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NHS Addiction Services Outcomes

NHS Addiction Services Outcomes. Annette Dale-Perera Strategic Director of Addiction and Offender Care. Effective treatment, changing lives. NHS provider land. NHS Foundation Trusts BIG FISH EAT LITTLE FISH

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NHS Addiction Services Outcomes

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  1. NHS Addiction ServicesOutcomes Annette Dale-Perera Strategic Director of Addiction and Offender Care Effective treatment, changing lives

  2. NHS provider land NHS Foundation Trusts BIG FISH EAT LITTLE FISH Financial efficiency savings required (20% over 4 years) Implementing service line management & getting ready for Payment by Results (PbR) : Outcomes

  3. CNWL PDU population 2009: aging and ill population 4,077 PDUs in community drug treatment Age: Mean 36, almost half (48%) 40+: almost a third (31%) over 45 BBV 58% of IDUs have Hep C; 15% Hep B; 4% HIV Severe mental health problem: 27% severe depression; 8% psychosis; 37% Personality Disorder. Smoking: almost all Socio-demographics: • 24% NFA or housing problem • 79% unemployed at intake • A third (34%) to 40% have severe physical health plus severe mental health issues plus long term unemployment and are over 40 At least 25% HCV + get chronic liver disease 20 - 30yrs after infection: NOW People with severe mental illness die15 -20 yrs early Heavy smoking reduces life by average of 8.8 yrs Only 15% previous regular employment EVER

  4. CNWL Outcome results: at TOP review CNWL addiction services had a positive impact on SM • 73% of opioid only users were abstinent or reliably improved Of opioid plus crack users • 53% were abstinent or had reliability improved their opioid use • 60% were abstinent or had reliably improved their crack use. • Injecting behaviour also reliably improved in almost 80% of injectors. • CNWL addiction services performs better than national data NTA data (cited in the Lancet 2009) on changes in illegal opioid use amongst opioid (not crack) users at treatment review and slightly less well (3-4%) with opioid plus crack users.

  5. CNWL Outcomes substance use at review

  6. CNWL Outcomes substance use at review • Alcohol users, 43% were abstinent or reliably improved at review.

  7. Health, social functioning and crime outcomes at review • CNWL drug treatment had significantly reduced crime in more than 80% of cases (both reducing shoplifting and selling drugs). • 3% were in education at treatment start – less at review. • Around a quarter were working prior to treatment. There was no change in mean days employed at review • 3-5% in the number of drug users working more than 10 days • and a 1% fall in alcohol users working more than 10 days) • 13% heroin users, 21% heroin & crack users, 11% alcohol users had housing problems at start: some improvement (3-6%fall) at review • Health and quality of life ratingsincreased slightly (by 1 or 2 out of 20) at review but not generally to a level of reliable change.

  8. Substance misuse outcomes at exit • CNWL services had a positive impact on substance misuse by exit: • 90% of opioid only users were abstinent at exit and 6% were reliably improved thus 96% had achieved positive change. • Of opioid plus crack users – 83% were abstinent and 9% had reliably improved their opioid use • and in terms of crack use 83% were abstinent and 6% had reliably improved. • Injecting behaviourhad also stopped n 94% of injectors. • There were however, a small minority of clients did not reliably change as a result of treatment.

  9. CNWL drug use outcomes at exit

  10. CNWL alcohol use outcomes at exit Of CNWL primary alcohol users, 76% had positively changed and were abstinent or reliably improved.

  11. Health, social functioning and crime outcomes at TOP review:key points • CNWL drug treatment had significantly reduced crime in more than 94% of cases (both reducing shoplifting and selling drugs). • Although there was an increase in the number of drug users working at exit BUT rates of employment were low, 24% heroin users, 21% heroin and crack users, 19% alcohol users. • All groups were less likely to be in education. • Less people with housing problems at exit (1-2% alcohol and heroin users but 8-10% heroin & crack users) • Health and quality of life rating increased slightly on ratings at review but not to a level of reliable change. Around a third of clients had significantly improved ratings, sixth of clients reported feeling worse and half had ratings that were unchanged compared to start.

  12. Conclusions • Yes: commission me on my outcomes BUT • I do well to keep some alive – I have 50 deaths a year • 35-40% of my services users who are drug users are over 40, have never worked, have multiple substance misuse, mental health issues and have Hep C • We can increase quality of life, health and well-being and reduce crime…….but employment ?????? • Overly complex PbR is at worst likely to fail. No evidence it works for employment…………….. • Beware of `gaming’

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