Agenda item

10.40 am

At the last meeting of this Committee the Oxfordshire Local Involvement Network (LINk) made reference to the closure in 2007 of the Oxford Drug Recovery Project (DRP). Members of the OJHOSC were concerned by what they heard from the LINk particularly as it appeared that there had been no consultation when the closure of the DRP had taken place. Furthermore, undertakings had been given to reopen the DRP but , to date, there had been no action.

Members decided to defer full consideration of the report until this meeting so that additional contributors could be invited to enable a rounded picture to be developed.

Richard Lohman and Adrian Chant from the LINk will attend again for this item. In addition the following people will attend the meeting to provide background to the past and future of the DRP:

-           Jo Melling, DAAT Director;

-           Alan Webb, PCT Director of Service Redesign;

-           Darren Worthington, Chief Executive of SMART, a charity working to reduce drug and alcohol use in Oxfordshire;

-           Glenda Daniels, service user involvement coordinator of an independent charity that represents drug and alcohol service users; and

-           Dr Angela Jones who is a GP who worked from 1999 – 2007 in the Luther Street Medical Centre in Oxford providing drug and alcohol services for people experiencing homelessness in Oxford.

A copy of the LINk report from the January meeting is attached at JHO7(a) together with a report from the DAAT (JHO7(b)).

The Committee welcomed Jo Melling, DAAT Director; Alan Webb, Oxfordshire PCT; Darren Worthington, Chief Executive of SMART; Glenda Daniels, service user involvement coordinator of OUT; Dr Angela Jones, GP formerly working at the Luther Street Medical Centre; and Richard Lohman, Steering Group member of Oxfordshire LINk to the meeting;

Alan Webb introduced the item giving a brief resume of the situation to date, stating that the service had been retendered in 2007 as a result of a change in its major funder, which had previously been Housing Services. Since then the major challenge had centred around finding suitable premises. He reported that property had now been found in Iffley Road, Oxford and would be secured in the near future. Mr Webb pointed out that when the PCT as host commissioner had gone out to re-tender, the DAAT had been assured that the service would not be disadvantaged and that funding would be provided from out of county placements if needed.

Jo Melling added that, when re-commissioning the service, the principal aim had been to develop a good, effective local treatment programme which was different from  other services provided in other areas. At the time, practitioners had been consulted on the new service, but the premises issue had been sprung upon them and there had thus been no opportunity to go out to further consultation. Her view was that the clients had not felt disadvantaged by this, citing statistics from an annual user survey. No individual cases of people disadvantaged had been brought to light by service users themselves of by other organisations. In response to a question from the acting Chairman asking if she was sufficiently confident that there had been sufficient consultation, Ms Melling and Glenda Daniels assured the Committee that the service consulted constantly and that they were satisfied with the level of involvement. Some cases had been resolved via advocacy over the last three years and each had been assured that placements could be provided out of county. Moreover the new service was working with SMART to ensure that there was ongoing service user consultation. Users were happy with the service provided.

In response to a question from a member of the Committee asking if all the service users were happy to work with SMART, and if there was a reciprocal consultation arrangement with other counties, Glenda Daniels commented that SMART was a criminal justice focused service and that there had been a cohort of people stating their dissatisfaction with this. She added that much work had been done to rebrand SMART in light of the different nature of services they were to provide and it was her view that a new side to SMART would be experienced when the new drop in centre was established. Darren Worthington added that SMART now provided a range of services for each stage of recovery and indeed provided services across the Thames Valley region, not just to the DAAT. Jo Melling confirmed this, adding that although SMART as an organisation had been established in Oxford 14 years ago, it was now competing against large national providers at a national level. Moreover, its processes demonstrated a robust transparency.

At this point the Chairman invited Dr Angela Jones, who had been a GP working in the Luther Street, Oxford Medical Practice for the Homeless, during the period when it was a charity until it subsequently became a PCT provided service, to speak. She made the following points:

·         Prior to when the DRP  was set up it had been an ‘old fashioned’ service with providers who were able to meet need in a flexible, rapid way;

·         The DRP was set up in response to an identified need to address the requirements of a marginalised, core group of insecure users, a group which, in her view, cost the County, the NHS and the Criminal Justice System a significant amount of money. The DRP would put service users on a pathway from use of prescription medication to when they moved on to County rehabilitation services. She added that she would have liked to see the service extended to stabilization of the client within the community;

·         The DRP was a very valuable and creative project in which rough sleepers were given the opportunity to become socially acclimatized once again by embarking on a structured programme of cooking, cleaning etc. It had ‘astonishing’ results, clients blossomed, and the DRP could have filled the Unit many times over;

In response to Dr Jones’ query as to whether the views of the local GPs had been sought with regard to the new unit, Jo Melling responded that they had not asked every City GP, but consultation took place on a regular basis with GPs via the GP Forums which met on a bi-annual basis. Glenda Daniels added that service users were given a structured, hour long interview in which they were asked their thoughts about every service. There was also a county-wide piece of research  undertaken each year. She added that this work had proved very valuable in  for her in her role as a member of the commissioning group for the DAAT.

Dr McWilliam expressed concern about seeing a service reduction for people suffering from substantial social problems, due to budgetary problems . He asked Dr Jones her view, in her capacity as a national expert. On the new tender plans. Dr Jones responded that she had not seen them and indeed did not now have the local knowledge with which to do so. She advised that the views of the clinicians working in the City be sought, particularly of those working directly with Luther Street.

Members of the Committee asked a number of questions of the panel of invitees, a selection of which are included below:

Q Will the plans still include the service for rough sleepers so valued by Dr Jones?

R( Jo Melling)      Yes. It will take complex cases who will require long term detox programmes.  However, it will be directed at users from the whole county, not simply for rough sleepers.

Q When you consult, do you involve the families of service users’? Some may not be the best position to comment themselves.

R (Jo Melling)      We haven’t in the past engaged families as well as we could have. We are committed to engaging the service users’ stakeholders. We do have a Family Support service and this will be addressed this year.

Q Could you give us an idea of the long term success rate for the project? How much does it cost the tax payer and does it bring value for money?  So far we have only referred to drugs, is there a danger that there is too much focus on drugs and too little on treatment for alcohol abuse?

R (Jo Melling) The cost of the DAAT overall is £7m and the PCT contributes on a local basis. We retain over 70% of people entering treatment over a 12 month period.  Our national database indicates that Oxfordshire is currently ranked fifth in the country for treatment effectiveness, which is a service this county can be proud of.  We do provide a service for those suffering from alcohol abuse but it is  very much a ‘poor relation’. Many drug users have alcohol problems also. We do, however hope to develop a service           . The DAAT is trying to drive forward the community safety aspects of alcohol abuse.

Q Would it be possible to use the new unit for income generation?

R (Jo Melling) This cannot be ruled out and could be considered when we have the building specification.

Q When will the new service be begin operating?

R (Darren Worthington) We have begun negotiations with a landlord on the Iffley Road, Oxford and we are very shortly to start discussions with the local council with regard to planning permission. We estimate that it will open in late summer 2010.

Jo Melling commented that the search for premised had been wider than just Oxford City.

Q Will it have 8 beds?

R (Darren Worthington) We are looking to it operating with 10 beds. There will be a dedicated nurse working at the unit.

Q What lessons have the PCT/DAAT  learned from this? Does the LINk have good cause for concern?

R (Alan Webb) We need to look at the communications issues across all parties with regard to when a service is to be re-provided and/or when there is a service break. He expressed his confidence that there were no governmental issues, as he chaired the DAAT. He added that, although there were lessons to be learned, the DAAT had an excellent track record and this should be kept in focus. The PCT were anxious to ensure that service users were not compromised in any way with the new service.

Richard Lohman was invited to give a response to the debate on behalf of the LINk DRP Group. He put forward the following comments:

·         In terms of value for money, a review of the former DRP undertaken in 2005 stated that nowhere in the country could one find a better cost per unit. The unit was exceptionally good value for money;

·         The National Treatment Agency for Substance Misuse (NTA) carried out an audit of 22 outcomes and found that 10 out of the 22 were not auditable. It is difficult to assess where a person is in terms of whether they have become a productive member of society within a 2 year period;

·         Interviews carried out with some service users have echoed the statements given by Glenda Daniels and Daniel Worthington that SMART was now able to offer a much broader service;

·         Dr Andrew McBride had confirmed that unless money was earmarked for detox provision for rough sleepers, the provision offered would be unworkable. Darren Worthington, who has worked closely with the DRP Project Group, is very optimistic that the new service will cater for this treatment group by redirecting funding from elsewhere;

·         The LINk had experienced some difficulties in extracting information from the Supporting People Team.

 It was AGREED to:

(a)               Thank the Oxfordshire LINk for their report;

(b)               Request Mr Edwards to write to Oxfordshire PCT and the DAAT giving the Committee’s view that the DRP should be re-provided as soon as possible and that the services should be at least to the standard of those that were provided formerly, particularly the ‘base’ level services offered to people prior to entry to rehabilitation;

(c)               Any planning or nursing issues that would be likely to halt or delay re-provision, be reported to this Committee at the earliest possible moment;

(d)               Oxfordshire PCT be reminded of the importance of consulting with this Committee should there be any change for service users; and

(e)               The Oxfordshire Supporting People Team, Oxfordshire PCT and the DAAT be reminded of their duty to respond to requests for information from the Oxfordshire LINk.