Chapter 6: Making it Work
Chapter 3 set a challenge for Government and its partners across Scotland - to embed recovery in its approach to tackling drug use. Other parts of this strategy have emphasised the need for joined-up action across all relevant partners if we are to succeed in meeting the challenge of Scotland's drug problem.
This chapter sets out how the Scottish Government intends to work with all relevant partners and experts in the field to make sure that our collective efforts to tackle Scotland's drug problem stand the best chance of achieving the outcomes we all want to see.
This Chapter sets out:
- the conclusions of the Stocktake of Alcohol and Drug Action Teams, which identified strengths and shortcomings in the performance of existing delivery arrangements;
- action which the Government will take forward in partnership to reform delivery arrangements, both to address the shortcomings identified, and to embed recovery in future delivery arrangements;
- the resources which are available to support the delivery of services to tackle Scotland's drug problem;
- action which the Government will take forward in partnership to ensure that those working in drugs services in Scotland have the skills and knowledge they need;
- how the Government will seek to improve the information and evidence base upon which services are commissioned; and
- how our progress in tackling Scotland's drug problem will be reviewed and refreshed at a national level.
THE STOCKTAKE OF ALCOHOL AND DRUG ACTION TEAMS
197. Effective local arrangements for delivering services and activities are clearly critical to the success of an effective national drugs strategy. With this in mind, the Scottish Government welcomed the publication of the Stocktake of Alcohol and Drug Action Teams.
Stocktake of Alcohol and Drug Action Teams
This review, chaired by Sandy Cameron OBE, had been commissioned by the previous administration to consider the current performance of ADATs, and their capabilities to deliver future priorities on drugs and alcohol. The report was published in July 2007.
The Stocktake team concluded that a partnership approach, as demonstrated by ADATs, remained essential to effective action, and that many ADATs had done excellent work; but that there were serious shortcomings in a number of ADATs. Generally, there was a need for greater clarity in their remit and function, and for a more effective relationship between ADATs and central government.
198. Having considered this report and discussed the issues it raised with the Chairs of ADATs in September 2007, Ministers invited SACDM and its equivalent body dealing with alcohol, the Scottish Ministerial Advisory Committee on Alcohol Problems ( SMACAP) to set up a joint group looking at the future of delivery arrangements. This group, the Delivery Reform Group, met for the first time in January 2008.
199. The Delivery Reform Group's aim is to develop and propose arrangements for delivery which as far as possible ensure that:
- all elements of the system are clear about their role, responsibilities and relationships with each other, to allow appropriate accountability to be expressed;
- local strategic priorities are developed and implemented effectively, reflecting both national priorities and local circumstances;
- decisions on the mix of treatment and rehabilitation services are based on evidence including how effective they are in meeting identified need;
- resources are used efficiently and effectively, and that local partners can demonstrate to Government that this is the case; and
- any local delivery structure is run in a professional and business-like fashion, with proper information management that can underpin accountability and reporting to Government and local communities.
The Group's specific remit is as follows:
- to develop and propose an outcomes-based framework for assessing and managing performance at a local level;
- to develop and propose a clear statement of the strategic functions which need to be carried out at a local level to deliver national alcohol and drugs strategies;
- to develop and propose robust accountability arrangements between central government and partner organisations, consistent with the new relationship with local government under the terms of the Concordat agreed in November 2007; and
- to consider the need for a national support function and, if supported, develop proposals for its role, structure and responsibilities.
200. The Scottish Government is committed to maintaining this partnership approach to the development of effective new arrangements for delivery. However, the publication of this strategy impinges on the work of this group in two ways.
201. First, the need to embed the recovery model in future delivery arrangements becomes an explicit aim of this Group. The Group will need to ensure that, for example, the outcomes-based framework it is developing includes outcomes which fully capture the principle of recovery.
202. Secondly, the Government now confirms its intention to establish a national support function, as a means of taking forward the developments outlined in the strategy - in particular, the development and implementation of the recovery approach in drugs services. This will work closely with Government, service commissioners and providers and service users to support improvements in service delivery. The Delivery Reform Group will be invited to propose specific functions and priorities which the national support function should provide.
203. Furthermore, since the Group was established it was confirmed that Audit Scotland would be undertaking an exercise to identify the scale and effectiveness of public expenditure on drugs and alcohol. The Government warmly welcomes this development, and believes that the thoroughness, independence and rigour that Audit Scotland will bring to bear will be an important contribution to our ongoing work to reform delivery structures.
204. Audit Scotland intend to report no later than Spring 2009; their findings will help inform future spending priorities at a national and local level, as well as the future shape of performance management and accountability frameworks.
205. In taking forward its work, the Delivery Reform Group will also take account of the challenges that delivery of drug treatment and rehabilitation services presents in rural areas. We recognise that no one size fits all and that innovative approaches are sometimes needed in these circumstances. Any changes to the existing funding formula for distribution of funding to Health Boards for drug treatment services will also consider this issue.
206. The Delivery Group will also need to take account of wider developments in the relationship between central government and local partners - in particular, the development of Single Outcome Agreements.
207. Under the Concordat between national and local government, Single Outcome Agreements will provide the basis for mutual accountability between central and local government. The Scottish Government intends that as of April 2009 agreements will be concluded with Community Planning Partnerships.
208. This approach provides the opportunity both to ensure that action to tackle local drug problems is fully embedded within local partnership structures, and to ensure that all partners, including local communities, are playing their part in tackling drug problems, and in contributing to local and national outcomes.
209. The Scottish Government will publish and respond to the conclusions of the Delivery Reform Group in time to allow its work to inform accountability arrangements from April 2009.
210. The Scottish Government recognises the work, dedication and professionalism of many people working in the substance misuse field. As well as reforming local delivery arrangements, there is a need to ensure that the workforce delivering services are well trained, motivated and flexible to changing need. This is particularly necessary if we are to give effect to a new focus on recovery.
211. Those who work to tackle drug problems in Scotland are a diverse range of individuals working in health, social care, housing, education, justice and employment services within the statutory, private and voluntary sector. The workforce is currently governed by different regulations, professional bodies, qualification frameworks and standards. It is essential however that a consistent level of service is provided to all those who seek help. Those who come into contact with a service, whether it be service users, individuals, families and carers, organisations, communities, or training providers, should be able to know what can be expected of the staff providing the service and that those staff are able to demonstrate their competence.
212. Staff should be able to move between sectors, with qualifications being recognised and standards agreed so that the same standard of care will be delivered to all service users. Staff should also be able to identify their own training needs and know how to access appropriate education and learning opportunities. It is essential that we ensure that vacancies can be filled quickly by people with the necessary skills to carry out the job and that services can attract talented and qualified people.
213. This is particularly important if we are to realise our aspiration of a recovery approach. Working in a recovery focussed way will present a new challenge for many people and require a significant change in attitudes and values. Appropriate education and training must be available to help ensure staff are able to practice in a recovery focussed way. STRADA (Scottish Training on Drugs and Alcohol) is funded by the Government to provide drugs and alcohol misuse training across Scotland. They will have a key role in delivering this cultural change, for example, by embedding the recovery concept in all of its training courses, examining values, beliefs and principles of practice.
214. The Scottish Alcohol and Drugs Workforce Development Strategy Steering Group, chaired by NHS Health Scotland, was established by the then Scottish Executive in January 2007. Its remit is to create a co-ordinated national training and development strategy to support a competent, confident, valued and responsive workforce. The group aims to publish its strategy in late 2008 and an implementation plan in spring 2009.
215. Outcomes from this work will include: enhanced capability of the substance misuse workforce around identified priorities, such as recovery; improved staff retention; increased understanding of the complex needs of service users; greater clarity about required capability levels and where the gaps are; enhanced competence of the workforce; enhanced opportunities for career progression; and opportunities for multi-disciplinary training and working. It is anticipated that, as with the Skills Strategy for Scotland, individuals will be able to take more ownership of their own development; employers will invest in and make the best use of their workforce's skills; and learning and training providers will work as one system, geared towards helping people develop the skills they need.
FUNDING FOR TACKLING DRUGS USE
216. There is significant Government expenditure on all areas of tackling drug use covering education and information; treatment; early intervention and support; and enforcement.
217. Since 1999, there has been a significant increase in investment in drug treatment services. Over £94m is being made available within the Justice portfolio over the period 2008-11 for tackling drug use. This is a 14% increase against the comparable baseline of 2007-08 in spending by 2010-11.
218. The great majority of these monies will be released to Health Boards to fund drug treatment and rehabilitation services, with a small amount being retained to fund centrally determined projects, such as the national support function and to improve our current research and evidence base.
219. In addition to these ring-fenced monies, we also expect local authorities to provide funding for activity on drugs. In line with the local government finance settlement, it is the responsibility of each local authority to allocate additional funding for drug treatment services to a level decided by them on the basis of their local needs and priorities. In the past, the level of this funding has been significant, and at least comparable to the ring-fenced funding provided to NHS Boards by central government - for example, in 2006-07 £42.3m was spent by local authorities on community care services for people with drug and/or alcohol problems.
220. In addition to this, funding has also been made available for criminal justice social work services, including interventions to break the cycle between drug use and offending. This funding, which includes expenditure on Drug Treatment and Testing Orders, will remain ring-fenced and will be routed through Community Justice Authorities. Almost £50m is also being made available over the next 3 years to implement the Hepatitis C Phase II Action Plan published on 18 May, which supports people with Hepatitis C - the vast majority of whom are current or former injecting drug users.
221. There are also a number of other budgets which provide resources for tackling drug use. We know that Health Boards use resources from their unified budget to supplement funds provided through the Justice portfolio. We also know that other relevant budgets, such as the police, use some of their resources towards tackling drug use. There are also other sources of funding, apart from the Scottish Government, which are used at a local level to tackle drug use, such as resources from the private sector, lottery and charitable bodies.
DIVERSITY AND EQUALITY
222. The Scottish Government is required by law to consider the impact of its policies on those people from particular groups who may find themselves excluded from mainstream services and suffer discrimination as a result. This includes considering the impact of this strategy.
223. However, as well as fulfilling these duties, the Scottish Government, in keeping with its vision of One Scotland, wants to go beyond this. It wants to proactively address the issues surrounding the provision of advice and support to address problem drug use, to those members of excluded communities who may be in need of help.
BLACK AND MINORITY ETHNIC COMMUNITIES
224. We know there is a lack of national data regarding the prevalence of drug use amongst Black and Minority Ethnic ( BME) communities both at a Scottish and at a UK level. Recent prevalence reports based on information gathered from across the UK, suggest that drug use prevalence is lower among young people from BME backgrounds. However, these reports also suggest there is under reporting of the issue, with indications that drug use amongst these groups is in fact increasing.
225. Recent surveys of what we do know have examined the perceptions of BME communities on the prevalence of drug use within their own communities. Within some communities it is perceived to be increasing, and, per head of population, as prevalent as it is within the white population. As within the indigenous community, there is a connection between problem drug use and social exclusion.
226. It has been argued that when it comes to the reasons why younger members of BME communities use drugs, these are the same as for the white population, i.e. curiosity, boredom, peer influence and pleasure. It has also been suggested that drugs are used to gain acceptance from or to 'fit in with' white peers and to cope with the tension of being a member of a BME group in a predominantly white community.
227. The Drugs Misuse Database statistics for 2006 show that in 2005-06, 99% of individuals, where asked, reported to the Scottish Drugs Misuse Database as new individuals using services, described their ethnicity as 'white'. It is clear from this that mainstream services are not well used, if at all by those from BME communities. We can see from the newly formed Scottish Drugs Services Directory, that there are a total of 227 drugs services operating in Scotland, delivered by a range of statutory, voluntary and private organisations. Only one claims to specialise in supporting people from BME communities. We need to change this.
228. We can do this by:
- acknowledging the need for services for BME communities. Although we should continue to carry out both quantitative and qualitative studies, this should not stop us now from making services more acceptable and accessible to use by communities with distinct needs;
- more effective ethnic monitoring of the uptake of services;
- better publicity of services; and
- more services for those from BME communities caring for drug users.
In doing this, we need to take into consideration the diversity between and within BME groups.
229. Both generic and specialist services are needed to allow people to access services outwith their own communities for reasons of confidentiality or family reputation, as well as being able to provide a service which they recognise as catering for their particular needs.
230. There is a need for more qualified drugs workers, of both genders, from Asian and other minority ethnic backgrounds, as well as those who are able to connect with Scotland's new migrant communities and those seeking asylum who have been given leave to remain in Scotland.
231. Finally, we need to also intervene more through school based information provision, as well as addressing the general lack of knowledge and awareness of drug related issues amongst parents from BME communities.
Action to Help Families and Better Inform Parents
232. Consultation from those services currently working with BME communities indicate that families, carers and young people in these communities are still hesitant to acknowledge and discuss this issue, and clearly still very reluctant to approach mainstream drug services for assistance.
233. The Scottish Government intends to fund a number of initiatives centrally to offer a lead to local bodies in taking this agenda forward.
234. This will include initiatives designed to offer parents and carers information and advice on how to support the members of their family who may be experimenting with drugs, or using them to a problem degree. Discussions are currently taking place about the form these initiatives should take, but they are aimed at offering discreet and confidential support to encourage family members affected to come forward for help and advice.
235. In addition, the Government expects local delivery arrangements to reflect activity in not only meeting the legal requirements to evidence knowledge of local need amongst minority communities, but to begin to formulate outcome focussed activity designed to produce a local action plan which can map progress in service design and provision, not only as an element of mainstream services, but through specialist provision where necessary.
236. In addition, the Scottish Government will discuss with the Human Rights Commission, and generic specialist services, the context within which information, advice and services can be extended appropriately to other excluded people, including those with a disability, and lesbian, gay, bisexual, transgender and transsexual people.
237. On a national and local basis, the Scottish Government will support an analysis of the sources of data available to determine patterns of drug use and service needs within these communities and the development of outcome setting and monitoring in developing the necessary service provision on the ground.
EVIDENCE INFORMED DRUGS POLICY AND PRACTICE
238. Delivery of services at the local level (as well as national policy) needs to be informed by the best available evidence and research and practice from across the world. Sound evidence, proper evaluation and reliable data are at the heart of good policy-making. To deliver real change for people who are affected by drug use it is essential that drugs policy continues to be informed by what works, how it works and why. However, we must acknowledge that in some areas in this field good evidence is available to guide decisions, but in other areas the research evidence and data could be improved. That is why the Government is committed to the following actions.
Strengthening our evidence base about what works
239. A considerable body of UK and international research on the extent and nature of drug problems and the effectiveness of interventions already exists. We need to use this, and emerging research, to develop further our understanding of the drug using population, the factors affecting people's substance misuse, the harms experienced and the most effective interventions in education, prevention and treatment.
240. To do this successfully, it is essential that we have in place a systematic and co-ordinated approach for feeding the evidence base into national and local policy making and practice and for identifying gaps.
241. To achieve this, we have recently established a National Drugs Evidence Group - as a project group of the Scottish Advisory Committee on Drug Misuse ( SACDM). This will enable us to draw on the expertise of our best minds and leading academics in the field of drugs in Scotland and the UK. Academics will work in partnership with policy, practice and service users to support the delivery of this strategy.
242. One of the key tasks of the Group will be to advise on research priorities flowing from the strategy, identifying areas where information is available, as well as where key gaps in knowledge and information exist.
243. The Group will also identify those who commission and provide evidence on drugs policy and set priority areas for future research. This will result in more effective use of funding through pooled budgets to deliver new research initiatives that will improve our understanding of addiction.
244. Scotland is a nation of ideas, innovation and experimentation. We want to see this flourishing at a national and local level in the drugs field. The National Evidence Group will play a key role in making this happen by identifying opportunities for new forms of treatment and prevention.
Learning from other countries
245. There has been a significant amount of drug use research undertaken within Scotland, but the formal evidence base for practice is lacking in some areas. There is much we can learn from other countries. However, we need to remain mindful that what works in some countries may not necessarily work in Scotland - because it is not possible to separate off public policy on drugs from the rest of societal norms, traditions and cultures. We already have good external links, working with the UK Drugs Research and Information Working Group, the Advisory Council on the Misuse of Drugs, the British Irish Council and the EU Monitoring Centre ( EMCDDA). The National Evidence Group will consider ways we can capitalise further on these links, for example through joint evidence workshops.
Improving data on the drug misusing population
246. In addition to strengthening our evidence base through the National Evidence Group, we want better quality data on the drug using population. We are doing this by working with the Information Statistics Division to create a Drug-related Deaths Database and to greatly enhance the Scottish Drug Misuse Database.
247. The Drug-related Deaths Database will systematically record details of an individual's circumstances surrounding their death. The information collected will be cross-matched with other datasets to give a more complete picture of a person's treatment pathway prior to death. This information will then be used by local partners to identify where there may have been opportunities for intervention, which could be used to prevent future deaths.
248. In April 2008, the new Scottish Drug Misuse Database Follow-up Reporting System will be introduced. It will provide better outcome information, vastly improving our ability to assess treatment effectiveness and a data recording system that will be among the most useful in the world.
249. It is imperative that the research and good practice that flows from the Evidence Group is disseminated among relevant agencies to encourage greater integration of evidence within the wider local delivery framework.
250. We are setting up a new interactive website to promote the aims of this strategy. It brings together all policy and research in one place, can be easily accessed by academics, practitioners and policy makers. The national support function will also have a role in ensuring that the flow between evidence and action is not one-way but is a dialogue. Evidence informs action and evaluation of action adds to the evidence base.
MONITORING AND REVIEWING THE STRATEGY
251. It is important that we monitor and review the implementation of this strategy, especially in relation to progress towards, and achievement of, our objectives on drug use as set out in Chapter 1. We will draw on European drug policy evaluation methods and approaches to assess our progress.
252. We intend to re-constitute the Scottish Advisory Committee on Drug Misuse ( SACDM) to give it a key role in monitoring the implementation of the strategy. The reconstituted SACDM will report to Scottish Ministers, who will in turn report to the Scottish Parliament. SACDM will also review the strategy after 3 years and consider whether it needs updated, as Scottish Ministers' priorities, existing practice and other circumstances change. Details of the membership and remit of the reconstituted SACDM will be published by July 2008.
253. The Chapter focussed on the action the Government is taking with partners to reform how drugs services are planned, commissioned and delivered - with a much stronger focus on outcomes and recovery, backed up by a robust evidence base.