Written - The Report from Healthcare Inspectorate Wales “Substance Misuse Services: All Wales Review Of Substitute Prescribing Services”

This Written Statement follows the publication of the Healthcare Inspectorate Wales’ (HIW) report of the review of substance misuse services in Wales.  The report can be found on the HIW web-site at www.hiw.org.uk.  The Welsh Assembly Government published a Written Statement in August 2008, announcing the intention of developing a programme of external thematic review and providing the terms of reference to the first review. 

 ‘Working Together to Reduce Harm’, the Welsh Assembly Government’s  new 10 year strategy to tackle and reduce the harm associated with substance misuse was launched on 1st October,2008 .  The strategy sets out a clear national agenda for how the Welsh Assembly Government and our partners can tackle and reduce the harms associated with substance misuse in Wales.    Improving the quality and consistency of treatment services across Wales is a key objective in the strategy and this report is welcomed for the contribution it will make to securing improvements in services. 

Since 2003, the Welsh Assembly Government has invested heavily in the substance misuse agenda resulting in a huge expansion of services; the Substance Misuse Action Fund (SMAF) stands at £28.6m for 2009-10 supplemented by £11.1m ring-fenced in the budgets of the Local Health Boards (LHB).  This represents a 168% increase on the total funding available in 2003-04 when the SMAF budget stood at £7.4m and the LHB’s ring-fenced budget was also £7.4m. 

The Community Safety Partnerships (CSPs) and service providers across Wales have worked hard to respond to the challenges and improve the quality of services.   However, such a period of unprecedented growth in services requires a pause and review to reflect upon where the focus and emphasis needs to be to secure further improvements in the future.  This is why the Welsh Assembly Government commissioned the HIW to undertake this review; the first time that substance misuse services in Wales have had such a comprehensive review. 

The report is a snapshot taken 12 months ago and since the fieldwork there have been considerable developments.  The report contains a number of important messages about what is working well and should be shared as good practice and what needs further work.  The recommendations contained in the report are consistent with the Welsh Assembly Government’s substance misuse strategy “Working To-gether to Reduce Harm” and reinforces the four key aims of the Strategy and the priority action areas.  It is particularly pleasing that that the review has identified many high quality services and cites a number of examples. 

Strategic Leadership and Service Planning

There are key messages for CSPs about strengthening their strategic leadership and improving the planning and performance management of substance misuse services.   Since 2003 the statutory responsibility for planning substance misuse services in Wales has sat with CSPs.  The commitment of CSPs and their component bodies has been pivotal in the progress that we have made in Wales in tackling this agenda in recent years.  It is our intention therefore to continue to build on and enhance these strong partnership arrangements to move this challenging agenda forward over the next 10 years. 

As part of the changes being made as a result of the reconfiguration of the NHS in Wales, the new LHBs, when they are established later this year, will become a “responsible authority” within the CSPs.  This will mean that the new LHBs will share the statutory responsibilities for tackling substance misuse in their area.  It is also intended that the new NHS Trust, Public Health Wales, will provide an objective leadership role.  These changes will ensure that all bodies responsible for planning and commissioning substance misuse services will be formal members of CSPs. 

“Working Together to Reduce Harm” advocates strongly that CSPs and other agencies need to plan treatment services at a regional level and pool resources where appropriate.  We therefore are supporting CSPs and other commissioning bodies to put in place a Substance Misuse Area Planning Board in each of the new 7 Local Health Board areas to be fully operational by April 2010.    A key role for the new Area Planning Boards will be to take decisions on the use of NHS resources for substance misuse services, the Home Office DIP resources and the Substance Misuse Action Fund capital budget.  

The capital programme worth £4.1m annually has funded 193 projects across Wales since it was introduced in 2005.  We will continue with this important programme of improvements to premises for service users and believe that pooling this budget at the new Area Planning Board level will strengthen capital investment and link it more explicitly to strategic service planning. 

The aim is for these resources to be seen as the foundation for partners to build upon; moving towards agreeing wider arrangements for the pooling of resources for tackling substance misuse at the new Substance Misuse Area Planning Board level, including Social Services Departments, other Welsh Assembly Government funding streams, the Home Office and criminal justice agencies.

To underpin this, we are working with HIW and a range of partners, including Public Health Wales, on the development of guidance to support the new Area Planning Boards.   The guidance will set out core standards for substance misuse services; models for integrated care pathways and also cover the arrangements for area-based planning in more detail.  The guidance will be available in draft form in the autumn – i.e. in time to inform the Boards’ work later this year.

These new arrangements will strengthen greatly CSPs’ ability to undertake a more strategic role in tackling substance misuse and plan and establish more cost effective and integrated services underpinned by robust governance systems and commissioning processes. 

Waiting Times

The report draws attention to waiting times and recognises the clear downward trend in national waiting times.  As at 1 September 2009, nearly 88% of individuals referred for help in 2008-09 began treatment within the Welsh Assembly Government’s target of 10 working days and there is a slow but steady reduction in the numbers of people with longer waiting times.   For example, the additional £1m made available last year for inpatient detoxification and residential rehabilitation resulted in 127 people being able to access this treatment quickly.  

There is more to do to maintain sustainable low waiting times for treatment and this will continue to be a national and local priority.  Waiting lists are sensitive to peaks in demand and the figures show that numbers in treatment have risen significantly since the Welsh Assembly Government began investing in this agenda.  In the late 1990s, less than 2,300 individuals were reported receiving treatment.  This figure has increased year on year and in 2007-08, had risen to 14,259, reflecting how our investment has addressed previously unmet demand by creating additional treatment places across Wales.    

The Welsh Assembly Government attaches a high priority to reducing waiting times which will be reinforced by the inclusion of relevant indicators within the new NHS performance framework, local authority performance frameworks and the priorities set for Public Health Wales.  For non devolved bodies, these all support the delivery of targets set by the Home Office and the Ministry of Justice.  

Encouraging Move on From Treatment

The HIW report identifies a need for services to improve the recording of positive outcomes for individuals in treatment and encourage individuals to move on from treatment.  At the time of the review, a year ago, work was well advanced to introduce the Treatment Outcome Profile – a means of measuring how an individual is benefiting from their treatment.  That work completed earlier this year and was introduced across Wales in April 2009.  This initiative puts the spotlight on the quality of services in a tangible way and will provide valuable information in 2010 about the impact of treatment at a local and national level. 

In the Welsh Assembly Government’s strategy, we acknowledge that for many people, it is the aftercare support to help find work and somewhere to live that will be central to their recovery.  Often there are barriers to achieving this such as a lack of skills and confidence.  We know from research that people can achieve better outcomes and sustain recovery if they receive effective “wrap around” support.  In October this year, a new national Peer Mentoring Scheme will become operational supported by £9m from the European Social Fund.  The scheme will support service users to access training, education and employment.  There will also be assistance with other practical problems such as accommodation and help and support to prevent relapse.  

This report is the first full stocktake of substance misuse services in Wales and provides a platform to build on the considerable progress made in recent years.  It will help the Welsh Assembly Government and partners to target energies and resources effectively towards securing even greater improvements.  All organisations are due to receive individual feed-back from HIW and we will be supporting partners in the development of local improvement plans.  We will be asking CSPs to report progress in implementing those plans in early 2010.