Alcohol and Drug Partnership (ADP) Letters - 2024/25

Alcohol and Drug Partnership Letter

Population Health Directorate

Drug Policy Division & Health Improvement Division

E: Drugsmissiondeliveryteam@gov.scot

ADP Chair

Integration Authority Chief Officer

Copies to:

• NHS Board Chief Executive
• Local Authority Chief Executive
• NHS Director of Finance
• Integration Authority Chief Finance Officer
• ADP Co-ordinators

21 June 2024

Dear ADP Chair and Integration Authority Chief Officer,

Supporting the Delivery of Alcohol and Drug Services: 2024-25 Funding Allocation, Programme for Government Funding and Ministerial Priorities

1. We are writing to provide detail about the funding arrangements, Ministerial priorities and planning and reporting arrangements for Alcohol and Drug Partnership (ADP) work for 2024-25. These arrangements will support the delivery of services to reduce harms and deaths associated with alcohol and drugs.

2. The Scottish Government is committed to addressing the public health priorities of both alcohol and drug harms and the appointment of a dedicated Minister for both Alcohol and Drugs Policy reflects the importance of this area within the wider health portfolio. The majority of funding outlined in this letter is for the delivery of both drug and alcohol services and we need to ensure the momentum and response to tackling the rise in drug deaths and harms is being replicated in our work to address alcohol specific deaths and harms.

Funding Allocations

3. The funding arrangements are summarised in the following table and explained in more detail below.

* No change on 2023-24 baselined figure.

**Agenda for Change uplift for staffing costs for financial years 22-23 and 23-24

4. Collectively this funding represents a national investment of £112.9 million for ADPs. This means that funding has been maintained at the 2023/24 level. As you will be aware, the Scottish Government’s total funding to support ADP projects in 2024-25 is transferred via NHS Boards for onward delegation to IAs to be invested, in their entirety, through ADPs, and should not be subject to any wider savings targets. For 2024-25, baseline and Programme for Government funding has already been transferred. The annual in-year allocation will be transferred in two tranches on an 80%/20% split which is explained further below. Full details of this breakdown by ADP and Health Board are available in the appendices (appendix 2 and 3).

5. To improve monitoring and evaluation, and increase transparency, we also expect ADPs to return a bi-annual financial report. These are due to be submitted on 31 October 2024 and 30 April 2025, and will contribute to the annual report.

Note on Allocation Timing and Reserves

6. In 2023-24 we issued the £17 million PfG uplift as a recurring allocation and therefore in 2024-25 it is being issued along with all prior year recurring allocations and moved into Board baselines from 2025-26. In June we will issue a recurring allocation for the Agenda for Change (AfC) element relating to PfG (£2m) which will also move into Board baselines.

7. We will issue the remaining 2024-25 in-year allocations in two tranches based on an 80%/20% split. Tranche one is being issued with the June allocations. Please see appendix 4 for tranche one allocations by Health Board and Integrated Authority (IA). Tranche two will be allocated around December 2024 and will reflect the forecast spend for the remainder of the year.

8. We previously highlighted the significant accumulation of reserves held by IAs on behalf of ADPs. In 2023-24, financial returns were commissioned to minimise reserve balances being carried forward to 2024-25. We intend to continue this process for financial year 2024-25 and monitor reserves on a bi-annual basis through financial returns. Tranche two allocations will therefore also take into account confirmed levels of reserves that are available to contribute towards the 2024-25 funding requirement, as well as any in-year slippage that may arise, in order to ensure we continue to allocate funding based on need and avoid a build up being carried forward into future financial years. Reserves where there is a funding requirement for a non-recurring commitment may be excluded from this process by agreement.

9. SG are unable to roll forward any underspends from 2024-25 therefore the funding set out in the table above and associated appendices is the maximum allocated in-year and will be available in full where forecasts reasonably demonstrate that funding can be spent.

10. Any reserves held in 2025-26 as a result of underspend, that have not been flagged to the SG as legally committed, will need to be spent before new allocations are drawn down in 2025-26.

11. As per the process in 2023-24, as part of the financial returns we will capture and consider any specific requests demonstrating the requirement to carry reserves for non-recurring commitments into 2025-26.

NHS Board Baseline contribution

12. The Scottish Government’s direct funding to support ADP projects in 2024-25 has been transferred to NHS Boards via their baseline allocations for onward delegation to IAs to be invested, in their entirety, through ADPs and should not be subject to any wider savings targets. Where there is more than one IA within the Health Board area, the level of funding should be agreed jointly by the IAs within the Health Board area. The value in the table above is at the same level as the baselined figure per the 2023-24 letter.

NHS Agenda for Change uplift

13. The funding available includes an uplift for Agenda for Change (AfC) for 2023-24. The uplift has been calculated based on the returns submitted by Health Boards via the Corporate Finance Network in 2023-24 and reflects anticipated costs for the full year. The returns showed varying proportions of staffing costs within total funding due to different delivery models being in place across each Health Board. We recognise these delivery models may change and will collect further information when considering future year impact of the AfC. The AfC relating to PfG is being issued recurring to move to Board baselines with the core PfG funding. Please see appendix 3 detailing the AfC uplift by Health Board.

14. As previously advised in the letter from Richard McCallum, Director of Health, and Social Care Finance, Digital and Governance to NHS Boards and IAs of 19th December 2023, the Scottish Government will revisit the funding arrangements for the impact of 2024-25 AfC following the outcome of pay negotiations.

Additional Programme for Government Uplift - £17million Nationally (+£2m AfC)

15. Since 2018-19 additional funding of £17 million per year has been delegated to IAs for onward use by ADPs as part of the Programme for Government to support improvement and innovation in the way alcohol and drug services are developed and delivered as part of the Rights, Respect and Recovery strategy and the Alcohol Framework 2018 Preventing Harm. This funding has been allocated via NRAC and the same amount is available for 2024-25. As noted above this allocation is being issued with all 23-24 recurring allocations with May allocations and the AfC uplift relating to PfG was issued recurring with June allocations (see appendix 5).

16. This means we will increase the proportion of funding to be baselined in 2024-25 by 33% to a total of c.£77m allowing greater security and flexibility to local areas. Going forward we will be exploring the potential of further baseline funding to ensure sustainability of the National Mission beyond 2026.

National Mission Uplift - £11 million

17. This funding has been allocated via NRAC and the same amount is available for 2024-25 as in 2023-24. It is expected that this funding will be directed towards programmes of work which deliver the outcomes set out in the National Mission Outcomes Framework (appendix 1). This funding stream combines three funding streams which were separate in the first year of the national mission (2021-22) - the general uplift stream (£5m) and specific funding for non-fatal overdose pathways (£3m) and outreach (£3m) - to provide more flexibility at the local level. It is expected that both outreach and nonfatal overdose remain priorities as core parts of the national mission and MAT standards delivery.

Specific programme funding

Medication-Assisted Treatment Standards - £10.3 million

18. The MAT standards funding remains the same as 2023-24. Funding agreed with local services in each IA area for the implementation of the MAT Standards followed detailed, local discussion on additional resources required to implement the MAT standards by recruiting staff, service improvements and sustaining these through the national mission and beyond. Implementing, improving and sustaining the MAT Standards is a key priority for Ministers and delivery of these standards must also be key priority for Chief Officers and other leaders in IAs.

19. Allocation of funding has been based on priority needs – taking into account what each area has already got in place and what each area requires. This has meant that allocation decisions have not been based only on NRAC. Full details of the MAT funding allocation are detailed in appendix 2.

20. Public Health Scotland, through the MAT Implementation Support Team (MIST) will continue to help local areas monitor their progress in implementing the standards over the year and performance against standards will be captured in ADP annual reporting cycles and Scottish Government Implementation Plan Progress Reporting.

Residential Rehabilitation - £5 million

21. Ministers have committed to increase the number of publicly funded placements by over 300%, so that in 2026 at least 1,000 people are funded for their residential rehabilitation. This is an ambitious target and to meet it we require the full support of the sector. This is the third year of this funding uplift to support residential treatment and services associated with preparation or aftercare.

22. While monitoring data from 2023-24 indicates a substantial increase in the number of people accessing treatmet via public funding, more work needs to be done to deliver on this ambition.

23. We expect all ADPs to have an operational and published pathway in place and to continue to increase the number of people being referred to residential rehab in their areas.

24. Healthcare Improvement Scotland have established regional improvement hubs that will bring together groups of Alcohol and Drug Partnerships and other key parts of the local system to design and improve pathways into, through and from rehab. Much of this work is already underway however it is our expectation that ADPs will continue to engage with this work in a constructive manner.

25. Public Health Scotland will continue the regular monitoring of referrals and spend on residential rehab and ADPs are asked for their continued support of this data collection. Public Health Scotland are developing a comprehensive evaluation framework to support the residential rehabilitation programme and further details of this work will be shared in due course.

26. Scotland Excel’s National Commissioning Framework (NCF) for residential rehab placements went live on 01 April 2024, this work brings together two years of market analysis and stakeholder engagement to deliver on one of the recommendations made by the Residential Rehab Working Group. We expect that ADPs utilise this framework as a tool to make commissioning of RR placements easier and more efficient.

Whole Family Approach/Family Inclusive Practice: £3.5 million

27. £3.5 million is committed to support the implementation of ‘Drug and alcohol services – improving holistic family support: A framework for holistic whole family approaches and family inclusive practice^[1]’ also known as the Whole Family Approach Framework. This was published in December 2021. Chapter 11 and sets our expectations for local areas to put in place accessible, consistent, sustained and inclusive support for families.

28. We recognise that the challenges families face are often complex and wide ranging and linked to inequalities. Therefore, it is the expectation of Ministers that this £3.5 million investment is used to implement and strengthen holistic whole family approaches and family inclusive practice, in accordance with the Framework. Working collaboratively with local partners, and in particular Children’s Service Planning Partnerships (CSPPs) will be vital to improving family support. In particular, we encourage ADPs and CSPPs to view this investment, and the additional allocation to CSPPs through the Whole Family Wellbeing Fund, as part of a programme of investment in families. ADPs and CSPPs should plan accordingly and pool resources to achieve the maximum impact for families.

29. At a minimum, we expect ADPs to be able to demonstrate that they are working towards embedding holistic whole family approaches and have:

• Undertaken an audit of family provision, including the quantity, quality and reach, taking account of support delivered by paid workers, volunteers and peers, including mutual aid/fellowships.
• Utilised this funding to improve and expand the service provision for families in their area in partnership with relevant bodies.
• Included the expertise, views, and needs of families in this work from the outset and have established meaningful feedback loops that seek the views and experiences of families and use them to improve serice provision.

30. ADPs provided a baseline report of their implementation progress in March 2023. This demonstrated that ADPs are at different stages in developing their approach. Scottish Government, in partnership with the Whole Family Approach Implementation Working Group, encourage local areas to keep building on the progress made. As indicated last year, they are developing a similar survey for completion Autumn 2024, to understand and measure implementation progress to date.

31. There will be an update to ADPs on the national progress, with an example of implementation in the Autumn. We are currently exploring a platform for sharing best practice/case study examples. Further information will follow.

Lived and Living Experience Participation

32. £0.5 million is being allocated to support ADPs to develop meaningful, accessible and inclusive ways for people to be involved in decision-making.

33. Ensuring the voices- and the rights-of people affected by substance use^[2] are acted upon is a cross cutting priority for the National Mission. It builds on the rights-based approach laid out in Rights, Respect, Recovery (2018) and is being driven forward at a national level through the National Collaborative.

34. Participation and empowerment are key principles of a human rights-based approach. Everybody has the right to participate in decisions affecting them and to influence outcomes. This is relevant to decisions about their care (or the care of somebody they support) as well as decisions about the design and delivery of services.

35. Engagement with ADPs so far has shown that flexibility is important. We recognise that ADPs are at different stages of developing their approach to involving people affected by substance use. Some examples of how this has been taken forward include: a panel or reference group made up of people affected by substance use (including lived, living and family experience); LLE representation within the ADP Board; funding and involving independent groups of people with lived and living experience; interviews as part of theMAT Standards experiential monitoring programme.

36. We intend to share examples of what is working well through the National Collaborative. The Charter of Rights will provide guidance on participationand support ADPs to work through shared challenges for example on remuneration, support and training.

37. Progress will be monitored through the ADP Annual Survey Report. Questions ask what feedback mechanisms are in place and about opportunities for active participation as well as how feedback is used to influence decision-making. The survey also asks ADPs to detail how the £0.5m has been allocated.

Stabilisation fund

38. Ministers have ringfenced £3 million for the Stabilisation fund which was introduced in 2023-24. The Stabilisation funding is allocated to ADPs to develop or bolster existing arrangements for residential stabilisation and crisis care support - to help deliver on the Taskforce recommendations made in Changing Lives that will help align crisis care, stabilisation, detox and rehabilitation.

Context for Delivery

Alcohol and Drug service delivery

39. Baseline funding and PfG funding is expected to cover both alcohol and drugs. In addition, people with alcohol dependence can be supported to residendital rehab via the dedicated funding.

National Mission to Reduce Drug Related Deaths and Improve Lives

40. This is the penultimate year of the National Mission announced by the former First Minister in January 2021 and supported by an additional £50 million funding per year for the lifetime of the parliament.

41. The National Mission on drug deaths continues to be a priority for Scottish Ministers and is brought into sharper focus by the threats of a dynamic and increasingly harmful illicit drug supply. Local areas need to prepare for this new threat and work with Public Health Scotland to ensure appropriate responses are in place.

42. The aim of the national mission is to reduce deaths and improve lives. To underpin this work, Scottish Government has developed an outcomes framework (appendix 1) and summarised below) which sets out the key outcomes required to achieve this aim.

43. This outcomes framework incorporates and builds on the priorities set out in Rights, Respect and Recovery and the Alcohol Framework which are still relevant. These cover both alcohol and drugs, with the exception of priority 5, which refers to alcohol only:

• A recovery orientated approach which reduces harms and prevents deaths
• A whole family approach.
• A public health approach to justice.
• Prevention, education, and early intervention.
• A reduction in the affordability, availability, and attractiveness of alcohol.

DAISy

44. DAISy has been live in all NHS Board areas since 1 April 2021. The system was built and is maintained by Public Health Scotland and it primarily functions as a national database which gathers key demographic and outcome data on people who engage in alcohol/drug treatment services. This information contributes to strategic planning.

45. It is imperative and expected that local areas input data into DAISy as it measures the performance against Local Delivery Plan standards and is an invaluable source of data for monitoring and evaluating drug and alcohol services across Scotland, informing policy development and funding. The Scottish Government is working closely with Public Health Scotland on issues of data compliance and are considering the remedies and actions that will be taken to improve compliance.

46. Much of our ability to understand the impact of funding and progress towards our objectives is reliant on having quality and complete data within the Drug and Alcohol Information System (DAISy). We ask that ADPs work with service providers to ensure that completion of DAISy is a condition of grant. Without robust data to inform our resource allocations, future funding decisions may not adequately reflect local needs and it is therefore incumbent upon service providers to ensure they are accounting for their activity.

47. PHS are progressing a review of DAISy. They have undertaken work to engage with delivery partners on how the system may be improved in terms of the user experience, automation of data input, and system outputs. Whilst the Review continues there is no change to the Scottish Government’s expectations in relation to local data input.

Drug and Alcohol Waiting Times

48. The Local Delivery Plan (LDP) standard supports sustained performance in fast access to services and requires that 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery.

49. Nobody will wait longer than 6 weeks to receive appropriate treatment. 100% compliance is expected from services delivering tier 3 and 4 drug and alcohol treatment in Scotland

50. Performance against the Standard will continue to be measured via the Drug and Alcohol Information System (DAISy) with national reports being published on a quarterly basis via Public Health Scotland. We will use this report to monitor areas who do not meet the target and consider necessary next steps to improve performance in each area and how we can support ADPs at a national level.

Planning and Reporting Arrangements

51. ADPs are our primary partner in the delivery of the National Mission and the Alcohol framework and key to their success. Therefore, a clear commitment to monitoring and evaluation at the local level is vital.

52. We are stepping up our commitment to monitoring and evaluation not only to improve accountability but also to support the sharing of what works in different areas and with different communities. We have begun work with Public Health Scotland and analysts within Scottish Government to develop a monitoring and evaluation framework which will be published later this year. It is important that ADPs are involved in developing a monitoring and evaluation process and further information about how to engage with this process will be shared in due course.

53. The annual progress report of the national mission will be published in Autumn 2024. This report will draw on data provided by ADPs and other sources and will set out plans for evaluation going forward. It is therefore important that accurate data recording and reporting is prioritised by ADPs and the services they fund.

54. If you have any queries on the content of this letter, please contact: Drugsmissiondeliveryteam@gov.scot.

Yours sincerely

Alison Byrne

Deputy Director, Drug Policy Division

Population Health Directorate