Agenda item

5.1          The Committee considered a report by the Director of Adult Social Care and Health updating it on the progress of the new Support and Treatment for Adults in Recovery (STAR) service. STAR is commissioned by the Drug and Alcohol Action Team (DAAT) and provided by Crime Reduction Initiatives (CRI).

5.2       The Joint Commissioning Manager, Substance Misuse, and representatives of East Sussex Recovery Alliance (ESRA) and Active in Recovery (AiR) provided the following additional information to supplement the written report:

·              CRI sub-contracted some of the services it provided as part of STAR to Sussex Partnership NHS Foundation Trust (SPFT). Consequently, the DAAT had no input into SPFT’s decision to serve notice on its involvement in STAR as the Trust was not commissioned directly by DAAT.

·              There have been notable improvements in the performance of STAR since SPFT withdrew from the contract. This could be due to better communication between the individual services provided within STAR now that they are all provided by the same organisation (CRI).

·              The purpose of STAR was to address the previously high number of re-presentations of the same clients within 6-18 months of completing treatment. The latest figures against the baseline show that this is being achieved.

·              The STAR service uses a recovery based model of treatment rather than a medical model. The recovery model focuses on psycho-social and empathetic treatment for drugs and alcohol and involves the referral of people for rehabilitation at mutual aid groups. This model is increasingly favoured as the most effective model for recovery.

·              Mutual aid groups include:

o  12 step fellowship groups, such as Alcoholics Anonymous; and

o  local recovery groups run by people with lived experience of addiction who act as role models for patients, encouraging and inspiring them to complete their recovery process. AiR and ESRA are two local recovery groups to which STAR refers patients.

·              Active in Recovery (AiR) is a project run by Action for Change that provides peer-led activities in Eastbourne. AiR is using funding from Public Health England (PHE) to set up a community café in Eastbourne. The café will offer a dry bar and a social space for people in recovery to use; it will also offer training in food hygiene and first aid – with other courses to follow.

·              East Sussex Recovery Alliance (ESRA) is a peer-led local recovery group with hubs in Eastbourne and Hastings. It is run by Community Recovery Champions (who themselves are in recovery) who develop and facilitate peer-led support groups. ESRA is reliant on funding but is aiming to be self-funding.

·              ESRA support groups are gender specific as men and women tend to have different support needs. The groups are designed to increase self-esteem and offer a safe space – which are best nurtured in a gender specific environment.

5.3       The following additional points were made in response to questions from the Committee:

·              There is no time limit to when a client is considered out of recovery. If a client relapses at any time after completing treatment, the system will record it as a re-presentation. CRI receives payment for each new individual who receives treatment, so it is in the organisation’s interest to reduce cases of relapse.

·              Treatment is deemed to have been completed only once a clinician has discharged the client. Long-term remission is monitored by referring to GP records, for example, whether a client receives methadone prescriptions.

·              Payments by Result for the STAR service are based on 27 separate measures. These include:

o    the seriousness of the client’s needs, as assessed by the Local Area Single Assessment and Referral Service (LASAR);

o    whether the client has been tested for blood-borne viruses during treatment; and

o    whether the client has entered training following completion of their  treatment.

·              East Sussex County Council is ultimately the accountable body with the duty to provide drug and alcohol recovery services, but it worked very closely with partners in the DAAT to commission the STAR service and continues to work closely with partners to monitor the service.

·              CRI has the contract to provide STAR until 2017 with the opportunity to extend it for a further two years. DAAT regularly checks on the outcomes of the service to ensure that CRI is fulfilling the terms of its contract.

·              STAR operates out of two treatment hubs in Eastbourne and Hastings with a third hub coming online in Uckfield in the future. People either self-refer for treatment, or are referred by prison services or GPs on request. There is roughly the same completion rate of treatment from all three sources as each requires high motivation on the part of the individual.

·              SPFT is not a primary source of referrals to STAR, even though people with drug and alcohol issues are often in contact with mental health services; this is because the two services are not as joined up as they should be yet. Clients who are self-medicating for mental health disorders and have drug and alcohol issues often will not be referred to STAR by SPFT. If the client does self-refer to STAR, however, there will be three way meetings between SPFT, STAR and the client.

·              The targets set for STAR are locally set. STAR is exceeding the national targets by an even greater margin. The number of actual drug reviews by CRI significantly exceeds the target because it has taken over this role from SPFT since the target was set.

·              Outcomes, rather than output, may provide a better measure of the success of the service, but outcomes could not be included in the current payment by results model due to the complexity of monetising them. Outcomes are measured by DAAT through interviews with clients.

5.4       RESOLVED:

1) to thank the witnesses from ESRA and AiR and to wish them well in their future endeavours;

2) to recommend to Cabinet that, due to its great success, STAR is a high priority service and consideration should be given to protecting it from savings over the next medium term financial plan period.