Needs Assessment

2011/12

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Contents Page Executive Summary pg 4 - 5 Glossary of Terms and Abbreviations pg 6-7

Chapter 1: Introduction pg 8 - 10 1.1 What is a Needs Assessment? pg 8 1.2 Background pg 8 1.3 Purpose pg 8 1.4 Objectives of this Needs Assessment pg 9 1.5 Summary of Study Methods pg 9 1.6 Priorities for improving our knowledge pg 9 1.7 Acknowledgements pg 9 1.8 Information on Moray pg 10

Chapter 2: The make up of Moray pg 11 - 14 2.1 Population and projections pg 11 2.2 Scottish Index of Multiple Deprivation pg 11 2.3 Alcohol Related Deaths in Moray pg 12 2.4 Employment in Moray pg 12 2.5 Ethnic Minority Populations in Moray pg 12 2.6 Scottish Government Background and Information on Substance Misuse (Minimum Pricing) pg 13-14

Chapter 3 – Alcohol and Drug Prevalence in Moray pg 15 - 17 3.1 Executive Summary pg 15 3.2 Number of Estimated Problem Drug Users pg 15 3.3 Gender Split of Estimated Problem Drug Users pg 15 3.4 Estimated Problem Drug Users Age Groupings – Males only pg 16 3.5 Comparison 2006 and 2009 Percentage of estimated pg 16

Problem Drug Users 3.6 Alcohol Consumption and Prevalence pg 16-17

Chapter 4 – Services offered by the MADP pg 18 - 25 4.1 Executive Summary pg 18

4.2 Services Offered by the MADP pg 18-19 4.3 Those engaging with MADP Services pg 19-22 4.4 Service Users with children pg 22 4.5 Waiting Times Data pg 23 4.6 Service User Data pg 23-34 4.7 Service Provider Data pg 25

Chapter 5 - Harm Reduction pg 26 - 33 5.1 Executive Summary pg 26 5.2 New Clients Misusing Substances pg 26 5.3 New Client Age Groupings – 2008/09 pg 27 5.4 Type of Drugs being used pg 27 5.5 Injecting Habits of New Clients 2009/10 pg 27 5.6 Hospital Admissions pg 28 5.7 General Acute Inpatient and day case discharges with an

alcohol related diagnosis in any position 2005/06-2009/2009/10 pg 28 5.8 General Acute Inpatient and day case discharges with

a diagnosis of drug misuse in any position pg 28

5.9 Psychiatric inpatient discharges with an alcohol-related pg 29

diagnosis in any position 5.10 Co-Occurring Heath Issues – Drugs pg 29 5.11 A&E Attendances in Moray 2010 pg 30

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5.12 Enhanced Special Contracts pg 31 5.13 Alcohol Brief Interventions pg 31 5.14 Blood Borne Viruses pg 31 5.15 Needle Exchange pg 31 5.16 Drug Related Maternities in Moray 2008/09 pg 32 5.17 Alcohol Related Deaths pg 32 5.18 Drug Related Deaths pg 32-33

Chapter 6 – Substance Misuse and Fire pg 34 - 36 6.1 Executive Summary pg 34 6.2 Fatal Fires in Scotland pg 34 6.3 Primary and Secondary Fires with a link to Substance Misuse pg 35 6.4 Accidental Dwelling Fires pg 35 6.5 Wilful Fireraising pg 36

Chapter 7 - Alcohol, Drugs and Crime pg 37 - 41 7.1 Executive Summary pg 37 7.2 Serious and Violent Crimes pg 37-38 7.3 Antisocial Behaviour Crimes pg 38 7.4 Licensing Offences pg 38 7.5 STORM Command and Control Calls pg 39 7.6 Drink Driving pg 39 7.7 Initiatives Held by Grampian Police pg 40 7.8 Illegal Drug Charges pg 40 7.9 Arrest Referral Scheme pg 40-41 7.10 Substance Misuse in Scottish Prisons pg 41

Chapter 8 - Licensing in Moray pg 42 - 43 8.1 Executive Summary pg 42

8.2 Current provision of Licenses in Moray pg 42-43

Chapter 9 – Alcohol, Drugs and Age pg 44 - 50 9.1 Executive Summary pg 44 9.2 Drinking Patterns and Young People pg 45 9.3 2010 Salsus Data – Alcohol pg 46-47 9.4 2010 Salsus Data – Drugs pg 48-49 9.5 Drink Patterns and the Elderly pg 50

Chapter 10 – Recommendations pg 51 References pg 52 - 53 Appendix 1 Questionnaire – Service Providers Survey pg 54-55 and Answers

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Executive Summary

• 0.64% of the population of Moray are estimated to be drug users.

• Moray is ranked at the bottom for the number of problem drug users on the Scottish Mainland.

• There is a ratio of 2:1 for male to female drug users in Moray

• There has been an increase in the number of harmful/hazardous drinkers who are aged over 75 years old. However this may be a blip in the figures due to changing reporting methods.

• The total number of clients using alcohol and drug services in Moray during 2010/11 was 431.

• Most clients accessing Moray Drug and Alcohol Services have either self referred or been referred by a GP.

• 27.24% of clients accessing Drug and Alcohol Services in Moray have left services after successfully receiving support.

• 75 service users had children living with them and there were 129 children in Moray who lived with a service user.

• 0.74% of children in Moray had an alcohol or drug service user living with them in 2010/11.

• There has been a drop in the number of new clients by 2130 between 2006/07 and 2009/10; this drop is double the national average.

• The largest group of those misusing substances are aged between 25 and 29 years old, the mean age for a service user in Moray is 29 slightly below the national average of 31.

• There is a very low proportion of new clients aged 40 and over.

• Heroin is the drug that most new clients have an issue with, this is the same as the benchmarking areas and Scotland as a whole.

• 20% of drug users in Moray had injected in the past month this is higher than the national average of 15%.

• There has been a 56.25% rise in the number of acute inpatient and day case discharges for drugs and a drop of 17.71% for those acute inpatient and day case discharges for alcohol related issues. The rise in the number of drug cases bucks the national trend.

• Keith is the only town in Moray not to have a needle exchange.

• 11.79% of people were under the influence of alcohol when they attended at A&E Dr Grays were under the age of 16 compared to 5.63% for Aberdeen Royal Infirmary and Royal Aberdeen Children’s hospital.

• In 2010 there was a drop in the number of drug related deaths; however this has risen again in 2011.

• In 2010 the number of alcohol related deaths in Moray was static compared to the previous year. However the Scottish picture was reducing.

• 61.28% of all fatal fires in Scotland are alcohol related.

• In 2009/10 0 primary fires were linked to substance misuse this rose to 2 in 2010/11

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• Between 2009/10 and 2010/11 there was a decline of 1 fire in relation to the number of secondary wilful fires that were linked to substance misuse.

• In 2009/10 10 dwelling house fires were related to substance misuse in 2010/11 this rose to 11 fires.

• 40.88% of all serious crime in Moray during 2010/11 was committed whilst the accused or suspect was under the influence of Alcohol.

• 30.88% of all antisocial behaviour crimes were committed whilst the accused or suspect was under the influence of alcohol or drugs.

• There were 47 licensing offences in moray in 2010/11

• There has been a decline in the number of calls to Grampian Police in relation to alcohol or substance misuse between 2008/09 and 2010/11.

• 88.88% of all drunk drivers in Moray during 2010/11 were male.

• 55.53% of all drunk drivers were aged between 15 and 35 years old.

• 24 persons were charged with being concerned in the supply of an illegal drug in 2010, which was a drop on the past two years. However in the first two reporting quarters (April – December) of 2011/12 there have been 24 people charged with this offence.

• In 2010/11 there were 201 persons charged with possession of an illegal drug this is also a drop on the previous two years. However in the two reporting quarters (April – December) of 2011/12 157 people have been charged with this offence in Moray.

• Proportionally there is a licensed premises for every 274.13 people in Moray this is compared to 398.35 in Aberdeenshire and 389.33 in Angus.

• In 2010 the 16-24 age grouping was the category with the largest percentage (49%) who drank out with the government sensible drinking guidelines compared to 43% across all age groups.

• In Moray it is estimated that there are 1441 males and 729 female who are hazardous drinkers over the age of 65. There are 196 males who are classed as harmful drinkers in Moray compared with 136 females who are considered the same.

• According to the 2010 SALSUS data the number of young people drinking alcohol and using illegal drugs has declined when compared with the 2006 data.

• In 2010 a higher percentage of young people reported drinking alcohol at home, at someone else’s home or at a party. There has been a decline in drinking alcohol outside on the street when compared to 2006 data.

• Moray is below the national average with regards to young people who have ever tried using illegal drugs.

• Cannabis was the illegal drug that most had reported ever having used, followed by glue, gas and other solvents in 2010.

• There has been a drop in the percentage of young people who would know where to go to obtain help for their drug use.

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Glossary of Terms and Abbreviations MADP – Moray Alcohol and Drug Partnership – The Moray Alcohol and Drug Partnership is a partnership of all the organisations involved in reducing the harm caused by alcohol and drugs to both individuals and communities across Moray. Its primary purpose is to deliver the Governments strategy in relation to drugs and alcohol by bringing together many different agencies and co-ordinating a partnership approach to tackling substance misuse. Our primary aim is to help our communities find local solutions to local problems. There are twenty eight members including Local Authority staff, representatives from health, the police, the prison service, the local voluntary sector and many more. ABI – Alcohol Brief Intervention – a short, evidence-based, structured conversation about alcohol consumption with a patient/service user that seeks in a non-confrontational way to motivate and support the individual to think about and/or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm. Off-sales - is a term used to describe a shop licensed to sell alcoholic beverages for consumption off the premises. Off-licences can also be used. Off-sales premises can include supermarkets, grocers, convenience stores, dedicated off-sales and garages. On-sales - is a term used to describe venue which is licensed for consumption of alcohol at the point of sale. On-sales premises can include pubs, clubs, hotels and restaurants. New Clients – any person who at the time of presenting is not currently in contact with a service that provides specialist assessment of a clients drug misuse care needs. Serious Crimes – Murder, attempted murder, culpable homicide, serious assault, rape, assault with intent to rape. Antisocial Behaviour Crimes – Minor assault, vandalism, breach of the peace, drunk and incapable, urinating in a public place and using threatening or abusive behaviour. Licensing Offences – Purchase of alcohol for consumption by persons under 18 years, sale of alcohol to persons under 18 years, persons under 18 buying or consuming alcohol in a bar, licensing other offences, confiscation of alcohol from under 18, refusing to quit a licensed premises, drunk in charge of a child, drunk and attempting to enter a licensed premises, and disorderly on a licensed premises. SW – Social Work SSMS – Specialist Substance Misuse Service CJ – Criminal Justice NHS – National Health Service MIDAS – Moray Integrated Drug and Alcohol Services made up of Addictions Social Work and NHS Mental Health Nurses. SALSUS – Scottish Schools Adolescence Lifestyle and Substance Use Survey

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Primary Fire – is defined as falling into one or more of the following three categories:

• A fire involving buildings, vehicles (not derelict), agricultural/forestry premises or outdoor plant and machinery and other structures i.e. post boxes, bridges, tunnels etc.

• Any fire involving casualties or rescues.

• A fire attended by five or more appliances. Secondary Fire – is defined as: Incidents that are not in a primary fire location and are recorded in six categories, these being fires involving: single derelict buildings, grassland, intentional straw/stubble burning, outdoor structure, refuse/refuse container or derelict vehicle. ISD – Information Services Division (Health Service Data) ACPO – Association of Chief Police Officers Scotland

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Chapter One – Introduction

1.1 What is a Needs Assessment? A Needs Assessment is a way of determining and addressing needs, or "gaps" between current conditions and desired conditions within any organisation. The need can be a desire to improve current performance or to correct a deficiency. It is also a way of estimating the nature and extent of the needs of a population so the necessary services can be planned accordingly.

1.2 Background A Strategic Assessment of the Moray Alcohol and Drug Partnership was carried out by Anna Jermyn, Research and Information Officer in 2009 which formed the basis for the 2009-11 strategy. This Needs Assessment will assist the Alcohol and Drug Partnership in developing the Strategy for 2012-2015.

The importance of the Moray Alcohol and Drug Partnership in conducting a Needs Assessment has been displayed through a number of recent Scottish Government documents. In the 2009 Audit Scotland report it was recommended that:

“ADPs should ensure that all drug and alcohol services are based on an assessment of local need and that they are regularly evaluated to ensure value for money.”1

The Scottish Government Delivery Framework has also reinforced the need for the MADP to produce a Needs Assessment by outlining the role and responsibilities of each ADP and The Scottish Government. 2

A number of other Scottish Government documents have also set out ways in which Hollyrood proposes to tackle the alcohol and drug misuse situation in Scotland. One such document is the changing Scotland’s Relationship with Alcohol: a Framework for Action which sets out what the Government propose to do to tackle alcohol issues in Scotland.3 The other prominent document is the Road to Recovery: a New Approach to Tacking Scotland’s Drug Problem which details how the Scottish Government plans to tackle the issues with substance misuse in Scotland.4

1.3 Purpose The purpose of this report is to assist the Moray Alcohol and Drug Partnership in identifying Strategic Priorities. This will assist the Moray ADP to achieve all of the objectives of the Delivery Reform Group Report 2009 by assessing the needs of the current Alcohol and Drug Specialist Services, as well as identifying any local needs or gaps.

The Scottish Government in Changing Scotland’s Relationship with Alcohol in 2009 identified a need for sustained action in four key areas:

1. Reduced Alcohol Consumption 2. Supporting Families and Communities 3. Positive Public Attitudes, and Positive Choices 4. Improved Treatment and Support.

All of which will be assisted through this Needs Assessment

1Drug and Alcohol Services in Scotland: Audit Scotland Report 2009: (page 28) 26 March 2009. http://www.audit-scotland.gov.uk/docs/health/2009/nr_090326_drugs_alcohol.pdf 2 A New Framework for Local Partnerships on Alcohol and Drugs: 20 April 2009 http://www.scotland.gov.uk/Resource/Doc/270101/0080412.pdf 3 Changing Scotland’s Relationship with Alcohol: A Framework for Action: February 2009 http://scotland.gov.uk/Resource/Doc/262905/0078610.pdf 4 The Road to Recovery: a New Approach to Tackling Scotland’s Drug Problem 29 May 2008 http://www.scotland.gov.uk/Resource/Doc/224480/0060586.pdf

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1.4 Objectives of this Needs Assessment: The objectives of this paper are set out as follows:

1. To assess current provision and examine current use of the specialist drug and alcohol services in Moray.

2. To conduct an assessment of the local need for these services. 3. To identify gaps in the current provision of services. 4. To identify evidence based recommendations for the MADP to consider.

1.5 Summary of Study Methods The methods used to collate this data were:

• Open source internet searches

• Survey of Service Users

• Survey of Service Providers

• Data from ISD Waiting Times Database

• Outcomes Data from Service Providers

• Grampian Police Crimefile and STORM Command and Control Systems

• Grampian Fire and Rescue Services

• Angus Council – Licensing Department

• Aberdeenshire Alcohol and Drug Partnership Please note - Aberdeenshire and Angus Local Authorities were used for benchmarking purposes due to their similarities with Moray with regards to population and geography. 1.6 Priorities for improving our knowledge In line with improving routes to recovery our priorities for improving understanding are:

• Who is in treatment for which it appears to be meeting their needs?

• Who is in need of treatment, for which it does not appear to be working, what are the unmet needs?

• Who are the people with a treatment need who are known to local services but not currently in treatment? How do we engage these people?

1.7 Acknowledgements The Author would like to acknowledge the following services who provided data: Grampian Police NHS Grampian – Health Intelligence Team Grampian Fire and Rescue Services The Moray Council – Licensing Services/Criminal Justice Social Work/Addictions Social Work Moray Council on Addiction Turning Point Scotland – Studio 8 Quarriers Carers Support Service MIDAS – NHS Health Team

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1.8 Information on Moray As an area Moray has a lot to offer people both those who are visiting as well as those who live and work in the area. Moray is beautifully nestled between the Cairngorm Mountain Range to the south and the magnificent coastline of the Moray Firth to the north, it benefits from large areas of unspoiled sea shore which is dotted by picturesque fishing villages along the coast. It has many interesting historical sites as well as bustling shopping areas in the main towns of Elgin, Forres, Keith and Buckie. Moray is also a top destination for sea fishing as well as salmon and trout fishing along the famous rivers Spey and the river Findhorn. Moray is indeed the country of Macbeth and has a vast amount of history attached to it, it is also Whisky country and has the only Malt Whisky trail in the world which is a unique selling point for this area.

Moray is the 8th largest Local Authority in Scotland geographically however it ranks number 26th with regards to population size as it is not as densely populated as some other Local Authority areas in Scotland. The estimated population of Moray in 2010 was 87,720 people an increase of 0.1% when compared with 2009. The population of Moray accounts for 1.7% of the population in Scotland. In Moray 15.9% of the population is aged 16-29 years which is smaller than the Scottish average of 18.7%. Persons aged 60 and over make up 25.8% of the population of Moray which is larger than the Scottish average of 23.1%.5

5 National Records for Scotland – General Register Office for Scotland: April 2011 http://www.gro-scotland.gov.uk/files2/stats/council-area-data-sheets/moray-factsheet.pdf

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Chapter 2 - The make up of Moray

2.1 Population and Projections According to the 2001 Census, Moray has a population of roughly 86,940. With approximately 80 percent of this population living in towns or villages. Almost 60 percent of Morays population live in the five main towns which are; Elgin (20,929), Forres (9,174), Buckie (8,172), Lossiemouth (6,873), and Keith (4,597). There are several small towns in Moray such as Burghead, Cullen, Dufftown, Fochabers, Hopeman, Lhanbryde, Mosstodloch and Rothes who all have populations of approximately 1,000 to 2,000, with the rest of the population scattered across smaller rural areas. The population density of Moray is 38 people per square kilometer which is well below the national average of 66. 6 By 2018 it is projected that those aged 30-49 will make up the biggest age bracket in Moray, with 22.71% of the population being in this age bracket. However the percentage of people aged 30 years and under is expected to drop in Moray with a rise in those aged 50 and over as projected by the Scottish Government. The age bracket with the largest projected growth on Moray between 2013 and 2018 is the 65-74 age bracket.7 2.2 Scottish Index of Multiple Deprivation The percentage of the population who are income deprived is 11.2% in Moray compared to a Scottish average of 15.1% and 3.1% of the working age population in Moray are claiming Jobseekers Allowance while the Scottish average is 4.4%. There was one data zone in the 15% most deprived data zones in Scotland in 2009 in Moray compared with 0 in 2006. This data zone is S01004303 with a rank of 789 out of 6,505. It can be found in the South Lesmurdie area of Elgin in the ward of Elgin City North. This represents 0.9% of all the data zones in Moray. As well as the above there are two data zones in Moray in the 20% most deprived in Scotland, these are S01004321 (Buckie Millbank in the Buckie Ward) which is ranked 1051 out of 6,505 and S01004282 (New Elgin West Thornhill in the Elgin City South Ward) which is ranked 1150 out of 6.505.

• Elgin South Lesmurdie has a very high frequency of emergency hospital admissions and hospital episodes related to either drugs or alcohol.

• Buckie Millbank, New Elgin West Thornhill and Forres Central all have particularly high frequencies of hospital episodes related to drugs.

• New Elgin West Thornhill and Forres Central have particularly high frequencies of hospital episodes related to alcohol.

Thirty-two of Moray data zones (27.6%) were in the 15% most access deprived in Scotland in 2009; the same as in 2006. The most access deprived data zone in 2009 is the area of Dallas, Logie and Beachans. In the public transport sub-domain, this zone ranked 3 out of 6,505, i.e. it is the 3rd most public transport deprived data zone in Scotland.

6 Moray Census 2001 Provided by The Moray Council: 30 September 2002 http://www.moray.gov.uk/Census_2001/MORAY%20CENSUS%202001.PDF National Records for Scotland – General Register Office for Scotland: April 2011 7 http://www.gro-scotland.gov.uk/files2/stats/council-area-data-sheets/moray-factsheet.pdf

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2.3 Alcohol Related Deaths in Moray In Moray there were 18 alcohol related deaths in 2010, this is a slight drop from 24 in 2009. Alcohol related deaths reached their peak in Moray in 2003 and 2004 where there were 28 alcohol related deaths in each year. In 2010 1.37% of all of the alcohol related deaths in Scotland occurred in Moray. Ranking Moray at 22 out of the 32 Local Authority areas for alcohol related deaths.8 In 2009 there were 14 males and 10 females who had an alcohol related death this relates to a ratio of 1.4:1. The 2009 ratio for Moray is slightly less than the Scottish ratio of 1.88:1 males to females. The male to female ratio in Moray has fallen since 2008 when the ratio of males to females was 2.71:1 and in 2007 it was even higher 5.33:1. 9 This will be expanded more in Chapter 4 – Harm Reduction.

2.4 Employment in Moray In December 2009 the unemployment rate for Moray was 2.6% this is compared to a rate of 4.1% for Scotland and Great Britain. Unemployment rates in Moray are consistently lower than the national averages; however the rate in Moray can be seasonal in that the rates tend to fall in the summer due to temporary seasonal work being available. There has been an increase in the rate of unemployment in Moray which is not as significant as the country as a whole due to the recession in Great Britain.

In December 2009 the male rate of unemployment was 3.5% which is nearly double the female rate of 1.8%. In Moray the differential bucks the Scottish average where unemployment rates for males were 6.0% and females 2.1%. This gap between male and female unemployment has remained fairly consistent over the past 3 years, but has widened in 2009 due to the recession. One reason for the widening of the gap may be the increase in part-time working which tends to be of more interest to female workers or young people who are still engaged with education who would not qualify for unemployment benefits. 10

2.5 Ethnic Minority Populations in Moray

The 2001 Census Data shows that the largest ethnic group in Moray is white with 86,175 people in this group the second largest ethnic group is Chinese with 151 people. The other 614 people are from 8 other ethnic groups this translates to less than 1% of the population of Moray being from other ethnic backgrounds. This being said when Moray resident information is broken down to country of birth, it shows that 69,040 residents were born in Scotland with the second highest number being born in England (11,207) thus 16.23% of Morays population were born in England.11

8 National Records for Scotland – General Register Office for Scotland: April 2011 http://www.gro-scotland.gov.uk/files2/stats/alcohol-related-deaths/ard-10-table3.pdf 9 National Records for Scotland – General Register Office for Scotland: April 2011 http://www.gro-scotland.gov.uk/files2/stats/alcohol-related-deaths/ard-10-table3.pdf 10 Highlands and Islands Enterprise Area Profile for Moray January 2011

http://www.hie.co.uk/highlands-and-islands/economic-reports-and-research/ 11 Scotland Census Results Online

http://www.scrol.gov.uk/scrol/common/home.jsp

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2.6 Scottish Government Background and Information on Substance Misuse (Minimum Pricing)

The Scottish Government have suggested that alcohol is not an ordinary commodity it is indeed a psychoactive and potentially harmful and addictive substance, and is a contributory factor in a number of a range of illnesses and deaths ranging from stomach cancer to assaults and road traffic collisions. Alcohol related hospital discharges have more than quadrupled in Scotland since the early 1980’s whilst alcohol mortality has more than doubled.12 The problems with alcohol consumption in Scotland are not just limited to health, and nor are they experienced by the person consuming the alcohol alone, potential damage can occur to family, friends, communities, employers and the nation as a whole. The societal cost of alcohol misuse in Scotland for 2007 study showed that alcohol affects the social and economic growth of the country, using the studies mid point estimate this translates to costing around £3.56 billion per year including £866 million in lost productivity, a cost of £269 million to the NHS and £727 million in crime costs. 13

The Minimum Pricing Bill was re-introduced to the Scottish Parliament on 31 October 2011 by Nicola Sturgeon, Health Minister and is currently sitting with the Health and Sport Committee of the Scottish Parliament with the first stage due to be completed by 9 March 2012. 14 Research has been undertaken by Sheffield University who have found that in Scotland a

minimum price of 45 pence per unit of alcohol would reduce the alcohol consumption in

Scotland thus presenting the following reductions:

• Reduction in deaths in year 1 by 50 • Reduction in deaths per year by year 10 by 225 • Fewer hospital admissions in year 1 by 1,200 • Fewer hospital admissions per year by year 10 by 4,200 • Fewer cases of violent crime by 400 per year • Fewer days absent from work by 22,900 • Fewer numbers unemployed by 1,200

These researchers further found that if a minimum pricing of 45 pence per unit was introduced it would lead to moderate drinkers spending only £8 extra per year or 16 pence a week more. This weighted up with the estimated savings to the healthcare system of £83 million and crime savings of £18 million over a ten year period. 15

These figures were first published in April 2010 and Sheffield University are currently re-running the model with the most up to date data including the Scottish Health Survey 2010 data which was published on September 27, 2011.

12 Monitoring and Evaluating Scotland’s Alcohol Strategy. Setting the Scene: Theory of change and

baseline picture. Edinburgh: NHS Health Scotland; March 2011 http://www.child-smile.org.uk/uploads/documents/15312-MESASsettingTheSceneReport.pdf 13 The Societal Cost of Alcohol Misuse in Scotland for 2007, Scottish Government, 2010

http://www.scotland.gov.uk/Publications/2009/12/29122804/0 14 Alcohol (Minimum Pricing) (Scotland) Bill November 2011

http://www.scottish.parliament.uk/parliamentarybusiness/Bills/576.aspx News Release Minimum Pricing Bill November 2011 15 http://www.scotland.gov.uk/News/Releases/2011/11/01093248

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Aberdeen University Professor Anne Ludbrook also found that the middle to high-income groups are just as likely to buy off-sales at below 40 pence a unit as those on the lower incomes. The study of Household and Income Expenditure showed that the highest earning households bought the most off-sales. Only one out of every three low-income households bought off-sales, contrasted with two out of every three in the higher income bracket. 16 The Scottish Government believe that the largest impact of the minimum pricing with regards to the reduced consumption and the increased spend is estimated to be on those who currently drink the most. Thus it is thought that hazardous and harmful drinkers will reduce consumption the most, while still increasing their spend. The effect on moderate drinkers is thought to be marginal as they drink less and do not tend to drink the cheaper priced alcohol. If alcohol was to be 45 pence per unit minimum the greatest change in consumption will be to the harmful drinkers. On October 1st 2011 a new law came into force which prohibited shops and supermarkets from using quantity discounts encouraging consumers to buy alcohol in bulk. This meant that offers such as buy one get one free and three bottles of wine for £10 were no longer lawful.17 It was stated by The World Health Organisation that alcohol policies and interventions targeted only at vulnerable persons can prevent alcohol–related harm. However they further explained that policies which address the populations as a whole have proven to have a protective effect on vulnerable people whilst also reducing the overall level of alcohol issues. Therefore it seems fair to note that both whole population based strategies and interventions as well as those targeting particular groups in society are needed. The Scottish Government consider minimum pricing to be a whole population approach which would be applied equally across the whole population. But it does also target the more harmful drinkers who are known to buy cheaper alcohol relative to its strength, thus making this also a targeted approach. 18

16 Alcohol: minimum pricing could decrease consumption, while increasing industry revenue by 68%

http://www.abdn.ac.uk/news/archive-details-3718.php 17 Alcohol etc (Scotland) Act 2010

http://www.legislation.gov.uk/asp/2010/18/enacted 18ALCOHOL (MINIMUM PRICING) (SCOTLAND) BILL EXPLANATORY NOTES (AND OTHER

ACCOMPANYING DOCUMENTS) http://www.scottish.parliament.uk/S4_Bills/Alcohol%20(Minimum%20Pricing)%20(Scotland)%20Bill/Ex_Notes_and_FM.pdf

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Chapter 3 – Alcohol and Drug Prevalence in Moray The latest data available for estimated number of drug users in Scotland is dated 2009.19

3.1 Executive Summary

• 0.64% of the population of Moray are estimated to be problem drug users.

• Moray is ranked at the bottom for the number of problem drug users on the Scottish Mainland.

• There is a ratio of 2:1 for male to female problem drug users in Moray

• The majority of estimated problem drug users in Moray are aged between 25 and 34 years old.

• There has been a decline in the number of units that Scotland consumes on a weekly basis. Between 2003 and 2010 there has been a drop from 33% to 27% of males and a drop of 23% to 18% for females describing themselves as harmful/hazardous drinkers.

• There has been an increase in the number of harmful/hazardous drinkers who are aged over 75 years old. However this may be a blip in the figures due to changing reporting methods.

3.2 Number of Estimated Problem Drug Users

Council Area Number of persons Percentage of Population

Moray 370 0.64

Angus 1100 1.38

Aberdeenshire 1400 0.75

Scotland 59600 1.71

(Please note this data includes those aged 15-64 years old only)

• The Moray Council area had an estimated drug misusing population of 370 people, this equates to 0.64% of Moray’s population aged between 15 and 64 years.

• The Moray Council area is ranked 28th out of the 32 Council areas in Scotland with the Western Isles (130) and Shetland Isles (130) and Orkney Isles (too small a number to be given) below it.

• The percentage of the population with an estimated drug misuse issue in Moray is almost half of the national average.

• The number of estimated drug users in Moray accounts for 0.62% of all of problem drug users in Scotland.

3.3 Gender Split of Estimated Problem Drug Users

Council Area Male Female

Moray 250 (0.86%) 120 (0.42%)

Angus 640 (1.87%) 420 (1.17%)

Aberdeenshire 980 (1.21%) 400 (0.50%)

Scotland * 42000 (2.49%) 17300 (1.00%)

*Figures for Mainland Scotland only. ( ) % of population aged 15-64 years with an estimated drug misuse issue.

• Moray is ranked bottom for both the number of estimated males and females with a drug misuse problem.

19 Estimating the National and Local Prevalence of Problem Drug Use in Scotland 2009/10 Publication date - 29th November 2011

http://www.drugmisuse.isdscotland.org/publications/local/prevalence2009_10.pdf?20852297545

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• More Males are estimated to be problem drug users than females with a ratio of 2 males to every 1 female.

• Moray accounts for 0.60% of all males and 0.69% of all females who have an estimated substance misuse issue in Scotland.

3.4 Estimated Problem Drug Users Age Groupings – Males only

Council Area 15-24 25-34 35-64

Moray 70 (1.20%) 111 (2.47%) 70 (0.36%)

Angus 130 (1.94%) 300 (3.37%) 220 (0.96%)

Aberdeenshire 360 (2.43%) 400 (5.94%) 220 (0.41%)

Scotland* 7900 (2.28%) 16000 (4.99%) 18200 (1.78%)

*Figures for Mainland Scotland only. ( ) % of population aged 15-64 years with an estimated drug misuse issue.

• In Moray the majority of those estimated to have a substance misuse issue are aged between 25 and 34 with 44.22% falling into this age grouping, bucking the national trend which has 43.23% falling into the age grouping of 35-64 and only 38.00% in the 25-34 age group.

• There are no comparable figures available for females at present as ISD could not break this data down further as there were such small numbers of estimated females who have a substance misuse issue.

3.5 Comparison 2006 and 2009 Percentage of estimated Problem Drug Users

Council Area 2006 2009

Moray 0.53% 0.64%

Angus 1.24% 1.38%

Aberdeenshire 0.80% 0.75%

Scotland 1.62% 1.71%

• Between 2006 and 2009 the estimated percentage of Morays population with a problem drug use has risen very slightly. Moray is not alone in this rise, out of the 32 Local Authority areas 21 saw a rise.

3.6 Alcohol Consumption and Prevalence The recommended sensible drinking guidelines set out by the Scottish Government show that men should not drink more than 3-4 units of alcohol per day regularly and women should not drink more than 2-3 units per day on a regular basis. The Scottish Government also recommends that all should aim to have at least two alcohol free days per week. Within one week it is recommended that men should have no more than 21 units and women should have not more than 14 units. Definitions of ‘binge’, ‘hazardous’ and ‘harmful’ drinking Harmful Drinking describes those who are drinking at a level which is already causing physical, social and psychological harm. With regards to units it describes those who consume above 50 and 35 respectively for males and females. Hazardous Drinking describes those whose drinking is not currently causing any harm in the future but who are consuming between 21 and 50 units a week for males and for females those who consume between 14 and 35 units per week.

17

Binge Drinking There is no absolute definition of this in the United Kingdom, however the Health Survey for England and the General Household Survey define it as drinking more than 6 units on one occasion for women and more than 8 units for men.20 Within Scotland the general trend shows a decline in the weekly consumption of alcohol between 2003 and 2010. The average weekly consumption for men aged 16 and over was 19.8 units in 2003 and 16.0 units in 2010. The figure for women has also declined from 9.0 units in 2003 to 7.6 units in 2010. There was also a downward trend with regards to the mean weekly consumption of units between 2003 and 2010. In 2003 28% of adults of both sexes in Scotland were classed as harmful/hazardous drinkers in 2010 this had dropped to 22%. For men the percentage of harmful/hazardous weekly drinkers dropped from 33% to 27%, whilst the figures for women also declined from 23% to 18%. In the age group of 25-64 year old this decline was evident however for 16-24 year olds the pattern was less consistent. For those aged over 65 the figures were rather static and those aged 75 and over the percentage of harmful/hazardous drinkers seems to have increased, especially among women. In 2003 3% of women aged 75 and over were harmful/hazardous drinkers, this has risen to 10% in 2010. However this must be interpreted with caution as it may be a blip caused by sampling variation between the years. The prevalence of drinking out with the prescribed guidelines nationally was highest for men who lived in the least deprived areas. 54% of men drink more than recommended in the least deprived areas compared to 45% in the most deprived areas. The female figures were not dissimilar to the males with regards to depravation in that 44% of those in the least deprived areas drank more than was recommended compared to 34% of those most deprived. 21 When looking at this data there is a general observation that this survey underestimates the alcohol consumption rates. Thus it is worth noting that although the alcohol consumption rate seems to be falling, this type of data relies heavily upon self reporting, therefore the actual prevalence of alcohol consumption is likely to be greater than that suggested here. However in Scotland the data shows that there was 11.8 litres of pure alcohol consumed per adult in 2010 with the majority of this alcohol being bought from off-licensed stores, mainly from supermarkets. In 2010 alcohol was more affordable in real terms than it was in 1980 and there is no coincidence in the fact that alcohol consumption has doubled over the past sixty years in Scotland. In 2010 there was enough alcohol sold in Scotland to enable all people over the age of sixteen to exceed the recommended guidelines set out by the Scottish Government. 22

20 The Scottish Health Survey 2010 http://www.scotland.gov.uk/Resource/Doc/358842/0121284.pdf

21 The Scottish Health Survey 2010: September 2011

http://www.scotland.gov.uk/Resource/Doc/358842/0121284.pdf 22 Alcohol Statistics Scotland 2011: February 2011

http://www.alcoholinformation.isdscotland.org/alcohol_misuse/files/alcohol_stats_bulletin_2011.pdf

18

Chapter 4 – Services offered by the MADP 4.1 Executive Summary

• The total number of clients using Alcohol and Drug Services in Moray during 2010/11 was 431.

• Most clients have either self referred or been referred by a GP.

• 61.87% of clients were referred into service due to problems with alcohol misuse.

• In 2010/11 there were 136 unplanned discharges which amounts to 43.59% of all discharges being unplanned.

• 27.24% of clients left services after successfully receiving support.

• 55 % of clients attended their referral appointment, 55.51 attended their assessment appointment and 92.01% attended their treatment appointment.

• 75 service users had children living with them and there were 129 children in Moray who lived with a service user.

• 0.74% of children in Moray had an alcohol or drug service user living with them in 2010/11.

The MADP is a partnership of all the organisations involved in reducing the harm caused by alcohol and drugs to both individuals and communities across Moray. Its primary purpose is to deliver the Governments Strategy in relation to drugs and alcohol by bringing together many different agencies and co-ordinating a partnership approach to tackling substance misuse. Their primary aim is to help our communities find local solutions to local problems. There are twenty eight members including Local Authority staff, representatives from NHS Grampian, Grampian Police, the Scottish Prison Service, the local Voluntary Sector and many more.

4.2 Services Offered by the MADP MIDAS – NHS Provide mental health and general health Needs Assessment for clients, as well as providing substitute prescribing for alcohol and drug addictions. They provide alcohol detoxification and onwards referrals to General Practitioners for in patient detoxification and or rehabilitation. MIDAS NHS will also be providing the training for the take home Naloxone. They maintain links with the Pharmacists in relation to needle exchange and such like as well as with the Haematology department based in Aberdeen with regards to Blood Borne Viruses and linking in with the Hepatitis C Action Plan for testing and treatment. There are currently 4 Community Psychiatric Nurses within this service. MIDAS SW Social Work offer services to any person, they look at the whole person and work out a long term recovery plan with the service user. Social Work looks at the issues arising from the Single Shared Assessment and helps the service user to identify how to aid their recovery, by giving the service user the tools to be able to help themselves. Social Work use REAL time evaluation in their questionnaires in that it discovers how the person feels at a given time, these are carried out at regular intervals whilst the person is engaged with the service. Social Work also carries out rehabilitation assessments for those wishing to access rehabilitation in the area. There are 6 Social Workers and 3 Family Support Workers; the Social Workers provide reports for children hearings, child protection cases and looked after children meetings. The Family Support Workers assist the service user with the more practical aspects of recovery in that they offer support on matters such as gate keeping and the keeping of appointments.

19

Studio 8 Studio 8 operates the Single Door Access for the Moray Alcohol and Drug Partnership from which service users are then referred onto the necessary agency for their needs. Studio 8 also provide a drop in crisis centre for anyone who needs help or advice, this also caters for those who do not wish to have a case worker or a key worker but would still like to have support and guidance. A needle exchange is also operated from Studio 8 where those who inject can obtain information and advice on their injecting habits. In conjunction with Grampian Police Studio 8 operate an Arrest Referral Scheme whereby anyone brought into police custody that has a substance misuse issue is offered support and advice. Group work is also offered by this service where those engaging with the service can access alternative therapies, and groups with regards to the following: Arts and craft, peer support, family support, harm reduction, anger management and safe working practices. Studio 8 is open each week day from 1000 hours and operate late night opening on Tuesday and Thursday where they are open until 1900 hours. Moray Council on Addiction MCA offers a free confidential counselling service to those in Moray with addiction issues, as well as to those who are significant others of those with an addiction. MCA also operate a GP Project Scheme whereby those working in primary care can refer into the service through the Studio 8 Single Door Access programme and where possible the service user will be seen in Health Centres across Moray. Counselling appointments are available Monday to Friday from 0900 hours to 2100 hours and Saturdays 1000 hours to 1200 hours. Quarriers Carers Support Service Quarriers is commissioned by The Moray Council to provide a carers service to the people of Moray. They provide emotional support, peer support training on knowledge, skills and confidence, and information and advice. Quarriers have a confidential helpline that can be called during working hours and an answering machine facility for after hours. There are a small number of drug and alcohol carers who are involved with Quarriers, however due to the stigma that is often attached to drug and alcohol users and their families they tend to dip in and out of the service as they require help or information. Due to Quarriers being a small service they only have enough funding available to provide a service in Elgin. Criminal Justice Social Work Clients are referred to Criminal Justice Addictions for various reasons, often as a condition imposed by the court, such as as part of a probation order, diversion from prosecution, and release from prison under licence or a supervised attendance order. Referrals are also received from the Criminal Justice Social Work Team and Community Service Order Supervisors. Clients can voluntarily refer themselves for this service also if they wish to continue the work they have done during their probation period. The Throughcare Addictions Service is linked to the Scottish Prison Service. Those in prison for alcohol and drug-related offences who have received a service whilst in prison can volunteer to continue with addictions work following release.

4.3 Those engaging with MADP Services Each fiscal quarter statistics are collated from the services supported by the MADP which allows for the collation of statistics on those engaged in the services provided. The source for this data comes from the ISD Waiting Times database.

20

• It is clear that the highest number of clients are either referred by their GP (182) or are self referred (171).

• There were 0 clients referred into service by the court system, however there were 2 clients referred through the DTTO process.

• The majority of referrals in Moray have come from the individual seeking the service; this is not dissimilar to the national picture or that of Angus and Aberdeenshire.

• During 2010/11 there were more clients engaging with alcohol and drug services due to issues with alcohol misuse rather than drug misuse, in fact 61.87% of new referrals were referred due to alcohol misuse.

• In 2010/11 there were 176 planned discharges from alcohol and drug services in Moray, compared with 136 unplanned discharges.

• 43.59% of clients had an unplanned discharge from an alcohol and drug service in Moray during 2010/11.

21

• The majority of people leaving the alcohol and drug services in Moray during 2010/11 have left due to an unplanned discharge, this accounts for 43.59% of all discharges.

• 27.56% of clients left a service due to being referred to another service, and 27.24% of clients left due to have sucessfully received support.

• 3 people left due to being referred to their General Practioner and 2 left for disciplinary reasons.

• In 2010 there were 413 clients who attended a referral appointment.

• 55% of those offered an appointment for referral attended the appointment offered.

• 236 persons did not attend the appointment given for referral and 80 could not attend the first appointment offered.

• Addictions Social Work was the organisation with the highest number of appointment cancelled by the service, with 7 cancellations. This may have been due to a capacity issue which has since been rectified, with a Social Worker and a Family Support worker supplementing the existing team.

• Most of the clients had attended the appointment for their assessments; with 413 clients attending their appointment.

• Of those not attending the assessment appointment 236 did not attend, 80 could not attend and 15 were cancelled by the service.

22

• 92.01% of service users attended their appointments for treatment in 2010/11.

• There were 23 instances of service users who did not attend their appointments. The Moray Drug and Alcohol Team (NHS) had the most clients who did not attend, with 21 of those who did not attend engaging with this service

• There was only 1 instance of a service cancelling a treatment appointment and 3 appointments where a service user could not attend.

The above three graphs show that it is clear that there is a higher proportion of people who did not attend or could not attend the referral appointment compared with those who did not or could not attend the treatment appointment. This could be due to the service user having more of a vested interest when they have passed the referral stage and are beginning to engage with a service for treatment.

4.4 Service Users with Children The source for this data comes from the outcomes data provided to the MADP by each individual service on a quarterly basis.

• In 2010/11 there were 75 service users who had children living with them in their households.

• There were 129 children in Moray who lived with a service user in their household.

• According to the 2001 Census there were 17501 young people under the age of 16 living in Moray this means that 0.74% of children in Moray live with someone with a substance misuse issue.

• Of the 44 children on the register in Moray 45% had a risk factor of Parental Drug Misuse, equating to 18 children.

• 20 (41%) Children on the register in Moray had a risk factor of Parental Alcohol Misuse.

• 18 children in Moray had more than one risk factor listed. 23

23 http://www.nescpc.org.uk/AboutNESCPC/Statistics.asp

23

4.5 Waiting Times Data During 2010/11 there were 431 persons recorded on the NHS Waiting Times Database for alcohol and drug service users. Of this number 251 had alcohol as the substance they misuse and 180 misused drugs. In 2010 the target was that by March 2012 90% of clients would wait no longer than 5 weeks from referral received to appropriate drug treatment that supports their recovery. During 2010/11 75.30% of all alcohol clients and 58.89% of drug clients had received treatment within 5 weeks of referral.24 The current NHS HEAT Target A11 promotes that:

• By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug treatment that supports their recovery.

Currently Moray is above the trajectory to meet this target in 2013, however it must be noted that Moray has relatively small numbers engaged in alcohol and drug services so this can have an impact on the percentages overall. 4.6 Service User Data An essential element of any Needs Assessment is to secure a wide range of views and experiences from service users. This has been enabled through the Service User Improvement Officer who put together a feedback sheet called The Voice – of Moray Alcohol and Drug Service Users. The group was asked:

• Is there anything really good about any of our services?

• Is there anything you think we should do differently?

• What do we need to do to ensure positive outcomes for service users who are using our service in the future?

• And the service users general comments about the current service provision. Ways that the Moray Alcohol and Drug Partnership is helping the service users.

• Service users felt that they could drop in at any time in Studio 8 for a coffee and a chat and that it was a very informal setting which allowed them to engage with the service.

• Service users felt that they could get help on the day that it is needed, in that they did not have to wait for an official appointment.

• The service users who reported back enjoyed the peer support and the help from those who have been through what they were going through and had had similar experiences to theirs.

• Smart recovery was described as being useful.

• Service users identified one to one relationships with those engaging with the services was best and they liked the continuity of the staff they were engaging with.

• Another service user identified that the Dr Grays drug nurse was really helpful and that he was a good link into the positive outcomes they were experiencing.

However as with all services there is always something that can be improved on. What better way to discover what is not working with the services providing help to those with a substance misuse issue in Moray, than to ask those actually engaging with the services.

24 Data gathered from ISD Waiting Times Database.

24

Ways that the Moray Alcohol and Drug Partnership can improve what is provided as identified by the service user.

• It was felt that there was a rivalry between services and that it would be much better if they all worked together for the service user.

• There is no service at weekends and service users needed help then as well as during the week.

• A service user forum being set up would be good, this is in the process of being set up and the first meeting was set up for 18 November 2011.

• It was thought that there was not enough co-ordination with the mental health teams in Moray.

• A service user thought that better integration with young people’s teams and Moray Alcohol and Drug Services.

• It was thought that a crisis phone line would be a good idea because most of the services can only be contacted during office hours. Quarriers do provide a confidential helpline for carers of those who have substance misuse issues, although this operates during office hours and has an answering service after hours.

• A service that helps with the needs of family members of people affected with addiction would be a welcome addition. Then those people could have a range of options available to help them to support the person with the substance misuse problem. Moray Council on Addictions provide a counselling service to family members of those who have a substance misuse issue, as well as the carers service provided by Quarriers.

• It was suggested that a ‘Buddy System’ would allow for service users to get help from other people like them.

• One service user felt that sometimes services were too patronizing.

• Another service user highlighted that the service user also needs help once they had ‘recovered’, in order to achieve the positive lifestyle they had been looking for.

• It was felt that there was not enough information in the public domain on the services that are provided in Moray, and they the service user needed more information on services, e.g. NA, AA. A service user directory is currently being formulated and will be available early in 2012

• Fear of turning up at an appointment in case the police were present was something identified that stopped service users engaging with a service. It was felt that the police just want to solve the crime and find out who the dealers are where as the service user just want to recover.

• Stigmatism was also identified as a barrier to helping those in the services.

• One service user wanted a follow up to the confidence building courses as they felt it needed to be a process not an event.

• A service user also identified the need for help to build self confidence and get away from the feelings of guilt and low self esteem, this goes along with the previous comment on stigma.

• A gap was identified in helping service users to build good practical skills for life.

• It was felt that there was more advertising needed to promote the services that the Moray Alcohol and Drug Partnership offer and where a potential service user would go to access this information, in order to help change their lives. In fact one service user wrote that they believed that many people hadn’t heard of the services offered by the MADP.

• It was identified that service users believed that they needed more help in getting back into employment, it was acknowledged that some services did try to help with this but there just was not enough support in this field.

• It was felt that Moray offers very few positive activities in that there were a lot of pubs to socialise but very little else in the area for those looking to recover from substance misuse issues.

25

5.7 Views of the Service Providers A survey was sent out to all those who are employed or volunteer in the Moray Alcohol and Drug Partnership services. This was quite well received with 20 staff across each of the five services returning the completed survey. See Appendix 1

• When asked if their particular service facilities ought to be expanded 14 respondents said yes. It was thought by some that they ought to expand into through care and after care, another thought that more workers would assist them in developing a better service with a range of diversionary activities. Another felt that a drop in centre outside of Elgin would benefit the service users. It must be noted that a number of the services provided do offer rural appointments in the Moray area.

• When it came to the venue or building of the services it was identified by the majority of those who responded that the present buildings are not adequate to meet the needs of a disabled client, in that all except those engaging with Criminal Justice Services are required to use stairs to access the premises. There are a number of services who do go out and meet with clients who cannot access the premises in Elgin.

• Another item that was brought up by both service users as well as service providers was the opening times of the services. 12 respondents saw that the opening times of their service were reflecting the needs of the service user. Studio 8 is open late on two evenings during the week, MCA is open late each evening during the week and on a Saturday morning. However there may be a bit of a lack of knowledge of these late openings among the service users as this was something that was identified by them as a weakness in the MADP services.

• Only 1 respondent felt that their service needed more evaluating or monitoring.

• Contrary to what the service users opinion it appears that service providers thought that they were good at letting service users know about other services that might be useful to them and that all of the services worked well together.

• The only statements that respondents felt that they disagreed with was that service users find it easy to access services; this relates to the lack of disabled access to most services, providing information on the service prior to seeing a service user, allowing service users to let them know what they need and allowing service user involvement in how the service ought to be run.

26

Chapter 5 - Harm Reduction 5.1 Executive Summary

• There has been a drop in the number of new clients by 2,130 between 2006/07 and 2009/10; this is double the national average drop.

• The largest group of those misusing substances are aged between 25 and 29 years old, the mean age for a service user in Moray is 29 slightly below the national average of 31.

• There is a very low proportion of new clients aged 40 and over.

• Heroin is the drug that most new clients have an issue with, this is the same as the benchmarking areas and Scotland as a whole.

• 20% of drug users in Moray had injected in the past month this is higher then the national average of 15%.

• There has been a 56.25% rise in the number of acute inpatient and day case discharges for drugs and a drop of 17.71% for those acute inpatient and day case discharges for alcohol related issues. The rise in the number of drug cases bucks the national trend.

• Moray is ranked 29th for the number of psychiatric inpatients discharges with an alcohol related diagnosis, however there has been a drop in the number of cases in Moray which again goes against the national picture in which the number is actually rising.

• Keith is the only town in Moray not to have a needle exchange.

• 11.79% of people were under the influence of alcohol when they attended at A&E Dr Grays were under the age of 16 compared to 5.63% for Aberdeen Royal Infirmary and Royal Aberdeen Children’s hospital.

• 0.49% of all births in Moray had a recording of drug misuse attached to them in 2009/10 compared to the national average of 0.98%.

• In 2010 there was a drop in the number of drug related deaths; however this has risen again in 2011.

• In 2010 the number of alcohol related deaths in Moray was static compared to the previous year. However the Scottish picture was reducing.

5.2 New Clients Misusing Substances 25

2006/07 2007/08 2008/09 2009/10

Scotland 12455 12780 11955 10325

Moray 121 95 82 77

Angus 177 316 246 150

Aberdeenshire 355 299 291 259

• Since 2007 there has been a drop in the number of new clients accessing services nationally, this had been reflected in Moray as well as Angus and Aberdeenshire. This may be due to more people having engaged in services and receiving help or that people are not aware of the services in place to help them.

• Moray has seen a drop of 36.36% in the number of new clients, which is over double the national percentage drop between 2006/07 and 2009/10.

• In 2009/10 Moray was ranked number 28 with regards to the number of new clients accessing services, above Eilean Siar, Shetland and Dunbarton East.

25 Scottish Drug Misuse Statistics 2010: December 2010

http://www.drugmisuse.isdscotland.org/publications/10dmss/10dmss.pdf

27

5.3 New Client Age Groupings – 2008/09 26

Under 15

15-19

20-24 25-29 30-34 35-39 40+ Total Median

Scotland 92 628 1478 2280 2231 1694 1921 10325 31

Moray * * 12 26 14 14 * 77 29

Angus * 25 31 31 23 18 * 150 27

Aberdeenshire - * 44 67 72 41 * 259 30

Source – Drug Misuse Stats Scotland *Low number not disclosed to prevent identification of clients.

• In Moray there are more people in the 25-29 age group than the others and the median age for new clients in 2008/09 was 29 this is slightly below the national median age of 31; however it is not as low as the median age in Angus which was 27.

• There are very few people aged over 40 who are engaging with service in Moray as well as the benchmarking areas; however the over 40’s account for 18.61% in Scotland.

5.4 Type of Drugs being used 27

Number

reporting Illicit Drug Use

Heroin Methadone Dihydro-codine

Other Opiates

Diazepam

Cannabis

Scotland 8086 5340 648 490 200 2758 313

Moray 62 44 * * * 18 23

Angus 231 204 * 12 * 40 38

Aberdeenshire 150 120 91 10 * 55 80

*Low number not disclosed to prevent identification of clients.

• In Moray it seems that most who are presenting at drug services are doing so due to issues with heroin. This seems to be a common theme nationally and with the benchmarking areas.

• The next highest drug that people are seeking help for seems to be cannabis with 23 people seeking a service due to this type of drug.

5.5 Injecting Habits of New Clients 2009/10 28

Injected in previous Month

Injected in the past

Had never Injected

% of clients info available

for

Scotland 15% 40% 45% 89.45%

Moray 20% 37% 43% 100%

Angus * * 57% 91.30%

Aberdeenshire 28% 40% 32% 97.54%

• The percentage of new clients who have injected in the past month is above the national average; however it is below that of Aberdeenshire.

• The percentage of those who have injected in the past is below the national average as well as below Aberdeenshire’s figures.

• The percentage of those who had never injected was below the national average by 2% however it was above Aberdeenshire’s figure.

26 Scottish Drug Misuse Statistics 2010: December 2010

http://www.drugmisuse.isdscotland.org/publications/10dmss/10dmss.pdf 27 Same as 25

28 Same as 25

28

5.6 Hospital Admissions For each hospital admission a number of different diagnosis codes are recorded to describe the reason for admission. Often when substance misuse has played a part in leading to hospital admission the underlying admission (i.e. the first admission code applied) may not identify substance misuse. For that reason this report has used a dataset of alcohol related admission codes and drug related admission codes 5.7 General Acute Inpatient and day case discharges with an alcohol related

diagnosis in any position 2005/06-2009/2009/10 29

2005/06 2006/07 2007/08 2008/09 2009/10

Scotland 38,323 40,180 43,054 41,977 39,278

Moray 563 593 575 561 488

Angus 437 372 354 405 427

Aberdeenshire 987 994 1043 1051 1028

• For the past 3 years the number of alcohol related diagnosis’s in general acute inpatient and day case discharges have dropped following the national trend.

• Since 2005/06 there has been a drop of 75 cases in Moray, this amounts to an 11.49% drop.

• In 2009/10 Moray Local Authority area ranks at number 27 compared with the other areas in Scotland.

5.8 General Acute Inpatient and day case discharges with a diagnosis of drug misuse

in any position. 30

2005/06 2006/07 2007/08 2008/09 2009/10

Scotland 4440 4830 5477 5867 5705

Moray 31 21 32 40 48

Angus 24 28 35 59 74

Aberdeenshire 89 89 128 145 136

• Between 2005/06 and 2006/07 there was a drop in the number of those with a diagnosis of drug misuse in Moray however this bucked the national trend and that reflected in Angus and Aberdeenshire Local Authority areas.

• Since 2006/07 the number of patients in this category has risen in Moray with Moray accounting for 0.84% all cases in Scotland.

• Thus it is apparent that alcohol related cases have dropped over the past four years but drug misuse cases have risen over the same period.

• There has been a 56.25% rise in the number of drug cases and a 17.71% drop in the number of alcohol cases.

• In 2009/10 Moray ranks at number 24 compared to the other Local Authority areas in Scotland.

29 Same as 25

30 Same as 25

29

5.9 Psychiatric inpatient discharges with an alcohol-related diagnosis in any

position.31

2004/05 2005/06 2006/07 2007/08 2008/09

Scotland 4392 4289 4068 3865 4177

Moray 36 44 31 30 16

Angus 96 124 82 111 99

Aberdeenshire 43 21 50 58 41

• Moray ranks at number 29 when compared with the other Local Authority areas.

• There has been a drop in the number of psychiatric inpatients with an alcohol related diagnosis since 2005/06.

• Between 2007/08 and 2008/09 the number has almost been halved, this was not reflected nationally where the overall number actually rose, however both Angus and Aberdeenshire saw drops in the numbers of patients.

There are no figures available for the number of psychiatric inpatient discharges with a drug misuse diagnosis in any position as the numbers were too low and were not released to prevent identification.

5.10 Co-occurring Health Issues – Drugs Percentage of new clients with co-occurring health issues (2009/10)

• Nationally 25% of those with substance misuse also have a co-occurring drug related physical harm, this is compared to just 18% in Moray, 32% in Angus and 46% in Aberdeenshire.

• In Moray 17% of those with a substance misuse issue also have mental health issues; this is higher than those in Aberdeenshire but is below the national average.

• 14% of those with a substance misuse issue also have an issue with alcohol; this is very similar to the national figure but is higher than Aberdeenshire and Angus.

It should be noted that the information available in Moray only accounted for 57.04% of clients.

31 Same as 25

30

5.11 A&E Attendances in Moray 2010 Drug and alcohol related admissions to hospitals can be an important indicator of unmet need or weaknesses in the services provided. Below are the numbers of those attending A&E at Dr Grays Hospital in Moray where alcohol had been a contributory factor. A key word search was done on the following – alcohol, been drinking, or triage complaint = appears intoxicated, or diagnosis = contains word alcohol – Alcohol poisoning – by and exposure to alcohol Alcohol problem Alcohol related incident – self Alcohol related incident – third party Alcohol, unspecified Alcoholic gastritic Blood – alcohol and blood drug test Mental & behavioural is due to alcohol Mental & behavioural is due to use of alcohol intoxication.

Under 16 16 and Over Total

ARI 52 1174 1226

Dr Grays 33 247 280

RACH 18 0 18

Total Attendances 103 1421 1524 (Source NHS Grampian Health Intelligence Team)

• The above table shows that 11.79% of all people attending A&E Dr Grays were young people under the influence of alcohol compared to 5.63% in Aberdeen attending both RACH and ARI.

• It is clear that there were a number of single attendances due to alcohol 89.12%, however 7.11% of attendees had attended twice with 2.09% attending three times and 0.84% attending four and 0.84% having attended five times

A&E Attendances

(2010)

Proportion of A&E attendance attributable to alcohol misuse

(based on national average 11%)

Dr Gray's Hospital 62,178 6840

Fleming Cottage Hospital 3,705 408

Leanchoil Hospital 1,288 142

Seafield Hospital 12,596 1386

Stephen Cottage Hospital 992 109

Turner Memorial Hospital 491 54

Total 81,250 8938 (Source NHSG Health Intelligence)

31

• Unsurprisingly in Moray, Dr Grays had the highest number of A&E admissions attributable to alcohol misuse. Dr Grays Hospital accounted for 76.53% of all alcohol attributable admissions.

• Seafield Hospital in Buckie had the next highest number of admissions to A&E due to alcohol misuse, with 15.50% of patients presenting there.

• It is clear that there were a number of single attendances at A&E Dr Grays due to alcohol (89.12%) however 7.11% had attended twice, 2.09% had attended three times, 0.84% had attended four times and 0.84% had attended on five occasions.

5.12 Enhanced Special Contracts Enhanced Special Contracts were introduced to allow the following aims to be achieved:

1. To improve the identification of patients with harmful and hazardous drinking patterns presenting to general practice.

2. To opportunistically screen patients in defined at risk clinical groups. 3. To deliver Alcohol Brief Interventions (and follow up interventions as necessary) to

appropriate patients, with the aim of reducing their alcohol consumption to safer and healthier levels.

In Moray there are two GP Practices who have not “signed up” to the Enhanced Special Contracts, these being Seafield and Cullen Medical Group in Buckie and Aberlour Medical Practice. All other Medical Practices in the Moray have signed up and are delivering this early intervention tool.

5.13 Alcohol Brief Interventions An Alcohol Brief Intervention is described as a:

“short, evidence-based, structured conversation about alcohol consumption with a patient/service user that seeks in a non-confrontational way to motivate and support the individual to think about and/or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm.” 32

In 2010/11 there were 1174 Alcohol Brief Interventions carried out in Moray, compared to 3,347 in Aberdeenshire. This was a vast improvement for Moray with a rise of 866 ABI’s carried out compared to the previous year. For the two reporting quarters of 2011/12 so far there have been 432 ABI’s carried out in Moray.33

5.14 Blood Borne Viruses In Moray 65% of service users have been tested for Hepatitis B, 63% for Hepatitis C and 62% for HIV, this is well below the national averages, as well as below that of Angus and Aberdeenshire.34 5.15 Needle Exchange The following pharmacies provide a needle exchange service in the Moray area: Dufftown Pharmacy - 15 Balvenie Street, Dufftown Lloyds Pharmacy - 48 High Street, Elgin Bishopmill Pharmacy 20 North Street, Bishopmill, Elgin Lloyds Pharmacy 23a Clifton Road, Lossiemouth Your local Boots Pharmacy 88/94 High Street, Forres Norvik Pharmacies Ltd 1 High Street, Buckie

32 HEAT: Alcohol Brief Interventions National Guidance on Data Reporting: 2011-12: December 2010

http://www.healthscotland.com/uploads/documents/15219-ABI%20National%20Guidance%20on%20Data%20Reporting%202011_12.pdf 33 NHS Grampian Health Intelligence Team

34 Same as 25

32

There are several locations in Moray offering this service; however the only major town in Moray not providing a needle exchange service is Keith. Studio 8, Elgin also operates a needle exchange in Moray and report into the needle exchange data base. During 2010/11 there were 109 individuals that accessed the injecting equipment provision service with there being 335 visits made in total. 5.16 Drug Related Maternities in Moray 2008/09 35 In 2008/09 there were 2843 births in Moray 14 of these births had a recording of drug misuse attached to them, this relates to 0.49% of all births. This percentage is slightly less than the 0.98% national average and is less than those recorded in Angus (0.89%) however it was more than the number of drug related births in Aberdeenshire which accounted for 0.39%. 5.17 Alcohol Related Deaths 36 The figures in this section relate to deaths from medical conditions which are wholly attributable to alcohol, and therefore are likely to be an underestimate of the total burden of mortality due to alcohol.

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10

Scotland 1671 1730 1792 1637 1644 1489

Moray 30 21 26 20 27 27

Angus 33 34 25 17 22 24

Aberdeenshire 19 31 34 29 41 31

• There has been no change in the number of alcohol related deaths in Moray between 2008/09 and 2009/10 however in Scotland there has been a drop of 9.43%. Aberdeenshire also saw a drop of 24.39% compared to a rise in Angus.

• Between 2005/06 and 2006/07 there was a rise in all of the benchmarking areas except Angus which saw a drop of 9.

5.18 Drug Related Deaths 37

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10

Scotland 356 336 421 455 574 545

Moray 4 2 5 5 3 7

Angus 8 8 11 3 8 19

Aberdeenshire 8 10 10 17 11 18

• Moray has seen a rise in the number of drug related deaths since 2005/06 with a slight dip in 2008/09. Although there has been a rise the numbers are still very low compared with Angus and Aberdeenshire.

• Nationally there has been a rise in the numbers of drug related deaths between 2005/06 and 2008/09, however in 2009/10 there has been a drop again.

• The Scottish Government believe that the drop in numbers is due to the fact that "In the last year, they have been rolling out a national programme, within communities and the Scottish Prison Service, to supply naloxone kits and training to those at risk of an opiate overdose. This offers a chance to save a life and hopefully offer a second chance of recovery.

• Naloxone training is due to be rolled out in Moray in late 2011 and early 2012.

35 Same as 25

36 Same as 22

37 Same as 25

33

In 2009 there were a very high number of drug related deaths in Moray where Benzodiazepines were thought to be involved, where as heroin / morphine was found in roughly half of the drug related deaths in Moray.38 In 2010/11 there were only 3 drug related in Moray and 36 in the whole of Grampian.39 However the picture for 2011 is changing. Dr Bruce Davidson who is a Consultant Psychiatrist for Substance Misuse said

“Since late last year, it appears that the availability and quality of heroin in the region has been particularly variable and there have been widespread reports of a shortage of the drug both here and across the UK. This situation may have a bearing on the increased number of drug related deaths we have seen this year (2011)”.

The higher anticipated numbers in 2011 could be attributable to a loss of tolerance for the drug by those who use it as well as those turning to other drugs in the absence or lack of availability of heroin.

38 Same as 25

39 Drug Related Deaths in Scotland 2010 – National Records of Scotland 9 August 2011

http://www.gro-scotland.gov.uk/files2/stats/drug-related-deaths/2010/drug-related-deaths2010.pdf

34

Chapter 6 – Substance Misuse and Fire 6.1 Executive Summary

• 61.28% of all fatal fires in Scotland are alcohol related.

• In 2009/10 0 primary fires were linked to substance misuse this rose to 2 in 2010/11

• Between 2009/10 and 2010/11 there was a drop of 1 fire in relation to the number of secondary wilful fires that were linked to substance misuse.

• In 2009/10 10 dwelling house fires were related to substance misuse in 2010/11 this rose to 11 fires.

• Of the 77 incidents of wilful fireraising in Moray during 2010/11 10 had an accused or suspect that was under the influence of alcohol at the time of committing the crime.

6.2 Fatal Fires in Scotland In 2010/11 substance misuse was a factor in at least one in six accidental house fires in Scotland. During the same year substance misuse was suspected to have contributed to 835 of the 5,254 accidental fires and caused 11 deaths in Scotland.40 Alcohol is the greatest single contributory factor in deaths caused by house fire in Scotland. In 2006/07 the estimated cost to the Fire and Rescue Services in Scotland when dealing with alcohol misuse was £6 million. 41 According to the Scottish Health Action on Alcohol Problems alcohol is a contributory factor in over half of deaths in fires in Scotland.42 SCOTTISH COMMUNITY FIRE SAFETY STUDY FATAL FIRE SURVEY 2009 43

Cause Number Number where alcohol was

involved

Smokers Material 54 29

Cooking Appliances 28 18

Electrical 20 15

Candle 7 5

Electrical Heater 2 1

Open Fire 2 2

Other 4 3

Unknown 14 8

Total 131 81

• Over half (61.83%) of all fatal fires in Scotland had alcohol involved.

• Smokers material and cooking appliances were the top two causes related to alcohol.

This study found that due to the lack of information recorded in relation to the involvement of alcohol at a fire death incident, the full extent of its involvement with fire was not made subject to accurate reporting. The number of accidental dwelling fire deaths with an alcohol involvement is therefore likely to be under reported.

40 http://www.bbc.co.uk/news/uk-scotland-15461825

41 Economic Costs and Benefits: Institute of Alcohol Studies:

http://www.ias.org.uk/resources/factsheets/economic_costs_benefits.pdf 42 Scottish Health Action on Alcohol Problems

http://www.shaap.org.uk/pages/74,Health_costs.html 43 Scottish Community Fire Safety Study (2009) Fatal Fire Survey: 20009

http://www.lothian.fire-uk.org/IMAGES/Scotland_Together.pdf

35

6.3 Primary and Secondary Fires with a link to Substance Misuse (Data for the following 3 graphs was provided by Grampian Fire and Rescue Services)

• In Moray during 2009/10 there were no primary fires attributed to substance misuse, however in 2010/11 there were 2 primary fires attributable to substance misuse in 2010/11.

• There were more secondary than primary fires where substance misuse was a factor..

• In 2009 5 out of 107 were substance misuse related, in 2010 this number had dropped by 1 to 4, however there were 131 secondary fires recorded in this year.

• In 2009 4.67% of fires attributable to substance misue however in 2010 this had dropped to 3.05%.

6.4 Accidental Dwelling Fires

• There were more instances of fires where substance misuse was a factor in accidental dwelling fires than primary and secondary fires in both years.

• In 2009 there were 64 dwelling house fires and 10 of these related to substance misuse.

• In 2010 this had risen to 74 fires in total and 11 were related to substance misuse, so although the number of fires had risen the proportion relating to substance misuse had actually fallen.

36

6.5 Wilful Fireraising

• There were 77 people accused or suspected by Grampian Police of fire raising in Moray during 2010/11, of this number 10 were either drunk or had been drinking, and 42 were sober. There were 0 who were thought to be under the influence of drugs whilst committing this type of crime.

(Source Grampian Police IKap System)

37

Chapter 7 - Alcohol, Drugs and Crime (All crime data is taken from the fiscal year 2010/11 and was provided by Grampian Police using the IKap, Crimefile and Storm Command and Control Systems).

7.1 Executive Summary

• 40.88% of all serious crime in Moray during 2010/11 was committed whilst the accused or suspect was under the influence of alcohol.

• 30.88% of all antisocial behaviour crimes were committed whilst the accused or suspect was under the influence of alcohol or drugs.

• There were 47 licensing offences in Moray in 2010/11

• There was 1 person charged with the sale of alcohol to a person under the age of 18 years old in Moray.

• There has been a decline in the number of calls to Grampian Police in relation to alcohol or substance misuse from 2008/09 to 2010/11.

• 88.88% of all drunk drivers in Moray during 2010/11 were male.

• 55.53% of all drunk drivers were aged between 15 and 35 years old.

• 24 persons were charged with being concerned in the supply of an illegal drug in 2010, which was a drop on the past two years. However in the first two reporting quarters of 2011/12 there have been 24 people charged with this offence.

• In 2010/11 there were 201 persons charged with possession of an illegal drug this is also a drop on the previous two years. However in the two reporting quarters of 2011/12 157 people have been charged with this offence in Moray.

Drug use particularly use of a Class A drug such as heroin is generally associated with crime and offending. Measuring the accurate extent of alcohol and drug related crimes in Moray is problematic as the individual officer has to record if the accused or suspect was under the influence of drugs or alcohol, although this has become more accurate in recent years as since 2008 as it has become a mandatory field on the Grampian Police Crimefile Reporting System. On 27 April 2011 Grampian Police launched an ongoing crackdown on violence, antisocial behaviour and the drugs trade in Moray, called operation Moravia. This operation targets drug dealers in Moray in response to concerns from the local community. This initiative sees Grampian Police working in partnership with the Moray Council, NHS Grampian, Grampian Fire and Rescue Services and the Crown Office and Procurator Fiscal service, in a bid to share information to deal with the themes that have an adverse affect on the community of Moray. By the 22 November 2011 there were over 50 drug search warrants executed and a 250% increase in the number of people being arrested for being concerned in the supply of a controlled drug. 44 7.2 Serious and Violent Crimes

Drunk / Had been Drinking

Drugs Sober Total detected

crimes

Total 74 1 65 181

• There were no Murders or Culpable Homicides in Moray that were committed while the accused was under the influence.

• 80.11% of all serious and violent crimes were Serious Assaults and 46% of these were committed whilst the accused was under the influence.

44 http://www.grampian.police.uk/NewsArchive.aspx?id=130&pid=30%3b33%3b14

38

• Serious Assault was the only serious crime that was committed while the accused was under the influence of drugs.

• 40.88% of all serious and violent crimes detected were committed whilst the accused was under the influence of alcohol.

7.3 Antisocial Behaviour Crimes

Drunk / Had been Drinking

Drugs Sober Total detected

crimes

Total 1564 31 2300 5065

• Minor Assault was the antisocial behaviour crime that was mostly committed while under the influence of alcohol or drugs, 35.85% of persons accused or suspected of causing a Minor Assault were under the influence of alcohol, while 0.66% were under the influence of drugs.

• The crime with the highest percentage of people under the influence of drugs was Threatening and Abusive Behaviour.

• Perhaps unsurprisingly the two antisocial behaviour crimes with the highest number of crimes committed whilst under the influence of alcohol were Drunk and Incapable with 34 out of 35 persons being drunk or had been drinking and Consuming Alcohol in a Public Place with 18 of 19 of these persons being under the influence of alcohol at the time of committing the offence. The remaining 1 person for each of the crimes was marked as having their sobriety status not known.

• Of the total detected crimes 30.88% were committed whilst the accused was drunk or had been drinking and 0.61% had been committed whilst the accused was under the influence of drugs.

7.4 Licensing Offences

Drunk / Had been Drinking

Drugs Sober Total detected

crimes

Total 21 0 16 47

• The licensing offence which had the highest number of accused was Refusing to Quit Licensed Premises with 14 accused and 8 were under the influence of alcohol. This was closely followed by Disorderly Conduct in a Licensed Pemises with 12 accused of this offence and 6 being under the influence.

• 11 people were charged with Purchasing Alcohol for Consumption by Persons Under Eighteen and 2 were under the influence at the time of arrest.

• There were 0 people who were under the influence of drugs at the time of committing any licensing offences.

• 1 person was charged with the Sale of Alcohol to a Person Under the Age of Eighteen.

• 4 persons were charged with Attempting to Enter a Licensed Premises While Drunk.

39

7.5 STORM Command and Control Calls

2008/09 2009/10 2010/11

Drinking in Public + - - 40

Drunk driving / in charge of a vehicle

501 461 260

Drunk Male 271 223 140

Drunk Female 69 51 26

Offence on a Licensed premises

0 1 2

Persons Drunk / Glue Sniffing

1 1 1

Underage Drinking* 215 177 106

Drugs - Illegal Possession of *

171 155 51

Drugs Substance Misuse +

- - 37

Total 1228 1069 663

Storm call categories changed in November 2010 and as a result those marked with * are no longer used, new categories are marked with +.

• Over the years the number of storm calls that have been received by Grampian Police Moray Division has fallen in all substance misuse categories except the offence on a licensed premises which has risen by 1 between 2009-2010.

• Between 2008/09 and 2010/11 there has been a reduction of 46% in relation to calls received with regards to substance misuse.

7.6 Drink Driving

• From this chart it is plain to see that in Moray the vast majority of drunk drivers are male, with 88.8% being male.

• The chart to the right shows that those in the 15-35 age bracket account for over half of all drunk drivers. This supports the anecdotal evidence that young people tend to drink and drive.

• Those in the over 56 category account for 10.32% of all drink drivers in Moray during 2010/11.

40

7.7 Initiatives Held by Grampian Police Grampian Roads Policing Unit Moray Division usually holds a summer and winter driving campaign in line with ACPOS guidelines. They also run a high viability; intelligence led policing initiative called Operation Taurus which is directed to specific areas targeting drink drivers. 5 Operation Taurus Initiatives were held during the summer driving campaign in 2010/11 this led to a 100% drop in instances of drink driving in Moray when compared with the summer campaign held in 2009/10. 7 Operation Taurus Initiatives held around the winter safety campaign in 2010/11 and instances of drink driving during this campaign was down from 11 in 2009/10 to 4 in 2010/11 year. 415 drivers were stopped in 2010/11 with 153 being breath tested this is a decrease of the number of drivers stopped when compared with 2009/10 figure (1,582) as well as the number who were breath tested (541) in 2009/10. 7.8 Illegal Drug Charges Drug specific crime is unlike other types of crime in that there is usually no “victim” to report the crime thus the police are required to be more intelligence led and proactive to detect these types of crimes. For this reason it is generally not a wise option to use crime statistics alone to infer the level of a populations drug use. In 2010/11 24 were people charged with being Concerned in the Supply of a Controlled Drug in Moray this was a drop from 25 in 2009/10 and 41 in 2008/09. However for the first two reporting quarters of 2011 there have been 24 people charged with this offence. In 2010/11 there were 201 persons charged with Being in Possession of a Controlled Drug, this was also a drop from 222 in 2009/10 and 259 in 2008/09. However again in the first two reporting quarters of 2011/12 there have been 157 persons charged with this crime. The rise in the number of those charged with regards to Illegal Drugs may have risen in 2011/12 due to Operation Moravia concentrating primarily on specific types of crime one of which is the drugs trade. 7.9 Arrest Referral Scheme The arrest referral scheme was set up in 2010 and is a partnership approach between Studio 8 (Turning Point Scotland) and Grampian Police which provides an opportunity for all those taken into custody aged 16+ who have an alcohol and/or drug misuse issue to meet with a worker. The individual is offered advice and support on how to access services in order to address their substance misuse issues. For the fiscal year 2010/11 67 referrals were received through this method by Studio 8 this is further broken down into 15 email referrals and 52 who were through staff members from Studio 8 visiting the custody suite at Elgin Police Office. The total number of custodies processed by Grampian Police in Moray for the same period was 2,613 with 1,720 persons being under the influence of alcohol when brought into custody. 45

45 Data provided by both Studio 8 and Grampian Police

41

• The above charts show the gender split in those who were taken into police custody under the influence of alcohol and those who sought assistance through the arrest referral scheme.

• It is clear that the majority of people who are brought into police custody under the influence of alcohol or drugs did not engage in the arrest referral scheme, this may be due to them already being engaged with a service or simply not wishing to be involved with a service or a lack of understanding as to what is provided at the initial outlay.

• Proportionally 3.37% of males brought in to police custody under the influence of alcohol or drugs engaged in the arrest referral scheme while 6.77% of female chose to engage.

• There are meetings ongoing with the Service Manager of Studio 8 and Grampian Police to try to raise these numbers and raise the profile of the arrest referral scheme in Moray.

7.10 Substance Misuse in Scottish Prisons Currently there are 13 persons in a Scottish prison who are engaged with addictions services. All of these are over the age of 21 and are all male. 46 Upon coming into prison in Scotland in 2009/10 57% tested positive for all drugs and 56% tested positive for illegal drugs. When liberated from a prison in Scotland in 2009/10 30% tested positive for all drugs with 17% testing positive for an illegal drug. 47

46 Data provided by Scottish Prison Service

47 Drug Misuse Information Scotland

www.drugmisuse.isdscotland.org/publications/10dmss/10dmss_C3.xls

42

Chapter 8 - Licensing in Moray (Data provided by Licensing Section of The Moray Council) 8.1 Executive Summary

• 43.75% of licenses in Moray are both on and off sale licenses.

• Proportionally there is a licensed premises for every 274.13 people in Moray this is compared to 398.35 in Aberdeenshire and 389.33 in Angus.

8.2 Current provision of Licenses in Moray

The above chart shows the majority of licensed premises in Moray are both on and off sales, with 43.75% of licensed falling into this category. The next largest portion is on-sales with 30.31% of licenses and the off sales making up 25.94% of the total. Unsurprisingly Elgin has the highest number of all three types of licenses in Moray. With 22.89% of off licenses, 25.77% of on sales premises and 20% of on and off sales premises all being situated with the city. In Aberdeenshire there are 420 on-sale premise and 197 off-sales premises this is compared to Angus who has 83 on-sale premises, 76 off-sales premises and 125 on/off-sales premises. While Aberdeenshire has more on and off-sale premises than Moray, Angus has less in all three categories compared with Moray. For every 274.13 people in Moray there is a licensed premises, this is compared to one for every 398.35 persons in Aberdeenshire and one for every 389.33 persons in Angus.

Town Off-Sales On-Sales On and off-

Sales Total

Elgin 19 25 28 72

Buckie 7 13 9 29

Forres 8 12 11 31

Keith 6 5 8 19

Lossiemouth 3 6 14 23

Elsewhere in Moray

40 36 70 146

Moray Total 83 97 140 320

43

• 22.5% of all licensed premises are based in Elgin this is perhaps unsurprising given that this is the main town in the area; this means that for every 290.69 person that lives in Elgin there is a licensed premises.

• Keith is the town with the highest ratio of licensed premises to people in that for every 199.87 people there is a licensed premises in the town.

• Lossiemouth has the lowest ratio of the towns in Moray with a licensed premises for every 298.82 persons.

44

Chapter 9 – Alcohol, Drugs and Age 9.1 Executive Summary

• There has been a drop in the number of males and females aged between 16 and 24 who are classed as harmful/hazardous drinkers between 2003 and 2010.

• In 2010 the 16-24 age grouping was the category with the largest percentage (49%) who drank out with the government sensible drinking guidelines compared to 43% across all age groups.

• In Moray it is estimated that there are 1,441 males and 729 female who are hazardous drinkers over the age of 65. There are 196 males who are classed as harmful drinkers in Moray compared with 136 females who are considered the same.

• According to the 2010 SALSUS data the number of young people drinking alcohol has declined when compared with the 2006 data.

• The vast majority of young people source their alcohol through a friend in 2010; however 15% reported their parents have bought them alcohol.

• In 2010 a higher percentage of young people reported drinking alcohol at home, at someone else’s home or at a party. There has been a decline drinking alcohol outside on the street when compared to 2006 data.

• There has been a rise when comparing 2010 with 2006 regarding those who have been drunk ten or more times.

• There has been a drop in the percentage of young people who are allowed to drink alcohol at home.

• Moray is below the national average with regards to young people who have ever tried using illegal drugs.

• There has been a drop in the percentage of young people who have ever used drugs in Moray when comparing 2006 data with 2010.

• Cannabis was the illegal drug that most had reported ever having used, followed by glue, gas and other solvents in 2010.

• 25% of young people in Moray felt it would be very or fairly easy for them to obtain illegal drugs, however this was a drop from 41% in 2006.

• Most young people source illegal drugs through an older friend or a friend their own age.

• There has been a drop in the percentage of young people who would know where to go to obtain help for their drug use.

In the European Charter on Alcohol The World Health Organizations states that:

“All children and adolescents have the right to grow up in an environment protected from the negative consequences of alcohol consumption and, to the extent possible, from the promotion of alcoholic beverages.”

This charter further calls on the Government to:

“Implement strict controls, recognising existing limitations or bands in some countries, on direct and indirect advertising of alcohol beverages and ensure that no form of advertising is specifically addressed to young people, for instance, through the linking of alcohol to sports.” “Promote health by controlling the availability, for example for young people, and influencing the price of alcoholic beverages, for instance by taxation.”

This Charter on Alcohol has been signed by Member States of the European Union, including the UK. 48

48 European Charter on Alcohol Adopted 12-14 December 1995 in Paris, France.

http://www.euro.who.int/__data/assets/pdf_file/0008/79406/EUR_ICP_ALDT_94_03_CN01.pdf

45

9.2 Drinking Patterns and Young People 49

• The trend data for men aged 16-24 in Scotland shows that there has been a slight rise in the percentage of men who class themselves moderate drinkers and those who are non-drinkers and a drop in those who are harmful or hazardous drinkers.

• In 2003 men in this age group typically consumed 17.4 units of alcohol pre week this has dropped to 15.4 units per week in 2010

• Between 2003 and 2010 there has been a rise in the number of female moderate and non - drinkers in this age group. Mirroring the male data with a slight drop in the number of harmful/hazardous female drinkers.

• There has also been a decline in the number of units women drink in 2003 it was 11.5 this has dropped to 10.8 in 2010

• In 2010 the category with the highest percentage of 16-24 years olds were those who drank out with the Government guidelines, in that 49% of respondents reported that they were in this category. 50

• Nationally 43% of respondents reported that they drank out with the government guidelines 6% less than in the 16-24 age group.

• However 7% reported that they were ex-drinkers.

49 Alcohol Statistics Scotland 2011: February 2011

http://www.alcoholinformation.isdscotland.org/alcohol_misuse/files/alcohol_stats_bulletin_2011.pdf 50 Scottish Health Survey 2010 http://www.scotland.gov.uk/Resource/Doc/358842/0121284.pdf

46

9.3 SALSUS Data 2010 - Alcohol On 20 December 2011 the most recent 2010 SALSUS Data was published showing the views and use of alcohol and drugs among those aged 13 and 15 years old in the Scotland and more specifically the Moray area. 7 of the 9 schools in Moray participated which was higher than the national percentage. 594 Moray pupils took part in the survey with a response rate of 70% which was lower than the 91% response rate nationally.

In Moray 46% of 13 year olds and 87% of 15 year olds had had an alcoholic drink (a whole drink not just a sip). This was a reflection of the picture nationally with the percentage being roughly the same. However there was a marked decrease of 19 percentage points when comparing responses from 13 year olds in 2006 and 2010. When asked if it was okay for someone their age to have an alcoholic drink to see what it tasted like 60% of 13 year olds and 85% of 15 year olds (73% over all) felt that it was okay for this to happen. The percentage of teenagers who had had a drink in the last week has dropped from 34% in 2006 to 27% in 2010. With the majority in 2010 (34%) having never had an alcoholic drink. 70% of respondents never spend any money on alcohol; however 12% spend over £5 but no more than £10 a week and a further 12% spend over £10 but no more than £20. In the week prior to the survey beer, lager or cider was the type of alcohol that most boys had consumed with 90% who had drunk in the past week reporting drinking this type. Alcopops was the type of alcohol that most girls had consumed with 71% of respondents reporting drinking this, although this was closely followed by spirits or liqueurs with 70% reporting drinking these.

• When asked “the last time someone bought alcohol for you who was it?” The vast majority of 13 and 15 year olds in Moray had an older friend who bought them alcohol (56%). 15% of respondents reported parents buying them alcohol; however for those who were 13 years old the percentage of those whose parents bought them alcohol was 17%.

• In the four weeks prior to the survey 5% reported buying alcohol from a shop, off-license or supermarket. 1% had tried but had been refused. The majority 79% had never tried to buy alcohol themselves.

47

• In 2010 most youths drank either in their home, someone else’s home or at a party with friends. There has been a rise in the percentage of those who drink alcohol at their friends’ home or at a party with friends when comparing 2006 and 2010.

• Between 2006 and 2010 there has been a decrease in the number of young people who drink alcohol outside, this may be due to Operation Avon in the Moray area. There has also been a decline in the percentage drinking alcohol in a club or disco, in a pub or bar and those drinking somewhere else.

When asked if they thought it was okay for someone their age to try getting drunk to see what it’s like, 14% of 13 year olds thought it was okay and 72% thought it was not okay, however 51% of 15 year olds thought it was okay with 15% thinking it was not.

• There was a slight drop in the number of those who had never been drunk when comparing 2006 and 2010. However there was a rise of 6 percentage points between 2006 to 2010 with regards to the percentage who had been drunk more than ten times.

• 47% of pupils responded that their family don’t mind them drinking alcohol, with only 12% saying their family didn’t like it. However 17% responded that their family did not know they drank alcohol.

• 5% reported always being allowed to drink at home, with 60% reporting that they were sometimes allowed to drink at home this is a drop from 72% in 2006 35% reported that they were never allowed to drink alcohol at home a rise from 22% in 2006.

78% agreed or strongly agreed with the statement that their school provided advice and support on drinking alcohol with only 6% disagreeing or strongly disagreeing with this statement.

48

9.4 SALSUS Data 2010 - Illegal Drugs Of those responding to the survey in Moray 4% of 13 year olds and 18% of 15 year olds had tried drugs. This is below the national level of 8% and 26% respectively. There has also been a decrease when compared to 2006 as then 7% of 13 year olds and 30% of 15 year olds had tried drugs in that year. In the past month 5% of all respondents had used drugs in 2010 compared to 8% in 2006. Cannabis was the drug that most had reported using however only 3% reported using this in the past month with 1% using glue, gas or other solvents. 9% reported using drugs in the past year a drop of 7 percentage points compared to 2006.

• In the past year 7% had used cannabis compared to 13% in 2006.

• The drug with the next highest percentage in 2010 was glue, gas or other solvents with 3% however this again was a drop of 1 percentage point compared with 2006.

• In 2010 1% had used poppers in the past year compared to 5% in 2006.

In 2010 24% of youths aged 13 and 15 years old had been offered drugs, this breaks down to 10% of 13 year olds and 37% of 15 year olds. In 2006 22% of 13 year olds and 55% of 15 year olds had been offered drugs.

• In 2010 the drug that most had been offered was Cannabis, this was from the same in 2006. Although there was a drop of 13 percentage points with regards to the percentage offered the drug between 2006 and 2010.

• Those offered gas, glue or other solvents also dropped by 50% when comparing 2010 with 2006.

• Poppers dropped from 14% in 2006 to 3% in 2010 and ecstasy dropped from 12% to 5% in the same time.

49

• However it should be noted that newer drugs such as Mephedrone was offered to 3% of respondents.

From the above two charts it is apparent that there has been a shift from youths using drugs in the street and at clubs discos or raves in 2006 to youths using drugs at either their own home or at a party. 25% of youths felt it would be either very easy or fairly easy for them to obtain illegal drugs this is a drop compared to the 2006 figure of 41%. 17% said it would be very difficult or fairly difficult to get them, a rise from 14% in 2006. 14% said that it would be impossible a rise again from 9% in 2006. 43% did not know also a rise form 37% in 2006.

• In 2010 it is apparent that most youths who are sourcing illegal drugs are doing so through an older friend with 53% obtaining drugs this way a rise from 36% in 2006.

• 3% are obtaining them through their mother, father or carer a rise from 1% in 2006.

• 24% are sourcing them through a friend their own age this has dropped from 45% in 2006.

2% of all youths surveyed felt that they needed to get help because they were using drugs. And 66% felt they would know where to go for help compared to 78% in 2006. 96% agreed with the statement that taking cocaine was dangerous and 93% agreed that heroin was addicitve. However only 37% agreed that injecting drugs could lead to Hepatitis C.

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9.5 Drink Patterns and the Elderly There seems to be a general belief that alcohol consumption declines as one ages which implies that levels of alcohol misuse will be higher within the younger age groups, however this may not be the case, it may be due to an under reporting of those who are older with an alcohol or drug misuse issue. 51 According to The Societal Cost of Alcohol Misuse in Scotland for 2007 roughly 10% of all hazardous and 7% of all harmful drinkers are 65 years of age and over. In Moray it is estimated that there are 1,441 males and 729 female who are hazardous drinkers over the age of 65. There are 196 males who are classed as harmful drinkers in Moray compared with 136 females who are considered the same. In 2009/10 there were 56 persons aged 65 and over who had an alcohol related hospital admission (main or secondary diagnosis) in Moray. This amounts to 17.78% of all admissions. 52 There were 45 persons admitted for alcohol related admission episodes due to alcohol related mental and behavioural disorders in Moray that were aged 65 and over, compared to 238 as a total number.

51 Salme Ahlstrom alcohol use and problems among the older men and women: A review Nordic

Studies on alcohol and drugs vol.24.2007 http://nat.stakes.fi/NR/rdonlyres/CE872FD3-0778-44B9-9C9D-D7CC5D4EDC1F/0/Ahlstrom.pdf 52 The Societal Cost of Alcohol Misuse in Scotland for 2007:2010

http://scotland.gov.uk/Resource/Doc/297819/0092744.pdf

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Chapter 10 – Recommendations From the research and information gathered the following recommendations are being put forward for consideration by the MADP. This list of recommendations is by no means exhaustive and it is anticipated that further recommendations will be brought to light by local experts through the consultation process.

• Regularly review the commissioning and funding of all alcohol and drug services in Moray to ensure maximum value for money whilst also taking into account the views of the service users to ensure that they reflect the needs of Moray.

• Ensure a more robust recording mechanism of person’s specific data from those organisations reporting into the MADP, to include data on gender, ethnicity, area of habitation. This will allow for more investigation into the needs of those with a substance misuse problem in Moray.

• Explore the possibility of post-treatment services in Moray to help service users to build confidence, job skills and prepare for post substance misuse life.

• Highlight the risk of injecting habits and the sharing of needles. The number of those in Moray who inject substances and share needles is still above the national average. Explore the possibility of establishing a needle exchange in Keith.

• Increase the awareness of the general public with regards to the alcohol and drug services offered in Moray.

• Conduct research into the drinking habits of the elderly in Moray, there are very few people in the older categories engaging with alcohol and drug services although there are estimated to be 2170 hazardous and 332 harmful drinkers over the age of 65 in Moray.

• Conduct research into why so many of those engaged with alcohol and drug services fail to attend appointments for referral and assessment. Also research into why there are so many unplanned discharges throughout the services in Moray.

• Construct a more effective way of measuring a service user’s progression through alcohol and drug services; possibly through the use of an Alcohol or Drug Outcome Star tool kit.

• Explore the blockages in the Waiting Times Data and formulate an action plan detailing how the MADP proposes to meet the 3 week target by March 2013.

• Engage with Grampian Fire and Rescue Services to secure their input to the MADP, as their work is also affected by substance misuse.

• Ensure that the alcohol and drug services in Moray are recording accurate figures on the SMR25 Drug Database, which is where the data from the Scottish Drug Misuse Statistics are taken from.

• There is currently no provision for young people who are misusing substances within the MADP services therefore it may be worth the Partnership exploring the feasibility of providing services for this age group.

• MADP to explore making stronger links with Children and Families Social Work with

regards to the parents who’s Children who are on the Child Protection Register due

to parental Alcohol or Drug abuse. Then encourage these parents to engage with

MADP services.

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References Ahlstrom, Salme: Alcohol use and problems among the older men and women: A review Nordic Studies on alcohol and drugs vol.24.2007 http://nat.stakes.fi/NR/rdonlyres/CE872FD3-0778-44B9-9C9D-D7CC5D4EDC1F/0/Ahlstrom.pdf Alcohol etc (Scotland) Act 2010 http://www.legislation.gov.uk/asp/2010/18/enacted Beeston C, Robinson M, Craig N, and Graham L. Monitoring and Evaluating Scotland’s Alcohol Strategy. Setting the Scene: Theory of change and baseline picture. Edinburgh: NHS Health Scotland; March 2011 http://www.child-smile.org.uk/uploads/documents/15312-MESASsettingTheSceneReport.pdf Calderwood, Carol: Child protection Register – Information Management March 2011 http://www.nescpc.org.uk/AboutNESCPC/Statistics.asp Drug Related Deaths in Scotland 2010 – National Records of Scotland 9 August 2011 http://www.gro-scotland.gov.uk/files2/stats/drug-related-deaths/2010/drug-related-deaths2010.pdf European Charter on Alcohol Adopted 12-14 December 1995 in Paris, France. http://www.euro.who.int/__data/assets/pdf_file/0008/79406/EUR_ICP_ALDT_94_03_CN01.pdf Economic Costs and Benefits: Institute of Alcohol Studies http://www.ias.org.uk/resources/factsheets/economic_costs_benefits.pdf Ludbrook, Anne: Alcohol: minimum pricing could decrease consumption, while increasing industry revenue by 68%: March 2009. http://www.abdn.ac.uk/news/archive-details-3718.php Moray Census 2001 Provided by The Moray Council: 30 September 2002 http://www.moray.gov.uk/Census_2001/MORAY%20CENSUS%202001.PDF National Records for Scotland – General Register Office for Scotland: April 2011 http://www.gro-scotland.gov.uk/files2/stats/council-area-data-sheets/moray-factsheet.pdf National Records for Scotland – General Register Office for Scotland: April 2011 http://www.gro-scotland.gov.uk/files2/stats/alcohol-related-deaths/ard-10-table3.pdf ISD Scottish Government: Drug Misuse Information Scotland. www.drugmisuse.isdscotland.org/publications/10dmss/10dmss_C3.xls Scottish Government: Estimating the National and Local Prevalence of Problem Drug Use in Scotland 2009/10 Publication date: 29th November 2011 http://www.drugmisuse.isdscotland.org/publications/local/prevalence2009_10.pdf?20852297545 Scottish Government: Alcohol Statistics Scotland 2011: February 2011 http://www.alcoholinformation.isdscotland.org/alcohol_misuse/files/alcohol_stats_bulletin_2011.pdf

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Scottish Government: The Societal Cost of Alcohol Misuse in Scotland for 2007: 2010 http://scotland.gov.uk/Resource/Doc/297819/0092744.pdf

Scottish Community Fire Safety Study (2009) Fatal Fire Survey: 20009 http://www.lothian.fire-uk.org/IMAGES/Scotland_Together.pdf

Scottish Government: HEAT: Alcohol Brief Interventions National Guidance on Data Reporting: 2011-12: December 2010 http://www.healthscotland.com/uploads/documents/15219-ABI%20National%20Guidance%20on%20Data%20Reporting%202011_12.pdf Scottish Government: Scottish Drug Misuse Statistics 2010: December 2010 http://www.drugmisuse.isdscotland.org/publications/10dmss/10dmss.pdf Scottish Government: The Scottish Health Survey 2010: September 2011 http://www.scotland.gov.uk/Resource/Doc/358842/0121284.pdf Scottish Government: ALCOHOL (MINIMUM PRICING) (SCOTLAND) BILL EXPLANATORY NOTES (AND OTHER ACCOMPANYING DOCUMENTS) http://www.scottish.parliament.uk/S4_Bills/Alcohol%20(Minimum%20Pricing)%20(Scotland)%20Bill/Ex_Notes_and_FM.pdf Scottish Government: The Societal Cost of Alcohol Misuse in Scotland for 2007: 2010 http://www.scotland.gov.uk/Publications/2009/12/29122804/0 Scottish Government: Alcohol (Minimum Pricing) (Scotland) Bill November 2011 http://www.scottish.parliament.uk/parliamentarybusiness/Bills/576.aspx Scottish Government: News Release Minimum Pricing Bill November 2011 http://www.scotland.gov.uk/News/Releases/2011/11/01093248 Scotland Census Results Online http://www.scrol.gov.uk/scrol/common/home.jsp Scottish Government: Drug and Alcohol Services in Scotland: Audit Scotland Report 2009: 26 March 2009. http://www.audit-scotland.gov.uk/docs/health/2009/nr_090326_drugs_alcohol.pdf Scottish Government: A New Framework for Local Partnerships on Alcohol and Drugs: 20 April 2009 http://www.scotland.gov.uk/Resource/Doc/270101/0080412.pdf Scottish Government: Changing Scotland’s Relationship with Alcohol: A Framework for Action: February 2009 http://scotland.gov.uk/Resource/Doc/262905/0078610.pdf Scottish Government: The Road to Recovery: a New Approach to Tackling Scotland’s Drug Problem 29 May 2008 http://www.scotland.gov.uk/Resource/Doc/224480/0060586.pdf Scottish Health Action on Alcohol Problems http://www.shaap.org.uk/pages/74,Health_costs.html

Smith, Heather, McKinnon, Kateryna, McDonald, Claire: Highlands and Islands Enterprise Area Profile for Moray January 2011 http://www.hie.co.uk/highlands-and-islands/economic-reports-and-research/

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Appendix 1 Questionnaire – Service Providers Survey and Answers Strongly

Agree Agree

Don’t Know

Disagree Strongly Disagree

Everyone is treated equally regardless of race, gender, disability, age or belief.

11 3 1

Our confidentiality policy is clearly explained to service users.

15 4

We make service users aware of other services that may be of use to them.

15 4

We provide service users with a safe and comfortable environment when they attend appointments.

15 4

We help service users to find adequate health care and give them good health advice.

8 7 3 1

We aid service users to make their situations better.

10 8 1

The single shared assessment allows service users the ability to work out what the issues are and what can be done about them.

10 3 3 2

We work well with other services. 10 5 2

When we receive a referral the application is dealt with quickly

11 6 0

We are good at finding ways to keep improving the service we provide

8 6 4

If a service user is not happy with the service provided we tell them how to make a complaint.

10 5 2

We are good at adapting when service users need change

6 7 4

We provide enough information about our service to help service users decide whether to engage with our service.

11 6 1

Service users find it easy and convenient to get to our service

6 10 2 1

We help service users to get ready for work, training and volunteering

4 8 4 2

We allow service users/families/partner/carers to let us know what they need.

3 5 6 4

Service users get to have a say in how the service should be run.

4 9 4 3

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Yes No Don’t Know

Should your services be expanded

14 3 1

Is your venue/building adequate for the needs of the service user

5 14 0

Do the opening times of your service reflect the needs of the service

11 5 1

Do you feel there are any staffing issues within your service

10 9 0

Do you feel that there should be more service user involvement with your service

13 5 1

Does your service make provisions for those living in a rural area or those unable to attend Elgin

17 1 0

Does your service consider the aftercare issues of the service user

14 3

Would you like more communication with GP’s/Health Policy? Other networks or services

15 3

Does your service require more evaluating and or monitoring

3 16