Manchester City Council
Executive
Item 5f
13 February 2015
Manchester City Council
Report for Resolution
Report to:
Executive - 13 February 2015
Young People and Children Scrutiny Committee - 10 February
2015
Health Scrutiny - 12 February 2015
Finance Scrutiny - 23 February 2015
Subject:
Children & Families Consultation - Drug and Alcohol
Report of:
Deputy Chief Executive (People), Strategic Director Adult Social
Services, Strategic Director of Children’s Services, Director of
Education and Skills and the City Treasurer
Summary
This report forms part of a suite of reports to the Executive and Scrutiny Committees
for consideration in reaching decisions on the level of budget and Council Tax and
should be read in conjunction with the Children and Families budget report which
provides information on the proposed changes to Children and Families Directorate
as part of the 2015/17 budget proposals.
There has been wide ranging consultation on the budget options for the Children and
Families Directorate. The consultation, which commenced on 1st December 2014 and
ended 1st February 2015, was devised along eight key themes. The results of the
consultation has fed into the decision making process. Each of the eight areas is
covered by an individual report which sets out an analysis of the responses from the
public as well as the key themes emerging from the consultation. Each report
describes the adjustments that have been made to the budget options as a result of
the consultation. This report focuses on Drugs and Alcohol,
The consultation had been extended for a week as a result of the development of
changes to the budget options after the announcement of the airport dividend.
The savings proposals included in this report are informed by the outcome of the
consultation, equality impact assessments and the options reported to the Executive
on 21st January as part of the initial draft budget proposals. Subject to decisions on
the Council’s budget the proposals in this report will be built into the business plan for
the Children and Families Directorate.
Recommendations:
The Executive is recommended to:
• Accept the budget option of reducing the drug and alcohol budget from £12.1
million to £9.043 million over 2015/16 and 2016/17. This would produce a saving
of £3.057 million.
Wards affected: All
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Manchester City Council
Executive
Item 5f
13 February 2015
Community Strategy Spine
Summary of the contribution to the strategy
Performance of the economy of
the region and sub region
Supporting the Corporate Core in driving forward
the growth agenda with a particular focus on
integrated commissioning and delivery which will
focus on utilising available resources effectively
and developing a diversity of providers including
entrepreneurs and social enterprises. This will
provide opportunities for local jobs.
Reaching full potential in
education and employment
Integrated commissioning will focus on utilising
available resources to connect local people to
education and employment opportunities,
promoting independence and reducing
worklessness. Working with schools to engage
and support our communities.
Individual and collective self
esteem – mutual respect
The focus is on changing behaviours to promote
independence, early intervention and prevention,
the development of evidence-based interventions
to inform new delivery models integration with
partners where appropriate.
Neighbourhoods of Choice
Development of integrated health and social care
models and local commissioning arrangements
that connect services and evidence-based
interventions to local people and enable families
and their workers to influence commissioning
decisions aligned to locally identified needs.
Schools as community hubs playing an essential
role in reaching out to communities and leading
early intervention and prevention approaches at a
local level
Implications for:
Equal Opportunities
Yes
Risk Management
Yes
Legal Considerations
Yes
Financial Consequences for the Capital and Revenue Budgets
The proposals set out in this report form part of the draft revenue budget submitted to
the Executive on 13th February 2015.
Contact Officers
Name:
Position:
Telephone:
E-mail:
Geoff Little
Deputy Chief Executive (People)
234 3280
g.little@manchester.gov.uk
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Manchester City Council
Executive
Item 5f
13 February 2015
Name:
Position:
Telephone:
E-mail:
Michael Houghton-Evans
Interim Strategic Director for Families, Health and Wellbeing
234 3952
m.houghton-evans@manchester.gov.uk
Name:
Position:
Telephone:
E-mail:
David Regan
Director of Public Health
234 3981
d.regan@manchester.gov.uk
Name:
Position:
Telephone:
Email:
Hazel Summers
Head of Strategic Commissioning
0161 234 1327
h.summers@manchester.gov.uk
BACKGROUND DOCUMENTS (available for inspection)
Public Consultations 2015/16 Open Text Responses
Consultation Demographic information
Available on request from the following contact officer:
Name
Telephone
Email
Zoe Robertson
0161 234 1767
z.robertson@manchester.gov.uk
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Manchester City Council
Executive
Item 5f
13 February 2015
1.
Purpose
1.1
This report relates to the Children and Families budget report elsewhere on
the same agenda. There has been a general consultation on the budget as a
whole, with specific consultations on options within Children and Families,
these were organised into eight themes. The Children
and Families
Consultation started on the 1st December and was originally to end on the 26th
January, however this was extended to the 1st February 2015 as a result of
the changes to the total resource available when the airport dividend became
available. The general consultation has been extensive and this has
signposted Manchester residents into the Children and Families specific
consultations.
1.2
This report explains the methods used to consult on the eight themes within
Children and Families Directorate and focuses specifically on Drug and
Alcohol services. It sets out the results of the consultation and how these have
adjusted some of the options for savings being recommended. The changes
are reflected in the options for savings in the budget report elsewhere on the
agenda. Members are requested to consider the Council's priorities and
budget principles as set out in the budget report as well as the results of
consultations and the EIAs set out in this report before reaching decisions on
the budget. This report focuses on Drug and Alcohol Services
2.
Budget Options Consultation
The City Council has a long track record on delivery of consultation and
engagement, particularly with regard to budget options and proposals for
change within the Children and Families Directorate. The consultation, which
commenced on 1 December 2014, was devised along eight key themes:
1.
2.
3.
4.
5.
6.
7.
8.
The Voluntary and Community Sector*
Mental Health*
Youth and Play*
Children and Young People*
Homelessness and Housing-Related Support*
Drug and Alcohol
Wellbeing Services*
Sexual Health*
* This report focuses on the Drug and Alcohol consultation – see additional reports
on the other budget option consultations via www.manchester.gov.uk
A detailed plan was prepared which set out a comprehensive consultation and
engagement methodology to encourage service users, stakeholders and residents to
participate in the consultation.
This included:
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Manchester City Council
Executive
Item 5f
13 February 2015
1. Using the Council’s website – all eight themes had their own dedicated
consultation area
2. Individual questionnaires – see Appendix 1
3. Public Events – These events took place throughout the consultation period
and were spread geographically across the city
4. Targeted Events – each theme identified key stakeholders they needed to
consult with during the consultation period
5. Engagement with established Citizen Groups – grouped by disability (and
including young people’s fora) to ensure known communities of interest had a
voice
The Budget Options Consultation had the following aims and objectives:
•
•
•
•
•
•
•
•
•
•
Meet with users of services and carers to listen to their views on the budget
options
Engage the public in understanding and discussing the challenges facing the City
Council in meeting the requirements of the budget process
Inform stakeholders of the proposed options
Inform staff and a range of other stakeholders of the proposed options
Seek feedback from all parties in their preferred format
Identify any equalities issues that were previously not considered
Allow a reasonable and sufficient period for those being consulted to put their
views forward
Listen to alternative proposals brought forward by Consultees
Ensure that the consultation approach was as accessible as possible to ensure
that communities of interest could fully participate in the process
Encourage participation in the consultation process
Targeted Events
Each consultation theme arranged a significant number of targeted events. A
targeted event is an event with a defined service user groups or
providers/stakeholders who have an active interest in the particular consultation
theme e.g. mental health and the mental health service user group. The full list of
targeted events by theme can be found in Appendix 2. In total, 14 meetings and
events have been held across the Drug and Alcohol consultation. Feedback from the
consultation events can be found later in this report.
Public Events
A series of consultation events were held across the city. These events were actively
promoted through:
•
•
•
•
Posters displayed in libraries, provider venues and the Town Hall Customer
Service Centre
Stakeholder and Voluntary/Community Sector mail circulation lists
The budget pages on the Council’s website
Local radio advertising
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Executive
Item 5f
13 February 2015
All venues were selected for their range of disability considerations e.g. level access,
close to transport links and/or car parking facilities. BSL signers were made
available if requested advance of the session.
In summary, 6 all-day public events were arranged spread geographically across the
city. Each event had different sessions throughout the day in order to attract people
to the event they were either most interested in or wanted to get their views across.
Attendance at the sessions was low but enabled residents to participate in the
consultation at a local venue
Date
Venue
Consultation Theme
15 December
2014
Wythenshawe
Forum
16 December
2014
Irish Heritage
Centre
18 December
2014
Longsight
Library (check)
13 January
2015
Irish Heritage
Centre
15 January
2015
Wythenshawe
Forum
19 January
2015
Longsight
Library
Sexual Health
Mental Health
Wellbeing
Drug and Alcohol
Wellbeing
Sexual Health
Drug and Alcohol
Mental Health
Wellbeing
Drug and Alcohol
Mental Health
Sexual Health
Homelessness
Voluntary and Community Sector
Youth and Play
Children and Young People
Children and Young People
Homelessness
Voluntary and Community Sector
Youth and Play
Youth and Play
Children and Young People
Homelessness
and
Housing
Related Support
Voluntary and Community Sector
Numbers in
attendance
0
9
21
1
9
1
1
0
9
1
1
1
7
4
2
0
0
1
3
10
2
7
8
4
Accessibility considerations
Through all face to face events and upon request, people could request a
questionnaire through their preferred format. This included:
1. A general questionnaire available for all eight themes
2. An Easier to Read questionnaire
3. Braille versions (with support to complete the questionnaires provided on a
one-to-one basis or via telephone support)
4. Large print
5. Translations into other languages on request
6. Audio/MP3 formats
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Manchester City Council
Executive
Item 5f
13 February 2015
All alternative formats were widely used at both Targeted and Public Events:
•
•
•
•
the Easier to Read questionnaires were used by the citizen disability groups e.g.
the learning disability partnership board and also were preferred by children and
young people
The large print versions were ordered by health therapists in particular for
consultation with older people around Falls Services
The Braille and Audio versions were well used by Visually Impaired people.
With regard to requests for translations, these were by organisations in the
Voluntary and Community Sectors (BME network) and we supplied all eight
consultation themes into 5 key community languages e.g. Chinese Cantonese,
Somali, Arabic, Bangla and Urdu. Translations were provided by the in-house
Translation and Interpretation service (TIS) and also translated back into English
upon receipt.
A significant number of partner organisations requested hard copy versions of the
questionnaires across all eight themes and these totalled:
Different groups chose different ways to participate in the consultation as follows:
Type
Online via website
General questionnaire
Easier to Read
Translated
Totals
Drug and Alcohol
153
6
2
4
165
Citizen Disability Groups
The Directorate policy is to ensure that all consultation and significant service
developments are communicated to our Citizen Groups. This is to ensure that
communities of interest have a voice and ensure that the Council both understands
and considers any equalities issues fully before any decisions are made.
The Council has four groups Citizen Groups:
1.
2.
3.
4.
The Learning Disability Partnership Board
The Physical Disability Partnership Board
The Visually Impaired Steering Group
The Deaf and Hard of Hearing Steering Group
Together with established groups for Young People such as the Youth Zones and
Youth Council.
Once the consultation was live, individual sessions were arranged with each of the
above groups. The approach was to set out the key options across all eight themes,
generate discussion and feedback and seek both their collective and individual views
through group feedback and questionnaire completion. The results of what each
groups’ views were can be found in the individual theme sections later in this report.
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Executive
Item 5f
13 February 2015
On 8 January 2015, the consultation was extended to 1 February 2015 and a
supplementary questionnaire was developed. This was due to the revised financial
position of the Council following the receipt of the Provisional Financial Settlement
and the application of the interim airport divided has enabled the Council to relook at
the savings options and has created capacity for £5.5m for investment in priority
areas. Clarity on the budget meant that we could more accurately inform our
consultees that the Council is now expected to make £55.24 million in worth of
savings rising to £70.22 million is 2016/17.
The supplementary questionnaire focused on three additional questions and this was
made available:
•
•
•
•
3.
Online through the budget options consultation pages
As a separate additional questionnaire
Available in all formats previously requested (Easy Read, Braille, Large Print,
Audio as well as translated into the 5 requested languages)
Members are able to access the consultation open text responses upon request.
Overview of Budget Options for Drug and Alcohol Services
The option under consultation for alcohol and drugs is to reduce the overall budget
for alcohol and drug services commissioned by public health from £12.1 million to
£9.043 million over 2015/16 and 2016/17; this would produce a saving of £3.057
million. At present, drug services have more money invested in them than alcohol
services, and this option seeks to rebalance that investment. This option does not
focus on any individual drug or alcohol service or its staff.
To achieve this saving, the options proposed in the consultation were to:
•
Redesign and recommission alcohol and drug early intervention and treatment
services as an integrated alcohol and drug treatment system
•
Review services commissioned from GPs and pharmacies in order to make
savings and redesign provision to address alcohol misuse as well as drug
misuse
•
Review young people’s substance misuse services and look at opportunities
for linking these with other health-related services for young people
This report deals with the consultation on Drugs and Alcohol. This consultation
breaks down into a number of sub themes:
• Drug and Alcohol treatment services
• Primary Care services
• Young People’s substance misuse services
If a decision is taken to proceed with this option, commissioners will develop a model
for an integrated alcohol and drug early intervention and treatment system to respond
to alcohol and drug-related need in Manchester, to be in place from January 2016.
The Council will also set out plans for young people’s substance misuse services.
These models will be co-produced with local stakeholders.
4
Consultation Results
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Manchester City Council
Executive
a)
Item 5f
13 February 2015
Results of the consultation questionnaire
A total of 165 questionnaires were received for alcohol and drugs. Analysis of the
responses received is as follows:
1A. Do you agree or disagree with the option to redesign drug and alcohol services
and commission a new fully integrated adult drug and alcohol service?
Don't know; 1%
No response; 0%
Disagree or Strongly
Disagree; 25%
Neither agree nor
disagree; 7%
Agree or Strongly
Agree; 67%
Question 1A The Council asked whether people agreed or disagreed with the
option to redesign drug and alcohol services and commission a new fully integrated
alcohol and drug service for adults. The majority of respondents (67%) said that they
agreed or strongly agreed with this option, however 25% of respondents said they
disagreed or strongly disagreed.
1B. Do you agree or disagree with the option to rebalance investment?
Don't know; 2%
No response; 1%
Disagree or Strongly
Disagree; 8%
Neither agree nor
disagree; 9%
Agree or Strongly
Agree; 80%
Question 1B The Council asked whether people agreed or disagreed with the
option to rebalance investment in alcohol and drug services. The majority of
respondents (80%) said that they agreed or strongly agreed with this option. 8% of
respondents said they disagreed or strongly disagreed.
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1C. An option is that an integrated adult drug and alcohol treatment service would
include the following elements: Targeted prevention and early intervention, Intake,
access, triage and outreach support, Clinical treatment for people who need to see a
specialist doctor or a nurse as part of their treatment and Recovery, with a strong focus on
employment. Do you agree or disagree with the option?
No response; 1%
Don't know; 2%
Disagree or Strongly
Disagree; 15%
Neither agree nor
disagree; 12%
Agree or Strongly
Agree; 70%
Question 1C The Council asked whether people agreed or disagreed with the option
of an integrated adult drug and alcohol treatment service which included the following
elements – targeted prevention, early intervention, clinical treatment, and recovery.
The majority of respondents (70%) said they agreed or strongly agreed with this
option. 15% of respondents said they disagreed or strongly disagreed.
Primary Care Services
2. Do you agree or disagree with the option to change how we work with GPs and
pharmacies so that it includes alcohol as well as drug misuse?
Don't know; 2%
No response; 1%
Disagree or Strongly
Disagree; 13%
Neither agree nor
disagree; 6%
Agree or Strongly
Agree; 78%
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Question 2 The Council asked whether people agreed or disagreed with the option
to change how we work with GPs and pharmacies so that it includes alcohol as well
as drug misuse. The majority of respondents (78%) said they agreed or strongly
agreed with this option. 13% of respondents said they disagreed or strongly
disagreed.
Young People’s substance-misuse service
3. Do you agree or disagree with the option to review the young people's
substance-misuse service and see if this service could be more closely linked with
other health-related services for young people?
Don't know; 3%
No response; 1%
Disagree or Strongly
Disagree; 8%
Neither agree nor
disagree; 13%
Agree or Strongly
Agree; 75%
Question 3 The Council asked whether people agreed or disagreed with the option
to review the young people’s substance misuse service and see whether this could
be more closely linked with other health-related services for young people. The
majority of respondents (75%) said they agreed or strongly agreed with this option.
8% of respondents said they disagreed or strongly disagreed.
Additional Comments
The Council asked whether people had any further comments or suggestions on drug
and alcohol services. 80 respondents made additional comments or suggestions.
There were a total of 173 comments. The key themes were:
19 comments were in support of services remaining separate.
25 comments were supportive of the option to integrate alcohol and drug
services.
34 comments were made in support for the current service provided by the
Manchester Mental Health and Social Care Trust at the Brian Hore Unit in its
location next to Withington Community Hospital.
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Manchester City Council
Executive
Item 5f
13 February 2015
Elected Members can access the full log of written responses and freetext comments
from the questionnaires upon request
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Executive
b)
Item 5f
13 February 2015
Results of the Easier to Read questionnaire –
i)
disabled people ii)
Young People and Children
There were less than five easy read responses completed for the drugs and alcohol
consultation. In general they were in agreement with the options presented in the
consultation although there were different views about looking at moving some
money from drug services to alcohol services. Respondents requested that more
information should be readily available.
c)
Themes arising from the Targeted Service-Specific Events
A targeted event for providers of services for alcohol and drug misusers was held.
The key points raised at this event were:
•
Potential barriers to accessing integrated services
•
The different specialist skills needed for working with alcohol misusers, drug
misusers and young people misusing substances
•
The need to consider the geographical location of services and city-wide
accessibility
•
The need for further engagement with staff and service users as service
models are developed
An additional targeted event was held with a service user group at an alcohol
treatment service, at the request of that group. 30 members of the group attended.
The key points raised at that event were:
•
Concerns about integrating drug and alcohol services because alcohol users
have different needs than drug users
•
Concerns that alcohol users’ recovery may be compromised in integrated
services if ex-drug users are still using alcohol
•
Strong support for the current service provided by the Manchester Mental
Health and Social Care Trust at the Brian Hore Unit in its location next to Withington
Community Hospital
d)
Themes arising from the Public Consultation Events
The options relating to alcohol and drugs were discussed at the workshops held
across the city between. The workshops gave an opportunity for qualitative feedback
on the options for alcohol and drugs. Comments made by members of the public
attending those events mainly related to the consultation process and the potential
redesign and recommissioning process.
e)
Feedback from Citizen Groups
i) Young people
Between the 12-30th January 2015 Council officers facilitated consultation workshops
with young people aged between 11-19 years old with the support of VCS youth
service providers. Workshops took place during regular youth work sessions at the
Factory Youth Zone, Woodhouse Park Lifestyle centre, Barlow Moor Community
Centre and Brunswick Parish Church (M13 Youth Project)
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Manchester City Council
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The themes that young people were consulted on included, Children and Young
People (free school travel and crossing patrols), Youth and Play, Wellbeing (Physical
Activity), Drug & Alcohol, Sexual Health and Homelessness.
In total, 129 individual young people aged 11-19 directly responded to at least one of
the budget options across the six identified themes
The Council asked if the young people’s drug and alcohol service could work more
closely with other health services for young people. 58% of respondents agreed with
this option. 34% disagreed with this option. 8% of respondents said that they didn’t
know.
We think we should see if the young people’s drug and alcohol
service could work more closely with other health services for
young people. Do you agree with this?
Don’t Know
8%
Disagree
34%
Agree
58%
The key comments made by young people were:
•
•
The importance of providing a quality service to young people.
The possibility or a suggestion that pharmacists could be asked to provide
more support to people.
(ii) Feedback from Citizen Disability Groups
There was no feedback from:
The Learning Disability Partnership Board
The Visually Impaired Steering Group
The Deaf and Hard of Hearing Steering Group
Physical Disability Partnership Board Feedback
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A targeted event for Physically Disability Partnership Board was held on the
14/01/15. The key points made were:
•
•
f)
More funding is needed, especially for alcohol.
It is worth investing in this area – because, otherwise, there will be costs (in
terms of money and damage) to people and families.
Feedback from written responses and any petitions received
A written response was submitted by an alcohol treatment service, on behalf of staff
and service users. The key points raised in that response were:
•
A preference to retain separate service provision for alcohol and drugs
•
Agreement with the option to rebalance investment in favour of alcohol
services
•
The need to ensure that a redesigned service reflects the elements of service
required for alcohol misusers as well as drug misusers
•
Agreement with the option to review primary care services to include alcohol
•
A preference to retain a separate specialist service for young people’s
substance misuse
A letter was received from a GP practice that included comment on the options for
drug and alcohol services. The respondents commented that integrating drug and
alcohol services was not without merit. However, the potential for further disruption,
following the earlier reorganisation of drugs services, was noted. Concern was
expressed about the potential loss of shared care arrangements.
The Clinical Commissioning Groups for Manchester commented on the reduction of
service that will follow cuts of this scale. They highlighted that because the
Manchester population has a high percentage of people with drug and alcohol
problems there is a real risk of increase in secondary care activity and therefore cost.
They also stated that if the Alcohol Brief Intervention Project is decommissioned this
could have a significant impact as a result in non-elective admissions to hospital.
The Mental Health and Social Care Trust submitted a written response and raised
issues relating to alcohol and drugs. Specifically, they asked whether the needle
exchange, the alcohol IBA training, and strategic drug work move across to the
integrated service. In addition, they asked how should drug & alcohol recovery link
with well-being services in terms of referrals and pathways. These concerns will be
considered in conjunction with other consultation responses and questions and will
be addressed in the redesign work, working closely with providers and stakeholders.
Elected Members can access the full log of written responses and freetext comments
from the questionnaires upon request
g)
Key summary of all combined consultation results
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13 February 2015
For each option, around three quarters of questionnaire respondents agreed or
strongly agreed with the option being proposed. Therefore, there will be no change
to the budget options following the consultation process.
A number of comments including concerns were raised by respondents in qualitative
feedback in the questionnaires, in other written responses, and at public and targeted
workshops. Concerns were expressed about the potential impact on alcohol
misusers of an integrated system. Concerns were also expressed about the process
of redesigning services and the disruption that this may cause for service users and
staff.
Concerns will be addressed in the redesign phase, and the council intends to work
with stakeholders to co-produce models.
5.
Equality Impact Assessment(s)
Equality analyses (an Equality Relevance Assessment or Equality Impact
Assessments) have been carried out against each of the options to assess whether
they will affect people who identify with a protected characteristic to a
disproportionate degree compared to those who do not. The anticipatory analysis
has enabled consideration of what the nature of any identified impact is likely to be,
and what actions can be taken to mitigate this. Carrying out the analysis has
provided an opportunity to consider how to further promote equality, diversity,
inclusion and Human Rights in day to day business and meet the Council’s statutory
duty. EIAs are an iterative process and will need to be reviewed as options, once
agreed, are developed into service changes/re-commissioning. All EIAs relevant to
this option can be found in the appendices of this report. The key findings can be
broadly summarised as follows:
• Drug and alcohol treatment services for adults and young people are offered
on the basis of need and consequently there is nothing to indicate that
changes to this service will have a disproportionate impact relating to race,
disability, gender, sexual orientation, religion and belief, marriage and civil
partnership or carers.
• Young people from some ‘vulnerable groups’ are more likely to develop
substance misuse problems, including young offenders, truants and excludes,
looked after children and children of parents who misuse drugs/alcohol. Any
impacts stemming from changes to these services are therefore likely to be
disproportionally felt on these sub-categories of young people.
These impacts will be mitigated by:
• Ensuring that EIA risk areas are flagged up and considered prior to any decommissioning decisions being made
• Maintaining and improving the on-going collection and monitoring of activity
information relating to equality groups
• Reviewing the EIA during the redesign of alcohol and drugs service in order to
assess the impact of the changes on equality groups
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6. Adjustments to the Budget Options following Consultation and the Equality
Impact Assessment
There will be no adjustments to the budget options following the consultation
process.
7.
Conclusions
The current option is to reduce the budget for drug and alcohol services in 2015/16
and 2016/17 from £12.1million to £9.043million (a saving of £3.057million), through:
•
Redesigning current alcohol and drug treatment provision and tendering for an
integrated system, rebalanced towards alcohol
•
Reviewing arrangements for primary care and pharmacies and including
alcohol in these
o Reviewing young people’s substance misuse services and looking at
opportunities for linking with other young people’s health services
The results of the online consultation questionnaire show that for each question,
around three quarters of respondents agreed or strongly agreed with the option being
proposed. The results of the online consultation questionnaire show that for each
question, around three quarters of respondents agreed or strongly agreed with the
option being proposed.
A health impact review was conducted to identify which of the public health budget
options could have the most significant negative impact on the health of the City’s
population. It was highlighted that the option for alcohol and drug services could have
a negative impact on the health of adolescents, adults under 65 years, troubled
families and the residents of the most deprived areas of the city. This would need to
be taken into consideration and monitored if this option was agreed and
implemented. Identification of mitigating actions should be an ongoing process as
part of the service redesign. In the redesign phase the City Council will address
concerns raised, relating to the potential impact on alcohol misusers of an integrated
treatment system and work with stakeholders and service users to co-produce
models.
The City Council will continue to work closely with the three Manchester Clinical
Commissioning Groups and other partners, through the Health and Well-being Board
to consider the health impacts of commissioning decisions going forward and ensure
any potential negative impacts are addressed through a partnership approach.
8.
Recommendations
Executive to accept the budget option of reducing the drug and alcohol budget
from £12.1 million to £9.043 million over 2015/16 and 2016/17. This would
produce a saving of £3.057 million.
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Manchester City Council
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Appendix 1 - Item 5f
13 February 2015
Appendix 1
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Appendix 2 - Item 5f
13 February 2015
Appendix 2
Drug and Alcohol Targeted Events
Date
Event Details
Location/Time
03 December 2014
Shared Care Network
(Drugs & Alcohol)
17 December 2014
18 December 2014
Public Event – Targeted
Public Health
Public Event – Target
Public Health
Public Event
08 January 2015
Alcohol
12 January 2015
North CCG Clinical
Executive Group,
Health Bus - Clayton
Learning
Disability/Learning
Disabled People
Partnership Board
Phoenix Mill,
Ancoats 13:00 15:00
Friends Meeting
House 12:00 - 14:00
Friends Meeting
House 15:30 - 17:30
Longsight Library
Drugs and Alcohol
11:45-13:15
Brian Hore Unit
12:30-14:00
Silk Mill, Newton
Heath
Clayton 10.00-18.00
10.30am until
12.30pm
Manchester People
First offices; 3
Broughton Street,
Cheetham Hill, M8
8RF
Silk Mill, Newton
Heath 14:00-15:30
10am
Gorton District
office, conference
room
Withington 10.0018.00
Ardwick Green
10.00-18.00
10.00am
Manchester Deaf
Centre
Crawford House
Booth Street East
Manchester
M13 9GH
1.00-3.00pm
Manchester Deaf
Centre
Crawford House
Booth Street East
Manchester
M13 9GH
17 December 2014
13 January 2015
13 January 2015
14 January 2015
14 January 2015
North CCG Clinical
Redesign Group
Physical Disability
Partnership Board
14 January 2015
Health Bus - Withington
15 January 2015
Health Bus – Ardwick
Green
Visual Impairment (VI)
steering group
22 January 2015
23 January 2015
Deaf/Hard of Hearing
group
593
Other
Themes
Attendance
9
64
34
1
30
All PH
10
All PH
All themes
2
All PH
12
All themes
All PH
20
All PH
15
All themes
All themes
Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
Appendix 3
EQUALITY IMPACT ASSESSMENT
1. Directorate
Children and Families
2. Section
Public Health
3. Name of the
function being
assessed
Drugs and alcohol
services
4. Is this a
new or
existing
function?
Existing
5. Officer
responsible for
the assessment
Neil Bendel
6. Lead manager
responsible for
the assessment
Marie Earle (drugs) and
Lydia Fleuty (alcohol /
young people’s substance
misuse)
7. Date
assessment
commenced
12 December 2014
8. Date of
completion
28 January 2015
9. Date passed to
BIP Equality
Team
30 January 2015
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
Equality Impact Assessment Template
1. About your function
Briefly describe the key
delivery objectives of the
function being assessed
The function being assessed is alcohol and drug services commissioned from the Public
Health Grant by the Public Health Team in Manchester City Council. The key delivery
objectives of this function are:
1. Adult drug treatment services which are a city wide service for adults aged 18+ with drug
misuse problems. This includes the following elements:
• Intake: providing engagement, assessment, brief interventions and extended brief
interventions as well as a Needle Exchange & Harm Reduction Service and a Criminal
Justice Team.
• Clinical: providing substitute prescribing, other drug treatments and psychosocial
interventions.
• Recovery: providing a recovery motivation programme, community development,
psychosocial interventions, employment skills training and family support.
2. Access to drug & alcohol in-patient detoxification and residential rehabilitation services
including:
•
•
short episodes of specialist drug &/or alcohol treatment in in-patient settings (hospital
based or equivalent) for adults aged 18+ who are assessed as requiring this.
a period of stay (usually not more than 26 weeks) in abstinence based accommodation
for treatment and support for adults aged 18+ with drug misuse problems who are
assessed as requiring this.
3. Interventions that support ‘drug rehabilitation requirements’ and ‘integrated offender
management’ processes for drug driven offenders. The service is provided to adults aged 18+
who are in drug treatment and who are assessed as requiring this particular service by the
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
provider.
4. Alcohol liaison projects for adults aged 16+ with alcohol misuse problems attending
hospitals in the city. This service is made up of the following elements:
• Training and support for Accident and Emergency department staff to screen patients
for alcohol misuse and deliver ‘brief advice’ aimed at reducing alcohol misuse
• Extended brief advice outpatient clinics for patients requiring additional alcohol
interventions
• Care facilitation in partnership with ward staff, to identify dependent drinkers and, where
clinically appropriate, arrange discharge and referral to community based alcohol
services
5. ‘Shared Care’ for drug misuse in primary care general practice, and observed supervised
consumption service for drug misuse in community pharmacies. The service is provided to
adults aged 18+ and provides:
•
•
a care plan/regular review/prescribing of opiate substitution medication by the service
user’s own GP and their drug treatment worker
observed supervised consumption of prescribed substitute medication by a community
pharmacist
6. An early intervention service for vulnerable young people at risk of developing substance
misuse (alcohol and/or drug) problems, and specialist young people’s substance misuse
treatment and specialist support for young people in substance misusing families.
7. Community based alcohol treatment services for adults aged 16+ with alcohol misuse
problems. This includes the following elements:
• Engagement, assessment, brief interventions and extended brief interventions; and a
criminal justice link worker service.
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
• Clinical treatment including community detoxification, prescribing, and psychosocial
interventions
• Recovery support including one to one and group-based support programmes and peer
support
8. Other services to support alcohol and drug users with complex needs, including dual
diagnosis support, assertive outreach with dependent drinkers, resettlement support for
female offenders, recovery support for drug/alcohol users in supported housing, social care
support for dependent drinkers in ‘wet’ accommodation, and drug and alcohol social work
teams.
A reduction in Grants from central government has meant that Manchester City Council has
devised a number of savings options to manage the gap in the level of anticipated spend,
against the level of Grants received to enable the council to have a balanced budget in
2015/16.
In the Children and Families Directorate options have been consulted on with residents and
final decisions will be made by elected members. An EIA has been carried out to provide
anticipatory analysis to ensure that decision makers are aware of any potential
disproportionate impacts of the option on people with a protected characteristic in line with the
Council’s statutory responsibility to have due regard for Equality in everything we do.
There are 8 areas being considered for draft savings options in the Children and Families
Directorate, including drugs and alcohol. The current options for drugs and alcohol are to:
-
review, redesign and re-commission adult drugs and alcohol treatment services as an
integrated alcohol and drugs service with investment rebalanced in relation to need
review how we work with GPs and pharmacies including how those services address
alcohol misuse
review young people’s substance misuse services to see if there are opportunities for
linking with other health-related services for young people
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
This will be delivered with a funding reduction of £1,450,000 in 2015-16 with a further
reduction of £1,606,000 in 2016-17 (a total reduction of £3,057,000 on the current combined
citywide funding for drugs, alcohol and young people’s substance misuse of £12,374,000).
This will leave a funding resource of £9,317,000. These savings will be achieved through a
combination of decommissioning, remodelling/redesigning, and recommissioning, which will
impact on all drug and alcohol services currently commissioned by Manchester City Council.
This EIA therefore focuses on all services commissioned by Public Health for adult alcohol
and drug users and young people with substance misuse problems.
What are the desired
outcomes from this function?
Drug and alcohol services need to support the delivery of national and locally agreed outcome
measures.
National indicators include:
• the successful completion of drug treatment
• reducing alcohol-related admissions to hospital
Local priorities include
• early intervention to prevent problems developing
• treatment which is effective in helping people change their behaviour and, where
appropriate, come off drugs and alcohol completely
• protection of children from harm
• reducing substance misuse-related offending and re-offending
• supporting recovery and reintegration
In day-to-day delivery, these services work towards a range of wider outcomes, some of which
are also dependent on the performance of other services. These include the following service
and client outcomes:
• Harm reduction
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
•
•
•
•
•
•
•
•
Safeguarding vulnerable children
Waiting times for access to treatment
Unplanned exits from treatment
Reduced offending and re-offending
Improved physical health, mental health and wellbeing
Reduced homelessness
Increased access to education, training and employment
Improved social functioning
The successful completion of drug treatment for opiate clients is a key performance indicator
(KPI) in the Public Health Outcomes Framework, and is also included in Manchester Council’s
Community Strategy 2011-2015. There are no national KPIs for alcohol treatment or young
people’s substance misuse treatment. Information on many of these is collected through
national (NDTMS) monitoring and local performance monitoring for individual services.
Drug, alcohol and young people’s substance misuse services also support the objectives of
other local strategies, including the Manchester Health and Wellbeing Strategy and Crime and
Disorder Strategy.
The desired outcome of this EIA is to understand how the reduction/removal of funding and/or
redesign of how services are configured may have a differential impact on people with a
protected characteristic. Subject to the outcome of the consultation process, this EIA will be
reviewed during the redesign of alcohol and drugs service in order to assess the impact of the
changes on equality groups
2. About your customer
Do you currently monitor the
function by the following protected
characteristics?
Protected Characteristics
599
Y/N
If no, please explain why this is the case and / or
note how you will prioritise gathering this
equality data
Manchester City Council
Executive
What information has been
analysed to inform the content of
this EIA?
Appendix 3 - Item 5f
13 February 2015
Race
Y
Gender (inc. gender
reassignment, pregnancy
and maternity)
Disability
Y
Sexuality
Y
Age
Y
Religion or belief (or lack of
religion or belief)
N
Drug and alcohol services do not routinely collect or
report on the religion or belief of their service users.
Questions around religious beliefs can be perceived
as a potential barrier to honesty with service users
where drug or alcohol use is strongly opposed by
certain faiths.
Marriage or civil partnership
N
Marital or civil partnership status is not routinely
monitored or reported. All services are required to
monitor sexuality and report on the parental status
and access to/living with children status of clients
and act according to safeguarding procedures as
required. Services also need to be aware of the
childcare responsibilities of clients and ensure that,
where possible, any barriers to treatment and care
that this responsibility presents are minimised
through their operating procedures.
Y
Current analysis involves a review of the data collected by services on current service
users across the range of protected characteristics listed above. These data have been
routinely collected by drug and alcohol services and, for the most part, reported both to
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Manchester City Council
Executive
Please include details of any data
compiled by the service, any
research that has been undertaken,
any engagement that was carried
out etc.
Appendix 3 - Item 5f
13 February 2015
commissioners through contract monitoring and to national data sets. Low level analysis
of this information is continual to ensure contractual compliance but wider comparison to
city-wide data sources is specific to this equality analysis.
Service user profile data is drawn from current drug and alcohol treatment services and
the young people’s substance misuse service. Where possible the analysis includes
comparisons with national service user profiles. In particular, comparative data available
as part of the Healthier Lives Alcohol and Drugs tool produced by Public Health England
has been used to look at local performance in relation to some of the key performance
measures for drug and alcohol treatment services, including recovery outcomes.
The tool shows that Manchester performs poorly relative to other local authorities in
England on a range of key measures, including:
• Proportion waiting more than 3 weeks for drug treatment (129th out of 151 local
•
•
•
•
authorities and 13th out of 15 similarly deprived local authorities)
Proportion waiting more than 3 weeks for alcohol treatment (126th out of 151 local
authorities and 12th out of 15 similarly deprived local authorities)
Successful completion of treatment for opiate use (99th out of 149 local authorities
and 9th out of 15 similarly deprived local authorities)
Successful completion of treatment for non-opiate use (119th out of 149 local
authorities and 14th out of 15 similarly deprived local authorities
Successful completion of treatment for alcohol (122nd out of 150 local authorities
and 12th out of 15 similarly deprived local authorities)
Full data is available at http://healthierlives.phe.org.uk/topic/drugs-and-alcohol.
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
3. Delivery of a customer focused function
Does your analysis indicate a
disproportionate impact relating to
race?
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
Y
N
N
Information on new presentations to adult drug treatment services has been
collected since July 2012. The latest profile of service users that were in treatment in
2013/14 (at Quarter 4) shows that 81% of service users are recorded as being White
British. There are very small cohorts across all other categories. Users recorded as
being White Irish make up 3% of the overall cohort of services users. A similar
proportion (3%) is recorded as being from a mixed White & Black Caribbean
background.
This information is compares with national information as follows - the majority of
service users, nationally, are White British at 83%. The next cohort is White – Other at
4%. No other ethnic groups account for more than 2% of clients.
For adult alcohol treatment services (full year data for 2013/14), 87% of service
users are recorded as being White British, the next largest category is White Irish
(3%), then White – other (2.5%) and White & Black Caribbean (1.5%).
For young people’s substance misuse treatment (full year data for 2013/14), 75%
of service users are recorded as being White British, the next largest categories are
White & Black Caribbean (5%), then White & Asian, Pakistani, and African (3% each).
Drug and alcohol treatment services for adults and young people are offered on the
basis of need and therefore a person’s race plays no part in determining eligibility for
this service. Consequently, there is nothing to indicate that changes to this service will
have a disproportionate impact relating to race.
Which action plans have these actions
been transferred to?
N/A.
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Manchester City Council
Executive
Does your analysis indicate a
disproportionate impact relating to
disability?
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
Appendix 3 - Item 5f
13 February 2015
Y
N
N
For adult drug treatment services, the proportion of users self-reporting having a
disability differs between the three community-based treatment services, with one
service reporting 4% of service users with a disability, another reporting 11% of
service users with a disability, and the third reporting 38% of service users with a
disability.
For adult alcohol services, the proportion of users self-reporting having a disability
differs between the two community-based treatment services, with one service
reporting 5% of service users with a disability, and the other service reporting 14% of
service users with a disability.
For young people’s substance misuse services, the proportion of young people
assessed by the service who self-reported having a disability was 15% for the first two
quarters of 2014/15.
Drug and alcohol treatment services for adults and young people are offered on the
basis of need and therefore whether a person has a disability or not plays no part in
determining eligibility for this service. Consequently, there is nothing to indicate that
changes to the overall service with have a disproportionate impact relating to
disability. However, one adult drug treatment service reports a noticeably higher
proportion of disabled service users compared with other types of services. This will
require further investigation.
Which action plans have these actions
been transferred to?
Risk register and associated action plan in order to mitigate against any
disproportionate impact on users of that particular service. Review EIA during the
redesign of alcohol and drugs service in order to assess the impact of the changes on
users with a disability.
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Manchester City Council
Executive
Does your analysis indicate a
disproportionate impact relating to
Gender (including gender
reassignment or pregnancy and
maternity)?
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
Appendix 3 - Item 5f
13 February 2015
Y
N
N
Information on new presentations to adult drug treatment services has been
collected from adult drug treatment services since July 2012. The latest profile of
service users that were in treatment in 2013/14 (at Quarter 4) shows that 73% of
users (2,042) were male and 27% (751) were female. Nationally, 74% of service users
were male.
For adult alcohol services, the latest full year profile of service users in treatment
(2013/14) shows that 63% were male and 37% were female.
For young people’s substance misuse services, the latest data (for 2013/14)
shows that 74% of service users in treatment were male and 26% were female.
Although the users of drug and alcohol treatment services for adults and young
people are predominantly male, the services themselves are offered on the basis of
need and therefore a person’s gender plays no part in determining eligibility for this
service. Consequently, there is nothing to indicate that changes to this service with
have a disproportionate impact relating to gender (including gender reassignment or
pregnancy and maternity).
One of the services under consideration within the alcohol and drug options is a
resettlement support service for female offenders in HMP Styal. If this service
stopped, then it would have an impact on women only. However, at present, there are
other services being provided to this client group on site at HMP Styal (‘Gateways’
and a service provided by Acorn) and these services could mitigate against any
negative impact.
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Manchester City Council
Executive
Which action plans have these actions
been transferred to?
Does your analysis indicate a
disproportionate impact relating to
age?
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
Appendix 3 - Item 5f
13 February 2015
N/A
Y
N
Y
Information on new presentations to adult drug treatment services has been
collected since July 2012. The latest profile of service users that were in treatment in
2013/14 (at Quarter 4) shows that the age of service users ranges from 18-65,
although the majority (66%) are aged between 35 and 49 years. Younger adults and
older adults make up a smaller proportion of the overall cohort of service users.
Nationally, the median age of service users at their first point of contact in their latest
treatment journey is 36 years old.
For alcohol services, the latest full year profile of service users in treatment (Quarter
4 of 2013/14) shows that the age of service users ranges from 18-84, within this the
largest age groupings are 30-39 (20% of all clients), 40-49 (34% of all clients) and 5059 (24% of all clients).
The young people’s substance misuse service works specifically with young
people under the age of 19, consequently data for that service shows that 100% of
users were aged under 19. As these services are specifically targeted for young
people, there is the potential for changes to this particular range of services to have a
disproportionate impact on this age group (i.e. children and young people aged 19 or
under).
Young people from some ‘vulnerable groups’ are also more likely to develop
substance misuse problems, including young offenders, truants and excludes, looked
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
after children and children of parents who misuse drugs/alcohol. Any impacts
stemming from changes to these services are therefore likely to be disproportionally
felt on these sub-categories of young people.
Which action plans have these actions
been transferred to?
Does your analysis indicate a
disproportionate impact relating to
sexual orientation?
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
Risk register and associated action plan. Review EIA during the redesign of alcohol
and drugs service in order to assess the impact of the changes on equality groups.
Y
N
N
Information on new presentations to adult drug treatment services has been
collected since July 2012. The latest profile of service users that were in treatment in
2013/14 (at Quarter 4) shows that the majority of users are recorded as being
heterosexual (based on activity information from providers).
For adult alcohol services, activity information from providers indicates that in
2013/14 approximately 5% of service users identify themselves as lesbian, gay,
bisexual or transgendered.
For young people’s substance misuse services, provider activity information
indicates that in the first 2 quarters of 2014/15, 9% of young people using the service
identified themselves as lesbian, gay, bisexual or transgendered.
A higher prevalence of some types of drug/alcohol use is reported in lesbian and gay
communities. However, drug and alcohol treatment services for adults and young
people are offered on the basis of need and therefore a person’s sexual orientation
plays no part in determining eligibility for this service. Consequently, there is nothing
to indicate that changes to this service with have a disproportionate impact relating to
sexual orientation.
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Manchester City Council
Executive
Which action plans have these actions
been transferred to?
Does your analysis indicate a
disproportionate impact relating to
religion and belief (including lack of
religion or belief)?
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
Appendix 3 - Item 5f
13 February 2015
N/A
Y
N
N
Information on religious belief is not recorded by NDTMS (the national drug treatment
monitoring system which is managed by PHE) and consequently there is no
information available on which to base an assessment of whether the budget options
will have a disproportionate impact relating to religion and belief (including lack of
religion or belief).
However, drug and alcohol treatment services for adults and young people are offered
on the basis of need and therefore a person’s religion or beliefs plays no part in
determining eligibility for this service. Consequently, the impact of changes to this
service will not be disproportionately felt on people with a particular religion or belief.
Which action plans have these actions
been transferred to?
Does your analysis indicate the
potential to cause discrimination in
relation to marriage and civil
partnership?
N/A
Y
N
N
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Manchester City Council
Executive
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
Appendix 3 - Item 5f
13 February 2015
Information on marriage/civil partnership is not recorded by NDTMS (the national drug
treatment monitoring system which is managed by PHE) and consequently there is no
information available on which to base an assessment of whether the budget options
have the potential to cause discrimination in relation to marriage and civil partnership.
However, drug and alcohol treatment services for adults and young people are offered
on the basis of need and therefore a person’s marital or civil partnership status plays
no part in determining eligibility for this service. Consequently, the impact of changes
to this service does not have the potential to cause discrimination in relation to
marriage and civil partnership.
Which action plans have these actions
been transferred to?
Does your analysis indicate a
disproportionate impact relating to
carers?
Please describe the nature of any
disproportionate impact/s
Please indicate what actions will be
taken to address these
N/A
Y
N
N
There is currently no information available on which to base an assessment of
whether the budget options have the potential to cause discrimination in relation to
carers. Drug and alcohol treatment services for adults and young people are offered
on the basis of need and whether person is a carer (or cared for) plays no part in
determining access to this service. Consequently, there is nothing to indicate that the
budget options will have disproportionate impact relating to carers.
However, there remains the potential for any changes to the way alcohol and drug
services are provided to have an impact not only on the users of these services but
also on the main care givers to adults with drug and alcohol problems. As part of the
detailed modelling of the new alcohol and drugs service we will investigate the
potential impact on carers in more detail (subject to the outcomes of the budget
consultation).
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Manchester City Council
Executive
Appendix 3 - Item 5f
13 February 2015
Which action plans have these actions
been transferred to?
4.
Review EIA during the redesign of alcohol and drugs service in order to assess the
impact of the changes on equality groups
EIA Action Plan
Service / Directorate lead: David Regan
Strategic Director: Mike Houghton-Evans
Business Improvement and Partnerships – Equality Team lead: Keiran Barnes
Actions identified from EIA
Target
completion
date
Responsible
Officer
EIA risk areas to be flagged up and
considered prior to any decommissioning decisions being
made.
End of
January 2015
Marie Earle/Lydia
Fleuty
On-going collection of equality
activity info and monitoring of this
On-going
Marie Earle/Lydia
Fleuty
Identify actions for service
improvement plans and
communicate these to providers.
Review EIA during the redesign of
alcohol and drugs service in order
to asses the impact of the changes
on equality groups
End of March
2015
Marie Earle/Lydia
Fleuty
January 2016
Marie Earle/Lydia
Fleuty
609
Is this action identified
in your Directorate
Business Plan and / or
Equality Action Plan?
(Yes / No / n/a)
No – business plan predates the budget
proposals
No – business plan predates the budget
proposals
No – business plan predates the budget
proposals
Comments
To include young
people and users of
the adult drug
treatment service
where 38% reported
having a disability in a
Risk Register.
N/A
To include in team
work plans.
Manchester City Council
Executive
5.
Appendix 3 - Item 5f
13 February 2015
Director level sign off
5th February 2015
Name:
David Regan
Date:
Directorate:
Children and Families
Signature:
610