I recently received notification through NeLM that the new Harm Reduction Strategy was out.

This usualy gives a link to the document but all there was was the same press release, and there is still no new document on the DoH website (that I can easily find).

I have heard (through an aquaintance - though not directly myself) that Gordon Brown has recently commented that needle exchanges have not been the success they are cracked up to be!!!

Is there a rabbit off somewhere or can anyone shed light on the missing strategy??

Bill

It does exist:::
"Reducing
Drug-related
Harm:
An Action Plan"

© Crown Copyright 2007
281030 1p 3k May 07 (CWP)
Produced by COI for the Department of Health

i've been sent a copy by email on adobe, but can't find a link to post here anywhere.. doesn't seem to exist on the NTA site. hopefully womeone more technical will be able to find the link.

Judith you've ruined my next policy update! Seroiusly, this is called a drug related harm action plan but is actually a drug realted death action plan in response to the rise in DRDs. Its not a strategy as it is very short. At the moment I only have an e-mail copy. As soon as I get a link I'll post it here and it will be in the next policy update for members.

Try this link: http://www.dh.gov.uk/en/Publicationsandstatistics/Publi...ndGuidance/DH_074850

Cheers
Simon

quote:

Originally posted by Simon Morton:
Try this link: http://www.dh.gov.uk/en/Publicationsandstatistics/Publi...ndGuidance/DH_074850

Cheers
Simon

Show off

Just had a look at this booklet- oh dear! Almost nothing new, no real innovation, everything in it is being done already by any agency worth their salt, £2m will not go far, especially if it includes:-

'Competency based training' (attend a 'workshop' run by either your existing health educators, who should have been doing it already, or run by a entrepreneur diverting public funds to their bank account, and certainly don't expect to be tested that you have learned anything, let alone checked if you are putting it into practice).

A ‘Health promotion campaign’ (leaflet)

‘Engagement Projects’ for local service users and carers (another opportunity for long held grievances to be aired and listened to politely)

‘Regional road-shows’ (More time not at work delivering interventions, that you must attend ‘cos they’ll be taking a register)


£2m could instead:-
Extend the opening hours of needle exchanges and help challenge NIMBY objectors to new outlets.
Fund paraphernalia kits that include all requirements for safe, single use, including nasal naltrexone and ‘dialling 999 won’t bring the police knocking’ leaflets.
Reduce caseloads so that staff can spend more time with existing clients to improve the safety of their drug taking
Allow for alcohol use to be addressed properly (including making it a high value outcome target)
Target coroners to work in a less secretive and more standardised way with services trying to examine what ‘went wrong?’ in a timely and effective way.
Update NHS Direct staff in recognition of unsafe drug and alcohol use
Support A&E staff to address unsafe drug and alcohol use in a non-judgmental manner.
Support prisons in planning all releases of known drug users to avoid the Friday afternoon precipitation onto the streets because of a cell shortage (maybe even link it to early release to ensure co-operation of the client)

(Or a I just being a grumpy old man?)

Thanks everybody - got it.

Bill

hi jimjones,
well that sounds a remarkably sensible wish list for a grumpy old man. We should put in a bid for our own £2million. Is anyone doing anything with nasal naloxone?

quote:

(Or a I just being a grumpy old man?)

Well maybe Jim, but then again so am I.

I think overall, though sketchy, it's a helpful in a 'let's revisit (e.g. HCV) and tie in with other stuff (e.g. Healthcare Commission reviews)' way.

I liked the trailer that the new Clinical Guidelines would address HR (any insights about that Simon G. that you can share?).

Topically, the TOP is mentioned. Sounds like quite a lot is riding on that Susi.

So, yes, a bit bland maybe.
But helpful...

Cheers
Simon

Simon,
sorry I'm not allowed to comment. Will not be much longer to wait though.

Understand Si.
Cheers
Simon

Well, you finally flushed me out after lurking all this time. I’ve recently moved from the south east NTA regional team to HQ to manage this and other projects, so thought I should respond with some of the thinking behind the broad headlines

I can understand some of the cynicism about such health promotion campaigns, but the recent DRD campaign did appear to actually bear fruit. I think it is best to view the current strategy as a set of broad objectives, with more detailed actions and milestones to come at a later date. To take your comments in turn (


"'Competency based training' (attend a 'workshop' run by either your existing health educators, who should have been doing it already, or run by a entrepreneur diverting public funds to their bank account, and certainly don't expect to be tested that you have learned anything, let alone checked if you are putting it into practice)."

No, this is working with existing training providers (not for profit in the main) to align current training programmes with DANOS competencies and ensure good practice standards are built into such training. This will also be built into any dissemination events around the forthcoming NICE and clinical guidelines

"A ‘Health promotion campaign’ (leaflet)"
These will be targeted at at-risk groups and were well received in the last campaign.

"‘Engagement Projects’ for local service users and carers (another opportunity for long held grievances to be aired and listened to politely) "

Not really. We’re intending to pilot user led training packages which can be picked up by user groups and run locally to fit local need. This is based upon some successful work carried out by the Oxfordshire User Team.

"‘Regional road-shows’ (More time not at work delivering interventions, that you must attend ‘cos they’ll be taking a register)"

I've never known compulsory attendance for such events, but they do allow the development of more locally focused responses (e.g. low Hep C prevalence/high injecting in North East, high DRD in Brighton etc.)


"£2m could instead:-"
The budget for this year is actually nearer 1.2 million, given that the healthcare commission and St. Georges work is already allocated.
Extend the opening hours of needle exchanges and help challenge NIMBY objectors to new outlets.

"Fund paraphernalia kits that include all requirements for safe, single use, including nasal naltrexone and ‘dialling 999 won’t bring the police knocking’ leaflets."

Working on the basis of around 10p per needle (for single shot needles) utilizing the entire on million would provide one additional needle per user per week. This is very much a local commissioning issue, and should remain so.

We need a more robust evidence base on naltrexone (which is due), and there are legal issues over prescribing PGDs allow for own use, but not for others. These are being ironed out, but will take time.

"Reduce caseloads so that staff can spend more time with existing clients to improve the safety of their drug taking"
Again, how much would the funding assist on this? In any event, staff should be doing this as a matter of course. Unless they are working solely on abstinence issues (and even then relapse should be covered), what on earth are they talking about with their clients other than the nature and extent of their drug use?

"Allow for alcohol use to be addressed properly (including making it a high value outcome target)"
As is the overall NHS trend, targets should be set locally-hence the ansence of any such measures in the strategy
"Target coroners to work in a less secretive and more standardised way with services trying to examine what ‘went wrong?’ in a timely and effective way."
Agree entirely, though as I’m sure you are aware coroners do have a high degree of autonomy. This should be covered under the rewrite of the confidential enquiry guidelines, but I'd welcome anythoughts on how this could best be achieved.

"Update NHS Direct staff in recognition of unsafe drug and alcohol use
Support A&E staff to address unsafe drug and alcohol use in a non-judgmental manner."

That’s probably quite a behaviour shift to carry out in a year, but we will certainly be targeting A and E and paramedic staff

"Support prisons in planning all releases of known drug users to avoid the Friday afternoon precipitation onto the streets because of a cell shortage (maybe even link it to early release to ensure co-operation of the client)"

This should be covered in time by IDTS, but money is going into Hep B vaccination for those most at risk in prisons. I think this is really interesting though, and if you have any ideas about how we could target this group I would welcome them.


I hope this helps. Happy to discuss on this forum or at your convenience. As I say, there is much that is yet to be decided and any thoughts and suggestions for future activity are more than welcome. I can be contacted at Hugo.Luck@nta-nhs.org.uk

Hugo, (switching off grumpy old man mode)
Really good to have this dialogue, yes I know £2m is a drop in the bucket of funds and needs to be used carefully, and I welcome the initiative in more than principle. It is unsettling however to hear the published £2m has already become £1.2m.
I admit too that I was annoyed to see the booklet containing so much political spin in its introduction, the meat you see once past the propaganda is good.

My comments are based on what I observe in many areas regarding ways in which previous targets have had to be seen to be met, but not really done anything on the ground. Workloads are high and targets are driving consultation time, with pressure being put on completing paperwork to prove the targets have been met, rather than establishing relationships that can then be exploited for the good of the client. Perceived and actual cuts in jobs in services create an anxiety that one must be seen to be performing well, (see recent letters in Drink and Drug News for examples). So yes, workers are not always able to spend time discussing the nature and extent of a client's drug use, though they know full well that is what is needed.

I also have contact with non-specialist health services such as A&E, and see huge potential for efficient and timely work there, if only fear, ignorance and prejudice could be reduced. Staff do not have the background in their specialist training, and are seldom any more informed than the general public as to the nature of dependency and addiction, let alone able to offer effective intervention, or even a positive response the acute needs that present. Ignorance of the pain-control needs of opiate users for example leads to poor prescribing, fear in the client of untreated withdrawal and subsequent self-medication to deal with the injury, infection or other acute problem. (If you have an infected groin abscess, the prospect of time in hospital hiding your drug use, or being offered unsuitable ‘standard’ pain relief- or even none at all for fear of making the addiction worse - results in self-treatment with the ultimate analgesic/anxiolytic until septicaemia carries you off. It may not even count as a drug-related death)

The prison system is a sausage machine driven by the courts, and time after time releases are inadequately planned, exposing clients to the high-risk period after release unprotected. Linking release formally to after-care- as a condition set by the court from the outset; or by governors once drug dependency is identified after imprisonment; or by the parole board or whatever- may be more successful in bridging the dangerous gap that still exists, especially remand prisoners who are much less subject to (caring) control during and after imprisonment. The conflict will be between the rights of prisoners to be released unhindered at the end of their sentence, versus the need to be kept safe from their own impulses. I would welcome blue-sky thinking from prison staff on this (any ideas Nat?).

Alcohol is implicated in many drug-deaths, an approach that does not squarely face up to this is seriously deficient. There is a move on a wider agenda to address alcohol -related harm, so once the middle class wine-drinkers have had their say, it may target those at immediate, serious risk from the stuff.

The health promotion campaign for 'targeted groups', does this include families? Knowing how to recognise overdose and how to respond is key to tertiary prevention, we know most ODs are witnessed, we can teach drug users basic resus, how about engaging the parents/partners/children of drug users? (is the snoring noise coming from that bedroom a sign of deep-contented sleep, or a slowly obstructing airway?)

This has livened up the forum no end, must look for more flushing-out strategies.

Regards

Jim Jones

Hello Hugo. Very good to see you on the site. Not sure how long you've been lurking but a live NTA dialogue is appreciated.

Susi continues to be a great online connection, as Nat was/is too.
The only previous NTA Regional Manager who's ever posted previously to my knowledge (in the 6 years of the NTA's existence) was Mark Gilman, and then only once.

So, hoping that your presence is a sign of really positive engagement to come.

All the best.

Simon

well, survived my first posting...

Hello Jim. I see your point re: targets. I do think they have their value-we wouldn't have pulled money out of the treasury, reduced waiting times, kept DH on board etc. without them. However they become destructive when used as the sole means of evaluating performance-this is where I think tools like TOP and some of the ITEP work will become useful. I think it depends on whether the auditor/manager/whatever take an initial presumption of competence or incompetence.

I've been following osme of the debate in DDN and while I have sympathy for some of the views expressed, I'm not entirely convinced by others (this is a personal view, and not him in the NTA ivory tower BTW). I realis ethere's been an increase in NDTMS categories, but I do think that that majority of info requested is (a) relvant to any assessment and (b) can be elicited in the first ten minutes of any meeting. Image comes to mind of a worker with a clipboard reading down the NDTMS form "now are you male or female"...

Good point re: the prisons. WHat I should have mentioned is that we're currently discussing with the prison ombudsman fatalities lead about how we can use the three years of data they have on all the pre and post release fatalities, with a view to identifying key risk factors and acting accrdingly in training, protocol development etc. I know most of this will be stating the obvious to those in the field, but it will be good to have some robust data backing it up.

Yes we are including carers-dangers of posting late in the day. At least one of the pilots I mentioned will involve carers with a view to issuing a relevant training package.

We will be shortly reconvening hte drug related deaths steering group, and would welcome your input if you fancy a trip to London? feel free to e-mail/phone me (0207 261 8510) to discuss further.

Hi Simon. Lurked a while. I meet with Jim and Chris Godfrey every two months or so as a formal NTA/SMMGP/RCGP link meeting, so keep broadly abreast of things primary care related-i.e. the engagement is there, we probably just don't shout about it much. My silence isn't any fear of engaging in debate-when you have Mark Gilman, Susi, and Nat flying the flag I probably couldn't really add much more . Will be happy to contribute to debates, though will make it clear when it's my own views and not necessarily those of my organisation.

Hugo,

Ok Ok, you've got a point about targets, good will and good intentions is not enough. It is the local application as you say that makes the difference.

I would be interested in steering group input, I have been known to make the pilgrimage to the centre of all the major problems this country has. Just promise there will be no coffee-time chat about house prices. (:-)

that's great Jim. Welcome to the dark side.

Interested to know how IDTS will stop early releases?
A colleague advises that the guidance for prison based prescribing is more modest than on the out,40 mls tops?Perhaps I have been misinformed.As always, I am sure someone will put me right.

As far as I can tell it seems to vary greatly from one prison to another, but this is Nat's call really. But perhaps in their defence, with less freedom to indulge temptation people seem to be able to manage on less on the inside than the out - the risky time is when they come out, don't realise tolerance is lower, and don't want to lose sense of achivement in having reduced dose, when sometimes outside in riskier enviromnment it might be better to increase again.
Don't forget, it wasn't so long ago that we didn't see any maintenance in prisons. It was compulsory detox with a few paracetamol or DFs if lucky for all, so things are moving on.
I also think the prisons are doing a fantastic job on the immunisation and BBV testing front.

Really enjoyed the healthy debate on this thread, reminds me why I value this forum. Its a tool for recruitment too - great stuff! I'm pinching myself - I seem to find myself in the happy if slightly surreal position of being able to welcome Hugo to posting here and Jim to working with the NTA - delighted to do both