Existing services and the wraparound challenges

1
Existing services and the wraparound challenges

• Biba Brand
• West of Scotland Regional Manager

2
Core Services

• Structured 11 work
• Structured group work
• Substitute prescribing
• Medicated detoxification
• Community rehabilitation programmes
• Needle exchange
• Harm reduction
• Direct access drug services
• Residential rehabilitation (varies by area)
• Inpatient detoxification (varies by area)

3
Wraparound Services

• Primary health care
• Child care and parenting support
• Housing support and advice
• Employment and training support
• Financial advice and support
• Family planning services
• BBV testing, support and treatment
• Clinical psychology
• Mental health services

4
Models of wraparound

• Integrated wraparound services based within
  frontline drug services, but linked to mainstream
  providers
• In-reach from wraparound services - weekly legal
  surgeries, mobile crèches, mobile dental units,
  college input
• External wraparound services - Money Advice, P2W,
  Parenting support services
• Resource Officers

5
Barriers to wraparound

• Funding
• Blockages in services
• Overloaded frontline staff
• Lack of interagency referrals
• Reluctance to close cases or hand over to GPs
• Highly supervised prescribing - travel, cost
• Recovery impatience and caring fatigue
• Can drug policy really address other policy
  challenges

6
Methadone drug dispensing fee () Scotlands
total 12.2m
7
Cost of methadone supervision () handling
fee - Scotlands total 12.4m 1m for prisoners
8
Methadone Dispensing and Drug Deaths, 2006
9
Lothian Model

• 70 of GPs within the enhanced medical services
  (90 GP practices)
• 2500 stable drug users prescribed methadone
  within GP services. Here 84 are supervised once
  or more per annum (usually one 2 week period).
• 1000 unstable drug users within specialist drug
  services.
• Overall
• 80 daily supervised (estimate)
• 20 take home methadone (estimate)
• No higher rates of drug deaths

10
Choices

• 25m Scotlands spend on methadone and various
  fees
• 12.2m for the methadone drug and dispensing fees
• 12.4m cost for supervising and handling a
  controlled drug ( 1m for prisoners)
• methadone alone costs 1.45 100ml (BNF, 2006)

11
Wraparound - Employability

• 3.3m pa New Futures Fund (employability for
  all care groups)
• 1,100 service users supported annually
• How much of the Incapacity Benefit Reforms are
  going on Progress2Work in Scotland?
• Are we shifting people from benefits to in-work
  poverty?
• Should we recognise and value caring and
  volunteering carried out by those unable to
  work?

12
Wraparound Housing Support

• Accessing good quality housing
• Maintaining tenancies
• Affordable lets and support for people moving
  on
• Supporting People helped 164,000 people in
  2005/06 - only 2,500 drug users received support

13
Wraparound Welfare Advice

• SDF survey of 110 drug users average council
  tax debt of 2,000
• Total debt of 220,000 simply due to failure to
  complete a form
• What are the hidden debt challenges among the
  22,000 on methadone for mainstream drug and
  money advice services in Scotland?

14
Wraparound Parenting Support

• 1700 foster homes needed for vulnerable children
  currently Works out at 51m cost, i.e. 30k per
  child
• Average Parent Support service working with 40
  families costs 350k (approx)
• 15m to would support 1700 families based on
  these figures
• Far reaching benefits with this model

15
What makes wraparound work?

• More effective use of GPs
• Remove blockages in services reduce strain on
  services
• Find resources for wraparound provision
• Fund what makes a difference to drug users and
  whats best value
• Recommendations about wraparound support in
  Scotlands National Drug Strategy