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Chapter 1: Background to CATs
Over the last decade, the focus of addiction service provision in Scotland has gradually shifted towards an integrated model of care. The introduction of Community Addiction Teams ( CATs) in Glasgow in December 2003 formed part of this new approach to delivering better services.
This chapter summarises the national strategies, local developments and issues influencing the development of CATs. It illustrates the degree of environmental and organisational complexity that underpinned the launch of the first two CATs in the east and north-east of the city.
National strategy, policies and reports
The concept of CATs emerged as a result of strategic initiatives and reports at both national and local level in relation to drug and alcohol addiction services in Scotland and the UK.
The recurring theme from these initiatives was the recommendation for the need for health, social care and voluntary agencies to work more closely together and to rethink how addiction services could be jointly resourced, organised and delivered.
Local developments for integrated services in Glasgow
Since 2001, three major reviews of addiction services provision in Glasgow have been conducted.
- Glasgow City Council Addiction Services Review (2001)
- Joint Review of the Methadone Programme (2001)
- Joint Purchased Services Review (2002)
The findings of these reviews reinforced the need for the development of an integrated model of care for addiction, as well as increasing awareness of the Joint Futures agenda and the long term implications of this on strategic planning for both Greater Glasgow NHS and Glasgow City Council.
Other local developments, guided by national strategies for health and social care services, included:
- Greater Glasgow DAT Strategy (1999-2003)
- Greater Glasgow AAT Strategy (2000-2003)
- Greater Glasgow NHS Modernising Mental Health Strategy (2000)
- Glasgow Joint Community Care Plan (2001-2004)
- Greater Glasgow NHS Local Health Plan (2002-2005)
- Glasgow City Council Criminal Justice Plan (2002-2005)
- Glasgow City Children's Services Plan (2002-2004)
- Glasgow City Homelessness Partnership Strategy (2003)
Local issues in Glasgow influencing the development of CATs
Many 'ongoing issues' occurred in parallel with the implementation of CATs. These issues were not always directly linked into the integrated addiction service strategy but potentially determined how CATs would operate within Glasgow.
These issues included hostel closures in Glasgow during 2003-04, the introduction of an Arrest & Referral Scheme in 2004 in the East End of Glasgow, and the introduction of a Single Shared Assessment for addictions.
Key local developments, described below, help to provide some context for the implementation of CATs in Glasgow:
1. General Medical Services Contract (' GP Contract'): In 2003, the British Medical Association agreed a new GP contract with the UK government. This covered methadone prescribing, categorised as an 'enhanced service'.
2. Tier 4 Consultation Process: A consultation process, started in 2003, proposed a reorganisation of existing Tier 4 specialist services ( i.e. hospital-based services) in order to prevent duplication of service provision and to avoid confusion over referral pathways, taking the introduction of CATs into account.
3. Development of Community Health Partnerships ( CHPs):CATs would need to be represented and included within the full CHP implementation, planned for April 2005.
4. Glasgow City Council Social Work Services Staffing Review: During 2003, GCC Social Work Services proposed changes to enable the council to recruit and retain fieldwork staff following a 6-month staff grading review. This created a range of new posts and placed an increased emphasis on learning and development.
Stakeholders
Stakeholders, who were most likely to depend on CATs, and on whom CATs would depend, spanned a wide range of health, social work and voluntary sector services. They included agencies such as Adult Community Care Teams, Children & Families, Criminal Justice, Community Mental Health Teams, GP Shared Care Scheme, Homelessness Addictions Teams, Housing Agencies, Secondary Services (Health) and Women's Reproductive Health Services. Glasgow-based stakeholders included Glasgow Council for Alcohol, Glasgow Drug Crisis Centre, Glasgow Drug Court and Greater Easterhouse Alcohol Project.
Feedback from a consultation exercise in 2002-2003 suggested that implementing a joint approach to the management of both drug and alcohol addictions presented a significant challenge. CATs would find it difficult to meet all stakeholder groups' expectations in an equitable manner.
The Glasgow Addictions Services Strategy
During 2001-2002, Greater Glasgow NHS Board and GCC Social Work Services began to discuss partnership arrangements for addiction services in Glasgow in line with the recommendations of the Joint Futures Strategy.
Drug and alcohol addictions would no longer be managed separately, and new organisational structures were needed to manage and deliver integrated addiction services.
The development of a template for CATs resulted in CAT Service Specification for East & North East CATs in August 2002. This highlighted a number of strategic dilemmas, including:
- The presence of competing models of care i.e.'the medical model' of health staff versus ' the social model' of social care and voluntary staff.
- The need to balance the inter-linking of CATs with health, social care and voluntary services and recognition of a wide range of individual and group interests from staff and stakeholders.
- The challenge of developing the integrated model of care within the context of an ever-changing health and social care environment, where planning and implementation timescales are affected by external changes and events, such as the introduction of CHPs.
- Acknowledgement that not all staff and stakeholders may embrace the integrated model of care.
- The challenges of the new approach to managing drug and alcohol addictions within one ' whole system of care'.
Conclusion
A wide range of national and local strategic drivers underpinned the introduction of CATs in Glasgow in 2003. All of these stressed the need for an integrated model of care for addictions and improvements in the delivery of this care.
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