Existing services and the Existing services and the wraparound challengeswraparound challenges

Biba BrandBiba Brand

West of Scotland Regional West of Scotland Regional ManagerManager

Core Services Core Services

Structured 1:1 work Structured 1:1 work Structured group workStructured group work Substitute prescribingSubstitute prescribing Medicated detoxificationMedicated detoxification Community rehabilitation programmesCommunity rehabilitation programmes Needle exchangeNeedle exchange Harm reductionHarm reduction Direct access drug servicesDirect access drug services Residential rehabilitation (varies by area)Residential rehabilitation (varies by area) Inpatient detoxification (varies by area)Inpatient detoxification (varies by area)

Wraparound ServicesWraparound Services

Primary health carePrimary health care Child care and parenting supportChild care and parenting support Housing support and adviceHousing support and advice Employment and training supportEmployment and training support Financial advice and supportFinancial advice and support Family planning servicesFamily planning services BBV testing, support and treatmentBBV testing, support and treatment Clinical psychologyClinical psychology Mental health servicesMental health services

Models of wraparoundModels of wraparound

IntegratedIntegrated wraparound services based wraparound services based within frontline drug services, but linked to within frontline drug services, but linked to mainstream providersmainstream providers

In-reachIn-reach from wraparound services - weekly from wraparound services - weekly legal surgeries, mobile crèches, mobile legal surgeries, mobile crèches, mobile dental units, college inputdental units, college input

ExternalExternal wraparound services - Money wraparound services - Money Advice, P2W, Parenting support servicesAdvice, P2W, Parenting support services

Resource OfficersResource Officers

Barriers to wraparoundBarriers to wraparound

FundingFunding Blockages in servicesBlockages in services Overloaded frontline staffOverloaded frontline staff Lack of interagency referrals Lack of interagency referrals Reluctance to close cases or hand over to GPsReluctance to close cases or hand over to GPs Highly supervised prescribing - travel, costHighly supervised prescribing - travel, cost ‘‘Recovery impatience’ Recovery impatience’ Can drug policy really address other policy Can drug policy really address other policy

challenges?challenges? (…data…)(…data…)

Methadone drug & dispensing fee (£) Methadone drug & dispensing fee (£) Scotland’s total = £12.2mScotland’s total = £12.2m

0500,000

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Methadone drug cost + dispensing fee

Cost of methadone supervision (£) + ‘handling Cost of methadone supervision (£) + ‘handling fee’ - Scotland’s total £12.4m (+ £1m for fee’ - Scotland’s total £12.4m (+ £1m for

prisoners)prisoners)

01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,0008,000,000

Cost for people daily supervised (supervision + controlled drug fee)

Cost for people on take home (supervision + controlled drug fee)

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Numbers onmethadone

Number of DRDs

Lothian ModelLothian Model

70% of GPs within the enhanced medical services 70% of GPs within the enhanced medical services (90 GP practices)(90 GP practices)

2500 stable drug users prescribed methadone 2500 stable drug users prescribed methadone within GP services. 84% are supervised once or within GP services. 84% are supervised once or more per annum (usually one 2 week period). more per annum (usually one 2 week period).

1000 unstable drug users within specialist drug 1000 unstable drug users within specialist drug services. Higher supervisionservices. Higher supervision

Overall:Overall:20% daily supervised (estimate)20% daily supervised (estimate)80% take home methadone (estimate) 80% take home methadone (estimate)

No higher rates of drug deaths No higher rates of drug deaths

ChoicesChoices

£25m = Scotland’s spend on methadone £25m = Scotland’s spend on methadone and various feesand various fees

£12.4m cost for supervising and handling a £12.4m cost for supervising and handling a controlled drug (+ £1m for prisoners)controlled drug (+ £1m for prisoners)

methadone alone costs £1.45 = 100ml methadone alone costs £1.45 = 100ml (BNF, 2004) …choices…(BNF, 2004) …choices…

Wraparound - EmployabilityWraparound - Employability

£3.3m pa = New Futures Fund £3.3m pa = New Futures Fund (employability for all care groups)(employability for all care groups)

1,100 service users supported annually1,100 service users supported annually Are we shifting people from benefits to in-Are we shifting people from benefits to in-

work poverty? work poverty? How much of the Incapacity Benefit Reforms How much of the Incapacity Benefit Reforms

are going on Progress2Work in Scotland? are going on Progress2Work in Scotland?

Wraparound – Housing SupportWraparound – Housing Support

Accessing good quality housing Accessing good quality housing Maintaining tenanciesMaintaining tenancies Affordable lets and support for people Affordable lets and support for people

‘moving on’ ‘moving on’ Supporting People helped 164,000 people in Supporting People helped 164,000 people in

2005/06 - only 2,500 of this cited drug use 2005/06 - only 2,500 of this cited drug use as main problemas main problem

Wraparound – Welfare AdviceWraparound – Welfare Advice

SDF survey of 110 drug users – average SDF survey of 110 drug users – average council tax debt of £2,000council tax debt of £2,000

Total debt of £220,000 simply due to failure Total debt of £220,000 simply due to failure to complete a form on timeto complete a form on time

What are the hidden debt challenges among What are the hidden debt challenges among the 22,000 on methadone – for mainstream the 22,000 on methadone – for mainstream drug and money advice services in drug and money advice services in Scotland?Scotland?

Wraparound – Parenting SupportWraparound – Parenting Support 1700 foster homes needed for vulnerable 1700 foster homes needed for vulnerable

children currently – Works out at £51m cost, children currently – Works out at £51m cost, i.e. £30k per childi.e. £30k per child

Average Parent Support service working Average Parent Support service working with 40 families costs £350k (approx)with 40 families costs £350k (approx)

£15m would support 1700 families based on £15m would support 1700 families based on these figuresthese figures

Far reaching benefits with this model Far reaching benefits with this model

What makes wraparound work?What makes wraparound work?

More effective use of GPsMore effective use of GPs Remove blockages in services – reduce Remove blockages in services – reduce

strain on servicesstrain on services Find resources for wraparound provision Find resources for wraparound provision Fund what makes a difference to drug users Fund what makes a difference to drug users

and what’s ‘best value’ and what’s ‘best value’ Recommendations about wraparound Recommendations about wraparound

support in Scotland’s Drug Strategysupport in Scotland’s Drug Strategy