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Chapter 11: Good practice in the commissioning and delivery of needle exchange
Headlines from this chapter
Participants in this study highlighted a number of examples of good or innovative practice including:
- Expanding the range of needle exchanges
- Use of outreach services
- Good joint working between needle exchanges and other local services
- Use of pharmacy consultation rooms for harm reduction clinics
- Getting service users involved in the development and delivery of services
- Developing good rapport and trust with service users
- Providing on-going training and support to pharmacy exchange providers.
As part of this study, DATs, pharmacy and non-pharmacy services were asked to give examples of good or innovative practice in their areas. This chapter summarises this data - both the written responses from the survey, and the themes that arose in the focus group discussions.
Expanding the range of needle exchange services
Some respondents talked about their efforts to expand the number and range of needle exchange services in their area. The expansion of pharmacy services and the use of hospitals and police custody suites for needle exchange were cited as examples of this. The use of needs assessment and service review was also considered by both DATs and service providers to be good practice in the planning of needle exchange services.
Use of outreach services
The use of outreach services was considered to be an important way of improving the accessibility of needle exchange in remote and rural areas. However, outreach services were seen to have other advantages over fixed site services, in terms of:
- a higher rate of returned used needles / syringes
- the fact that outreach services don't require planning permission,
- the greater range of interventions (compared to pharmacies) which can be delivered by a specialist harm reduction worker or nurse.
These services were also seen to be more successful in reaching women injectors and certain high-risk, groups - for example, sex industry workers and homeless people. See Box 11.1. One rural respondent reported that plans were underway to develop a mobile exchange service to people with dual diagnosis.
For these reasons, DATs felt that outreach was the most cost-effective way of providing a specialist harm reduction service in rural areas and among hard-to-reach groups.
Box 11.1: Example of good practice in reaching out to sex industry workers
Drugs Action in Aberdeen and Scot- PEP in Edinburgh both provide outreach needle exchange services to women working in the sex industry - in the evening in places where the women are working.
Joint working
Good joint working was seen to be an example of good practice in many areas. Several respondents cited good partnership working between drug treatment services and needle exchange services, and between needle exchange services and sexual health, BBV screening and hepatology services. Other respondents mentioned positive collaborations between voluntary and statutory sector agencies, and between specialist harm reduction staff and pharmacy needle exchange providers.
Box 11.2: Examples of good practice in joint working
One voluntary sector outreach service in central Scotland had agreed with the local Children & Families Social Work Department to visit local injectors in their homes at least fortnightly where there were concerns about child protection. Clients of the service were aware of the agreement.
One Glasgow needle exchange service provided their clients with a range of related services from a single point of contact. These included: a well-woman clinic, a health clinic for homeless people, and access to legal advice from solicitors paid for by the Legal Aid Board.
One NHS needle exchange service used the premises of a Women's Aid service to distribute injecting equipment to female injectors.
Use of pharmacy consultation rooms
A number of areas made use of pharmacy consultation rooms, not only, in some cases, to provide the needle exchange service itself, but also to provide Hepatitis B vaccinations, wound management clinics and advice and information about safer injecting techniques from a specialist harm reduction nurse.
Service user involvement
Two service providers specifically mentioned that they had sought formal input from service users in the development of services. One service in Aberdeen had developed a successful service users' group. A DAT respondent from Lothian reported that a service in her area had employed a former injecting drug user to do sessions in the mobile needle exchange bus. This respondent said:
This is proving to be very effective, as existing users can see how he has managed to put his drug use behind him and secure a job. ( DAT survey respondent)
Developing rapport and trust with service users
Many service providers felt that "good practice" in delivering needle exchange had to go beyond simply giving out sterile equipment and taking in used equipment. Developing rapport and trust with clients was also necessary. One service provider said that because she ran her local exchange facility single-handed, her clients had come to know and trust her and, as a result, talked to her about a range of issues in their lives, including financial matters, legal matters, and relationship problems. Another said that whenever clients requested a certain type of needle, this triggered a discussion about injecting sites and information about the local nurse-led wound clinic.
Training and staff development
The issue of training for staff who deliver needle exchange services - particularly pharmacy staff - was also cited as an example of good practice in some areas. Good practice involved in-depth initial training for needle exchange providers, and regular on-going support and supervision - preferably offered within the pharmacy.
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