Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how NHS-led Sustainability and Transformation Plans, including accountable care systems of integrated health and social care, will work with local authority procured substance misuse services to ensure vulnerable service users are given the right priority of access to treatment and care.
Answered by Lord O'Shaughnessy
The Government is clear that decisions about service provision are best taken at a local level by local clinicians.
Sustainability and transformation partnerships (STPs) are five-year collaborations between the National Health Service, local government and other key partners for improving health and wellbeing, developing new models of care, and improving the quality and efficiency of services in local areas across England.
The way STPs work in practice will vary according to the needs of different parts of the country and any decision on how they will work with local substance misuse services will be taken at a local level.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, following research by Release in regard to variation in the provision of, and access to, the potentially lifesaving drug naloxone, what assessment they have made of the adequacy of the response from local authorities; and whether they will take action to implement a nationally coordinated and monitored take-home naloxone programme in England.
Answered by Lord O'Shaughnessy
Naloxone has a vital role in saving lives and the Government is committed to widening its use in England. Public Health England has reviewed available research including surveys conducted by the Local Government Association and Release, and will use those findings in supporting local authorities to extend their provision of naloxone. The Government has updated advice and guidance on naloxone as part of its commitment to develop a more consistent and joined up approach to commissioning and delivery in England and will continue to monitor provision in all local areas.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the increasing misuse of fentanyl; and whether they intend to introduce evidence-based key performance indicators for harm reduction initiatives in order to prioritise and support those initiatives.
Answered by Lord O'Shaughnessy
Substance misuse is lower than it was a decade ago but we must always be alive to emerging threats and the reports linking fentanyl to a number of fatal drug overdoses are extremely concerning. That is why the Home Secretary has asked the Advisory Council on the Misuse of Drugs to investigate the risks around fentanyl analogues, so that we can maximise the effectiveness of our response.
The Government’s updated Drug Strategy will capture the impact of wider health and social care costs and harms associated with drug misuse, including: hospital admissions related to drug misuse; rates of blood borne viruses and numbers of drug-related deaths, including on release from prison.
Public Health England supports local areas in responding to the threat from fentanyl, and other potent opiates.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, following the publication in 2016 by the ONS of statistics showing the highest rate of drug-related deaths amongst women since records began in 1993, what steps they have taken to tackle the specific issues faced by female drug misusers and to reduce any barriers to accessing treatment.
Answered by Lord O'Shaughnessy
The Government is investing over £16 billion over the Spending Review period for local authorities (LAs) to spend on public health. LAs are responsible for making decisions on how to spend their local allocation but the public health grant conditions make it clear that they must have regard for the need to improve the take up of, and outcomes from, their drug and alcohol misuse treatment services.
Public Health England supports LAs to commission effective drug and alcohol prevention and treatment services to meet the needs of their local population, and in working to reduce drug related deaths. This includes guidance developed with drug service providers with a focus on ensuring that women can access quality drug treatment and recovery services and interventions. A copy of Improving Clinical Responses to Drug-Related Deaths: A summary of best practice and innovations from drug treatment providers is attached.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they are taking to reduce the number of drug-related deaths of people in treatment services; and what data they have on whether the number of drug-related deaths of people who died while they were in treatment services increased over the last year.
Answered by Lord O'Shaughnessy
Public Health England (PHE) has issued advice on providing naloxone, supported the publication of updated clinical guidelines for drug treatment, and supported a network of treatment providers to establish good practice guidance on managing drug-related death risk factors.
PHE continues to work with local authorities and treatment providers to support their work in reducing drug-related deaths. This includes improving drug-related death review processes and increasing the number of people with drug problems who are in drug treatment.
Published figures by PHE show the total number of people who died while in contact with treatment services in 2016-17 was 2,680, showing a decrease from 2015-16 where there were 2,689 deaths in treatment. These figures are for all deaths in treatment, not just drug-related ones.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, in the light of reports that drug-related deaths are increasing in the areas of England where cuts to drug treatment budgets have been among the greatest, whether they intend to establish a national inquiry and action plan to tackle this issue in order to reduce the number of deaths.
Answered by Lord O'Shaughnessy
Public Health England (PHE) led an inquiry last year into the rises in drug-related deaths. The inquiry report, Understanding and preventing drug-related deaths: The report of a national expert working group to investigate drug-related death in England, was published on 9 September 2016 and a copy is attached.
The Government is investing over £16 billion over the current five-year spending review period for local authorities (LAs) to spend on public health. LAs are responsible for making decisions on how to spend their local allocation, but the public health grant conditions make it clear that they must have regard for the need to improve the take up of and outcomes from their drug and alcohol misuse treatment services. Whilst there is considerable variation across the country, with some regions showing large increases in recent years, PHE will continue to support LAs in delivering tailored, accessible and effective services where people stand the best chance of recovery.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, in the light of the increases in the number of opioid-related deaths, what consideration they have given to the advice of the Advisory Council on the Misuse of Drugs supporting the use of opioid substitution treatment.
Answered by Lord O'Shaughnessy
The Government has considered the Advisory Council on the Misuse of Drugs’ (ACMD’s) advice carefully and set out a range of work it is taking forward to address it in its response published in July.
For people to achieve and sustain freedom from drug dependence, the Government recognises the need for high quality treatment interventions as well as wider recovery support, including stable employment and housing, to enable people to build and maintain their recovery and live a life free from drugs. The ACMD’s recommendations and the findings of its published evidence review have informed the current and future work programme of Public Health England (PHE) in relation to supporting the quality of Opioid Substitution Therapy. PHE is also developing guidance, in partnership with NHS England, to support local areas to effectively meet the needs of people with co-existing mental health and substance misuse problems, which it is planning to publish this year.
As we continue with the implementation of the Drug Strategy published this summer, the advice of the ACMD will be fundamental to informing our approach and the Government will continue to seek its valuable input and advice.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, in the light of the research published in July 2015 in <i>Addiction</i> on the payment by results drug recovery pilots, what advice they plan to issue to public health directorates on the commissioning of drug treatment services.
Answered by Lord Prior of Brampton
The Department of Health-funded independent evaluation of the drugs and alcohol recovery payment by results pilots programme has yielded several interim reports to date and is currently drawing to a conclusion. We will wait for this report to ensure that any advice is based upon the fullest and best available evidence.
The article published in Addiction is an early output from the evaluation, based on data collected during the first year of the drugs and alcohol recovery payment by results pilots programme. The final evaluation report, which is due in late August 2015, is expected to be published in late Autumn 2015 following an independent peer review process.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what assessment they have made of changes in the number of deaths from heroin and morphine abuse over the first full year since they placed a financial incentive on the successful completion of drug treatment; and whether they have any plans to discontinue that policy on the grounds of patient safety.
Answered by Earl Howe - Deputy Leader of the House of Lords
Whilst no conclusions can be drawn from one year’s data, Public Health England is analysing the drug misuse and treatment datasets to identify possible reasons for the change in drug misuse deaths reported in 2013. This analysis is due to be published in a statistical bulletin in 2015 and will help inform any possible future actions.
Asked by: Lord Patel of Bradford (Non-affiliated - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, in the light of the findings in the <i>Evaluation of the Drugs and Alcohol Recovery Payment by Results Pilot Programme </i>(Interim Summary Report June 2014, National Drug Evidence Centre, University of Manchester) in respect of the impact of payment by results on practitioners and service users (1) what is their policy on reducing the number of service users prescribed opioid substitution medication; (2) what advice they give to local authority public health directorates on the use of the payment-by-result target for successful completions of drug treatment; (3) what regulatory framework covers local authority public health directorates' drug and alcohol commissioning and service delivery; and (4) who is responsible for regulation of the local authority commissioning of drug and alcohol provision.
Answered by Earl Howe - Deputy Leader of the House of Lords
The Drug and Alcohol Recovery Payment by Results (PbR) pilots ran from April 2012 to March 2014. Their purpose was to develop and test the PbR approach to contracting for drug and alcohol services.
As with services in other parts of the country, providers in the eight PbR pilot sites were expected to take account of the United Kingdom guidelines on the Clinical Management of Drug Misuse and Dependence and the relevant guidance from the National Institute for Health and Care Excellence. Services that prescribe opioid substitute treatment must be registered with the regulator, the Care Quality Commission.
The Government’s 2010 Drug Strategy is ambitious to support more people to recover from dependence on drugs and alcohol, acknowledging that all treatments with a sound evidence base, including opioid substitution medication, have a role to play depending on the clinical circumstances of individual cases.
Pending the publication in 2015 of the independent evaluation of the pilot programme, in August 2014 the Department published a note on lessons learnt. This document was intended for commissioners and providers who are considering using a PbR method and highlights the key areas where additional attention may need to be focussed to optimise the PbR approach.
Local Authority Circular LAC(DH)(2014)2, Public Health Ring-fenced Grant Conditions – 2015-16, dated 17 December 2014, stipulates at paragraph 20 that “in commissioning services using funds from this grant, local authorities should also ensure that appropriate clinical governance arrangements are put in place.” The circular contains a link to a public health commissioning template which emphasises the importance of good clinical practice.
The structures for coordinating local Joint Strategic Needs Assessments and the provision of services are set out in the Health and Social Care Act 2012. Should there be a complaint which cannot be resolved locally about a local authority’s discharge of its functions, an individual can refer the matter to the Local Government Ombudsman.