MIDLOTHIAN AND EAST LOTHIAN

DRUGS AND ALCOHOL PARTNERSHIP

ANNUAL REPORT 2011-2012

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CONTENTS

Foreword.............................................................................................................. 3

The Structure of the Partnership ............................................................................. 4

Our Achievements ................................................................................................. 6

Service Delivery .................................................................................................... 6

MELDAP Work Plan ............................................................................................. 6

Current Priorities ................................................................................................ 7

Publications ....................................................................................................... 8

Improving Service Quality ................................................................................... 9

Communication and Partnership ......................................................................... 11

Prevention and Protection .................................................................................... 12

Good Practice ................................................................................................... 12

Good Indicators ................................................................................................ 12

Future progress ................................................................................................ 13

Services for Prevention and Protection ................................................................ 14

Throughcare and Aftercare Health Practitioner ................................................... 14

East Lothian Substance Misuse Social Worker .................................................... 15

MYPAS Connected Service............................................................................... 16

ELYC (East Lothian Young Carers) .................................................................... 17

Integration Team, Substance Misuse Support Officers ........................................ 18

Children 1st – Midlothian Family Support Service ................................................ 19

Treatment and Recovery ...................................................................................... 20

Targeted Investment ........................................................................................ 20

Good Practice ................................................................................................... 21

Future Progress ................................................................................................ 22

Services for Treatment and Recovery .................................................................. 23

LEAP (Lothians and Edinburgh Abstinence Programme) ...................................... 23

PETE (Pathways to Education, Training and Employment) ................................... 24

ELCA (Edinburgh and Lothians Counsel on Alcohol) ............................................ 25

East Lothian Substance Misuse Service ............................................................. 26

CLEAR Project – Health in Mind ....................................................................... 27

Midlothian Substance Misuse Service ................................................................ 28

MELD (Mid and East Lothian Drugs) ................................................................. 29

MELDAP Budget for 2011-12 ................................................................................. 30

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Actual Income .................................................................................................. 30

Actual Expenditure ........................................................................................... 31

Governance Arrangements ................................................................................... 33

National Support ................................................................................................. 34

Appendices ......................................................................................................... 36

Appendix A: MELDAPs Tiered Model of Care. ........................................................ 36

Appendix B: Mapping Outcomes ......................................................................... 37

Appendix C: Table of Outcomes and Indicators .................................................... 38

www.meldap.co.uk

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“A comprehensive process of

quality assurance has been

undertaken to improve

service quality and develop

meaningful outcomes in

partnership with services.”

Acting Chair, Midlothian

Council

East Lothian Council

NHS Lothian

Lothian and Borders Police

Third and Voluntary Sector

FOREWORD By Eibhlin McHugh, Acting Chair

Firstly, on behalf of MELDAP, I would like to thank Alan Forsyth the

MELDAP Chair until March 2012.

The Partnership has grown into its role and it is clear that his safe

and guiding hands are a major contributory

factor in the Partnership maturing to its current

position.

Under his stewardship the partnership has

made significant improvement in service

performance and with regards to the HEAT A11

target has gone from being one of the poorest

performing ADPs to one of the best.

The past year has been a time of positive

change within Midlothian and East Lothian. A

comprehensive process of quality assurance has been

undertaken to improve service quality and develop meaningful

outcomes in partnership with services. All but one of our

services has had multiple visits and developed outcomes.

Positive results have been observed; less of our young people

are drinking at an early age; drink driving related offences have

fallen. There of course still remain many challenges which the

recent Delivery Plan addresses.

This Annual Report shows that the partnership has matured and

through the Delivery Plan 2012-2015 process, we have

identified focused work to meet the seven nationally agreed

outcomes for Alcohol Drug Partnerships.

Significant pieces of work that contribute to the Delivery Plan

have already been started. The MELDAP Commissioning Plan,

setting out a vision for future service commissioning, providing

longer contracts to allow services to better focus on service

quality and outcomes.

Service User Involvement has been emphasised as a key area of

work and MELDAP have taken the lead in commissioning a

Lothian Wide Framework to take this forward.

MELDAP is focused on our responsibility to encourage Recovery

within Midlothian and East Lothian and minimising the effects of

substance misuse on children, adults, families and communities.

We take this time to reflect on some of our achievements as a

Partnership and look forward to meeting the future challenges.

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THE STRUCTURE OF THE PARTNERSHIP

MELDAP is a Partnership comprising many different stakeholders

including; East Lothian and Midlothian Councils, NHS Lothian,

Lothian & Borders Police, the Voluntary Sector and other

partnership networks and

organisations. The Acting

Chair of the partnership is

Eibhlin McHugh, Acting

Director Communities and

Wellbeing, Midlothian

Council.

THE STRATEGIC GROUP

decides the scope and

strategic direction of the

Partnership and all

important decisions must

be approved through it.

Its role is as the Board of

the Partnership and

membership includes high

level representation from

all the Partners. The

Chairs from all the other Partnership groups sit on the Strategic

Group to aid good communication.

THE SUPPORT TEAM

supports all the different groups and undertakes the day to day

running of the partnership; gathers and disseminates information,

quality assures funded services, drafts key documents, manages

the finances and provides support to all partners.

THE COMMISSIONING GROUP AND THE PERFORMANCE GROUP

perform complementary functions and meet as one group as

standard. They commission new projects and services and quality

assure the performance of these services and contracts. Recent

work has included service presentations on the Scottish

Government‟s access to treatment target (the HEAT A11) as well as

individual service presentations, which has included the views of

service users, progress against agreed service outcomes and the

positive changes made to individuals and families.

Strategic Group

Performance Group

Commissioning Group

Support Team

Prevention, education, young

people

Support, treatment,

recovery for adults

Culture change, communities, availability

Figure 1:

Overview of

partnership

structure

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THE CULTURE CHANGE , COMMUNITIES AND AVAILABILITY GROUP

has a major focus on alcohol and specifically changing the local

culture towards alcohol use. Recent work involved planning a

coherent and robust approach towards events and campaigns

across East Lothian and Midlothian. The overprovision of alcohol

premises („on‟ and „off‟ sales) is another area that this group are

exploring.

THE SUPPORT , TREATMENT AND RECOVERY GROUP

focus mainly on Adult Treatment services and pathways and has

been looking at the design of an integrated recovery pathway. This

group will also be taking forward work from the Steering Group

responsible for guiding the excellent work around access to

treatment (the HEAT A11 target).

THE PREVENTION , EDUCATION AND YOUNG PEOPLE GROUP

will be key in driving forward the MELDAP priorities around

prevention and early intervention as well as addressing inequities in

the provision of services for young people across Midlothian and

East Lothian.

In addition to the above groups the Support Team also facilitates:

PRACTITIONERS FORUM

to which all practitioners and managers of services in Midlothian

and East Lothian with an interest in Drugs and Alcohol are invited

to attend. This provides an excellent forum for discussing service

development, sharing best practice and hearing about emerging

issues at a delivery level.

OPERATIONAL MANAGERS GROUP

The Support Team Manager Chairs this Midlothian Group focused

on delivery and management issues.

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OUR ACHIEVEMENTS

We have split this section into three broad logical areas:

1. SERVICE DELIVERY

This covers the Support Team and the strategic, quality assurance

and recovery focused work that it undertakes in partnership with all

stakeholders.

2. PREVENTION AND PROTECTION

Includes all services and work focused on prevention, early

intervention and protection.

3. TREATMENT AND RECOVERY

Include all services and work focused on treatment (prescribing,

psychosocial interventions, detox, rehabilitation) and recovery

(employability and other meaningful activities).

These are discussed below high-lighting the achievements and the

planned actions that have delivered them together with any

relevant indicators. A fuller list of mainly quantitative indicators is

mapped against MELDAPs outcomes in Appendix C. Also included at

the end of each section is a brief summary of MELDAP funded

services that have contributed towards these achievements.

SERVICE DELIVERY The MELDAP Support Team has undergone significant changes in

the last year; appointing two Recovery and Quality Assurance

Officers and a Senior Business Administrator in addition to the

current Manager and Administrative Assistant. This has allowed the

Support Team to continue the good work it has been doing and

expand into other essential areas of development such as Service

User Involvement and Workforce Development. After these final

recruitments to the support team they are now able to take a much

more proactive and strategic role, driving forward the recovery

agenda and outcomes based commissioning process.

MELDAP WORK PLAN Last year the Strategic Group agreed the following areas for the

Support Team to deliver against:

1. DELIVER OUR DRUGS AND ALCOHOL STRATEGY 2010-2013

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2. DELIVER A RECOVERY, OUTCOME FOCUSED, EFFICIENT AND

EFFECTIVE SERVICE DELIVERY SYSTEM THAT ENSURES EQUABLE AND

ACCESSIBLE SERVICES THAT PROVIDE A PATHWAY TO RECOVERY

3. DEVELOP MELDAP AS AN ADP: USING INNOVATION FROM

MIDLOTHIAN AND EAST LOTHIAN AS WELL AS GOOD PRACTICE

MODELS FROM AROUND SCOTLAND AND THE UK

4. HEIGHTEN MELDAPS PROFILE WITHIN OUR COMMUNITIES, LOCAL,

NATIONAL AND UK WIDE DECISION MAKING AND INFLUENCING

BODIES AND COMMUNICATE SUCCESSES, INNOVATIONS AND

CHALLENGES.

Within each area were a number of specifics to deliver against. The

plan focussed on 2011-12 but with cognisance that many of the

areas were either ongoing or wouldn‟t be delivered against until the

following year. Table 1 below shows these activities under the four

areas:

Area of

Work Plan

Delivered /

Delivering

against

Underway

Not started

Total

1 17 25 8 37

2 5 8 0 10 3 24 14 2 34 4 3 2 2 6

TOTAL 49 49 12 87

Table 1: MELDAP Activities Note: The total may be less than adding all columns together as some activities are very broad and may have been

delivered against in part and underway in part.

The MELDAP Work Plan will be updated in the near future to reflect

the new direction as laid out in the MELDAP Delivery Plan 2012-

2015.

CURRENT PRIORITIES MELDAP‟s key priorities are set out in the MELDAP Delivery Plan (on

p17). These priorities are mapped directly from MELDAPs

Implementation Plan 2010-13.

1. PREVENTING FUTURE HARM CAUSED BY THE MISUSE OF ALCOHOL AND

DRUGS

2. REDUCING HARM AND PROMOTING RECOVERY

3. PROTECTING AND SAFEGUARDING CHILDREN , YOUNG PEOPLE AND

COMMUNITIES

4. COMMISSIONING AND ASSURING HIGH QUALITY , COST EFFECTIVE AND

OUTCOMES FOCUSED SERVICES

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The Delivery Plan sets out the specifics of these in greater detail

and links them to outcomes and services (see appendix B for how

these outcomes have been mapped). Appendix C shows the

performance of indicators mapped against MELDAP and National

ADP outcomes. These indicators deliver against the previous

Implementation Plan 2010-13 and start to address the Delivery

Plan 2012-15.

PUBLICATIONS

MELDAP COMMISSIONING STRATEGY

This sets out the outcomes based commissioning approach that

MELDAP will pursue when re-commissioning existing services or

starting new services over the next three years. From this an action

plan for service delivery was taken to the Strategic Group which

endorsed the proposal. This sets in motion a significant piece of

work for the Partnership over the next year.

Click the following for an online copy: MELDAP Commissioning

Strategy.

SMALL AREA ESTIMATES FOR HEALTH RELATED BEHAVIOURS

MELDAP commissioned Ipsos Mori to carry out research into the

geographical patterns of drugs, alcohol and tobacco use across

Midlothian and East Lothian. Based on data from the Scottish

Household Survey, Scottish Health Survey and SALSUS, Ipsos Mori

were able to build a detailed picture of substance use at „datazone‟

(625 households) level.

The research indicated a trend, particularly apparent in East

Lothian, that areas of relative affluence are associated with

Hazardous levels of drinking. For men Hazardous levels are more

than the recommended amount but less than 50 units (over this

amount is considered harmful).

This indicates a need for the development of different approaches

to target this group, work that the Culture Change, Communities

and Availability Group is taking forward.

Please email MELDAP for a copy of the report.

DELIVERY PLAN 2012-2015

This has been a major piece of work set out by the Scottish

Government after consultation with ADPs. The Delivery Plan

updates MELDAPs 2010-13 Strategy and Implementation Plan,

aligning it more closely to the National Outcomes. From next year

this annual report will reflect the work of the Delivery Plan and its

proposed indicators more fully. See appendix C for indicators

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reflecting the previous Implementation Plan and current Delivery

Plan.

This will be available online shortly by clicking the following:

MELDAP Delivery Plan

SERVICE USER FOCUS GROUPS

Two focus groups were conducted by Scottish Drugs Forum on our

behalf to look at service user involvement within services. From

this a report was written and a number of useful recommendations

made. This serves as a good foundation for further work around the

development of service user involvement over the next year.

Click the following for an online copy: SDF Focus Groups

IMPROVING SERVICE QUALITY

BEST VALUE REVIEW P ILOTS

Two services piloted MELDAPs Best Value Review process. This is a

self-reporting tool managed by the MELDAP support team that

quantifies and qualifies the efficiency and effectiveness of a service

in line with cost. These successful pilots showed the robustness of

the tool and both pilot services showed excellent results. This

creates a solid foundation for using the tool with other services in

the future.

INTEGRATED RECOVERY PATHWAYS

Part of the work from the Commissioning Strategy was the need to

consider more integrated recovery focused pathways for those

people with a problematic drug and/or alcohol use. The Support

Team started this development in February and will take it to a

number of MELDAP‟s groups including the Support Treatment and

Recovery Group for initial discussion.

The pathway (figure 2) is based on the concept of risk linked to

appropriate interventions. Further work has been started to specify

what the delivery of this integrated recovery pathway would need

to include and a comparison with current delivery and service gaps.

This is underpinned by a number of additional needs. These are:

balancing the finances in Midlothian and East Lothian in a

sustainable way

meeting the gaps in service provision identified in the needs

assessment

delivering a sustainable person centred recovery pathway

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meeting any future needs identified in the CAPSM needs

assessment.

addressing the in balance in terms of investment between

Prevention and Treatment

These needs are pertinent to and highlighted in the future of

Commissioning and Service Delivery as discussed in the relevant

MELDAP publications.

Ou

tcom

eA

ssessm

en

tIn

terven

tion

Family, friends and social support networks, employability, meaningful activity

SMART Recovery

AA / CA / NA

Refe

rral*

Preven

tion

ABI in variety of

community settings

Social/norm marketing campaigns

Community Campaigns, information

Workplace Events

Education Formal/ Informal

Refe

rral*

Gateway to Recovery

Lowering risk

Bu

ildin

g R

eco

very

Cap

ital Develop and Review

Recovery Plan / Client Choice / Partnerships

Recovery

StabilisationDetox:

Community/Residential

Info, advice, short

intervention

Evidence Based PSI**

HIGH RISK MEDIUM RISK LOWER RISK

Moving on Plan

AbstinenceSafer

Drinking/drug use

*Referrals may still come in from from GP / Criminal Justice however most other referrals should be directed to the self-referral recovery gateways.

**These include: assessment skills, identifying and building on recovery capital, counselling skills, motivational interviewing, CBT, awareness of „other‟ counselling needs.

MELDAP WAITING TIMES PROTOCOL

In September 2011 MELDAP initiated a process regarding waiting

times to quality assure the protocols in place thus increasing the

accuracy of the information submitted. In tandem with this MELDAP

led a change process which centred around a multiagency Kaizen

event based on the „LEAN‟ principles. This work, co-ordinated by

the NHS Quality Improvement Team, was responsible for the

establishment of the Gateways to Recovery.

QUALITY ASSURANCE V ISITS

MELDAP are committed to a process of quality assurance

underpinned by formal quarterly visits by the MELDAP support

team to all MELDAP commissioned services. The support team work

Figure 2:

MELDAP

Recovery

Pathway.

P a g e 11

“ELYC found the quality assurance visits to be a very

positive experience. It was good to have the opportunity

to talk in depth about the service we provide as often the

only contact we have with funders is through written

reports. The meetings encouraged us to look at the

service we provide and identify what we did well and what

we could do better. It is good to know that we will

continue to meet with MELDAP staff as we have found the

regular contact to be very helpful. ”

Service Provider

with services in the role of „critical

friend‟ supporting and challenging,

providing accountability and most

importantly helping to improve

service quality. The support team

have been working through the

National Quality Standards for

Substance Misuse Services with

services over the past year.

In addition to this further work has

been done with the MELDAP

Commissioning and Performance

Group regarding service

presentations.

COMMUNICATION AND PARTNERSHIP

WEBSITE

MELDAP has a new website (www.meldap.co.uk) which contains

information on all services and other relevant information. MELDAP

also update the website with future developments, news and

partnership events.

REPRESENTATION ON KEY GROUPS

MELDAP sits on key groups within the Community Planning

Partnership including the Getting It Right For Every Child and

Health and Social Care Theme groups. It is also represented on a

number of strategic groups, Child and Adult Protection Groups, with

our health partners and through Community Safety Partnerships

led by Lothian and Borders Police. We sit on both Local Licensing

Forums and presented on the local alcohol misuse picture and are

working with our health partners to move forward our local

understanding of over provision.

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“ I never realised

vodka was so

strong! ”

MYPAS Service User

“ I haven‟t been doing as

much (drinking alcohol)

because it‟s informed me ”

MYPAS Service User

“The Midlothian screening

process is unique but in my view

is a very effective approach to

capturing children who might,

otherwise fall through any gap.”

Screening Group Member

PREVENTION AND PROTECTION Prevention and Early Intervention are key areas which are to be

further developed in the future in line with MELDAP priorities and

national guidance.

GOOD PRACTICE

M IDLOTHIAN SCREENING GROUP

MELDAP holds the current work and mechanism of the screening

group in high regard. It is multi-agency approach that acts as a

safety net for any children identified within services. This group

brings the right professionals together to review and

consider appropriate interventions.

MEST-UP TOOL

MELDAP has piloted the use of a young people‟s

screening tool, MEST-up? designed to provide the

„context‟ for a structured discussion on a young

person‟s risk taking behaviours while identifying

relevant protective factors. A final total score is used

to highlight to young people their level of risk, with

one possible option being a referral on to a young people‟s

specialist service.

GOOD INDICATORS

SALSUS

According to the 2010 Scottish Schools

Adolescent Lifestyle and Substance Use Survey

(SALSUS), which is conducted every 4 years

locally and 2 years nationally; 15 year olds are in

general drinking less, taking fewer drugs and the number of 13

year olds that had tried alcohol has reduced since the last

authority survey in 2006.

Not all the indicators are positive though, as the level of

drinking by those already drinking at harmful levels has

increased. Also the attitudes of parents in East Lothian

indicate that they are less concerned about children

consuming alcohol at 15 years old.

HOSPITAL DISCHARGES

Reducing the burden on acute hospital services would be one

positive outcome that could be linked to the intervention of services

and is one way that savings can potentially be made. Looking at

current levels we see that overall the level is slightly down from 5

years ago up to 2010/11 and that a downward trend was emerging.

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Figure 3 - Alcohol

related discharges

2006/7-2010/11

(taken from: Alcohol-

related Hospital

Statistics Scotland,

2012, ISD)

It will be interesting to observe figures from last year and see if the

downward trend

continues.

This data has many

different factors

influencing it. From

general health of

population to ratio of

deprivation of the

people discharged. The

services that MELDAP

funds can and will

influence these

discharges but this is a

medium to long term

outcome.

GOOD COVERAGE OF HEPATITIS C AND HIV TESTING

The Scottish average for people who have injected in the past who

have been tested for Hepatitis C and HIV is 76% and 73%

respectively. Across East Lothian the average is 87% for both and

84% for Hepatitis C and 80% for HIV in Midlothian (see appendix

C).

ALCOHOL BRIEF INTERVENTIONS

1,151 brief interventions were delivered in GP practices in

Midlothian and East Lothian this contributed to the total delivery in

Lothian of 17,093 which greatly exceed the Lothian target of 9,938.

The support team is working closely with NHS Lothian‟s Health

Promotion Service to take forward the role out of Alcohol Brief

Interventions within wider community settings.

FUTURE PROGRESS

CHILDREN AFFECTED BY PARENTAL SUBSTANCE M ISUSE GUIDELINES AND

NEEDS ASSESSMENT

New guidelines are about to be published for children affected by

parental substance misuse. MELDAP has been involved in the

development of these guidelines and a service user led leaflet for

parents and carers. The publication of the new guidelines will have

a significant impact on MELDAP services and the need to provide

training for staff on their use

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SERVICES FOR PREVENTION AND PROTECTION

THROUGHCARE AND AFTERCARE HEALTH PRACTITIONER

This worker supports young people aged 15 – 21 years, in East

Lothian, who are currently or were previously looked after and

accommodated (LAC), with health issues. MELDAP part fund this

post to provide young people with support/interaction re:

substance/alcohol issues. The aim is to provide a holistic approach

in supporting young people throughout the transition to

independent living, which combines the generic health support with

the specialised MELDAP role.

OUTCOMES AND EVIDENCE

The worker has contributed to effective working with substance

misusing parents, which has helped to reduce the number of

children on the Child Protection Register. This post has also

contributed to a greater uptake of contraception, less unplanned

pregnancies, improved sexual health and stronger links to sexual

health services.

All young people referred to the Health Practitioner have to

complete a health assessment and their health needs are identified

by both the service user and the health practitioner. All young

people are supported to register with a GP and Dentist.

The Health Practitioner delivers health and substance, alcohol and

tobacco misuse information sessions to young people in residential

care and foster care.

An annual questionnaire is undertaken which shows positive

responses from service users about health input and the improved

health outcomes for young people.

“ ...a holistic approach in supporting young people

throughout the transition to independent living. “

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“19 out of 24 people

referred to the service

engaged with the service

(Dec-March).”

EAST LOTHIAN SUBSTANCE M ISUSE SOCIAL WORKER

MELDAP funds a full time Substance Misuse Social Worker within

the Mental Health Team in Adult Social Care. They provide parents

with drug and/or alcohol problems with support, advice

and assistance in relation to their substance misuse and

associated issues. Parenting issues and substance

misuse treatment options are discussed with all clients

as well as safe storage of any medicines.

After approximately a 5 month gap in service provision

MELDAP resumed funding a newly appointed worker

again in December 2011 and all the information here relates to the

period from December 2011 until March 2012 only.

OUTCOMES

The following outcomes have been agreed with MELDAP: increased

access to a wide range of treatment and other therapeutic

outcomes; reduction in the consumption of alcohol/ drug use;

increased confidence and self worth; improved physical and mental

health; increased resilience in setbacks.

EVIDENCE TOWARDS OUTCOMES

19 out of 24 people referred to the service engaged with it. 8 of the

24 were signposted or supported to attend the Gateways to

Recovery successfully. A number of clients are given ongoing

support to attend other appointments e.g. Changes, GP, CMHT,

SMS.

6 of the 24 have reduced alcohol/drug use this is based on case

notes, conversations or feedback from clients within the 4 month

period (this can be difficult to measure accurately and we are

looking at other ways to do this).

Storage safes are offered to parents and two have been provided

for the safe storage of medicines.

The worker has also facilitated a number of meetings to gain

service user feedback on the new guidelines coming out in relation

to Children Affected by Parental Substance Misuse. This has been a

valuable process specifically looking at a leaflet aimed at

communicating the key outcomes of the new guidelines to parents.

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“ I have learnt about units

and how you don‟t have to

drink much to be binge

drinking ”

MYPAS Service User

“ It helps me understand

stuff I never knew and it

makes me feel safe and

that I can trust people. ”

MYPAS Service User

“ I‟m not as easily

influenced because I feel

more confident in myself. ”

MYPAS Service User

“ I would think twice

about mixing drinks now. ”

MYPAS Service User

MYPAS CONNECTED SERVICE

MYPAS (Midlothian Young People‟s Advice Service) is an award

winning, independent, community based, voluntary sector

organisation with charitable status. MYPAS provides a wide range of

integrated and creative services to improve young people‟s health

and well being in Midlothian. MYPAS employs a youth work

approach using a variety of methods to focus on young people‟s

sexual health, mental health and substance use needs.

The Connected Service works to reduce problematic substance use

among young people (12 - 18) in Midlothian using a variety of one

to one support, preventative group work, drop-in, diversionary,

educational inputs and street work to achieve it‟s outcomes.

Over the past year the majority of young people seeking support

did so due to problems related to their use of alcohol. The support

provided has enabled young people to make a wide range of

positive changes in their lives.

MYPAS provides longer term preventative group programmes

targeting young people who are at greater risk of being

disproportionately affected by substance use and risky behaviour.

This includes young people who are looked after and

accommodated, young people under supervision, those out with

mainstream education, young people requiring behavioural support

and those affected by parental substance misuse.

OUTCOMES

Outcomes agreed with MELDAP include a reduction in use of

substances and risk-taking behaviour; increased knowledge of the

harmful effects of drugs and alcohol; increased involvement in

prevention activity and increased confidence and self worth.

EVIDENCE TOWARDS OUTCOMES

20 young people significantly reduced their consumption of alcohol

(average reduction of 36 units/week). 21 young people significantly

reduced their consumption of drugs. 14 young people became

alcohol/drug free.

A wide variety of reduced risk taking behaviours was observed

including 28 young people reporting less involvement with the

police. Young people involved in group work showed an average

increase in knowledge of 73%.

15 longer term group work programmes were delivered to 97

young people. 70 education inputs were delivered to 593 young

people.

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What do you like about

coming to young carers?

“ Meet new people, gets

you out of the house ”

“ Meet new people and

have laugh ”

“ The workers ”

“ Time to yourself ”

“ Fun – get to do arts

and crafts, making

milkshakes, making t-

shirts and watching

movies and playing with

friends ”

“ better friends, go out

more because you get to

come to the club. ”

ELYC Service Users

“ …it has given me more

confidence to make new

friends ”

Young Carer

“ I wouldn‟t have

managed otherwise”

ELYC Service User Family

ELYC (EAST LOTHIAN YOUNG CARERS)

The project offers support to young carers through individual time

and attendance at ELYC‟s young carers clubs. The project also

offers family support. The project works holistically with young

carers and their families as they believe that by supporting the

young carer and their family they will achieve the best outcome for

the young carer.

OUTCOMES

MELDAP have agreed the following outcomes with ELYC: young

carers are less isolated; young carers self-esteem and confidence

are improved; young carers and their families are able to access

the support they need; young carers are more resilient; young

carers lead healthier lives.

EVIDENCE TOWARDS OUTCOMES

Workers record the progress against agreed outcomes. Together

with feedback from workers, an annual review and feedback from

young carers and their parents this information is used to report on

outcomes. Highlights from these sources include:

90% of young carers attending the project reported being less

isolated and 93% took part in regular social activities. 62% report

that their families are under less pressure and 79% that they have

better coping skills.

During the year the project together with funding from Lloyds TSB

provided 106 club sessions with 761 attendances with approx. 2824

hours of respite being provided. 114 individual sessions were

provided to young carers during the year and 66 home visits to

support young carers and their families were provided during the

year.

During the last year ELYC developed an intensive person centred

approach to working with young carers with significant behavioural

problems to ensure they enjoy successful respite sessions.

Family responses to: „Do you think having access to our service has

helped you?‟

“Yes, you have taken me to my CPN when I had no money to get there”

“Yes, you have helped with my flat and my benefits and helped me get a job”

“I would never have thought of applying for an OU course”

“I didn‟t know about the community care assessment”

P a g e 18

“... has helped ___ in lots of ways and has been an inspiration

to him; also we have had better behaviour from ___. Long may

it last!”

Feedback from parent (Integration Team)

“___ advised the support was good

and helped her think about why she

drunk so much alcohol and did not

care about what happened to her. She

said she feels she now has a future

and she has been listened too. ___

also said she no longer wants

anymore support and she can manage

things on her own now.”

Young Person (Integration Team)

“ This continued support has ensured ___ is now showing his true potential in his standard

grades. ___ recently completed a weeks work experience and continues to flourish as a lovely

lad whilst attending school now on a consistent level ”

Teacher (Integration Team)

INTEGRATION TEAM , SUBSTANCE M ISUSE SUPPORT OFFICERS

The service supports children and young people who are struggling

to deal with their own substance misuse or that of their parents or

carers. It is for school age children where, through a person centred

approach, support, advice, groupwork and education on substance

misuse issues are provided.

OUTCOMES

MELDAP had agreed the following outcomes with the Integration

Team: children are safe and cared for appropriately; improved

social and personal skills; increased attitudinal change towards

alcohol and harmful substances; reduction in

risk taking behavior; increased confidence and

self worth.

EVIDENCE TOWARDS OUTCOMES

The Closing Summary reports include feedback

from service users and referrers (usually

schools) on progress the young person has

made. Inspection Reports of Children‟s

Services highlight areas of good practice.

Staged Assessment Review meetings (including

LAC and Child Protection) provide evidence of

where progress has been made against

individual outcomes.

This year the Integration Team have provided

one to one support with 92 children/young people and 21 group

work events. They have also undertaken 8 group work or training

events with professionals and 12 with parents/carers.

P a g e 19

“ When my dad is drinking he gets

annoyed with us all and I feel nervous.

My worker helped my dad understand

how I was feeling and got him to think

about what he could do differently.

Things are better just now but if he

starts getting annoyed I give him the

sign we agreed on that he is to stop

and he has to stop “

Child 9 (MFSS)

“Our MFSS worker gave us the

space to talk about our mum‟s

drinking and how we felt about

it. She also explained why mum

and dad had to separate - it was

hard to take in but we knew

mum‟s behaviour was getting

worse “

Child 11 and Child 12 (MFSS)

“I don‟t have many friends and I

don‟t have anyone to play with at

school or at home. MFSS took

me on activity groups with other

children but I didn‟t know if I

would like the others as they kept

saying I was much taller than

them. We went out on the trips

and my worker kept telling me

good things I did and then the

other children started to say good

things too. One boy said I was

his favourite person in the group.

I liked this “

Child 8 (MFSS)

CHILDREN 1 ST – M IDLOTHIAN FAMILY SUPPORT SERVICE

Midlothian Family Support Service (MFSS) is jointly funded by

Lloyds TSB, MELDAP and Children 1st. The service is located in an

adult Substance Misuse Service, which is a real strength. MFSS

plays a significant role in enabling adult service providers to

consider the impact on the children whose parents

attend their service, ensuring children‟s needs and

wellbeing are highlighted.

OUTCOMES

MELDAP has agreed seven outcomes with MFSS that

are also used to report to their other funders. These

outcomes are focussed on: improved identification;

joint working; improved relationships; education;

accessing health care; parental education and

confidence.

EVIDENCE TOWARDS OUTCOMES

Prior consultation before referrals being made has greatly reduced

the number of inappropriate referrals and co-location has seen an

increase in referrals for alcohol patients from the treatment service.

MFSS were instantly able to offer the support the parents

felt they lacked and this had a very positive effect in helping

them to engage better with the school and make use of the

additional resources offered through the school system.

Parents were helped to establish better routines and

children were supported to understand why parents were

beginning to do things

differently.

MFSS‟s intervention has greatly

increased the number of family

members accessing the GP and

other health services.

There have been increased

referrals for children affected

by parental alcohol use but a

decline in the number of drug

referrals, the reason for this

needs further exploration.

P a g e 20

“I find as facilitator, substance

misuse professional and as a

person it helps me to use SMART

recovery strategies in my

practice and also my own life!!!”

- SMART facilitator, CPN

TREATMENT AND RECOVERY As the greatest area of spend it is right to apply a fair level of

scrutiny of the work of the services that undertake this. MELDAP

has a number of successes within this area and will continue to

build on the good work in partnership with all of its services.

TARGETED INVESTMENT

CLEAR FUNDING

MELDAP have taken over the full funding of CLEAR (Community

Lived Experience for Alcohol & Drugs Recovery). This is the only

service that MELDAP funds with a specific focus on dual diagnosis;

mental health and drug/alcohol misuse. CLEAR run a peer support

programme whereby a volunteer who has experienced drug/alcohol

misuse but is now recovering, provides support to another who is

at the start of their journey. The service offers drop-ins and one to

one support. A number of the peer tutors have gone on to achieve

full time employment something that was not considered possible

before their involvement in the project.

ALCOHOL CAPACITY

Due to a rapid and sustained increase in the number of referrals,

nearly double the 2010 figure for alcohol treatment at ELCA

(Edinburgh and Lothians Counsel on Alcohol) MELDAP was given

additional funding to increase capacity within the service and

increase the number of locations from which the service could be

accessed. This extra funding has been well used with the service

performing well against the HEAT A11 trajectory up to March 2012.

SMART

Self Management And Recovery Training (SMART)

is a service that has been commissioned across

the Lothians in partnership with the two other

Lothian ADPs. It offers an alternative format for

mutual aid than Alcohol Anonymous or Narcotics

Anonymous. The three ADPs have invested in a

year of development work to get professionals

facilitating meetings and the plan is for service

users to take increasing responsibility for the meetings and their

development.

SMART recovery groups allow clients to gain understanding and

develop skills in four basic areas of recovery;

1/building and maintaining recovery

P a g e 21

“ My daughter is always calling me a

„smack head‟ and this upsets me. My

worker spoke to my daughter and she said

she remembered when I was taking other

drugs and I behaved differently. She was

worried when I am feeling low that I might

start taking drugs again. We spoke about

this and she understands where I have

been and where I want to be – very

different places “

Mother of 14 year old (MFSS)

2/coping with urges

3/ managing thoughts feelings and behaviours

4/Living a balance life

The mutual aid/ support ethos empowers clients to take charge of

their own recovery and to help others with difficulties they

experience. It generates a confidence in clients to practice healthy

change and develop healthy, caring relationships within the group.

It encourages clients to explore almost every avenue in their lives

safely and gives user friendly strategies to bring about lifelong

changes and to cement their recovery.

GOOD PRACTICE

AN INTEGRATED FAMILY SUPPORT SERVICE

Within the Midlothian Substance Misuse Service

there are two Children 1st workers with a remit

to work with both children and adults of families

with substance misuse problems. Their work has

been key in supporting the comprehensive

nature of the Screening Group‟s work. The

Family Support Service have a preventative role

working with families that without their

intervention would be more likely to require

higher tariff social work and child protection

interventions.

GATEWAYS TO RECOVERY

Progress towards the HEAT A11 target has been a notable success

within the MELDAP area. This Scottish Government target is that by

March 2013 90% of people are seen within 3 weeks of referral to

treatment. In January 2012 the MELDAP services achieved only

41% making it one of the poorest performing ADPs in Scotland. By

March 2012 this had increased dramatically to 88% making

MELDAP the best performing ADP in Lothian and with a full year to

build on this, possibly exceeding the 90% target.

This improved level of performance was achieved by building on the

foundational work of the MELDAP waiting times protocol and the

Kaizen event. The introduction of the Gateways to Recovery

allowed people to turn up at set times and locations across

Midlothian and East Lothian and be assessed there and then. The

implementation of these were overseen by a steering group formed

at the Kaizen. The other factor in our success was a clear and

standardised discharge policy across all services.

P a g e 22

“ ...better way of life, very helpful in

meeting new people and promotes

esteem and promotes recovery ”

Service User from Recent Focus

Groups discussing what Service User

Involvement means to them

FUTURE PROGRESS

SERVICE USER INVOLVEMENT

MELDAP are currently leading the commissioning and development

of a Lothian wide Service User Involvement Framework. We are

also asking services as part of the quality

assurance visits about the role of service

user involvement building on the work of

the focus groups carried out by SDF on our

behalf. MELDAP envisions service user

involvement playing a greater role in

strategic planning as mentioned in the

Commissioning Strategy.

WORKFORCE DEVELOPMENT

Recently there has been no specific training within East Lothian or

Midlothian around Drugs or Alcohol although there is clearly a need

for it from a range of services, both statutory and voluntary. With

the greater resources within the Support Team this aspect of

MELDAP responsibilities is being developed and a full training

programme will be in place by September 2012.

NALOXONE

MELDAP sit on the Lothian Drug Related Deaths Group and see the

increased role out of Naloxone within the area as a key strategy in

reducing drug related death.

RECOVERY FOCUSED

MELDAP maintains its focus on promoting recovery and is looking

at showcasing recovery stories on the website. Another option

currently being looked at jointly with the Scottish Recovery

Consortium is hosting a conversation café event focused on

promoting recovery within services, services users and the wider

community.

P a g e 23

“ LEAP gave me awareness of another

way to lead my life showing me that

there is a life away from drugs and

alcohol. Treatment gave me the self-

belief that I can achieve things in life.

Becoming a resident at Portland

Recovery House gave me the

opportunity to deal with life on life‟s

terms. To learn about myself in early

recovery and make relationships with

fellow peers within Recovery House

aiming for the same goals. ”

East Lothian Client (LEAP)

“ Making a decision to go into LEAP was the best decision of my life to date. After competing

Treatment, the opportunity to become a resident of Portland Recovery House was also a great

decision as this gave me a good foundation to continue my recovery journey. I am so grateful. ”

East Lothian Client (LEAP)

SERVICES FOR TREATMENT AND RECOVERY

LEAP (LOTHIANS AND EDINBURGH ABSTINENCE PROGRAMME)

LEAP is a 12 week intensive treatment programme for people

dependent on drugs and alcohol. The programme runs seven days

a week and is highly structured with every patient having a care

plan. The programme addresses social, medical and psychological

elements of addiction with a focus on an abstinence based

recovery.

LEAP OUTCOMES

Based on MELDAP funding it was agreed that 20

places a year would be provided for Midlothian

and East Lothian. Over the last financial year six

patients from Midlothian were treated and ten

from East Lothian.

With lower than expected admissions from the

MELDAP area for the last financial year, LEAP have

conducted outreach activities targeted at GPs,

Social Work and NHS Services. This has resulted

in an improvement in the number and quality of

referrals.

In 2011-12 we had 301 referrals, admitted 110

patients and had a 62% completion (graduation)

rate. Graduates maintain a 52% abstinence rate.

Portland Street Recovery House has been

established and MELDAP area clients have

benefited from this second stage housing option.

More than 70% of LEAP Graduates have gone onto the Transition

Employability Programme

A family support group has been established and has a regular

attendance of 12-15 people, supporting, amongst others, family

members from Midlothian and East Lothian.

P a g e 24

“It helps not to feel so isolated.”

PETE service user.

“ Looks at options, looking forward. ”

PETE service user.

PETE (PATHWAYS TO EDUCATION , TRAINING AND EMPLOYMENT)

PETE works with individuals recovering from substance misuse.

The service uses a person-centered approach and looks to set

realistic goals and overcome barriers in progressing towards further

education, training or employment.

PETE OUTCOMES

PETE agreed with MELDAP to:

Increase in partnership working

Service to be provided on an outreach basis with individual

clients if this is required.

Create an Exit Strategy.

EVIDENCE TOWARDS OUTCOMES

Regular contact being maintained, usually by telephone or email,

with referrers to advise/update on individual progress (or lack of).

Procurement of services of external training providers in line with

service user requirements.

Initial interview and subsequent appointments offered at a time

and place to suit the individual.

Timescale in place to provide planned exit from service with follow-

up and re-referral offered.

63 clients were referred to the service in the period 1/4/11-

31/5/12. They have gone on to achieve a wide variety of education,

training and employment opportunities with PETE‟s support. These

include part-time employment, full time employment, voluntary

work and work experience. 19 clients are in Further and Higher

Education. 10 clients are currently engaging in group counselling

and four in one to one counselling.

P a g e 25

“ My circumstances have

improved and I am still

working on the problems

to help me on the way to

a full recovery ”

ELCA service user

“ I never waited very long. I have

been referred to go into the Royal

Edinburgh for detoxification. I have

got the support and the help I

needed ”

ELCA service user

“ It has changed my life. I‟m in control of my drinking now. I don‟t go over the 14 units per

week. Also, I have been able to stop smoking ”

ELCA service user

ELCA (EDINBURGH AND LOTHIANS COUNSEL ON ALCOHOL)

ELCA provide advice, information and one to one counselling to

anyone worried about their own or someone else‟s alcohol misuse.

ELCA work with Midlothian and East Lothian clients in their area or

in Edinburgh for various reasons eg anonymity, work in Edinburgh

or need evening/weekend appointments.

OUTCOMES

The following outcomes have been agreed with MELDAP: reduction

in consumption of alcohol; improvement in physical and

psychological health; improvement in confidence and self-esteem

and improvement in relationships.

EVIDENCE TOWARDS OUTCOMES

ELCA introduced a Client Review Form which all

counsellors have been using now for about a year. They

also introduced a new „End of Counselling Form‟ in

October 2011. This allows them to see when clients end

their contact (whether planned or unplanned) if any

progress has been achieved toward the outcomes and it

also allows sight of where people have moved on to e.g.

employment, volunteering, peer support, recovery groups etc.

ELCA also use CHRISTO on a monthly basis which gives an

indicator towards progress as well.

East Lothian Midlothian Edinburgh

Number of referrals to service 10/11: 90 53 22

Number of referrals to service 11/12: 135 83 39

Percentage Increase 50% 57% 77%

Table 2: Referrals to ELCA

There has been an obvious increase in demand for the service as

shown in the above table. MELDAP have increased resources to

ELCA in order to respond to this and are working with ELCA to

monitor this.

ELCA are also involved in the Gateways to Recovery.

P a g e 26

“ It‟s the first step in the right direction ”

East Lothian SMS service user

“ It works if you

work at it ”

East Lothian SMS

service user

EAST LOTHIAN SUBSTANCE M ISUSE SERVICE

East Lothian SMS is part of NHS Lothian‟s Substance Misuse

Directorate which provides an evidence-based treatment service to

individuals who have alcohol and drug problems, mainly

dependency. Although referrals historically were mainly from GPs

the onset of the new Gateways (access to treatment) have

introduced a self referral element at its core. Recovery underpins

the ethos of the entire team.

OUTCOMES

Not including referrals to Gateways (since February 2012) East

Lothian SMS received 266 drug referrals and 194 alcohol referrals

for the period (Apr 2011-Mar 2012).

A caseload snap shot for the service was 258 clients of which 184

(drugs) and 74 (alcohol).

The Gateways to Recovery in East Lothian are held at Edenhall

Hospital, Musselburgh and Roodlands Hospital, Haddington. Up to

31 March 2012 38 attended at Edenhall, 12 at Roodlands and 3 at

the NEON bus in Musselburgh. The Gateway offers a triage

appointment and clients are then seen by the most appropriate

service thereafter. EL SMS received 38 referrals after triage up to

31 March.

One member of staff has been trained to facilitate SMART Recovery

Groups in East Lothian and is currently recruiting service users to

this and setting up the first group.

Coping skills group: this has been developed by both nursing and

psychology staff. They work within a recognised model and client

responses have been favourable. Some quotes from clients:

“ Everyone at the group has a purpose in life and it has become clear to myself

since I started ”

“ No matter what substance or situation you are in the coping skills will help ”

“ I had started the journey to being clean. However I wouldn‟t be in the position I

am now without the help from the Coping Skills ”

P a g e 27

“ [attending the drop-in] helps to

relieve any stress I may be

encountering on a week to week basis ”

CLEAR service user

“ I have met a lot of

good friends at the

CLEAR project ”

CLEAR service user

“ I am looking forward to the future and becoming a volunteer soon so I can give back

a little to compensate for the large amount I have got out of the CLEAR project ”

CLEAR service user

“ Sharing my problems helps me ”

CLEAR service user

CLEAR PROJECT – HEALTH IN M IND

CLEAR is a Midlothian project that uses the lived experience of

people who have had substance misuse and mental health

difficulties to support people who are still experiencing these

challenges. CLEAR has two parts that run alongside each other: The

1:1 peer support service and the CLEAR drop-in group.

OUTCOMES

MELDAP has agreed the following

outcomes with CLEAR: improved

psychological health/wellbeing;

improvement in employment

status; increased confidence and self-worth.

EVIDENCE TOWARDS OUTCOMES

For one to one support service, self assessment before and after

use of service the average level of daily anxiety was down 3 points

on a scale of 10 and self esteem up 2.9 points on a scale of 10.

For the CLEAR drop-in, self assessment 7 out of 8 present on

assessment day felt self esteem had improved due to attending the

drop-in and 7 out of 8 felt more confident.

In 2011-12 three volunteers moved into employment, and two

service users moved into volunteering. Six trained volunteers

provided weekly one to one support and three to four volunteers

facilitated weekly drop-in. Much of the workers time was allocated

to supporting, supervising and training volunteers and supporting

service users.

P a g e 28

MIDLOTHIAN SUBSTANCE M ISUSE SERVICE

Midlothian SMS is part of NHS Lothian‟s Substance Misuse

Directorate which provides an evidence-based treatment service to

individuals who have alcohol and drug problems, mainly

dependency. Although referrals historically were mainly from GP‟s

the onset of the new Gateways to Recovery (access to treatment)

have introduced a self referral element at its core. Recovery

underpins the ethos of the entire team.

OUTCOMES

Not including referrals to Gateways (since February 2012)

Midlothian SMS received 204 drug referrals and 285 alcohol

referrals for the period (Apr 2011-Mar 2012).

The caseload snapshot for the service was 305 clients of which 228

(drugs) and 77 (alcohol).

Gateways: this has been a major development which came about

as a result of a Kaizen event which was supported by MELDAP. The

Gateways in Midlothian are held at Glenesk Centre in Dalkeith,

Loganlea, Penicuik and NEON bus at Gorebridge. Up to 31 March

2012 40 clients attended at Glenesk, 22 at Loganlea and 1 at the

NEON bus. The Gateway offers a triage appointment and clients

are then seen by the most appropriate service thereafter. ML SMS

received 42 referrals after triage up to 31 March.

The Substance Misuse Directorate has developed a service user

strategy which involved service users throughout the consultation

process in both East Lothian and Midlothian.

A SMART facilitator has been trained in Midlothian and has started

a SMART group in Bonnyrigg. The facilitator and group members

were also involved in the service user focus groups that took place

in March.

P a g e 29

“ I would again like to

thank MELD for their

outstanding work for

people who just don‟t

have ways and means

of doing the correct

things (moving on). ”

MELD service user

“ [my worker] made me

feel very comfortable and

I was able to talk to her

about everything. She

was able to point things

out to me that I was too

close to notice. ”

MELD service user

“ My worker was very

supportive, and easy to

get on with, he listened

to me. ”

MELD service user

MELD (M ID AND EAST LOTHIAN DRUGS)

MELD aims to provide locally accessible, confidential and non-

judgemental services to reduce substance misuse-related harm to

individuals, families and the wider community across Mid and East

Lothian. MELD provides one to one support, recovery groups

(including SMART), training and community groups.

OUTCOMES

MELDAP have agreed a number of outcomes with MELD including:

reduced use of illicit and prescribed drugs; improved psychological

health/wellbeing; reduced chaos in daily life.

EVIDENCE TOWARDS OUTCOMES

MELD were involved in the planning, delivery and development of

the Gateways to Recovery

MELD has developed a range of therapeutic Recovery Groups

including: the Acupuncture Group; Wellbeing Group; Peer Support

Group.

MELD is currently developing the inclusion of MELD Service Users

and volunteers in the delivery and planning of services.

65% of MELDs core service users reported a decrease in the use of

illicit and prescribed drugs and over 50% against the other two key

outcomes above.

Table 2: Referrals received

61% of people engaging with the Family Support Service showed

improved psychological health and well being

59% of the clients in the Midlothian Offenders Service showed

increased participation in community activity

79% of clients using the East Lothian Substance Misuse Service

reported reduced chaos in daily life.

MELD Office East Outreach Mid Outreach Total

No. client visits 411 441 197 1049

No. of needles out 15546 33480 8949 57975

No. needles returned 10997 28950 6716 46663

Table 3: Number of needles/syringes distributed (Outreach with NHS Harm Reduction Team)

Referrals received Total East Mid

Core Service 396 220 179

East Lothian Arrest Referral 23

Midlothian Offenders Service 12

MELD Family Support Service 27 10 17

P a g e 30

MELDAP BUDGET FOR 2011-12

In order to understand and analyse expenditure over the last year

MELDAP have grouped costs against the three broad themes

identified in “Our Achievements.”

These are shown in figure 4 as a

percentage of total spend. This

highlights the current balance of spend,

the majority of which goes towards

treatment and recovery. This has been

identified in our 2012-2015 Delivery

Plan as an area to address by

redirecting greater levels of spend into

Prevention and Early Intervention

activities and services.

The Scottish Government have

committed an annual £11,503,005

million to the Lothian ADPs for three

years (2012-15). This money is notionally split as 60% Edinburgh,

20% West Lothian, 10% East Lothian and 10% Midlothian. This

means that approximately £2.3 million is earmarked for MELDAP.

ACTUAL INCOME Table 4 below shows MELDAPs sources of income. This income does

not represent the total income apportioned to the MELDAP area

from Scottish Government (mentioned above). This remaining „top

sliced‟ money is spent by NHS Lothian who are currently working

with MELDAP towards a clearer understanding of how this is spent

as well as commitments from NHS Lothian‟s core budgets.

Source Alcohol Drugs MELDAP team

Scottish Government

(via NHS Lothian)1

£544,997 £544,997 £1,089,994

East Lothian Council £63,405 £63,405 £126,811

Midlothian Council2 £91,331 £101,645 £192,976

Criminal Justice

Authority

£8,781 £8,781

City of Edinburgh

Council

£5,000 £5,000 £10,000

Reserve Funds (ELC) £40,996 £40,996 £81,993

Reserve Funds (MLC) £16,243 £16,243 £32,487

TOTAL: £1,543,042

Table 4: Income sources for MELDAP Budget 2011-12 1 Recurring Funds only 2 Includes income returned from Service for 2010-11

60%

32%

8%

Treatment &

Recovery

Prevention &

Protection

Service

Delivery

Figure 4: Percentage

of Expenditure against

three broad areas

P a g e 31

ACTUAL EXPENDITURE Tables 5 - 7 below show the spend against the three broad themes

with an indication of the primary tier that the service or activity

undertakes. See Appendix A for an explanation of the tier model

the MELDAP uses.

The expenditure of „top sliced‟ money includes funding towards

LEAP, Ritson Clinic, a contribution to the cost of service user

involvement, service design and evaluation.

Treatment and Recovery

Tier Service MELDAP Funding Cost

3 Substance Misuse Service (Drugs),

Midlothian

Midlothian Council

MELDAP

£100,894

3 Substance Misuse Service (Alcohol),

Midlothian

Midlothian Council

MELDAP

£100,894

3 Substance Misuse Service (Drugs), East

Lothian: assessment, prescribing, detox,

counselling

MELDAP £161,271

3 Substance Misuse Service (Alcohol), East

Lothian

MELDAP £161,271

3 Midlothian and East Lothian Drugs (MELD)

MELDAP

Criminal Justice

Authority

City of Edinburgh

Council

£123,143

3 ELCA

MELDAP £34,304

3 Social Work Substance Misuse Team

(Midlothian)

Midlothian Council

MELDAP

£129,665

3 Social Worker (East Lothian) MELDAP £19,389

3 PETE (East Lothian) East Lothian Council

MELDAP

£77,168

3 VOCAL: Midlothian MELDAP £5,565

3 Oasis (Small Grant) MELDAP £1,000

TOTAL: £914,554

Table 5: Expenditure against Treatment and Recovery

Prevention and Protection

Tier Service MELDAP Funding Cost

2 MYPAS Connected Service (Midlothian) Midlothian Council

MELDAP

£161,862

2 Children 1st (Midlothian) Midlothian Council

MELDAP

£113,828

P a g e 32

2 Children 1st (East Lothian) East Lothian Council

MELDAP

£20,897

2 East Lothian Young Carers Project East Lothian Council

MELDAP

£55,430

2 Specialist Health Practitioner (East

Lothian)

NHS Lothian

MELDAP

£16,752

2 Friday Friends(East Lothian) MELDAP £10,009

2 CLEAR (Midlothian) MELDAP £21,931

2 Integration Team Substance Misuse

Support (East Lothian)

MELDAP £73,593

1 MELDAP: Training, campaigns, publications

& information

MELDAP £6,247

TOTAL: £480,549 Table 6: Expenditure against Prevention and Protection

Service Delivery

Tier Service Funding Cost

1 MELDAP Team, commissioning, strategy,

quality assurance

Scottish

Government

£123,745

Grand TOTAL £1,518,848

Table 7: Expenditure against Service Delivery

P a g e 33

GOVERNANCE ARRANGEMENTS

WELL CONNECTED

MELDAPs connections run both ways. Key Partners constitute the

membership of the Strategic Group and all other MELDAP Groups.

This is a drawing together of Partners around a MELDAP focussed

agenda. These Partners and the Support Team then connect

outwards. Constituting the parts of multiple important strategic

frameworks and taking the MELDAP agenda to them. Most notable

of these are the two

CPPs (Community

Planning Partnerships)

in Midlothian and East

Lothian. Figure 5,

shows the MELDAP

connection to these,

including below the

affiliation with the

public protection

agenda.

F INANCE

There is a Pan Lothian

Finance Delivery Group

which meets to make

decisions about Scottish

Government Drugs and

Alcohol monies in

relation to pan Lothian

services, service developments and projects. This group also acts

an oversight group with NHS Lothian the four Councils and 3 ADPs

present to discuss the use of available financial resources. MELDAP

had worked hard to accomplish a full picture of monthly income

expenditure through an agreed reporting procedure with both

Midlothian and East Lothian Councils. MELDAP is currently in

negotiation with NHS Lothian to streamline financial and reporting

processes. We are also in discussion with NHS Lothian regarding a

phased approach to understanding the totality of Health spend

across Midlothian and East Lothian.

Figure 5: Links to

Community Planning

Partnerships

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NATIONAL SUPPORT

NATIONAL SUPPORT OFFICER

MELDAP worked with National Support Officer to deliver joint

training for all services on National Quality Standards and

Outcomes for Services. These localised MELDAP standards and

outcomes have then become the basis for much of the initial quality

assurance processes. The National Support Officer also assisted in

the following:-

Providing advice, assistance and support with the

development of MELDAP as an ADP.

Providing a governmental perspective on structures and

proposed reporting mechanisms within MELDAP.

Providing assistance with development of work streams with

MELDAP and in partnership with other Lothian ADPs.

Sharing with the MELDAP team information on work being

undertaken in other alcohol and drug partnerships pertinent to

MELDAPs priorities and work plan.

Providing outcomes training for all MELDAP services and as

with the quality assurance initiatives providing a professional

perspective to materials developed.

Attending MELDAP Strategic group meetings to report on

relevant developments across other partnerships.

Disseminating professional practice in the broadest sense.

SCOTTISH GOVERNMENT V ISIT

In December 2011 representatives from the Scottish Government

visited MELDAP. MELDAP provided a range of examples for each of

MELDAPs priorities, including:

Developing an ADP Commissioning Plan

Adopting the SHARE approach to drug and alcohol

education, linked with Curriculum for Excellence

Developing a protocol for CLD, Police and the voluntary

sector services undertaking streetwork, which has resulted in

increased number of contacts

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Coordinating health promotion activities for Healthy Working

Lives initiatives

Funding initiatives such as a befriending service, provided

by Children First and a Young Carers initiative.

A Kaizen event had been undertaken with the specialist

services in the first instance.

In relation to drug and alcohol waiting times HEAT (A11)

target for MELDAP it was noted at the time that 36.5% of

individuals treated for their drug or alcohol problem within 3 weeks

of referral received

MELDAP had put in place an improved system in place for

monitoring progress and each service has an Improvement plan for

how it will achieve the target. It was agreed that the Kaizen,

improvement plans and improved monitoring by the ADP would all

result in reduced waiting times and that the ADP would be back on

trajectory by April/May 2012. Copies of monitoring reports and

service improvement plans were all tabled as evidence of actions

being taken to improve performance.

W IDER SUPPORT

The MELDAP Support Team would welcome networking

opportunities with other ADPs, which previously sat within the role

of SAADAT (Scottish Association of Drug and Alcohol Action

Teams). Scottish Government stated that they were keen to see

what support ADPs required and that if ADP support staff agreed

coming together for a specific purpose was a priority then they

should follow up with other ADPs.

Much of the national support from Scottish Government will focus

on supporting ADPs with implementation of their local strategies. In

particular regarding a Whole Population Approach and developing

recovery oriented systems of care through service redesign, and

using data/information to show progress against indicators.

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APPENDICES

APPENDIX A: MELDAPS TIERED MODEL OF CARE.

This diagram illustrates the tiered approach MELDAP will adopt to commissioning

services over the next three years. The definitions are from “Models of care for the

treatment of adult drug users: Update 2006” by the National Treatment Agency.

Tier 4: Residential services

providing in-patient detoxification

and rehabilitation

Tier 3: Structured alcohol and drug services

with care planning providing structured

counseling, detoxification, prescribing

Tier 2: Community alcohol and drug services designed to

engage people in treatment, keeping drug free, needle

exchange, outreach and ABI

Tier 1: Any service where the focus is not on substance misuse treatment.

Open access basic alcohol and drug information and referrals to tier 2/3

services. Information, advice, prevention

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APPENDIX B: MAPPING OUTCOMES (Table 2 from page 10 of the 2012-2015 MELDAP Delivery Plan)

National Outcomes for ADPs MELDAP Delivery Plan

Priorities

Single Outcomes Agreements

1. HEALTH: People are healthier and

experience fewer risks as a result of

alcohol and drug use

Priority 1: We will enable more people

living in East Lothian and Midlothian to

adopt a more responsible approach to

alcohol

Priority 2: We will enable people with

substance problems to recover from

them and live healthy crime free lives

East Lothian: We live healthier, more

active independent lives.

Midlothian: We live longer, healthier

lives

2. PREVALENCE: Fewer adults are drinking

and using drugs at levels or patterns that

are damaging to themselves and others

Priority 1: We will enable more people

living in East Lothian and Midlothian to

adopt a more responsible approach to

alcohol

Priority 4: We will reduce the harm

related to young people’s substance

misuse

Midlothian: Fewer people are affected

by alcohol and drug misuse

3. RECOVERY: Individuals are improving

their health and well-being and life

chances by recovering from problematic

drug use

Priority 2: We will enable people with

substance problems to recover from

them and live healthy crime free lives

4. FAMILIES: Children and family members

misusing alcohol and drugs are safe, well-

supported and have improved life-

chances

Priority 3: We will reduce the harm to

children and young people affected by

parental substance misuse

East Lothian: The life chances for

children, young people and families at

risk or with a disability are improved

Midlothian: We have improved the life

chances for children, young people and

families at risk.

5. COMMUNIY SAFETY: Communities and

individuals are safe from alcohol and drug

related offending and anti-social

behaviour

Priority 5: We will protect

communities from the harmful effects

of substance misuse

East Lothian: Fewer people experience

anti-social behaviour

Midlothian: We live our lives safe from

crime, disorder & danger

6. LOCAL ENVIRONMENT: People live in

positive, health promoting local

environments where alcohol and drugs

are less readily available

Priority 5: We will protect

communities from the harmful effects

of substance misuse

East Lothian: Fewer people experiences

antisocial behaviour

7. SERVICES: Alcohol and drugs

prevention, treatment and support

services are high quality, continually

improving, efficient evidence based and

responsive ensuring people move through

treatment into sustained recovery

Priority 6: We will develop services for

young people, adults and families

which are equitable, readily accessible

and designed around their needs.

Midlothian: Ensure the delivery of

national policy designed to address drug

and alcohol misuse including children

and families affected.

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APPENDIX C: TABLE OF OUTCOMES AND INDICATORS (adapted from the MELDAP DELIVERY PLAN)

*Status notes, where appropriate comparison will be made with: Scotland figure: worse than same as better than

From local surveys and data: negative change positive change

Core Outcome1. Health:

People are healthier and experience fewer risks as a result of alcohol and drug use

MELDAP Outcome Performance *Status Comments

Reduced acceptability of hazardous drinking and drunkenness

Anti social behaviour incidents reported in E-Division* 2010 2011 916 1087 *The Police E-Division covers all of East Lothian and Midlothian. % of 15 year olds being drunk between 4-10 times 2006 2010 Scotland 14% 16% East Lothian 12% 16% Midlothian 16% 19%

The figures for alcohol related anti social

behaviour were slightly difficult to obtain as

the reference code when the incident was

created may not match how the incident is

finalised.

Compared with the 2006 survey there has been a 3% increase in Midlothian a 4% increase in East Lothian, double the national increase, in the percentage of 15 year olds who reported being drunk between 4-10 times.

Fewer people are drinking above recommended weekly guidelines

% adults exceeding weekly limits Scotland 25% Lothian 30% % adults who are ‘problem drinkers’

Scotland 9% Lothian 11% Mean weekly alcohol consumption among adults aged 16 and over declined from 14.1 units in 2003 to 11.6 units in 2010. Among men, mean units per week fell from 19.8 units in 2003 to 16.0 units in 2010, while among women mean weekly consumption fell from 9.0 to 7.6 units.

From the Ipsos Mori data there were 18 concentrations of hazardous alcohol consumption in East Lothian and in Midlothian 11 concentrations. In both authorities areas with significant rates hazardous drinking are areas of ‘relative affluence.’ Levels of harmful consumption are more likely to be in areas of deprivation across both council areas.

Increased knowledge and changed attitudes to alcohol and drinking

A target of 9938 ABIs delivered between March 2011 and March 2012 ABIs delivered: Primary care 14,526 Maternity services 1,114 A&E 1,453 % 15 year old pupils that say their parents ‘don’t mind them drinking’ 2006 2010 Scotland 42% 43% East Lothian 41% 54% Midlothian 45% 45%

The total of 17,093 represents 172% of the original target. The MELDAP area contributed 15 % of these which is broadly in line with its proportion (20%) of the Lothian population.

While there has been no change in the

Midlothian figure, which is close to the

national figure there has been a significant

increase in East Lothian pupils reporting that

their parents ‘did not mind them drinking.’

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Reduced risky and chaotic behaviour

Current/past injectors who have been tested Hep C HIV Scotland 76% 73% East Lothian 87% 87% Midlothian 84% 80%

Alcohol related deaths/100,000 population

Males Females

Scotland 52.4 20.5 East Lothian 33.1 15.3 Midlothian 31.5 12.7

Reduced drug related morbidity and death

Drug related deaths /100,000 population Scotland 10 East Lothian 6 Midlothian 7 Annual local averages: 1996-2000 2006-2010 East 2 5 Mid 3 6

67 Naloxone kits issued in the

year 2010-11.

While the average/1000 population is lower than the Scotland figure the actual numbers while small have continued to rise. Toxicology reports show polydrug use with alcohol frequently reported.

Core Outcome 2.Prevalence:

Fewer adults and children are drinking or using drugs at levels and patterns that are damaging to

themselves and others

MELDAP Outcome Performance Status Comments

Reduced prevalence of drug and alcohol use

15 year olds who used illicit drugs in the last year 2006 2010 Scotland 13% 11% East Lothian 12% 12% Midlothian 9% 7% 15 year olds drinking once a week or more 2006 2010 Scotland 26% 20% East Lothian 28% 21% Midlothian 30% 17%

Prevalence of problem drug use (15-64yrs) 2006 2009-10 Scotland 1.6% 1.7% MELDAP 1.4% 1.2% Prevalence of injecting amongst problem drug users (15-64yrs) 2006 2010 Scotland 8% 6% MELDAP 7% 4%

Compared to 2006 the East Lothian figure has remained the same while the Midlothian figure has decreased by 2%. Compared to 2006 there has been a significant change in 15 year olds weekly drinking with a 7% decrease in East Lothian and a 13% decrease Midlothian. This compares to a national decline of 6%. While the national prevalence rate has shown a small increase there has been a fall in the MELDAP figure. The estimated number would be 1400 for the MELDAP area.

There has been a 3% reduction in the MELDAP figure between 2006 and 2010 compared to a 2% reduction nationally.

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Increased knowledge of local patterns of alcohol and drug use

Ipsos MORI report provided to MELDAP in 2011. Proportion of individuals drinking above daily and/or weekly limits 2003 2010 Scotland 28% 22%

Increase in the age of first alcohol and drug experimentation

15 years olds who have never had an alcoholic drink 2006 2010 Scotland 16% 23% East Lothian 13% 17% Midlothian 11% 18% 15 year olds who have never tried drugs 2006 2010 Scotland 74% 79% East Lothian 77% 78% Midlothian 74% 85%

Across the MELDAP area there has been an increase in the number of 15 year olds who have never had an alcoholic drink. However both figures are still lower than the national figure. There has been a significant increase in 15 year olds in Midlothian who have never used drugs up 15% from the 2006 survey.

Core Outcome 3. Recovery:

Individuals are improving their health, well being and life chances by recovering from problematic

drug and alcohol use.

MELDAP Outcome Performance Status Comments

Improved physical, and mental well-being

Reduction in no. clients injecting in last month 2009-10 2010-11 Scotland 27% 24% East Lothian 23% 26% Midlothian 25% 20%

While there has been a 5% reduction in Midlothian reflecting the trend nationally (-3%) there has been a 3% increase in East Lothian.

Increase in the number accessing and engaging with alcohol and drug treatment services

No. of people sustaining 12 weeks of planned programme (SMR25b) MELDAP 2010/11 2011/12 84 139

Services report the introduction of the

Recovery Gateways in January 2012 has

significantly reduced the level of DNA

services experience.

There has been a 40% increase in the

number of clients still engaged with services

at 12 week review

Increase the range of community based mutual aid and support groups

Three groups have been established by the end of March 2012.

In 2011 there were no SMART recovery groups established in the MELDAP area.

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Reducing the harm caused to young people misusing alcohol and drugs

In 2011 thirty five young people were provided with specialist 1:1 counselling for alcohol and drug misuse. In 2011 ninety three young people engaged in group work designed to reduce the harm associated with alcohol and drug use. In 2011 there were 170 weekly contacts with young people through street work services.

See Prevention and Protection Services for more details, in particular the Connected Service.

Core Outcome 4. Families:

Children and family members of people misusing alcohol and drugs are safe, well supported and have

improved life chances

MELDAP Outcome Performance Comments

The parenting capacity of substance users is improved

164 families/children at risk supported

A range of MELDAP funded services provide support to children and families affected by parental substance misuse.

Fewer women using drugs during pregnancy

3 year aggregates. Rate per 1000 maternities 2005-08 2007-09 2008-10 Scotland 9.5 9.9 11.9 MELDAP 11.9 11.6 22.3

This rate is far higher than the Scottish

average of 11.9. Work needs to be

undertaken to look into the reasons for

this and if evidence shows an unidentified

gap in service then further action needs to

look at how this is addressed.

Care should be taken when comparing

numbers over time as there has been an

improvement in drug misuse recording

over the last 5 years.

Improved identification of children at risk

Percentage of individuals with dependent children. 2009/10 2010/11 Scotland 38% 41% East Lothian 41% 50% Midlothian 47% 51% Number of referrals to Midlothian Substance Misuse Screening Group 2010 2011 66 107

East Lothian has shown a 9% increase in the number of clients with dependent children. The figures for both councils are well above the national figure of 41%. There has been a 62% increase in the referrals to the Midlothian screening group

Improved access to services for young carers

Number of young carers supported 2010 2011 MELDAP 37 37

Core Outcome 5. Community Safety:

Communities and individuals are safe from alcohol and drug related offending and anti-social

behaviour

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MELDAP Outcome Performance Status Comments

Reduced problem alcohol and drug use

New clients reporting funding drugs through crime 2009-10 2010-11 Scotland 29% 23% MELDAP 21% 22% Drink/drug driving offences E-Division 2010 2011 255 176

Effects of drinking alcohol, in the previous year: 15 year olds reporting that they had been in trouble with the police 2006 2010 Scotland 23% 19% East Lothian 21% 18% Midlothian 27% 14% Incidents of domestic abuse when alcohol and drugs were noted 2010 2011 Alcohol 1010 945 Drugs 61 55

Lower than the national average

There has been a 31% reduction in the number of drink/drug driving offences.

There has been a decrease in both areas, particularly in Midlothian (- 13%) of 15 year olds reporting they had been in trouble with the police. This reflects the national trend.

There has been a 6% decrease (alcohol) and 10% decrease (drugs)

Improved sense of safer communities.

% of victims of crime who report that the offender was under the influence of alcohol/drugs Scotland 2008-09 2009-10 2010-11 Alcohol 58% 62% 63% Drugs 26% 26% 34%

Offenders substance use being noted as a

factor in violent crime has between 2008-

11 shown a 5% increase for alcohol and a

8% increase for drugs.

Core Outcome 6. Local Environment:

People live in positive, health promoting local environments where alcohol and drugs are less readily

available

MELDAP Outcome Performance Status Comments

Reduced availability of drugs

% of 15 year olds who have been offered drugs 2006 2010 Scotland 53% 42% East Lothian 48% 44% Midlothian 54% 37%

% people that see drug dealing to

be common or very common in

their area

Scotland 12% East Lothian 8% Midlothian 15% % of people that say they have personal experience of drug misuse dealing

There has, in line with the national trend, been a significant reduction, particularly in Midlothian of 15 year olds being offered drugs.

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Scotland 5% East Lothian 4% Midlothian 5%

Better controlled supply

of alcohol

Number of test purchases carried out in E-Division 2010 2011 Number 21 67 Fails 4 3 % people noting ‘alcohol abuse’ as a negative aspect of their area 2007-08 2009-10 Scotland 4% 4% MELDAP 4.7% 6.2%

Occasional Licences issued in: 2010-11 2011-12 East Lothian 458 535 Midlothian 166 125

While there has been a significant increase in the number of test purchases carried out in 2011 compared to 2012 the number of fails has reduced. While the national figure has remained the same there has been a 1.5% increase in the MELDAP area.

In the last two years through to 31 March

2012 no licenses have been refused on the grounds of over provision. While the Midlothian figure for Occasional Licenses issued for 2011-12 has decreased by 25% compared to 2010-11 there has been a 17% increase in the East Lothian figure over the same period.

Core Outcome 7. Services:

Alcohol and drugs prevention, treatment and support services are high quality, continually improving,

efficient , evidence based and responsive, ensuring people move through treatment into sustained

recovery

MELDAP Outcome Performance Status Comments

The full range of needs of drug and alcohol users is addressed.

% of clients waiting for more than three weeks referral to treatment Dec 2011 June 2011 Scotland 17.2% 15.1% MELDAP 70.1% 52.3% The Prevalence Service Utilisation Ratios (PSUR) rates for alcohol services: Scotland 8.2%

East Lothian 2.7% Midlothian 5.1%

Service performance for up to Jan-March 2012 was 67.87% against the Trajectory target of 54%, evidence of continuing improved service performance. This is projected to rise significantly beyond March 2012 The PSUR are well below the Lothian and

national rates. In Sept 2011 the capacity

of a major MELDAP commissioned

alcohol service has been increased by

50% towards addressing this.

Service quality is improving

At April 2012 50% of services were

rated as Good of better against the

National Quality Standards for

Substance Misuse Service.

All services measured against the HEAT A11 target gave a presentation to the MELDAP Performance Group in January.

Service users views and comments are valued and used to improve services

Approximately 10% currently do this

in a systematic way.

80% of services have completed structured service user reviews. The level of participation in the development of an agreed care plan is variable according to comments from service users especially the recent SDF focus groups.

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People are provided with information to help them make informed choices.

MELDAP website established in

August 2011

The website has been updated regularly during the last quarter.