Policy paper

Government response to ACMD report 'Ageing cohort of drug users'

Updated 3 October 2019

This was published under the 2019 to 2022 Johnson Conservative government

Executive summary

The government welcomes the ACMD’s timely report the on the ageing cohort of drug users, which provides advice to the government on the changing age profile of people accessing drug treatment and the issues faced by this group in the UK.

We are committed to understanding the multiple, complex factors involved in drug misuse and to protecting people from the harm it causes. We have commissioned a major independent Review of Drugs, which will look at a wide range of issues, including the system of support and enforcement around drug misuse, in order to inform our thinking about what more can be done to prevent needless deaths and help people turn their lives around.

The council made several national recommendations for the government and devolved administrations to consider. As health is a devolved matter the government cannot accept recommendations on behalf of the Devolved Administrations. The Department of Health and Social Care (DHSC) sought contributions from the Scottish, Welsh and Northern Irish administrations and co-ordinated responses to the report.

Officials from each of the 4 nations have reviewed the Council’s advice carefully and set out work underway to address each of the recommendations below.

Recommendation 1

Specialist community-based drug treatment services should develop training for staff to highlight the treatments and specific risks for older drug users, particularly opiate/opioid users.

What metric would indicate that the recommendation had been implemented?

The availability of a national learning package on the needs of older drug users along with evidence that this had been implemented by specialist community drug services. These outcomes should be recorded and published, periodically reviewed and revised where appropriate.

England

We agree with this recommendation in principle, and while it is ultimately for local authorities and drug treatment service providers to decide what training they put in place for their staff, we are already committed to picking this issue up as part of our ‘Advancing our health: prevention in the 2020s’ green paper. We will work with a range of partners, including the Home Office, to develop a shared understanding of the difficulties facing the substance misuse workforce. For example, we are planning a DCMO chaired roundtable later this year with both cross government and external stakeholders to agree how to take work forward.

In addition, the green paper highlighted the importance of local authorities working together to plan and deliver services and sought views on what more national organisations can do to help local authorities and NHS bodies work well together. We consider that this is particularly important for the ageing cohort of drug users given their multiple comorbidities and want to explore how pathways between services can be enhanced.

Furthermore, Public Health England’s (PHE) Opioid Substitution Treatment (OST) good practice programme is already considering the inclusion of learning resources for drug treatment service staff. This will focus on OST but will inevitably include attention to issues of service user ageing and increasing susceptibility to disease and overdose.

Scotland

The Scottish Government’s Alcohol and Drugs Strategy published in November 2018 commits to a recovery orientated approach, with an appropriately trained and supported workforce. This will reduce harms and ensure people in need have good access to treatment and recovery services. Actions related to workforce training include: a multi-agency action plan with key partners (NHS boards, local authorities, Public Health Scotland) to deliver these commitments and supporting actions and providing funding for a Royal College of GP training course on substance misuse.

This is a multi-disciplinary course aimed at GPs, pharmacists, nurses, third sector workers and prison healthcare staff. The course will equip clinicians with the skills to assess, support and safely prescribe opiate substitution and other treatments for substance dependence with the aim of increasing access to treatment as quickly as possible, including for opiate users and the older cohort of substance misusers.

Wales

In Wales the ‘Substance Misuse Delivery Plan 2019-2022’ builds on the good progress made in the lifetime of the previous 2008 to 2018 strategy ‘Working Together to Reduce Harm’. The overall aim of the delivery plan is to ensure that people in Wales are aware of the dangers and the impact of substance misuse and to know where they can seek information, help and support if they need it.

The delivery plan contains a number of actions for Welsh Government and key partners. These have been developed following a pre-consultation process, along with findings from an evaluation of the 2008 to 2018 strategy (published April 2018) and the findings of the Healthcare Inspectorate Wales (HIW) Review of Substance Misuse Services (published July 2018). Within the delivery plan welsh policy officials have an action to review the workforce development needs of the substance misuse workforce (July 2021) and to prepare a workforce development plan ensuring it is aligned to relevant standards (March 2021). They will consider the needs of older drug users as part of this work.

Northern Ireland

The administration in Northern Ireland (NI) currently does not have plans to introduce this training locally. However, this training could be very useful and if produced it would be used by other sectors in NI. The administration would support a discussion about a UK wide approach to this with the English and Scottish governments, and the Welsh assembly.

Recommendation 2

Given the changes to the specialist community drug treatment workforce over the last 5 years, an assessment should be conducted of the current range and availability of skills, treatment and support available to people presenting to treatment. A particular focus should be the availability and knowledge of staff to address the complex physical and mental health issues of older drug users.

What metric would indicate that the recommendation had been implemented?

A published review of the workforce as part of a broader strategy to ensure that the workforce is skilled to meet the demands of an evolving treatment population.

England

We accept this recommendation to review the skills mix in the drugs treatment workforce. As highlighted in our response to recommendation 1, the government recently published a Prevention green paper which commits to developing a shared understanding of the issues faced by this group. The cross-government work will be led by the Drug Recovery Champion Dr Edward Day and DHSC. As part of this work we will specifically look at workforce competencies relating to the ageing cohort of drug users.

Scotland

The Scottish Government’s alcohol and drugs strategy commits to building on existing expertise to ensure that people have the right values, knowledge and experience as well as access to training and ongoing support to put commitments into practice. Our approach will bring together those working in treatment and other public services, along with volunteers and those leading recovery communities, and family members.

A workforce development framework, with an ongoing implementation plan, will set out our shared expectations for this workforce. The treatment provided by this workforce will cover all types of substance misuse, including opiate misuse and the needs of the older cohort of drug users.

Wales

In Wales’s ‘Substance Misuse Delivery Plan’ there is an action to review the workforce development needs of the substance misuse workforce and to prepare a workforce development plan for March 2021.

Northern Ireland

Northern Ireland is considering a wider workforce review through the development of a new commissioning framework for alcohol and drug services, although this will cover more than just older drug users.

Recommendation 3

An evaluated pilot programme to determine whether the use of the service navigator model will assist older drug users to engage more successfully in complex health and social care systems, improve the quality of care and health outcomes and be cost effective.

What metric would indicate that the recommendation has been implemented?

Published evaluation of service navigator model(s) to understand whether they are cost effective and improve the engagement of older drug users and improve the quality of care and health outcomes.

England and Wales

We do not accept this recommendation, as there are currently no plans for a pilot to be conducted nationally. If a pilot were provider led, public health agencies in England and Wales would be willing to disseminate the learning.

Service navigators are an established element of MHCLG’s rapid rehousing pathway. Although there are no national plans to pilot similar models for older drug users, individual providers may be considering such initiatives. PHE will help to disseminate learning to them from the MHCLG model, and any future learning from drug service navigators. In addition, in response to recommendation 1 we signalled our intention to look at strengthening treatment pathways for this vulnerable group.

Scotland

There are no plans to introduce a service navigator model in Scotland. NHS Health Scotland will lead on the evaluation of the Scottish Government’s Drugs Strategy, through an evaluation framework. The framework will be used to monitor and evaluate progress against the commitments and outcomes on an ongoing basis. This will sit alongside the existing evaluation framework for the Alcohol Prevention Strategy.

Northern Ireland

The administration in Northern Ireland would be interested in a pilot programme, although there are currently no plans to fund one. The Drink Wise Age Well Lottery-funded programme is currently being evaluated and may deliver some learning for these types of models focused on older people.

Recommendation 4

Close and ongoing analysis of treatment presentation data and wider metrics of drug misusing patterns, with particular attention given to refining and standardising age categories.

What metric would indicate that the recommendation had been implemented?

The standardisation of recording and presentation of age categories in prevalence of substance misuse data across the UK.

England

In England, the National Drug Treatment and Monitoring System (NDTMS) statistical reporting already conforms to the UKSA code of practice for gathering treatment presentation data.

Scotland

In Scotland, the Drug and Alcohol Information System (DAISy) has been designed to provide improved data on problem drug and alcohol use. DAISy will replace 2 data collection systems – the Drug and Alcohol Treatment Waiting Times (DATWT) and the Scottish Drug Misuse Database (SDMD) – which will reduce duplicate data entry and provide more meaningful outcomes information to inform improved service design and delivery.

When fully implemented, DAISy will support local and national decision making, inform national policy and practice development, offer the potential to join person-level data with other datasets, and provide timely information to support local service delivery, improvement and planning.

Wales

Data on treatment presentation and drug misusing patterns is collected via a national database in Wales. Like in England, the age categories in the data conform with the UKSA national code of practice. Wales also publishes an annual statistical report which provides a summary of routinely reported substance misuse related data currently available for Wales. Evidence is drawn from a number of data sources.

Alongside the Welsh Government Substance Misuse report this data provides a complete profile on the scale and nature of substance misuse, both drugs and alcohol, in Wales. Wales would consider any new UK-wide standard approach to collecting this data, but would need to conduct a cost benefit analysis.

Northern Ireland

In Northern Ireland statisticians in the health team are considering treatment presentation data and refining and standardising age categories to align with national standards.