the problem ofHepatitis C in Scotland

Hidden Harm – Next Steps Addresses the issues for children and young peopleaffected by parental substance misuse

Getting it Right for Every Child Programme that aims to improve outcomes for allchildren and young people

Helping Homeless People – Delivering The Action Plan for prevention and Effective ResponseReviews the progress made across the country indelivering the recommendations of the HomelessnessTask Force, with a particular focus on progress madein the time since the last report to Ministers waspublished in April 2005

Mental Health Delivery Plan Sets out targets and commitments for thedevelopment of mental health services in Scotland

Towards a Mentally Flourishing Discussion Paper on mental health improvementScotland: Discussion Paper on Mental 2008-2011Health Improvements 2008-2011


Strategy Brief Description

Respect and Respectability: Strategy This document is both a strategy and a practical planand Action Plan for Improving for action. It works its way systematically throughSexual Health what we must do to:

• promote respect and responsibility; • prevent sexually transmitted infections and

unplanned pregnancy through education, service provision and support; and provide better sexual health services which are safe, local and appropriate

NCJA Strategy Sets out the aims of the NCJA, performanceinformation, details of collaborative/partnershipworking and community and offender outcomes

A new Framework for Local This is a joint Scottish Government, COSLA and NHSpartnerships framework which clarifies the roles, responsibilities

and accountability of all bodies involved in tacklingalcohol and drugs problems

Delivering Better Outcomes An Outcomes Toolkit for Alcohol and DrugPartnerships (Version 1) provides guidance on workingtowards an outcomes approach for ‘Alcohol and DrugPartnerships’ across Scotland


Appendix 4Outcomes Framework for Moray

Activity • Number of new referrals• Number of Single Shared Assessments completed• Number of clients who have children

Access to services • Making appropriate referrals• Service Users satisfaction with referral process• Service users access to GP’s• Service user seen within rural area• Improved access to suitable accommodation

Substance misuse behaviour • Not using illicit drugs• Clients becoming drug free• Reduction in the use of prescription drugs• Reduction in the use of illicit drugs• Reduction in risk-taking behaviour• Changes in the method of use• Not consuming alcohol• Reduction in the consumption of alcohol

Physical, Psychological and • Improvement in physical healthMental Health • Improvement in psychological health/emotional

wellbeing• Improvement in mental health• Improvement in self management of BBV• Reduction in hospital admissions

Education, Training and Employment • Improved employability skills• Moved into employment• Improved engagement with education/training• Improved engagement with voluntary work• Improved literacy and numeracy skills

Parenting/Children • Improved parenting capacity• Improved supportive environment for children• Improved participation in family activities• Improved protection of children

Criminal Activity • Reduction in criminal activity• Improved personal safety

Housing and Accommodation • Improved ability to sustain a tenancy• Improved independent living skills• Improved ability to live independently• Improved suitability of accommodation

Personal Development • Improved personal relationships• Improved ability to manage finances• Increased motivation to change• Increased feeling of being able to make positive

choices• Increased ability to manage own behaviour • Increased understanding of impact of substance

use on carers/family member/children• Increased confidence and self esteem


Appendix 5Support Network


Appendix 6The 4 tier Structure: Currently being delivered:

Tier 4 Tier 4• Residential detox • Out of area• Crisis support • Integrated Alcohol and Drug Service

Tier 3 Tier 3• Stabilisation • Integrated Alcohol and Drug Service• Substitute prescribing • Criminal Justice Addictions Social• Community rehabilitation/ Work

detoxification • Direct Access Service• Relapse prevention • Counselling Services• Offender Support and

community throughcare• Protection of children from

parental use of alcohol or drugs

Tier 2 Tier 2• Support for families and carers • Direct Access Service• Early intervention • Counselling Services• Community led carer and • AA

parental support • NA• Community led recovery • SMART

support network • Needle Exchange• Harm reduction

Tier 1 Tier 1• Information • School• Prevention • Prison• Resilience and coping • Employers• Confidence building and • Pharmacists

enhancement • Front line health services (A&E,• Community engagement midwife, health visitor)• Education • Dentist• Development of alcohol and • Job centredrug workforce • Police

• Mainstream services • Housing• Research and information • Social Work Services

Index of Terms

Abstinence The philosophy of completely stopping the use of alcohol anddrugs.

Addiction A chronic, relapsing condition characterised by compulsivealcohol or other drug seeking and use and by neurochemicaland molecular changes in the brain.

Agency A statutory or third sector organisation providing services orsome intervention to address alcohol or drug problems.

Alcohol misuse Heavy consumption of alcohol on an individual occasion orthe persistent use of alcohol above sensible drinkingguidelines.

Alcohol related brain damage Over a long period of time, heavy drinkers may developvarious types of brain damage, including the Wernicke-Korsakoff syndrome and alcoholic dementia.

Assessment Interviewing a service user to obtain the sociologicalbackground, psychological makeup, educational and workhistory, family and marriage difficulties and medical issues tobetter assess their needs for treatment or support.

Binge drinker Drinking more than twice the sensible drinking guidelines on aperson’s heaviest drinking day (8 or more units for men and 6or more units for women in one session).

Blood Borne Virus (BBV) A microscopic infectious agent transmitted between humansthrough the exchange of blood or other bodily fluids, such asHepatitis B Virus, Hepatitis C Virus or HumanImmunodeficiency Virus (HIV), etc.

Brief intervention A short motivational interviewing technique to help reduceproblematic use of alcohol or drugs by getting people to thinkdifferently about their substance use so that they begin tothink about or make changes in their consumption.

Carer Someone who voluntarily helps another person who cannotmanage without their support due to illness, fragility, disabilityor use of alcohol or drugs.

Commissioning The systematic process of specifying, choosing andmonitoring services on the basis of identified need to deliverparticular outcomes under contract or service levelagreement.

Community A group of people with a common interest or identity, such asgeographic, ethnic, cultural, religious, sexual orientation orhealth status.

Community involvement Local people helping to direct the decisions about servicesaffecting their lives by sharing their views, experiences andideas.

Community Planning A partnership of the major providers of public and third sectorPartnership (CPP) services in our area working together with the community to

deliver better services on a variety of topics.

Competencies Skills that are essential to perform certain functions.CERGA Clinical Effectiveness and Reference Group for Addictions.

The purpose of CERGA is to act as a resource to support theuse of the best available evidence in clinical practice, in thefield of substance misuse, across Grampian.


Index of Terms

CHSCP Community Health and Social Care Partnership – Apartnership made up of The Moray Council and NHSGrampian.

Curriculum for excellence A programme of work that is reviewing the current schoolcurriculum. This has implications for teachers to be bettertrained in alcohol and drug education to help tackleproblematic use of alcohol or drugs.

Dependant A cluster of physiological, behavioural and cognitivephenomena causing a desire, often strong and sometimesperceived as overpowering, for continued substance usedespite having persistent social or interpersonal problemscaused or exacerbated by the effects of the substance.Results in withdrawal symptoms when use of the substance isdiscontinued.

Depressant A chemical agent that diminishes the function or activity of aspecific part of the body. The most common include alcohol,barbiturates, benzodiazepines, solvents and gasses.

Detox, Detoxification Physical process of coming off an addictive substance (intreatment, often medically supervised).

Drug A synthetic or natural chemical substance that affects one ormore biological processes. In this context, psychoactivedrugs alter mood, emotion, or state of consciousness andaffect function of the brain. Drugs include legal substancessuch as prescription medicines, solvents, glues, alcohol andtobacco, etc. Other drugs such as opiates, psychostimulants,depressants, hallucinogens and steroids, etc, may be illegal touse and possess unless lawfully prescribed.

Dual diagnosis Co-morbidity of mental illness and problematic use of alcoholor drugs.

Early intervention Intervening when someone first shows signs of havingdifficulties to ensure they receive help as soon as possible toprevent a problem escalating and becoming more difficult todeal with later on.

Employability Having enough skills and abilities for someone to employ you.

Evidence based The conscientious use of current best information in makingdecisions about the delivery of services to maximise benefitand minimise risk from the resources available.

Excluded children Children excluded from schools due to unacceptable, abusiveor violent behaviour. The majority of excluded children comefrom families facing a range of problems.

Governance The system and processes by which agencies are directedand internally controlled to achieve objectives and meet thenecessary standards of effectiveness, supervision,accountability, probity and openness.

Harm reduction The philosophy of reducing harm caused by alcohol and otherdrugs without necessarily seeking abstinence. Approachescan include using needle and syringe exchanges, substitutingprescribed methadone for street heroin, changing routes ofuse from injecting to smoking, or cutting down on the quantityof alcohol or drugs consumed.


Index of Terms

Harmful drinking A heavy pattern of drinking that causes damage to physical ormental health (e.g. liver damage or episodes of depression).

Hazardous drinking A pattern of drinking beyond sensible drinking guidelineswhich increases risk to health but has yet to cause observableserious harm.

Health inequalities Non-random variations in health between people due to theirsocio-economic status or other factors.

Health promotion The process of enabling people to improve and increasecontrol over aspects of their lives that affect their health andwellbeing.

Healthy Working Lives Scottish Centre for Healthy Working Lives Safe and HealthyWorking service provides small to medium enterprises thenecessary advice, resources and tools to confidently addresstheir own workplace health & safety duties.

HEAT Performance targets in the NHS around the areas of Healthimprovement, Efficiency, Access and Treatment.

Integrated care pathway A locally-agreed multidisciplinary care plan, based onguidelines and evidence where available, describing theessential anticipated steps over a set time period in the careof a specific client group and the resultant progress to beexpected.

Journey of care The pathway through services taken by someone to receivethe care that they require. Such a journey should ideally followan integrated care pathway.

Lapse Trying a substance after a period of abstinence.

Licensing Board A statutory body under the Licensing (Scotland) Act 2005responsible for determining applications for liquor andgambling licenses.

Looked after children Refers to young people for whom the local authority shares orhas exclusive parental responsibility.

Mainstream Using universal services routinely available to the generalpublic to deliver support rather than through narrowlyavailable specialist services.

Moving on service A service that helps people address their wider relationship,housing and employability needs whilst reducing their needfor specialist treatment services.

Northern Community A statutory partnership covering the north of Scotland to bringJustice Authority together a broad range of agencies to achieve a more co-

ordinated approach to delivering quality services for offendersand their families at a local level, with the jointly agreed taskof reducing re-offending.

NESCPC North East Scotland Child Protection Committee.

Opiate A class of drug that depresses activity of the central nervoussystem, reduces pain and induces sleep. Use of opiates oftenresults in addiction. Overdose can be fatal.

Outcome The identifiable impact on, or consequences for, individualsand the community due to the planned actions, interventionsor services of the MADP or its partners.


Index of Terms

Partner An agency working in cooperation with others as a member ofthe MADP partnership to implement this strategy.

Partnership A collection of partner agencies with mutual understanding,parity of esteem and shared objectives founded to co-planand share responsibility for service design to optimiseoutcomes for service users.

Performance management A process which contributes to the effective management ofservices in order to achieve high levels of performance. Itestablishes shared understanding about what is to beachieved and an approach to leading and developing serviceswhich will ensure that it is achieved.

Prevention Early detection and intervention to stop problems frombecoming more severe.

Psycho stimulant Any of several drugs that act on the central nervous system toproduce excitation, alertness and wakefulness.

Recovery A deeply personal, unique and voluntary journey of regainingcontrol over and living as meaningful and satisfying a life aspossible as a full and valued member of society.

Recovery Capital Those internal and external resources to which an individualhas access that either promote or limit the likelihood, extentor maintenance of recovery. Internal resources include: selfesteem, confidence, resilience and hope. External resourcesinclude: access to suitable housing, employment, family,relationships and social support.

Rehab Rehabilitation. The process of coming to terms with lifewithout alcohol or drugs.

Relapse Multiple lapses leading to a return to the previous levels ofproblematic use of alcohol or drugs.

Resources The labour, skills, information, finance, materials, equipment,supplies or accommodation assets available to plan,implement and deliver change, goods or services.

Self medicate Use of alcohol or other drugs to help cope with enduringdifficulties such as poor mental wellbeing or mental healthproblems.

Sensible drinking guidelines Guidelines recommending a pattern of drinking unlikely tocause harm. Sensible limits for men are 3 to 4 units per day,up to 21 units per week; for women 2 to 3 units per day, up to14 units per week. All individuals should aim to have at least 2alcohol-free days each week. Pregnant women or those tryingto conceive should avoid all alcohol.

Service Any statutory, third sector or community based agency thatprovides a mechanism of support, care, or motivation toaddress alcohol or drug use.

Service user A person who uses or could make use of a service.

Single Outcome Agreement An outcome based approach to define the relationshipbetween the Scottish Government, Local Authorities andCommunity Planning Partnerships. Part of the ScottishGovernment National Performance Framework.

Solvent A volatile substance that is capable of dissolving anothersubstance. Misused solvents include butane gas, dry cleaning


Index of Terms

Statutory sector Public agencies, funded by government, with specific legalresponsibilities.

Strategic Consideration of the widest possible set of factors andbroadly defined long term goals to address a particularproblem.

Substitute prescribing Use of methadone (or other medicines such asbuprenorphine) to treat heroin dependence.

Supplementary prescribing Prescribing undertaken by a specially qualified pharmacist,nurse or midwife after a diagnosis has been made and aClinical Management Plan drawn up for the patient by adoctor.

Third Sector Non statutory organisations from the voluntary or privatesector.

Treatment Procedures that are intended to relieve illness or injury.

Unit of alcohol A beverage containing 10ml (~8g) of ethanol equals one unit.A half pint of 3.5% ABV beer, one 25ml measure of 40% ABVspirit or a small glass (125ml) of 8% ABV wine equals oneunit.

Vulnerable A person or group is vulnerable when support is required toenable or promote independent living and safe and activeparticipation in the community.

Wellbeing A state of complete physical, mental and social wellbeing andnot merely the absence of disease or infirmity.

Withdrawal A variety of symptoms that occur after chronic use of alcoholor some other drugs is reduced or stopped.


References

1 A New Framework for Local Partnerships on Alcohol and Drugs.http://www.scotland.gov.uk/Resource/Doc/270101/0080412.pdf

2 Scottish Government News Release – Alcohol Related Deaths, June 2009. www.scotland.gov.uk/News/Release/2009/06/30102232

3 Scottish Government News Release – Funds to Tackle Alcohol Misuse, May 2009. www.scotland.gov.uk/NEWS/Release/2009/05/13103111

4 Alcohol Statistics Scotland, 2009. www.alcoholinformation.isdscotland.org/alcohol_misuse/files/alcohol_stats_bul_09.pdf

5 Estimating the National and Local Prevalence of problem Drug Misuse inScotland, 2009.http://www.drugmisuse.isdscotland.org/publications/local/Prevalence_2009.pdf

6 The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem, The Scottish Government, 2008.http://www.scotland.gov.uk/Resource/Doc/224480/0060586.pdf

7 Scottish Government ‘Changing Scotland’s Relationship with Alcohol: Discussion Paper’, 2008. www.scotland.gov.uk/Publications/2008/06/16084348

8 Grampian Police statistical report: Statistics for Moray Council DAAT Strategic Assessment, 09 February 2009.

9 Register of current licensed premises in Moray, 2008. www.moray.gov.uk/moray_standard/table_42032.html

10 Scottish Government Statistical Bulletin Crime and Justice Series: Scottish Liquor Licensing Statistics, 2007. www.scotland.gov.uk/Publications/2008/08/11160147/0

11 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) 2006. Smoking, drinking and drug use among 13 and 15 yearolds in Moray. www.drugmisuse.isdscotland.org/publications/abstracts/salsus.htm

12 Audit Scotland ‘Drug and Alcohol Services in Scotland’, 2009. www.audit_scotland.gov.uk/docs/health/2009/nr_090326_drugs_alcohol.pdf

13 Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland.www.drugmisuse.isdscotland.org/publications/local/prevreport2004.pdf

14 The Moray Council, Community Services, Business Support Unit.


References

15 Grampian Police statistical report: Statistics for Moray Council DAAT Strategic Assessment, 9 February 2009.

16 NESCPC Guidelines, available atwww.nescpc.org.uk/AboutNESCPC/ChildProtectionGuidelines.asp

17 The Moray Council “Neglect Pilot – Moray Needs Profile”.

18 National Outcomes Toolkit.http://www.scotland.gov.uk/Resource/Doc/270114/0080414.pdf

19 Getting Our Priorities Right – Policy and Practice Guidelines for Working with Children and Families Affected by Problem Drug Use, the Scottish Government, 2001.http://www.scotland.gov.uk/Resource/Doc/159094/0043262.pdf

20 Hidden Harm – Next Steps: Supporting Children – Working with Parents,2006.http://www.scotland.gov.uk/Resource/Doc/114027/0027764.pdf

21 Getting it Right for Every Child, the Scottish Government.http://www.scotland.gov.uk/Publications/2008/09/22091734/0


NOTES


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