Agenda item

ES 18023

The report dealing with adults who misuse drugs was written by Helen Buttivant, LBB Consultant in Public Health.

The report had been drafted to provide the Committee with the findings of a health needs assessment concerning the population of adults in Bromley that had issues with problematic drug use.

No decision was required by the Committee or the Portfolio Holder—the report had been submitted to the Committee for information only. The report was part of the JSNA (Joint Strategic Needs Assessment). 

The Committee was informed that Bromley had the 7^th lowest estimated rate of opiate and or crack use in the region. However much of the other data revealed in the report gave the Committee cause for concern.

·  The estimated consumption rate for opiate and/or crack use in young people in Bromley (aged 15-24) was higher than the national average

·  Opiate and or crack misuse was also rising in the older population

·  The rate of hospital admissions for substance misuse in young people in Bromley was significantly higher than the national average

·  In 2016/17 there were 100 children living in the Borough who were known to be living with people known to be misusing drugs

It was noted that hospital admission rates for substance misuse in Bromley correlated positively with levels of socioeconomic deprivation. Another cause for concern was that although the illicit use of drugs was increasing, the number of people entering treatment was decreasing. The Committee was also concerned to learn that the estimated level of unmet need in Bromley was much higher than the national average and that 63% of drug users in Bromley were not known to treatment services. A further cause for concern was that Bromley had a higher proportion (37%) of new clients presenting with a co-occurring mental health condition—the average for the rest of England was 24%. 

The Committee noted that people also presented to drug treatment services with problems related to prescription drugs, and over the counter medication. The lowest proportion of successful treatment for drug misuse was in connection with opiate abuse.

The Committee was appraised that the estimated socio-economic costs for drug misuse in England was estimated at £10.7 billion. The Committee heard that drug misuse was a cause and consequence of wider factors which included physical and mental health as well as other determinants.

The report noted that the proportion of people in treatment with entrenched dependence and complex needs, particularly heroin users, would increase. It was also expected that the number of deaths of older heroin users was also going to rise.

Ms Buttivant explained to Members that the report that was being presented to them would be analysed. Out of this, recommendations would be provided to inform the planned procurement of substance misuse services for adults, children and young people in Bromley in 2018.

The Committee heard that unemployment and housing problems had a marked negative effect on treatment outcomes, and that these factors would exacerbate the risk that someone would relapse after treatment. It was the case that wider issues of health inequality and social exclusion were fundamental to improving treatment outcomes.

The Chairman asked why there had been a growing number of young people affected by substance misuse. Ms Buttivant responded that the issue was complex and would require unpicking. It had to be established how much of the reported increases were increases in real terms or data anomalies. Dr Lemic felt that it was likely to be the case that more young people were entering treatment services. 

Dr Lemic briefed the Committee that a new tendering process had just been initiated to procure a substance misuse service for adults, children and young people in Bromley for 2018. The new service would need to work closer with schools as well as meeting the needs of an older group of people with more complex needs.

The Chairman was concerned that the top priority of treatment services was harm reduction and not abstinence. Dr Lemic explained that achieving total abstinence was difficult, and so it was important that individuals were engaged in a harm reduction programme where they could be managed and receive treatment. 

A Member asked if the service specification of the new contract was robust enough and Dr Lemic stated that it was. There would be a greater emphasis on joint working and on developing a holistic approach to treatment services. There was a need to ensure proper integration into the community. The provision of social care and housing would be built into the contract. Dr Lemic felt that it was important that clients were not put back into hostels to live with people with similar problems. There was a need to avoid detrimental housing environments.

A Member asked Dr Lemic if the new contract would have KPIs and the response was affirmative. 

A Member queried what the Police were doing to stop the supply of drugs to young people. Dr Lemic responded that the drug mis-use service had limited contact with the Police as this could deter individuals from accessing treatment.

A Member questioned if there was a lack of service provision and if the current provider was going to re-tender. Dr Lemic said that there was not a lack of service provision and it was the case that the current provider would be re-tendering.

A Member wanted to know why there had been an increase in substance mis-use in the Darwin Ward. Dr Lemic replied that this could be because if there was a small cohort of people using drugs previously, then a small rise in numbers would result in a high percentage increase.

The Chairman thanked Ms Buttivant and Dr Lemic for providing such a thorough report and for attending to respond to questions.

RESOLVED that the findings of the Health Needs Assessment in Bromley be noted.