Addiction Services hampered by lack of information and joined up working

The Northern Ireland Assembly Public Accounts Committee has published a report, entitled Addiction Services in Northern Ireland, which highlights long-standing problems with addiction services here. Issues covered in the report include a failure to work across government, the length of time it has taken to produce a new substance use strategy and the high use of prescription drugs.

In addition, the report reveals the lack of reliable data on addiction services, a problem that has not been resolved for years after it was originally identified. The Committee was particularly concerned about how the Department of Health could be assured that its services were effective if the available data was not of a high quality.

Chairman of the Committee, William Humphrey MBE MLA said: “We are all too aware that there is a serious substance use problem here in Northern Ireland and this has been known for many years. It is for that reason that we are particularly alarmed it has taken five years to produce a strategy to combat this.

“Substance use is a silent pandemic that has been ravaging our community for far too long. It is not just a health issue—it touches all aspects of our society and must be dealt with in a holistic way – across Government.

“While we are encouraged that the new strategy emphasises a collaborative, cross sectoral approach, a commitment on paper must be followed up by action and, in particular, sufficient funding to implement this strategy. It is not enough for the Department to implement a strategy; this issue needs to be led by the Executive, with the clear objective of reducing drug and alcohol related deaths.”

The Committee was also concerned that successfully implementing the new strategy will require more than the proposed £6 million per year of additional funding, which is not even agreed. Without securing these monies, the Department will be forced to make hard choices about the elements of the strategy that will be funded.

Similarly, the Committee noted that community and voluntary sector (CVS) organisations, which are key partners in delivering addiction services, are often the first ones to find their funding withdrawn to ease the Executive’s financial pressures. Not only does this impact on those using CVS services, it also harms some of the most cost-effective intervention programmes.

Chairman Humphrey concluded: “While we welcome the new integrated strategy, we believe that the Department needs to go further in how it approaches substance use. Not only does there need to be a serious and funded joined up approach, there also needs to be more attention paid to making counselling and intensive treatment available to those who would benefit from these approaches.

“We look forward to the execution of this new strategy and believe that if it is implemented in full, it will make a significant impact on substance use in our community.”

ENDS

Notes to Editors

The full Report on Addiction Services in Northern Ireland can be found on the Assembly website.

The Committee’s recommendations from the Report are:

Recommendation 1

Evidence provided to the Committee showed that Addiction Services has suffered from a lack of strategic attention. Strategy development, and a focus on outcomes demonstrates to stakeholders and service users that the Department is serious about tackling substance use. The absence of an up-to-date substance use strategy for the last five years indicates that this area has not been enough of a priority for the Department.

Setting clear objectives for reducing harms caused by addiction is an important part of strategy development. Whilst many of the targets within the old strategy were achieved, these have not effectively addressed the growing impact of substance use. Drug and alcohol related deaths have risen sharply, and are likely to continue without an effective strategy.

The Committee recommends that reducing the harm caused by addiction should be the focus of the Department’s efforts going forward, with a clear objective of reducing drug and alcohol related deaths.

Recommendation 2

Attempts at collaboration within the health and social care sector have not always been good in the past and the Committee has some reservations about how successful this approach will be this time around. It is clear that greater connectivity is needed and the Department should lead on this.

The Committee recommends that the Department puts a clear focus on continuing to build and strengthen collaborative work across the Health and Social Care sector to tackle drug and alcohol and use.

Recommendation 3

It is clear that actions taken by the Department alone will not be enough to deal with the significant and growing harms related to substance use. The co-production approach to the new strategy is a welcome development, and there is recognition that joined-up action across government is required to tackle these issues effectively.

Given the current pressures on the Health sector, the Committee recommends that consideration is given to the centre of government providing leadership to ensure a genuinely system wide-approach to tackling this issue.

Recommendation 4

Implementation of the new strategy will require more than £6 million per annum of additional funding which has not yet been secured. Without this funding the Department will have hard choices to make about which elements of the strategy cannot be fully implemented. Funding the strategy is a clear spend-to-save issue, and additional funding can make a significant contribution to future savings across the public sector.

The Committee recommends that the Department puts forward a robust case for the additional funding needed to fully implement the substance use strategy, outlining its spend-to-save potential, and urges the Executive to ensure that support for the strategy translates into actual budget cover.

Recommendation 5

The C&AG’s report highlighted significant deficiencies with the data the Department has on addiction services. Issues with data quality and completeness are a frequent cause for concern with public sector services and it is disappointing to note that these have been ongoing for years. Understanding what works, and the impact interventions have on people’s recovery should underpin future service provision. Resolving data issues, and getting better information on the services it funds and outcomes for service users should be a priority for the Department.

The Committee recommends that the Department addresses issues with data quality and completeness urgently, and that future monitoring has a clear focus on measuring outcomes for service users. Any future strategy and service development must be informed by robust, reliable evidence obtained from services.

Recommendation 6

Community and voluntary sector (CVS) organisations are key partners in delivering addiction services, and there is clear evidence that they provide successful and cost effective harm reduction and early intervention projects. However, CVS services are often amongst the first to have funding withdrawn when central government is under financial pressure. This kind of short-termism creates significant uncertainty for organisations, their staff and the service users that rely on them for help and will ultimately result in poorer outcomes.

The Committee recommends that the Department commits to working in partnership with Community and Voluntary Sector organisations and strongly encourages the Department to provide more certainty around funding arrangements and contracts for these organisations.

Recommendation 7

It is vitally important that people are able to access the right services, at the right time. For many of those suffering from addiction, their first contact with the health service comes either through attendance at the Emergency Department or via general practice. Whilst both of these areas are under intense pressure, it is essential that work is undertaken to ensure that there are effective pathways to refer people to addiction services. Referrals to the wrong type of service can have a serious impact on service users, and can contribute to prolonged waiting times.

There is much more work to be done with GPs, in particular raising awareness of Tier 1 and 2 services, and in improving participation in shared care for the Substitute Prescribing Service (SPS). It is clear that the shared care model for Substitute Prescribing has not worked, in part due to a reluctance by GPs to participate. Shared care is an important step in normalising care for patients, and could also reduce pressures on Community Addiction Teams.

The Committee recommends that the Department investigates the failure of the shared care model in some regions and establishes clear plans to increase the number of GPs involved in this care.

Recommendation 8

Some people will need more intensive, residential treatment for their addiction. However, there is little in the way of integration for residential rehabilitation services, and two HSC Trusts have no formal access to these beds. This is unacceptable. Although the Department has been aware of the need for a more consistent, regional approach to these services for years, it has made no attempt to review them, meaning that people continue to be treated in the community, even though this may often be inappropriate.

The Committee recommends that the Department should urgently undertake a fundamental review of residential rehabilitation services to ensure consistent and equitable access. Any review should include the provision of aftercare.

Recommendation 9

High prescribing rates of some prescription drugs are a significant cause for concern, particularly as these drugs are now involved in the majority of drug related deaths in Northern Ireland. Over the last decade, there have been a number of attempts by the HSC Board to highlight the risks associated Pregabalin, but these have made very little impact, with prescribing rates and related harms continuing to rise sharply.  The high prescribing rates of Pregabalin was raised as an issue in 2015 by the PAC in their inquiry into Primary Care Prescribing.  Progress in this area has been much too slow and it is very concerning that the Department does not appear to have a clear understanding of why prescribing rates are so much higher in Northern Ireland than elsewhere in the UK.

The Committee recommends that work is undertaken to investigate the sources of these harmful drugs. In our view, this is not just a Health issue, and so a wider response from the centre of government is also required.

Recommendation 10

Alternative therapies, such as cognitive behavioural therapy and counselling, can be as effective as prescription drugs for some people. However, there are often long waiting lists for these therapies and, although the Department intends to expand social prescribing, progress has been slow.

The Committee recommends that the Department continues its efforts to make progress on social prescribing and the availability of alternative therapies.

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Debra Savage

Communications Officer

Northern Ireland Assembly

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Email: debra.savage@niassembly.gov.uk