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7. Getting the framework right
Aims:
- To develop an appropriate structure to deliver alcohol action locally.
- To foster accountability for delivering results.
- To improve knowledge and information about alcohol problems.
- To develop training and support for those involved in implementation.
Key actions to date
- Actions identified and implemented by ADATs to address local priorities supported by a centrally funded National Alcohol Liaison Officer.
- National Alcohol Information Resource established to lead on the development, co-ordination and dissemination of information on the nature and extent of alcohol problems.
- High quality training on alcohol issues delivered to a wide range of practitioners by STRADA.
Monitoring of delivery
7.1 Delivery of the original plan has been monitored at national level by the Executive and at local level by ADATs. A planning framework is issued annually to ADATs which accounts for Executive and other resources and focuses action on local and national priorities. ADAT members are asked to sign off their plan to confirm their respective organisations are committed to playing their part in jointly agreed action. This is then reviewed by the Executive as part of ongoing accountability arrangements. Local plans show a considerable degree of variation in the level and range of current and planned activity reflecting different local needs, approaches and stages of development of action across the country.
7.2 Additional resources are helping to implement local priorities during 2005-07. We have made clear that ADATs and NHS Boards are expected to ensure that these resources are deployed for new and expanding alcohol activities which would not otherwise be funded, and not used to replace existing funding. The release of this funding is conditional on ADATs having agreed outcome expectations and systems in place to measure the number of people actively managed by alcohol support and treatment services, and the number of dedicated prevention services funded by ADAT partners. In addition to the normal NHS performance management arrangements, Boards, with other ADAT partners, will be held accountable for the use of this funding through annual ADAT accountability arrangements with the Executive, where the use of direct spend is required to be identified.
7.3 As has been highlighted under Chapter 6 - Provision of Services, our knowledge of local service provision has increased since the original plan was published as a direct consequence of Corporate Action Plans ( CAPs) being introduced. These are submitted annually to the Executive by Scotland's 21 ADATs. The requirements of CAPs are kept under review to ensure they continue to measure progress towards Ministerial priorities.
7.4 The Executive's Review of Drug Treatment and Rehabilitation Services: Summary and Action Plan recommended that the work and impact of ADATs should be reviewed to ensure best value. The terms of reference for this stock-taking exercise have been signed off by both Health and Justice Ministers; and a review team will be formed to take forward this work. This stock-take of ADATs will be based on the principles of best value, and will consider the partnership framework needed at a local level to deliver Ministerial priorities in relation to drugs and alcohol and, if appropriate, the practical measures and associated resource implications to develop ADATs.
7.5 Alcohol can be one of many factors affecting people's ability to sustain a tenancy or owner-occupied housing. Data currently collected on homelessness indicates that a significant proportion (13%) of homeless households assessed as having a priority need for housing were assessed as vulnerable due to alcohol or drug problems (operation of the Homeless Persons Legislation in Scotland: national and local authority analyses 2004/05, Nov 05). It is thought that this may be higher since the assessment records only the main reason for seeking homelessness assistance but substance misuse may also be a secondary contributing factor. Revised data collection arrangements will give a broader picture through asking whether any member of a homeless household has a support need due to alcohol or dry dependency. All local authorities have drawn up homelessness strategies which, together with NHS Boards' Health and Homelessness Action Plans, indicate how homeless people and people at risk of becoming homeless - because of problems with alcohol - will be supported and helped out of homelessness.
Targets
7.6 The original plan identified the headline target to reduce the percentage of men exceeding weekly sensible drinking levels from 33% in 1995 to 31% by 2005 and 29% by 2010 and the number of women exceeding such levels from 13% in 1995 to 12% by 2005 and 11% by 2010.
7.7 Whilst the Executive remains determined to reduce excessive drinking, the current measurement methodology is problematic. The latest available data from the Scottish Health Survey provides figures for 2003; and in general the gap between reporting periods hinders ongoing monitoring, particularly given that other more regular surveys have different methodologies and produce different and sometimes contradictory results.
7.8 A simple measure of excessive consumption is also problematic in that it does not give an insight into the ways in which cultures or the level of harm associated with alcohol may be changing in Scotland. This has been addressed in part by the Executive's sponsorship of a module on alcohol in the Scottish Social Attitudes Survey (as reported in chapter 3) and we will work with the National Alcohol Information Resource ( NAIR) to develop a range of indicators that allow for the progress made in changing alcohol cultures and reducing alcohol-related harm to be assessed.
Training and support
7.9 The evidence gathered as the basis for the original plan suggested gaps in both skills and support for staff in a range of disciplines including those in the voluntary sector that address alcohol problems. Progress in the statutory sector has been made in this area over the last 2 years. STRADA has revised and updated its training material in light of the plan to ensure the continuing alignment between training and policy objectives.
7.10 The Executive is providing an additional £500K during 2004-2007 to help STRADA increase the number of training places, expand the range of courses and ensure that training meets the needs of local areas. Medical colleges and a number of professional bodies have held events to raise the profile of training issues and the nurse education programmes of Glasgow Caledonian, Glasgow, Paisley and Napier Universities now have modules in substance misuse. The Royal College of General Practitioners Scotland has been funded by the Executive to train healthcare professionals in primary care, including GPs, pharmacists and others to deliver SIGN based brief interventions. Alcohol problems are addressed within the majority of midwifery education programmes and the Scottish Institute for Excellence in Social Work Education has input from STRADA to new social work degree courses. However, local alcohol plans show that gaps in skills and support remain and we believe that a more co-ordinated approach is now required.
Future priorities
7.11 Whilst considerable progress has been made since the publication of the original plan, more can be done to strengthen our capacity to deliver measurable outcomes. Scotland benefits from an extensive infrastructure of voluntary and statutory organisations determined to tackle alcohol problems. Our ability to deliver the actions and benefits in this updated plan will be enhanced by ensuring that:
- strategic and planning partnerships at all levels have the active support of all key stakeholders and are able to assess and reflect the specific needs of their communities;
- we set meaningful priorities which allow us to assess the progress made towards changing alcohol cultures and reducing alcohol-related harm in Scotland;
- local and national agencies and partnerships accept responsibility for the delivery of agreed outcomes and the contribution that these make to national priorities;
- relevant volunteers and staff in generic and specialist agencies (statutory and voluntary) have appropriate training in identifying, assessing and managing alcohol problems;
- training resources are provided on an equitable basis, recognising the value of voluntary and paid support to people with alcohol problems; and
- measurement systems are robust, fit for purpose and used to support the ongoing delivery of this plan.
Specific actions:
Structures
43. We are undertaking a stock-take of ADATs to assess their performance to date and capability to deliver Ministerial priorities on drugs and alcohol. This should establish a firm evidence base, using the principles of best value, to determine the future mechanism for effective local action to deliver national priorities. The stock-take will be completed by May 2007.
44. We will work with NHSHS and NHS Boards to further refine the operational and strategic relationship between ADATs and CHPs to continue to deliver improved joint services and health improvement activities aimed at reducing alcohol problems within local communities.
45. We will work with partners to ensure that NHS Board delivery plans reflect the links between alcohol problems and homelessness and monitor the implementation of Health and Homelessness Standards.
Information and evaluation
46. We will work with partners to develop a national accountability framework for alcohol services in Scotland.
47. Through the National Alcohol Information Resource at ISD we will:
- issue a range of quality assured statistics including local alcohol profiles and national alcohol statistics;
- provide access to and dissemination of information on alcohol through the National Alcohol Information website www.alcoholinformation.isdscotland.org; and
- provide an enhanced estimation of the burden of alcohol-related health problems in Scotland (spring 2007).
48. We will develop a range of indicators to help assess the progress made in changing alcohol cultures and tackling alcohol problems in Scotland. This may include data on service capacity, alcohol-related deaths, alcohol-related liver disease, links to homelessness, drink driving, attitudes to alcohol fines and alcohol-related violence and antisocial behaviour. Once established, we will then set improvement targets for ourselves and key partners. We will also develop specific evaluation arrangements in relation to the delivery of services.
49. We will publish an alcohol research programme in early 2007 to build upon the work undertaken by NHSHS to review gaps in research knowledge and evaluation practice. In tandem, we will consider how best practice from home and abroad might inform future policy and delivery of services.
Training
50. We will work with the Scottish Intercollegiate Group on Alcohol ( SIGA), NHSNES, the Scottish Association of Alcohol and Drug Action Teams ( SAADAT), AES, AFS, SDF, medical and nursing schools and colleges, the Scottish Institute for Excellence in Social Work Education, NHSHS and other relevant bodies and professional groups to develop a co-ordinated national drugs and alcohol workforce development strategy by late 2008. The strategy will cover the current training and education action points from the plan and consider the implications of wider initiatives and work including the development of single shared assessment, Joint Future, and the publication of the HTA and SIGN guideline, Mind the Gaps, A Fuller Life, Hidden Harm - Next Steps and Getting Our Priorities Right. Plans for implementation will be developed by spring 2009.
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