SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Clinical & Policy Updates:
SMMGP Policy Update January 2009

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Good Practice in Harm Reduction Report, NTA (October 2008)

November's Policy Update is dedicated to the Department for Work and Pensions (DWP) Green Paper "No one written off: reforming welfare to reward responsibility" and your response to it. The paper attempts to set out plans for improving support and work incentives to create a system that rewards responsibility and delivers greater choice and control over the support that is provided.

In chapter 2 "An Obligation to Work" the DWP estimate that 240,000 people in England are in receipt of out-of-work benefits and are dependent on opiates or crack cocaine (problem drug users). This is around three-quarters of the estimated total number of people who are dependent on these drugs. The proposed plans could have a significant impact, potentially both positive and negative, on people who are "out-of-work" and claiming benefit, but for drug users it means a new regime.

The aim of the report is to highlight good practice in harm reduction based on interviews with local drug partnerships that performed well in the 2006/07 National Treatment Agency (NTA) and Healthcare Commission (HCC) service reviews, and to identify good practice in interventions to reduce drug-related harm related to blood- borne virus and overdose.

Drug-related deaths have gone down in recent years but by 2004 government targets had not been met. Harm reduction was selected as a priority for the 2006/07service review because of concerns about the increasing incidence of blood-borne viruses being recorded by the Health Protection Agency (2007) and failure to reach the government targets on drug related deaths.

Harm reduction combines work aimed directly at reducing the number of drug-related deaths and blood-borne virus infections, with wider goals of preventing drug misuse and of encouraging stabilisation in treatment and support for abstinence. Providing effective substitution treatments and effective support for abstinence are complementary aims of such a balanced response.
- Reducing Drug-Related Harm: An Action Plan (DH & NTA, 2007)

The 3-year programme of annual service reviews started in 2005 and is a key element of the NTA's aim to enhance the quality, consistency and effectiveness of drug treatment. Service reviews are designed to assess local drug services and systems against national standards. They provide the benchmark of the quality of drug treatment and provide information on areas of weakness, against which improvement can be planned. The 2006/07 reviews assessed the performance of 149 local drug partnerships on two key areas:

Within these two themes, ten criteria were developed that were indicators for effective commissioning and harm reduction provision. Criteria 1-6 focused on commissioning and criteria 7-10 were developed to assess harm reduction interventions. Within each criterion there were a number of questions, the results are summarised in the graph below.



The NTA regional teams have used the results of the service review to inform their work with local drug partnerships, as part of the treatment planning process. In addition they interviewed partnerships that scored highly against the harm reduction criteria to find out about their strategies and practices in delivering harm reduction to determine what lessons could be learnt. Urban and rural partnerships and a variety of staff were interviewed, in order to identify a number of common themes that the partnerships believed contributed towards good practice. These are outlined below:

Key Factors Influencing Good Practice in Harm Reduction

Harm reduction embedded in the system

Prompt and flexible access

Making access to harm reduction services easy as possible for clients was achieved in the interviewed partnerships through:

Action to reduce deaths from overdose

Competent staff

Other factors

Community prescribing services

Community prescribing services were assessed as providing, in the main, a good range of harm reduction initiatives. However the interviews reflected that even in the partnerships that are performing well improvements were needed in the following areas:

SMMGP comment

This is an important report and it's great that harm reduction has been given prominence by the NTA and the HCC. There are useful examples of good practice highlighted in the report. It's pleasing that we are getting some things right but there is still work to be done. The recognition of the importance of service user involvement in planning and delivering harm reduction services and how this can effect change in services is refreshing and a vital point.

Although there are examples of good practice there are still many improvements to be made concerning services for hepatitis B and C and reducing drug-related deaths. We need to ensure that all our patients have access to testing and vaccinations and that they are competent to manage their own and other's overdoses.