A proposed new model for an Adult
Community Substance Misuse
Treatment and Recovery System in
Nottinghamshire County
Dr Chris Kenny
DPH Nottinghamshire County
and Nottingham City
26 September 2013
Purpose of today
To describe:
• Importance of substance misuse
• The proposed model
• The proposed outcome measures
Importance of substance
misuse
•
•
•
•
•
Health and wellbeing
Crime and disorder
Housing
Employment
Social functioning
Why ?
• Strategic shift in focus – Recovery emphasis,
treatment is part of that journey, not the
ultimate destination
• Whole system never formally tendered* or
subject to market exercise to test value for
money
*NHS Bassetlaw did undertake a formal tender process for part of the system in 2011
The current system
“If recovery is a train journey
from Nottingham to London
……. treatment is the taxi that
gets you to the station”
Simon Jenkins
12 Step Recovery
What are we consulting on?
Our vision to have an Adult Community Substance
Misuse Treatment and Recovery System, which will
enable individuals easy access to stigma free, high
quality cost effective treatment and recovery services
across Nottinghamshire, regardless of where they live
or the substances used
Proposed Model Principles
• A model with the Recovery at its core – everyone entering
substance misuse services has the potential to recover
• A consistent and responsive approach to treatment and
recovery service provision and delivery across all seven
districts of Nottinghamshire
• A consistent approach to outcome monitoring
• Equity of treatment and recovery provision regardless of
whether an alcohol or drug user
• A consistent approach to commissioning
• Clarity regarding financial efficiency and value for money
Possible outcome measures
•
•
•
•
•
•
Recovery – what does this mean?
Health and wellbeing
Reduced crime
Employment
Housing
Support for others
COMPLEX
As ENHANCED plus:
In-patient/unplanned withdrawal
or detoxification
Pregnancy shared care
Free of all substances
EXIT
Planned
Drop
out
Prison
ENHANCED
As STANDARD Plus:
ACCESS
POINT
Comprehensive assessment
Opioid Substitution/other prescribing
Structured psychological interventions
Harm reduction (BBV&TB testing, NSP)
Planned community withdrawal/detoxification
Assessment physical & mental health needs
Consider residential/community rehabilitation
STANDARD
ALL CLIENTS (including family member and carers)
Triage and initial assessment
Keyworker allocated
Family member/carer assessment
Low intensity psychological interventions/extended brief
interventions
Proactive/facilitated referral to housing, education, employment,
personal finance, healthcare support and Mutual Aid (self-help)
Based upon: National Treatment Agency (2012) Medications in recovery: Re-orientating drug dependence
treatment
Self
Primary
Care
Hospital
Criminal
Justice
System
Discussion points
• Relative importance of substance misuse
• Public and patient engagement in the
process
• Impact on providers
• Use of resources in the context of overall LA
financial plans
A proposed new model for an Adult
Community Substance Misuse
Treatment and Recovery System in
Nottinghamshire County
Dr Chris Kenny
DPH Nottinghamshire County
and Nottingham City
26 September 2013