Updating the NICE NSP Guidance

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• Updating the NICE NSP Guidance

• Chris Carmona, Public Health Analyst
• Centre for Public Health

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Plan

• Rationale for the update
• The draft NSP recommendations
• Changes from the original guidance
• Implementation issues
• Questions.

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Updating the guidance
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Process

• Guidance was published in Feb 2009 and was
  reviewed in Apr 2012
• An expert group considered whether any new
  evidence or significant changes in policy and
  practice would be likely to lead to substantively
  different recommendations.
• The proposal of the expert group was consulted on
  publicly.
• On the basis of consultation and expert opinion,
  NICE decide whether or not to update the guidance.

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Decision

• The review process concluded that
• There was no new evidence to contradict the
  current recommendations
• There was new evidence that could add to existing
  recommendations
• There was new evidence that could expand the
  previous work to more fully meet the scope

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• NICE decided to undertake an update of the
  existing NSP guidance.
• Following the expert group and consultation, the
  update focussed on
• New evidence related to existing recommendations
• Vending machines, outreach, drop boxes.
• NSP provision to PIED users
• NSP provision to under 18s

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Drafting the giuidance

• CPH commissioned reviews of the evidence.
• A public health advisory committee (PHAC)
  considered the evidence.
• On the basis of the evidence and public
  consultation they drafted new recommendations and
  updated old recommendations.

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Original recommendations
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Recommendation 1 Planning, needs assessment and
community engagement

• Look at local need and local data on use and
  geographic spread (including estimating coverage)
• Make sure NSPs are configured to meet this need
  both temporally and spatially
• Do all of this in consultation with PWID and
  local communities

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Recommendation 2 Meeting need

• Commission a range of generic and targeted
  services that aim to increase coverage (ideally
  to over 100)
• Develop strategies for disposing of dirty needles
  safely
• Encourage syringe identification schemes
• Audit services
• Integrated care pathways.

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Recommendation 3 Types of service

• Set up a 3-tier model of service provision
• Make sure services are co-ordinated to provide
  good temporal coverage in each 24 hour period.
• Make sure people who are on OST can also get
  clean needles and syringes.

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3 tier model of NSP provision

• level one distribution of injecting equipment
  either loose or in packs, with written
  information on harm reduction (for example, on
  safer injecting or overdose prevention)
• level two distribution of pick and mix
  (bespoke) injecting equipment plus health
  promotion advice (including advice and
  information on how to reduce the harms caused by
  injecting drugs)
• level three level two plus provision of, or
  referral to, specialist services (for example,
  vaccinations, drug treatment and secondary care).

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Recommendation 4 Equipment and advice

• Provide people with as many needles and syringes
  as they need, without arbitrary limitation.
• Provide them with sharps bins
• Provide them with other equipment they need to
  safely take drugs
• Provide them with information and a gateway to
  services

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Recommendation 5 Community pharmacy-based NSPs

• Make sure staff are appropriately trained for the
  level of NSP work theyre doing
• Collect used sharps bins
• Offer staff Hep B vaccination

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Recommendation 6 Specialist NSPs level three
services

• In addition to the above,
• Offer a range of needles, syringes and equipment.
• Provide harm-reduction services
• advice on safer injecting practices, assessment
  of injection-site infections,
• advice on preventing overdoses and
• help to stop injecting drugs.
• Where appropriate, offer a referral to opioid
  substitution therapy services.
• Offer (or help people to access) a range of
  health and welfare services.

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Whats new?
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Caveat

• The updated guidance is still not fully signed
  off so I am unable to share with you the exact
  wording and content, and anything that I say
  today may change during the final sign off
  processes within NICE.
• The final decisions will be made in mid Feb and
  the guidance will be published on March 26th 2014.

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Whats new?

• There are two completely new recommendations.
• There are some notable additions to
  recommendations.
• The early recommendations have been reorganised
  to make them more logical.

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Developing a policy for young people aged under
16

• Requires local areas to develop and implement a
  policy on providing NSP and related services to
  young people aged under 18 (including young
  people under 16).
• Asks how local services will achieve the right
  balance between the imperative to provide young
  people with injecting equipment and the duty to
  safeguard them and provide advice on harm
  reduction and other services. It includes
• the young persons capacity to consent
• the risks they face
• the benefits of them using services
• the likelihood that they would inject anyway,
  even if equipment was not provided.
• Provide NSP as part of a package of care (esp to
  under 16s) where possible.
• Offers some ideas about the things local areas
  will need to consider, for example consent,
  parental involvement, specialist substance
  misuse services for YP, training needs

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Provide equipment and advice to people who inject
IPED

• Ensure needle and syringe programmes
• Are provided at times and in places that meet the
  needs of people who inject IPED. (For example,
  outside normal working hours or outreach in
  gyms.)
• Provide the equipment, information and advice
  needed to support these users.
• Are provided by appropriately trained staff
• Specialist NSPs with high numbers of IPED users
  should provide specialist services for them. It
  includes
• specialist advice about IPED and side effects
  (stacking/cycling etc)
• advice on alternatives (for example, nutrition
  and physical training as an alternative to AAS)
• information about, and referral to, sexual and
  mental health services and to specialist IPED
  clinics, if these exist locally.

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Notable additions

• Not discourage secondary distribution
• Where possible, provide low dead space syringes
• More points about data collection and monitoring.
• Consider drop boxes (in consultation with police
  and communities)
• Consider whether NSVM might be appropriate

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Implementation
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NICE Guidance support

• Costing and Commissioning tools
• Press and dissemination
• Linking with national policies and systems-
  potential collaboration with PHE
• Good practice case studies

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Communications support

• Filming in house filming of a needle exchange
  program for the NICE website.
• Interviews with experts for the NICE website
• Opportunities for the press to film on location
• Press work with national media channels
• Press release
• Contact lyndsey.unwin_at_nice.org.uk
• Lyndsey Unwin Media Relations lead

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Into practice case studies

• Please contact mandy.harling_at_nice.org.ukSenior
  Implementation Adviser Please let us know about
  any local work underway where
• It has generated consultation withBME
  communities or men who have sex with men or
  emerging populations e.g. people injecting legal
  highs
• Local policies/protocols addressing NX provision
  for young people
• Services are delivering needle exchange (NX) for
  IPEDs users
• NX in settings custody suites GUM clinics or
  AE depts.
• Community pharmacies are integrated into local
  planning and pathways for NSPs

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Thank you.

• Chris Carmona Lead analyst
• Chris.carmona_at_nice.org.uk
• Mandy Harling Senior Implementation Adviser
  mandy.harling_at_nice.org.uk
• Lyndsey Unwin Media Relations lead
  lyndsey.unwin_at_nice.org.uk