Leeds has integrated its substance misuse services – and this is helping boost innovation. Support is being moved into GP centres, there is an enhanced family service and a new team to work with those with earlystage alcohol problems.
The challenge
Leeds has one of the largest treatment populations in England – second only to Birmingham among the core cities in terms of total numbers of people in drug and alcohol treatment.
At any one time there are around 3,500 active service users – 2,500 of which have alcohol issues.
A review of services was undertaken in 2014. At that point services were separate with different agencies providing support for drugs and alcohol, and children and young people.
The review recommended greater integration to create services that were more responsive to the needs of individuals.
The solution
A new service – Forward Leeds – was launched in July 2015 and is provided from three main integrated hubs where the full range of services can be accessed.
The service is run by a consortium of four voluntary sector organisations. It is led by Humankind (previously known as DISC) and also includes St Anne’s Community Services, Barca and Leeds and York Partnership NHS Foundation Trust. Council Adults and Health Directorate Commissioning Manager Ian Street said: “18 months of work went into developing the new service. We liaised closely with the providers and service users to work out what was best.
“Before, there was a degree of fragmentation. It was difficult when someone had a dual diagnosis – it wasn’t clear where they should be referred to. Was it the drug side or alcohol? We also wanted to improve the pathway when young people reached 18 years old and needed to be transferred to the adult services.
“The integration has allowed us to develop new approaches and build on what had started to be done in some cases.”
There are a number of examples of this, said Mr Street. A new focussed intervention team has been established, which can support people who do not necessarily need longerterm treatment as their drinking or drug use has not yet become dependent.
The consortium has also expanded the number of clinics being held in GP surgeries and created an enhanced service to work with families where both children and their parents/ carers can be supported.
Meanwhile, for those aged 18 to 24 years the service has made access easier by allowing meetings to take place in community settings, such as cafes, colleges and community centres.
Mr Street said: “This was already done for under 18s and the decision was taken to try it for young adults as there were quite high attrition rates between referral and entering treatment.
“Young people can be put off going into the clinics where they can find themselves with older people who have long-term problems. It is still early days, but the signs are encouraging.”
The impact
There have been significant improvements in completion rates for those entering treatment.
In 2016, 20 per cent of service users treated for alcohol misuse completed treatment, but that has now increased to more than 42 per cent.
The corresponding figure for those treated for both alcohol and drug misuse has gone up from 20 per cent to nearly 37 per cent. Meanwhile, the proportion of those who complete and do not re-enter treatment within six months has risen too. By the turn of the year more than 43 per cent of alcohol service users who completed treatment were not re-entering it, up from under 30 per cent since 2016.
The improvement has also been recognised by the Care Quality Commission, which carried out an inspection in spring 2019. It praised the “positive culture”, “passionate staff” and responsiveness of the service.
Those who have been helped by the new service are also full of praise. Sally attended a 14-week rehab programme for her heavy drinking. “My life was a mess. I was drinking morning, noon and night. “I couldn’t function without alcohol, my family were slowly becoming more distant towards me. I had a relationship break up and was spending less time with my son.”
She says she now has her life back. “I wake up every morning and I just embrace the day… rather than going to the bottle.”
Lessons learned
The new contract for the integrated service is much longer than previous services. Whereas drug and alcohol providers had tended to be given three year contracts previously, with options of an extra 12 months, the 2015 contract was for five years with an option of another three.
Mr. Street said: “We thought really hard about this. There are some people who say shorter contracts encourage innovation and keep providers on their toes, but we were not so sure about that. By giving the security of a longer contract you help providers invest in new ideas, recruit better staff and develop their services more.
“What is more, if you have short contracts providers are constantly worrying about retendering and the council is also having to invest time in that process. You can still build clauses into the contract to create flexibility. For example, we had to make savings to the contract because of the cuts to the public health budget.”
How is the approach being sustained?
The council conducted a review into the service, which was published in spring 2019. This was done to help the council decide whether to extend the five-year contract. The review concluded the service was “high quality, well performing and innovative”. The three-year extension was subsequently agreed. The move is allowing the service to further improve the way it works. For example, a pilot is about to start with a local hepatology consultant to identify those most at risk of advanced liver disease. Two portable fibroscanners are being purchased with a view to testing people using the Forward Leeds service or those attending GP centres. This will identify those with early stage liver disease, as well as those requiring alcohol treatment, triggering a referral into treatment. Possibilities of building on work with rough sleepers is also being looked into. Forward Leeds already has a member of staff who works with the city’s street outreach team and the council is looking into further funding to further develop the work in this area.
Contact details
Ian Street Adults and Health Directorate Commissioning Manager, Leeds City Council [email protected]