Issue - meetings

To consider an update from the Democratic Service Manager.

The Scrutiny Committee will be invited to consider the initial conclusions and recommendations of the Alcohol Services Scrutiny Review.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

The Chair invited the Scrutiny Committee to consider the possible conclusions and recommendations of the review of Alcohol Services. It was suggested that these be phrased in the form of questions.

Broadly, these were:-

·         What were partners doing to ensure front line staff were trained to identify those with alcohol dependency/ misuses issues and appropriately signpost to services? What more could be done to monitor referrals being made and whether questions were being asked during appointments with patients and clients?

·         Were partners ensuring that limited resources are targeted effectively at those cohorts most at risk?

·         Could partners do more to ensure those in treatment have more timely access to other mental health services, such as IAPT and counselling?

·         Were partners ensuring that support was provided to the family to those in treatment given the importance of family in someone’s recovery?

·         Were partners doing enough to provide practical support for people in recovery, e.g., help with housing, benefits etc.?

·         Could the Council and CCG be clearer in their public health messages about alcohol? Do the public understand how many units are safe?

·         Should the Council revisiting Minimum Unit Pricing and continue to lobby government for its introduction?

RESOLVED – That the Democratic Services Manager be requested to prepare the final report of the Scrutiny Committee’s Review of Alcohol Services for the next meeting on 24 February 2015 and that the conclusions and recommendations presented at this meeting form the basis of that report.

A copy of the Greater Manchester Alcohol Strategy is enclosed.

Officers from the Public Health Team will provide the Committee with an update on the implications of the Strategy for Stockport and work underway to support it.

A representative of the Director of Public Health submitted the Greater Manchester Alcohol Strategy (copies of which had been circulated) and highlighted the key issues relevant to Stockport.

The following comments were made/ issues raised:-

·         There was a lot of emphasis in the document on the economy and a strategic considerations rather than the impact on an individual’s health.

·         There were examples locally of successful engagement with licensees through Pub Watch schemes, particularly in Hazel Grove, but this was highly dependent on their willingness to drive the agenda. The Police were key to their success, particularly in supporting the work through enforcement. Enforcing the law in respect of not selling alcohol to those already drunk was a difficult task.

·         Dealing with offenders, or those in custody, was an area where working across Greater Manchester could make an impact. The development of lifestyle assessments being done in the custody suite was an example of good practice being shared across the area.

·         There were examples of services being commissioned through GM frameworks to get better value, such as residential detox, but there was always need for locally tailored services.

·         The Strategy currently lacked a detailed action plan, and this was being prepared.

RESOLVED – That the Strategy be noted and the Review Final Report include a recommendation to Public Health England seeking clarity on the likely impact of Priorities 6-11 on Stockport.

Councillors and officers are invited to provide feedback from the previous meeting and the discussions with service users, carers and volunteers.

Representatives of the Clinical Commissioning Group have also been invited to the meeting to address concerns raised in respect of access to services.

The Chair invited those at the meeting to provide feedback and reflect on the Scrutiny Committee’s recent engagement with Alcohol Treatment service users and carers.

A representative of the Democratic Service Manager also provided an update from the Clinical Commissioning Group (CCG) in relation to a number of points raised at the engagement session that the Scrutiny Committee had sought comment on related to the CCG activity. This included the following points:-

Dual/double diagnosis

An assessment of an individual patient be able to identify a person’s key problems and needs, including where alcohol dependency was masking an underlying mental health problem. The key to overcoming this was the effectiveness of the assessment process.

Delay in accessing IAPT and other therapies

IAPT, Self Help Services provide an e-Therapy dual diagnosis package called Breaking Free, it is targeted at people with mild to moderate conditions.

·         100 treatments are available on an annual basis

·         There is open referral to this service, i.e. people can self-refer, this is seen as the preferred method because it demonstrates motivation to engage

·         Referrals to the service are low

·         The service report good recovery targets and very good patient experience

·         Waiting times to access step two/services for people with mild to moderate problems are low, i.e. 99% of people can access Self Help Services within 4 weeks

In relation to Step 3 IAPT services, for Cognitive Behaviour Therapy (CBT) and counselling this continues to be challenging, largely based on the length of time people were in treatment, however good progress around waiting times had been made.

·         60% of people can access CBT within 18 weeks

·         455 of people can access counselling within 18 weeks (this is a much smaller service and the wait is longer)

·         Access to secondary care psychological services requires people to be care co-ordinated and this therapy takes place as part of a care package. 

Councillors expressed concerns that an 18 week wait was significant and would make ‘early’ intervention a challenge.

The following additional comments were made/ issues raised:-

·         The role of the GP in identification of those with alcohol abuse problems. It was commented that there was often variability in awareness amongst practices and engagement with training provided by Public Health. It was not possible to monitor whether GPs raised alcohol consumption during consultations, but data did show that there were some practices that never made referrals to the Healthy Stockport service.  In relation to the training of GPs, it was suggested that within a practice it may be that an individual GP specialised in a particular areas, so that not all GPs within the practice were as aware of alcohol issues as others. It was queried that if GPs were not referring to the Health Stockport service or to START, then what were they doing to address patients with unsafe drinking levels?

·         The issues raised in relation to benefits and advice from DWP was not within the remit of this Scrutiny Committee but the local MPs could be asked to write to the relevant Minister. Further detail was needed from colleagues at Pennine Care NHS Trust to understand the detail of these problems.

·         The role of the family was particularly important, particularly in identifying problem drinking, convincing relatives to seek help, and providing ongoing support through treatment and recovery. They could often act as an ‘ally’ to both the user and for those working within services.

RESOLVED – That in relation to the feedback from service users and carers, that further information be sought on the following issues for inclusion within the Review Final Report:-

·         Clarification from the CCG on the maximum waiting times for IAPT and CBT.

·         Whether the CCG had data on training and monitoring of GPs in relation to alcohol misuse.

·         Further details from Pennine Care NHS Foundation Trust on problems encountered by service users in relation to benefits payments and support from DWP and Job Centre Plus.  ...  view the full minutes text for item 3

(Note: the Chair was of the opinion that this item, although not included on the agenda, should be considered as a matter of urgency in accordance with Section 100B(4)(b) of the Local Government Act 1972 in order that the matter could be considered promptly as part of the current Scrutiny Review)

A representative of the Democratic Services Manager submitted a Public Health England profile for Liver Disease (copies of which had been circulated). The profile indicated that the rates of mortality for liver disease were significantly higher in Stockport than the national average. The Profile also posed 5 key questions for local decision makers.

RESOLVED – That the report be noted and the following questions be posed to the relevant departments:-

·         Question 3 – ‘Are the links between availability of alcohol and alcohol related harm explicitly considered in local licensing policy, and when reviewing new licensing applications?’ referred to the Public Protection Service.

·         Question 4 – ‘Are local health and social care staff trained to routinely provide early identification of problem drinking and provide brief alcohol advice?’ referred to Adult Social Care, Children & Young People Services, and Stockport Clinical Commissioning Group.

The Scrutiny Committee will discuss issues relating to alcohol services with current service users.

The Scrutiny Committee invited alcohol service users and carers to discuss their experiences of alcohol services and to give their views on potential improvements.

The following issues were identified for further consideration by the Scrutiny Committee as part of its Review:-

·         Problems with double diagnosis of alcohol dependency and mental ill-health.

·         Waiting lists for IAPT and other therapies.

·         Concerns about awareness amongst health professionals, particular GPs, of key symptoms of alcohol dependency, and the risk of missing opportunities for interventions.

·         Problems with the interaction between Job Centre, Work Programme providers and Department for Work and Pensions leading to benefit changes/ financial hardship.

·         The value of practical assistance and welfare support and the possibility of expansion of this activity.

·         The value of support for relatives and families.

RESOLVED – That the service users and carers be thanked for their contribution.

Providers of alcohol treatment and support services have been invited to the meeting to provide an overview of their services and to answer questions from the Scrutiny Committee.

A copy of the presentation slides from the last meeting are included as an aide memoir.

The Chair invited representatives of organisations providing alcohol treatment and prevention services to provide an overview of their services and identify key issues for the Scrutiny Committee to consider as part of the Review of Alcohol Services.

Matthew Phoenix – Pennine Care NHS Foundation Trust (Cirtek House)

·         Services provided for adults over 26 years.

·         Focus of services provided at Cirtek House was on those who were alcohol dependent (drinking daily).

·         Treatments including detoxification (nurse led), or control and reduction of consumption.

·         Work with Stepping Hill Hospital to address repeat/frequent attenders caused by alcohol and diversion into community-based support.

·         Increased focus on aftercare provision to maintain abstinence, run principally by ex-service users. This included drop-in groups, regular phone contact to monitor and support service users, and signposting to other support. There was also an emphasis on reintegration.

Billy Hooley - Addiction Dependency Solutions (ADS)

·         ADS was a charity, working from Cirtek House, and providing support to a range of substance misusers. Recently began work with alcohol misuse.

·         Focus of activity was at the lower thresholds of misuse, usually before dependency, but where behaviour was harmful. Provided support to improve their social circumstances.

·         Service users often had multiple problems and relied on support from a range of agencies.

Brett Pagdin – Healthy Stockport

·         Working at the lower end of the spectrum of need, with a focus on prevention, health promotion and awareness raising, particularly with GPs and other health professionals in relation to symptoms and signs of risky behaviour.

·         Brief interventions provided in the form of lifestyle discussions with clients to identify reasons for change and identify goals to motivate that change.

·         Engagement with health and social care workers to encourage their clients to have a conversation about lifestyle via a referral to Healthy Stockport.

·         Healthy Stockport took a holistic approach to lifestyle that made conversations easier, rather than focus on one behaviour only.

Grant Jackson – Stockport NHS Foundation Trust

·         Alcohol nurses were now embedded within the hospital, particularly in the Emergency Department. Research indicated that 1 in 8 patients would change behaviour as a result of conversation with a practitioner in hospital. Efforts were ongoing to ensure this contact was mainstream activity.

·         There were approximately 50 admissions per week due to alcohol intoxication, not including those who did not admit to this as a cause.

·         Efforts were ongoing to bring together services to address repeat attenders.

·         There was a particular problem with those who were homeless as they did not have access to GP and primary care services. There were pathways to support these individuals but often there were serious challenges in these cases.

Dr Steve Watkins, Director for Public Health

·         Limited intake of alcohol could have a beneficial affect, but most people did not drink such small quantities.

·         There was a danger in unsafe levels of drinking not just because of its impact on health, but because of the danger in being drunk and suffering impairment of judgement.

·         There were clear benefits to early intervention but often interventions were only successful in changing behaviour after a crisis.

·         The community and families of misusers were vital to supporting people in recovery and in maintaining abstinence.

Councillors then asked questions and made comments, including:-

·         Given the rise in 30 year old adults developing liver problems, it was suggested that alcohol messages in schools were not proving effective. There was research to suggest that public health messages directed at children were most effective with those children who were least likely to engage in risky behaviour, so it would be more effective to focus on developing young people’s skills to make sound choices. In California, significant reductions in smoking had been achieved with a policy to not promote anti-smoking messages in schools as this reinforced the impressions of smoking being adult behaviour.

·         Attitudes towards drinking were ingrained within British culture, with ‘fun’ often being framed within the context of alcohol. Unsafe  ...  view the full minutes text for item 2

To consider a report of the Deputy Director of Public Health.

The report provides background information to inform the Scrutiny Committee’s discussions and deliberations about alcohol services, including the national policy context and key service data.

A presentation will also be made at the meeting by commissions on current local provision to help ‘set the scene’ for the Review.

It is recommended that the Scrutiny Committee consider this paper and the presentation which will be delivered at the meeting, and discuss the key themes.

Officer contact: Alison Leigh, 0161 474 3017, alison.leigh@stockport.gov.uk

Donna Sager (Deputy Director of Public Health), accompanied by Alison Leigh (Community Safety and Neighbourhoods Manager, Public Health Substances Lead), Philip Leigh (Community Safety Operations Manager Substances, Commissioning & Policy Team), Simon Armour (Senior Public Health Adviser (Alcohol)) and Toria Dante (START Manager), attended the meeting and made a presentation on alcohol related issues in Stockport. The presentation sought to ‘set the scene’ for the Scrutiny Committee’s Review of Alcohol Services.

The presentation covered the following issues:-

·         On outline project plan for the Review.

·         Statistical information in relation to alcohol related harm, hospital admissions and deprivation.

·         Current preventative programmes.

·         The policy on specialist treatment and data on treatment.

·         Types of treatment available.

·         The referral process and the role of START (Stockport Treatment Access to Recovery Team).

·         Current challenges and drivers for the future.

Councillors then asked questions and discussed the issues raised in the presentation. The following issues were raised:-

·         The headline trend in relation to alcohol was that it was cheaper, stronger and more easily available. There was an overall increase in adult drinking, but young people were drinking less. There was increasing drinking amongst the older age ranges. The consequence was that although good treatment services were available, there was insufficient capacity to respond to rising demand. Greater emphasise was needed on outcomes and moving patients from treatment to recovery.

·         Health indictors in relation to alcohol suggested that current performance could be improved, and invited consideration of whether current levels of expenditure on recovery were effective.

·         Messages around safe alcohol consumption were often difficult to get across, particularly in relation to units. The clinical definition of ‘binge’ drinking was often much less than the public perception of what this term meant.

·         Although the amount women drink had increased over the last decade, this was now declining as part of the general decline. However, harmful levels of drinking were increasing.

·         START now acted as ‘gatekeeper’ to detox programmes so greater emphasis was placed on ensuring appropriate referrals and greater preparatory work before this took place. This had led to a reduction in the number of repeat detox treatments as there was greater emphasis on outcomes and recovery. Where residential detox was necessary, there was a short waiting time between initial assessment and placement within treatment.

·         There was research suggesting that many people who drank unsafe amounts of alcohol were able to resolve, manage or reduce this by themselves, although this was difficult to measure.

·         There was a strong recovery movement developing in Stockport, built on mutual support of those in recovery. These schemes, such as the Green Man project in Woodbank Park, were generated by those in recovery and were more sustainable because of that.

·         Social isolation amongst older residents may be a factor in unsafe, and unsocial, drinking.

·         There were also in-direct health implications of drinking, such as obesity from the ‘empty calories’.

·         It was difficult to assess the cost of alcohol misuse on council services, although the NHS had done work in this area. Research by the University of Sheffield had been done to estimate these costs.

·         Given the scale of the problem, how long would it take for changes to policies and services have to show any impact, and would any savings be accrued to those agencies making the difficult decisions?

·         The development of the Integrated Safeguarding and Prevention Service for children and young people was an example of a more holistic service, which would help with prevention of risky behaviour by building resilience.

·         It was the aspiration of the Council to continue to help every person who sought it, although it was not possible for professionals to maintain that support for the duration of someone’s recovery. It was important not to over-medicalise treatment and support, and the input of former users was invaluable. In many cases they were more challenging to clients and were willing to have difficult conversations in circumstances that professionals would be  ...  view the full minutes text for item 2