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3 THE ESSENTIAL COMPONENTS

3.1 Introduction

3.1.1 The essential components are the factors that need to be present to enable the ADAT to operate effectively. We have identified these as:

• National Framework and Policies
• Leadership
• Partnership
• Capacity Building

3.2 National Framework and Policies

3.2.1 Tackling Drugs in Scotland: Action in Partnership (1999) and The Plan for Action on Alcohol Problems (2002) are the key national policy documents which have guided the activities of ADATs. The more recent Plan for Action on Alcohol Problems: Update (2007) was published towards the end of the Stocktake exercise, so the policy context in which ADATs were operating for the purposes of this report was within the original 2002 Plan.

3.2.2 This section focuses on the national framework and policies which provide the underpinning guidance for ADATs and identifies some of the ways in which the ADATs role could be clarified and strengthened to ensure that they have the capacity to deliver on these plans. These are considered under the following headings:

• The role and remit of ADATs
• The role of the Scottish Executive
• Corporate Action Plans
• National guidance and research
• National groups

The role and remit of ADATs

3.2.3 ADATs have a wide ranging focus - on a continuum from education and prevention to rehabilitation, taking into account enforcement issues, treatment, throughcare services, employment issues, health education and a number of interventions aimed at reducing drug and alcohol misuse. They are responsible for ensuring the provision of information and services to a diverse client group from those whose use of alcohol or other drugs does not, at least at present, affect their lives adversely to those whose lives are dominated by their addiction.

3.2.4 The overwhelming majority of ADATs felt that the partnership and its activities should reflect this wide range of issues and services. However, many ADATs felt that at a national level there was a primary focus on treatment and that the prevention and health education aspects of their services were not viewed as having the same importance. This ranking of importance tended to be reflected at local level.

3.2.5 Almost all ADATs felt that there was an imbalance of focus and funding between drugs and alcohol services - with drugs having a higher national profile, priority and budget. However, in the main, outwith the major cities, while there was concern about levels of drug misuse, the majority of ADATs felt that alcohol issues were more of a concern within their areas and that the levels of centrally allocated resource for alcohol related activity were disproportionately small compared with that allocated to drugs activity.

3.2.6 In recent years there has been a number of policies, strategic developments and reports which have impacted on ADATs. These include issues around criminal justice, health and homelessness, community regeneration, children's services, community safety and mental health and addictions, drug related deaths and quality standards.

3.2.7 Child protection in particular has become a significant additional responsibility as part of the wide ranging response to the Hidden Harm report on children in substance misusing households. Children in substance misusing households have been the subject of new national policies and direction over the last 4 years. This had increased the attention of all the key partners in ADATs on the vulnerability of children and the range of actions and initiatives needed to improve the way in which they can be supported and protected. This area of work had been a significant priority for ADATs and most ADATs were able to demonstrate good links with Child Protection Committees.

3.2.8 The development of policies and approaches in relation to Drug Treatment and Testing Orders ( DTTOs) and Arrest Referral and the establishment of Community Justice Authorities appeared to have taken place without any reference to the role and potential contribution of ADATs. This had resulted in poor continuity at a local level so that people coming off a DTTO regime may have to wait to get back into mainstream treatment services. There was also some anecdotal evidence of people committing crime to get a DTTO and thereby fast track themselves into treatment.

3.2.9 Many ADATs expressed frustration with the lack of engagement between ADATs and Scottish Executive when national priorities and policies are determined. They felt that local needs and priorities should inform national priorities. Many ADAT members would welcome the opportunity to contribute their knowledge and experience to the development of national policies. They wanted a policy framework which set a clear lead in terms of robust national objectives but allowed the flexibility to address local needs.

3.2.10 It is our view that the development of national policies and priorities could be enhanced by drawing more actively on the valuable knowledge and experience that exists among ADAT members. This would enable ADATs to contribute their experience about what works at a local level and their views about where national policies could be developed. The Chairs of ADATs should be well qualified to support Ministers in this way and we propose that there should be regular dialogue, perhaps yearly or twice yearly, between Ministers and the ADAT Chairs collectively to assist Ministers in steering national policy. This might take the form of a National Steering Group. Discussion at such meetings would be informed by the advice of experts on the national advisory committees (see paragraph 3.2.33).

Recommendation 1: There should be a regular meeting between ADAT Chairs and the relevant Minister(s) to discuss and develop national policies on drug and alcohol misuse. This might take the form of a National Steering Group chaired by the Minister(s).

3.2.11 Almost all of those interviewed had a good understanding of the main role of the ADAT (in relation to the role envisaged when DATs were first established in 1995). However few ADATs had had any partnership discussion on clarifying and updating this understanding ( e.g. when new members or partners attend) which had led to partnerships not always having a shared, common understanding of their role and responsibility in relation to drugs and alcohol services. The majority of ADATs felt that it was important to revisit and clarify their role and core areas of responsibility - both at a national and local level and were keen to work with the Scottish Executive to develop this updated remit.

3.2.12 We have given considerable thought to whether ADATs should be responsible for the full spectrum of drug and alcohol misuse interventions from education and prevention through to treatment and rehabilitation. We have also looked at the perceived distinctions between people who are "problematic" substance misusers and those, for example, who by regularly drinking alcohol in excess of the recommended limits, are putting at risk their long term health. We concluded firmly that ADATs should retain their existing wide ranging remit because: the core education and prevention messages are broadly the same irrespective of the nature or extent of the substance misuse; for most purposes, it makes no sense to deal with alcohol separately from drug misuse, especially when there appear to be growing numbers who misuse both; and, some people will move from level of misuse to another. For example, binge drinkers or those who regularly drink in excess of recommended limits or "recreational" drug users may develop an addiction over time (or may live with someone who has an addiction). Accordingly, we take the view that ADAT partnerships should reflect the wide range of organisations that have an input into drug and alcohol related services.

3.2.13 That is not to assert that ADATs should give the same weight of attention to all aspects of substance misuse. For example, healthy living or lifestyle campaigns aimed at excessive alcohol consumption are most appropriately conducted at a national level, with ADAT support and reinforcement locally. And the respective partner organisations will have their own particular areas of expertise and specialism e.g. treatment services, enforcement issues, licensing, etc and these will continue to be developed by the individual organisations but inside the broad framework of the ADAT. Partnership working can not only ensure that these activities are more complementary and co-ordinated but can also add value through working together. ADATs should ensure that their activities are not simply a collection of partner services and plans 'bolted together' - but a complementary set of shared aims and targets which reflect local circumstances and priorities. Given the growing complexity of partnerships and the issues which impact on ADATs, an important aspect of an ADAT's work is to focus its energies on priorities that need the added value of a partnership approach.

Recommendation 2: The Scottish Executive should review the responsibilities of ADATs in consultation with them and set this out in a single guidance framework which should identify the respective national and local responsibilities and those which will benefit most from the strength of a local partnership approach. The framework should be kept under review and take into account changes in policies, strategies and partnerships.

The role of the Scottish Executive

3.2.14 It is widely recognised within ADATs that the Scottish Executive has a key role to play in leading the development of effective policies, facilitating effective partnership working and providing central support and guidance to assist partners to deliver national priorities at a local level.

3.2.15 We heard a widely expressed view that national policies, especially in relation to drugs, placed too much emphasis on treatment and too little on education and prevention. The balance between alcohol and drugs was mentioned frequently and ADATs welcomed the increasing emphasis at a national level on tackling alcohol misuse which in most areas was seen as a far greater problem than drug misuse. They saw a role for the Scottish Executive in influencing the major producers and suppliers of alcohol to reduce availability and increase price.

3.2.16 Generally the majority of ADATs felt that they had a good relationship with Scottish Executive officials. Comments mostly frequently cited were good communication, information provision and contact maintained regularly. However some commonly raised concerns included: lack of communication between and within Executive departments; frequent changes of staff making it difficult to achieve consistent relationships; information requests that are often made at short notice; and asking for information that is not easily obtainable at a local level or has already been requested by another part of the Executive. There were concerns also that the expectations about what ADATs could do or influence was unrealistic. They could not, for example, force GPs to provide treatment services, although they can and do encourage GPs to do so.

3.2.17 Most ADATs commented on the transfer of drugs policy into the Justice Department and its separation from alcohol policy. They found this unhelpful and out of step with action at local level and the increase they perceived in dual or poly substance misuse. It was clear that ADATs thought that the separation of Departmental responsibility for drugs and alcohol signalled a significant shift in drugs policy from being a health to a criminal issue, even although the Ministerial responsibilities remained unaltered.

3.2.18 There is undoubtedly a high level of frustration at perceived duplication of effort which ADATs feel diverts them from other activities. While ADATs were generally very happy with the contacts they had with individual officials, they perceived the organisation was not operating in the joined up way it expected of others. This led to cynicism about the Executive's commitment to tackling substance misuse which we believe could be addressed by a visible demonstration of a commitment to a more integrated approach.

Recommendation 3: The Scottish Executive should have an integrated team to lead on drug and alcohol misuse issues.

3.2.19 Overall the majority of ADATs felt that the processes of administration they had to adhere to and the level of guidance and support received did not meet their needs or expectations. A key example of this is the development, monitoring and feedback for the Corporate Action Plans.

Corporate Action Plans

3.2.20 ADATs are required to produce an annual Corporate Action Plan ( CAP) which reports on progress towards the national targets. The Plan sets out the ADAT membership and support funding, performance contract requirements, allocation of resources and provision of services, support and treatment information, ADAT progress in relation to the national targets and accounts for the ring-fenced resources expended on drug and alcohol prevention, treatment and support services. There is also a requirement to indicate in the CAP key planned actions for the forthcoming year. ADATs regard this document as the key accountability framework required by the Scottish Executive.

3.2.21 Despite this, few ADATs felt that the CAP was helpful and a number of ADATs had developed their own local delivery plans in parallel with the CAP. In the main, completion of the CAP was cited as a cumbersome exercise and it was not considered to be an accessible document. Few ADATs felt that the CAP helped them to take forward the business of the partnership and delivery in any robust way. Nonetheless, many ADATs seemed to rely on the CAP rather than a local strategy to direct their priorities. Six ADATs had no long term alcohol or drugs strategy and of the remainder, only eight had current specific strategies in place.

3.2.22 Overall ADATs are keen to progress national targets and priorities but with some degree of flexibility to take account of local circumstances, geography, social trends and issues. The process of annual action planning should provide a working framework for ADATs. The current CAP process should be reviewed and replaced with a more meaningful Annual Delivery Plan, which reflects negotiated local priorities and targets agreed between the ADAT and the Scottish Executive and will be useful as both a local planning and monitoring tool and a reporting mechanism for the Scottish Executive.

Recommendation 4: The Scottish Executive, in consultation with ADATs, should replace the Corporate Action Plan ( CAP) with an Annual Delivery Plan which meets local and national requirements.

National guidance and research

3.2.23 Access to central research and guidance was an area that ADATs felt was important, as was information on successful interventions and areas of good practice which they could replicate. Statistics and data provided via the Information Services Division ( ISD) of NHS Scotland to ADATs were regarded as being extremely useful. The dissemination and analysis of statistics and good practice on a national and international basis was deemed to be an important central role which could be strengthened.

3.2.24 The majority of ADATs reported that the Scottish Executive Effective Interventions Unit ( EIU) had fulfilled an important role in providing guidance and information about effective practice, evaluation and research and that its demise has left a gap in their knowledge. As a consequence, many ADATs expressed a strong desire for a central guidance and research function which would keep them informed of national and international findings, good practice and evidence of what works well.

3.2.25 Despite some ADATs having research and development staff, who do useful work in this area, we believe that they do need central support to ensure that research activity including national research analysis and information is co-ordinated and efficiently disseminated. It would be helpful if research information was brought together with statistical analysis, guidance and good practice advice into a National Support Unit. This Unit would bring together and build on existing resources and information currently produced by ISD and Analytical Services in Justice and Health Directorates of the Scottish Executive.

Recommendation 5: There should be at national level a support unit providing guidance, statistics and analysis, research findings and information. This National Support Unit would bring together and build on the existing resource provided by ISD and Analytical Services in the relevant Justice and Health Directorates of the Scottish Executive.

National Groups

SAADAT

3.2.26 The Scottish Association of Alcohol and Drug Action Teams ( SAADAT) is responsible for assisting ADATs, improving communication across ADATs and with other key organisations, sharing information and good practice and representing ADATs at a national level. SAADAT also directs the work of the National Drug Liaison Officer and the National Alcohol Liaison Officer. The Association receives almost all of its funding from the Scottish Executive.

3.2.27 Many of those interviewed commented on the role of SAADAT. The most frequent comments were: SAADAT meetings are too big to be useful and that it is trying to do too much being a forum for Chairs and practitioners, raising awareness of policy issues and practices and highlighting effective practices. A number of Chairs felt that attendance at SAADAT meetings was more appropriate for co-ordinators. There was a widely held view that SAADAT was trying to do too much for too many different participants and lacked focus.

3.2.28 Evidence and examples of good practice were identified throughout Scotland (as illustrated within this report). Sharing of good practice was an area which ADATs felt was important. There were a few examples where approaches, campaigns and activities were being shared. For example, the Pink Handbag campaign aimed at young women drinkers, and the Think Before You Drink board game were being shared across the country. Most ADATs see the need for a national ADAT Network which will allow them to share experiences and practice. Suggestions from a few of the ADATs included a more focused role for SAADAT to ensure shared experience and alignment of activities across Scotland. In the light of this we believe SAADAT should review its role and, in consultation with the Scottish Executive, consider how it can dovetail with the National Support Unit.

Recommendation 6: SAADAT should review and refocus its role to ensure it meets the needs of ADATs and it should explore ways to work co-operatively with and complement the work of the National Support Unit.

SMACAP and SACDM

3.2.29 The Scottish Ministerial Advisory Committee on Alcohol Problems ( SMACAP) and Scottish Advisory Committee on Drug Misuse ( SACDM) are the national expert groups which bring together representatives from a wide range of national organisations who have considerable knowledge and experience in their particular areas of expertise. However, a number of key interests are not represented. For example, despite the importance placed on the role of education in prevention, there is no education representative on either Committee and there is no social work representation on SMACAP although a representative has recently been added to SACDM.

3.2.30 These Committees have met sporadically in the last few years and direct Ministerial involvement has varied, especially in relation to SACDM. The perception this creates, however unintentional, is that substance misuse has declined in importance as a Ministerial priority.

3.2.31 The majority of the ADATs thought that the joining up of alcohol and drug teams at a local level was highly appropriate - the social causes and impact of these two issues having considerable overlap as well as the growing incidence of poly substance misuse. Many of the ADATs felt that this joined up approach should be reflected throughout local, national and central structures and felt that merging of the two national expert groups would be advantageous in developing national policies in relation to substance misuse. We believe this would be a sensible approach which would aid more integrated development of policy in relation to substance misuse and would be a more efficient use of resources.

3.2.32 With regard to the membership of the advisory committees, we take the view that all of the key interests that should be represented on ADATs should also be reflected at national level. The membership of both SMACAP and SACDM should be reviewed to include the Association of Directors of Social Work ( ADSW), the Association of Directors of Education ( ADES), the Association of Chief Police Officers ( ACPOS) and, possibly, the Society of Local Authority Chief Executives ( SOLACE).

3.2.33 We have also considered the role of the expert committee(s) in light of our earlier recommendation (Recommendation 1 refers) that there should be greater involvement by ADAT Chairs in advising Ministers in relation to national policy and priorities through the formation of a National Steering Group. There is undoubtedly a need for expert advice and information and we are in no doubt that their role should continue. But rather than advising the Minister(s) alone the advisory committee(s) would advise the National Steering Group.

Recommendation 7: The membership of both national expert committees, SMACAP and SACDM, should be reviewed and extended to include the same range of representation expected at local level. These Committees should be responsible for offering expert advice to the National Steering Group, chaired by the Minister(s). Consideration should also be given to merging the two expert committees to provide an integrated approach in a single substance misuse advisory committee.

3.3 Leadership

ADAT Chairs

3.3.1 The leadership of an ADAT is critical to its success and this was one of the most frequently cited characteristics in relation to identifying success criteria for ADATs. Chairs and support staff have a pivotal role to play in this success. This is clearly underlined by the evidence gathered which demonstrates that the most effective ADATs were those that benefited from strong, focused leadership.

3.3.2 The Chairs of ADATs across Scotland come from various organisations - but mostly health and local authority. The role of the Chair is an important one - but it is an additional role, and the time and commitment given to this varies throughout ADATs. The Chair needs to be able to take on this leadership role and champion the development and integration of drugs and alcohol services within the area. The Chair has to be well supported by the ADAT staff team to enable him/her to do this. The key issues here are that the ADAT Chair must be a very senior or chief officer; have the skills and competencies to lead, develop and give strategic direction to the ADAT; and be able to command the respect of his/her peers.

3.3.3 We gave consideration to how ADAT Chairs should be chosen and appointed. In this context we looked at whether it would be sensible and bring improvements if Chairs were appointed by Ministers following an open advertising and public appointments process. We concluded however that while that approach might resolve the capacity issues, it could give rise to conflicts of accountability between the appointed Chair of an ADAT and the chief officers of partner organisations. Furthermore, we concluded that partnership working would be more likely to be enhanced if the ADAT partners agreed among themselves which of them should provide the Chair of the ADAT, perhaps on a rotational basis.

3.3.4 We also considered the accountability of ADATs in relation to the delivery of national and local targets. This is considered in more detail in paragraphs 3.4.18-21. However, the role of the Chair and his/her direct relationship to the relevant Minister is crucial. This has eroded over recent years. We believe that there should be an annual accountability meeting between the Minister and each ADAT Chair which would provide an opportunity to discuss the national and local priorities and the achievement of targets.

Recommendation 8: The choice of Chair should be made by members of the ADAT partnership. The ADAT Chair must have the relevant skills to be able to lead the partnership.

Recommendation 9: ADATs should be directly accountable to the Minister(s) through an annual accountability meeting between the Minister(s) and the ADAT Chair.

ADAT Support Staff

3.3.5 Support staff across the ADATs are employed by a number of host organisations - but the majority are employed by the NHS or local authority. The roles, remit, conditions of service, salaries and levels of expertise vary enormously. Most support teams are led by a co-ordinator. While most of the co-ordinators work closely with the Chairs, few are line managed by the Chair. The majority are managed by their respective host organisations or have dual accountability arrangements. This could, on occasions, lead to difficulties with line management and appraisal responsibilities which could be resolved if the role of the employing authority was confined to "pay and rations".

3.3.6 A few ADAT staff had dual responsibilities - both for ADAT development and for other duties determined by the employing or sponsoring organisation. The majority of staff interviewed regarded themselves as being ADAT staff - responsible to the partnership rather than the organisation which employed them. This was confirmed by the majority of staff having work plans which reflected the aims and objectives of the ADAT and the Corporate Action Plans.

3.3.7 There was a great deal of expertise and skills within the support staff team - and some extremely capable co-ordinators who were fulfilling leadership roles. However there was wide variation in skill levels and areas of responsibility from management to administrative grades and salaries.

3.3.8 The staff team needs to have the right capacity and capability to provide effective support to the Chair who will almost always be a senior manager with other significant demands on his or her time. In particular the role of the Co-ordinator is crucial and that individual has to have the skills to act on behalf of the Chair to drive forward the work of the ADAT. There is a need to review the roles and responsibilities of ADAT support staff, ensuring that they are consistent and that there is a national competency framework in place, which ensures that the right people with the right skills are in post.

3.3.9 It is our view that the role of Co-ordinator (or senior support team officer) should be enhanced to require someone of sufficient seniority and ability to drive forward the work of the ADAT on behalf of the Chair and other partners. Such a post, perhaps entitled Team Leader, would be accountable to and managed by the Chair and have responsibility for the performance of the ADAT support staff. The roles and responsibilities of the Team Leader should be consistent nationally. The complexity and autonomy of the Team Leader role will require a high level of skills and experience and the grade and salary of the post should reflect these responsibilities.

Recommendation 10: The ADAT Team Leader roles and responsibilities should be consistent nationally, should reflect the high level of complexity and autonomy inherent in the role, and should be graded and paid commensurately. The ADAT Team Leader should have clear accountability to the Chair of the ADAT who will be responsible for the line management function of the Team Leader.

3.4 Partnership

Partnership and Joint Working

3.4.1 This section focuses on those aspects of joint working which enable some partnerships, more than others, to be more effective and have a higher, more credible profile within their area of operation.

3.4.2 Some of the difficulties encountered by ADAT members included the disparate cultures of partner organisations, exacerbated by different accountabilities, decision-making arrangements and timescales. In terms of trying to understand this and work together, the role of the ADAT support officers was crucial.

3.4.3 Most ADATs felt that they had a key role in improving the range and quality of drug and alcohol services within their area and to ensure that these are co-ordinated and complementary. While all the partnerships were at very different stages of capability, many cited positive joint working relationships at operational level within their area and there was good evidence that this had resulted in the delivery of improved services.

3.4.4 ADATs cited a range of characteristics which made effective partnerships. These included: willingness and commitment; trust; good leadership particularly in relation to the Chair; experienced ADAT support staff; and, optimum geographical size where knowledge and expertise is shared.

3.4.5 The majority of ADATs felt that the partnership relationships at an operational or implementation level (within the sub structure of the ADAT) were particularly good and that closer working relationships had been established through developing activities and services, sharing information, networking, support and training opportunities. We saw some good examples of partnership working at an operational level with the ADAT having led the development of multi agency teams and a more client centred approach. (See Case Study 1.)

Case Study 1: Locality Clinic

One ADAT agreed to provide funding to establish a Locality Clinic, to provide a fast and effective local treatment service to people referred by their GPs. The ADAT was concerned that the growth in numbers of people referred to treatment services during 2002, together with increasing reluctance among some local GP practices to treat drug users, meant that people referred to treatment services faced long waits for access to the help they needed. The ADAT partners developed the Locality Clinic model as a 'shared care' partnership between the LHCC, the Community Drug Problem Service, and a local voluntary organisation.

The service is available to people who are primarily dependent on opiates and are referred to the service by their GP. Waiting times are only a few days and, if necessary, patients can be seen the same day. The Clinic is staffed by a local GP, a specialist nurse and a drugs worker, who work with clients, to assess, treat and stabilise their drug use and to address other issues such as mental health, homelessness and debt. Once stabilised, the GP resumes direct care of the person, with ongoing support from the Clinic.

The Clinic has been operational for 4 years, and has proved a successful model of good collaborative practice between health, specialist drug service and the voluntary sector. In 2006-7 the service worked with 130 new clients, discharging 80 to their GP's care with ongoing support from the Clinic. The ADAT is currently evaluating the effectiveness of the service as part of an external review of all services it funds.

3.4.6 Some ADATs could respond rapidly to changing situations - eg the impact of drug seizures on a user community - based on the strength of the trust that had developed among the ADAT partners. Although some smaller ADATs attributed this to the size of their "patch" and the way in which everyone knew each other, there was evidence of similar responsiveness based on trust in the larger ADATs as well.

3.4.7 We found that where there is a maturity of partnership working within the area (which is not just confined to the issues of drugs and alcohol) ADATs function better and have stronger links and relationships with the range of strategic partnerships in that area.

3.4.8 We believe that the ability to work jointly within a partnership is critical to the success of the ADAT and the processes and arrangements which underpin the teams are essential elements in aiding their effectiveness and the impact they have on tackling drug and alcohol misuse within their area. (See Case Study 2).

Case Study 2: Development of a shared protocol for working with children and families affected by parental substance misuse

One area has developed a protocol - involving NHS, local authority, voluntary sector and police. By working together, the ADAT and the Child Protection Committee set out actions to address the issues which impact on children within substance misusing families. Impact assessment framework and checklists have been developed and are being implemented. A comprehensive exercise was undertaken to identify all those children and young people who were affected by parental substance misuse to ensure that children and young people could be better supported. Regular communication and co-operation between the agencies has resulted in appropriate and well co-ordinated care plans for clients and highlights the needs of the children.

3.4.9 Having an effective, proactive structure at local level, involving all the relevant stakeholders is necessary to deliver the Executive's drug and alcohol strategies. There needs to be a collective responsibility from the partner organisations to achieve this and a clear accountability to Ministers to delivering the key national priorities and targets.

The right partners, at the right level

3.4.10 It was originally envisaged that ADATs (or their predecessors) would comprise senior officers, or those within the key partner agencies able to make decisions and commit resources. Over time this has changed and many ADATs acknowledged that the seniority of those around the partnership table had drifted - with more middle ranking officers or substitutes representing the partner body. This has resulted in two developments: i) representatives of partner organisations lack the authority or seniority to make strategic decisions and commit resources and ii) the ADAT membership includes staff with a more operational/expert role. While operational staff undoubtedly have valuable expertise, their membership has tended to change the focus of ADATs to become more concerned with operational activity, thereby weakening the strategic focus.

3.4.11 We are in no doubt that to achieve their objectives, ADATs require to have representation from partner organisations at senior officer level - with the authority to commit and make decisions about resources (both budgetary and staffing) and to implement agreements made in the ADAT. ADAT partners should be in no doubt about what is expected of the individual identified to represent them in the ADAT. It would be helpful if guidance on this was prepared and issued by the ADAT.

3.4.12 ADATs were asked about the range of partners and the level of engagement that they had within the ADAT. A general picture throughout Scotland was that there were several partners who were not well engaged with the ADAT and consistently these were identified as education and, to a lesser extent, housing. The majority of ADATs felt that there was an extremely important role for education (schools in particular) in drugs and alcohol misuse prevention. Education services are in theory represented on 20 ADATs but in practice they often do not participate at all or are represented at a junior level. Where education is an active participant, it can have a beneficial effect on substance misuse education. (See Case Study 3.) Only 6 ADATs had a representative from housing in their membership.

3.4.13 Licensing Boards were also poorly represented and their decisions often undermined the work of the ADAT. But this was not true everywhere and we saw some good examples of co-operative working. In one area the Licensing Board had been very supportive of the ADAT and worked with it to persuade local licencees not to discount alcohol or to provide "happy hours". We heard the licensed trade generally was reluctant to become involved with the ADAT.

Case Study 3: Developing a more consistent approach to drugs and alcohol education in schools

Within one area an audit was undertaken of the drugs and alcohol education that was being delivered in all of the area's secondary and primary schools. The issue of consistency was initially discussed within the ADAT forum - having been brought to their attention by differences in messages being delivered by some visiting speakers. Although the need was identified through the ADAT forum, the audit was undertaken by education staff within the area. The findings revealed a range of different approaches - and the need to have a more consistent approach across all the schools in the area was agreed. A new framework for drugs and alcohol education has been developed, identifying the key messages to be delivered. Training for teachers has also been delivered to support implementation of agreed programmes of drug and alcohol education. This has helped to equip them with the necessary skills and information required to get information across to young people as part of the broader personal and social development curriculum. All schools have now adopted the new guidelines and the way in which this educational input to young people is delivered is now much more consistent across this ADAT area.

3.4.14 The majority of ADATs have voluntary sector partners and a number of teams fully embraced the voluntary sector as equal partners in delivering drugs and alcohol services. Many voluntary and independent groups gained strength from the partnerships involved in ADATs. ADATs offered a wide range of expertise and a co-ordinated approach to drug and alcohol services in their areas. However many voluntary sector representatives felt they were not equal participants in the process. They attributed this to a perception that not statutory means not professional and tension with some voluntary organisations providing commissioned services. It is interesting to note that while conflict of interest was cited as a reason for not involving the voluntary sector, it did not seem to be recognised that the statutory sector partners were also providers of service as well as commissioners. In some areas a review of the structure of the ADAT had reduced voluntary sector representation significantly, while creating a separate forum for voluntary agencies that some saw as less influential.

3.4.15 While the range of organisations originally envisaged for DATs in 1995 and AATs in 2002 remains valid today, some adjustment is needed to reflect changes in structures and organisations. ADATs are operating within a changed partnership landscape, with a number of partnerships bodies having been developed to tackle the growing complexity of social issues.

3.4.16 The role of GPs and pharmacists in education, prevention and treatment is more important than ever and this should be recognised in determining the membership of an ADAT. Partner representation whether at a strategic or operational level should include health (at Board and/or CHP level), local authority (including social work, education and housing), Licensing Boards, Community Justice Authorities, police, prisons, the voluntary sector,, employment, training, higher education, further education, procurator fiscal, pharmacists, General Practice, the local licensed trade and service user and community interests. However, it will be important to strike a balance between limiting the number of ADAT members to ensure an effective team while recognising the importance of relevant representation. Some representation will be more important at strategic level, other representation will be more appropriate at operational level. The structure of ADATs is considered in paragraphs 3.4.22-26.

Recommendation 11: There should be a review of the range of representation on ADATs bearing in mind the importance of limiting the size of the strategic team to maintain effectiveness. Membership of the wider ADAT structure should be enlarged to include, for example, CJAs and GPs.

Recommendation 12: Partnership representation should be at a very senior level and be representative of the strategic agencies that are involved in substance misuse issues. Partners should be given guidance about what membership of the ADAT will require of them.

Partnership with other Partnerships

3.4.17 In the course of the Stocktake, we wrote to other local partnerships to establish their perception of links with ADATs. The results were as follows:

• Child Protection Committees: 23 out of 32 of CPP's (71%) replied. Good links were clearly demonstrated throughout, the strongest of all partnerships. There were lots of examples of innovative partnership, working on joint initiatives and joint funding. Links were at a stage beyond merely structural arrangements - they were turning plans into action jointly. In some areas relationships were at an earlier stage of development but there was clear commitment and recognition of the importance of joint working.
• Community Health Partnerships: 12 out of 38 CHPs (32%) replied. All reported strong structural links and official representation.
• Community Justice Authorities: 6 out of 8 of the CJA's (75%) replied. All CJAs indicated that the ADAT had been identified locally as a key body to make links with; although all stated that they were currently in too early a stage of development to do this.
• Community Planning Partnerships: 15 out 32 of the CPP's (47%) replied. The response suggested that ADATs seem to 'float' around the structures of CPP's with no standard place in the structure and rarely formal links. Occasionally the ADAT was a subgroup of the CSP.
• Community Safety Partnerships: 16 out 32 of the CSP's (50%) replied. Where links existed they were with the alcohol side of ADAT business (where there is evidence of joint working), rather than the drug element.
• Health & Homelessness Partnerships: 7 out 14 of the HHP's (50%) replied. Whilst links had been identified, they seemed to be fairly undeveloped or about to be reviewed. Links all appeared rather structural with no evidence of these being turned into joint initiatives.
• Homelessness Local Authority Strategy Officers: At their request, a presentation was given this group. Feedback suggested that very few of them were aware of ADATs.

Accountability

3.4.18 ADATs are not statutory bodies and their lines of accountability are not always clear. Almost all ADATs felt that they were ultimately responsible to the Scottish Executive in relation to delivering the national targets and priorities and accounting for the monies allocated for this purpose. However, around half saw their accountability as being three fold: i) to the Scottish Executive; ii) collectively through the other ADAT partners and iii) ultimately to local citizens and service users.

3.4.19 At a local level, the lines of accountability and reporting were varied. Some ADATs had reporting lines within local structural arrangements - these included informing or actually reporting to Community Planning Partnerships, Community Health Partnerships and Community Safety Partnerships. Many ADATs were 'free floating' - not anchored in any local structural arrangements, and were consequently fairly autonomous bodies lacking formal links with other local priorities.

3.4.20 A number of ADATs indicated that they had informal links with other local partnerships - mainly through officers being represented on more than one of these partnerships. In particular, there was often cross-representation between ADATs and Child Protection Committees. In general, these personal, cross-representational relationships were based on individual knowledge and dependent on this being shared, and not necessarily formal linkages. While undoubtedly personal contacts can help to facilitate good partnership, they may also make it difficult to challenge decisions or positions. In addition, an over reliance on personal contacts means that linkages could break down when individuals move on.

3.4.21 Partner organisations felt that ultimately it was the budget holder that carried the accountability for funding received - and this was primarily the NHS and the local authority. Funding via local authorities could also be complicated by having to be routed via the governance arrangements of committee structures and procedures. Often it was the organisations who are the 'bankers' for the ADAT funding who were seen as the 'lead' partners.

The Size and Structure of ADATs

3.4.22 The majority of ADATs felt that there was a requirement to have a structure which reflected local circumstances, needs and priorities. Accordingly, the size and boundaries of ADATs across Scotland varies significantly. Those that covered larger populations and more than one local authority area tended to have substructures intended to facilitate effective relationships at a local level whilst maintaining strategic integrity at a higher level.

3.4.23 Many ADATs had developed operational/implementation or themed sub-groups. However, the relationship between the 'strategic' and 'operational' levels was not always clear. Only a few of the ADATs across the country appeared to have a truly strategic overview. A 'one size fits all' approach to ADAT structures is unlikely to meet the needs of the diverse populations across Scotland. Nevertheless, the more effective ADATs tended to have a good strategic overview underpinned by operational sub-groups which drove activity and had a clear connection back to the main ADAT. From the evidence we collected, we believe that there would be merit in a two tier structure for most ADATs.

3.4.24 At a strategic level, reflecting health board or police authority boundaries, there should be a strategic partnership - perhaps called a Substance Misuse Strategic Partnership ( SMSP). In some parts of Scotland it may be appropriate for health boards to join together in such a partnership. (We are aware of increasing activity across health board boundaries in relation to the planning of tertiary health services.) The SMSPs would take over the strategic roles and responsibilities of ADATs. The Chair of the SMSP would be accountable to the relevant Minister(s) as described in paragraph 3.3.4. The SMSP support team would be led by the team leader described in paragraph 3.3.9.

3.4.25 At an implementation or operational level, there is a need for close working with other key partnership groupings including Community Safety Partnerships, Child Protection Committees, Community Health Partnerships, Community Planning Partnerships and Community Justice Authorities. All of these partnerships are concerned with issues which connect with different aspects of drug and alcohol policy at a local level and the importance of a co-ordinated approach between them cannot be overstated. ADATs need to ensure that they recognise these interdependencies and ensure that they co-ordinate and align with these. For this reason we believe that at the level of Community Planning Partnerships, there should be implementation partnerships - perhaps called Substance Misuse Implementation Partnerships ( SMIP) - which are accountable to the SMSP but are also firmly rooted within the statutory CPP, ensuring that the CPP is aware of and can support the work of the SMIP and SMSP.

3.4.26 The SMSP support team will provide the necessary administrative support arrangements to the SMIPs. This structure, together with the establishment of a National Steering Group (Recommendation 1 refers) would provide a clear linkage between national policy development through the Ministerial Steering Group, strategic implementation and sub national policy development through the SMSPs and implementation through SMIPs who would be accountable to their SMSP and have a clear and explicit link to the Community Planning Partnership. A possible model, which also takes into account Recommendation 7, is illustrated below.

Recommendation 13: The Scottish Executive should review with ADATs (1) the number and size of strategic partnerships to enhance strategic capability and; (2) the best structure for implementation at local level to ensure a good fit in particular with Community Planning Partnerships.

Recommendation 14: We recommend the Scottish Executive should establish clear linkages and responsibilities between the following tiers:

• The Ministerial Steering Group (national)
• Substance Misuse Strategic Partnership (regional)
• Substance Misuse Implementation Partnership (local)

3.5 Capacity Building

What is it?

3.5.1 Capacity building is the process of developing and strengthening the skills, processes and resources that organisations need to grow and adapt. Individuals have the most important roles to play in that their personal and organisational skills, as well as development in terms of training, form a major part of this process. Good communication across structures and with individuals is essential. Capacity building within the ADAT structure should be driven by the leadership of the Chair and the organisations involved.

3.5.2 Capacity building is an area that needs to be constantly evaluated, monitored and supported. All ADATs require time, resources, flexibility and support to engage in training and development to sustain people, strategies and good performance monitoring to achieve their mission.

What we found and commentary

Training and Development

3.5.3 ADATs varied widely in how much priority they gave to addressing the training and development needs of ADAT members and staff as well as those of staff delivering services. A Training Needs Analysis for DATs was carried out by the DAT Association in 2002. However there appeared to be very little knowledge of it and no evidence that it had been acted upon.

3.5.4 STRADA (Scottish Training on Drugs and Alcohol) is a national training organisation which is funded by the Scottish Executive. STRADA is a partnership between the University of Glasgow's Centre for Drug Misuse Research and the Department of Adult and Continuing Education, and Drugscope ( UK wide policy and practice organisation). STRADA provides a range of training, education and development opportunities to staff working in the drug and alcohol field.

3.5.5 STRADA has developed and runs a programme for primary care practitioners - "Care and treatment of drug misuse in primary care". This can lead on to the Royal College of General Practitioners ( RCGP) Scotland Certificate in the Management of Drug Misuse in Primary Care, which is aimed at all practitioners with a special interest in drug misuse. The Scottish Executive has provided funding for 100 practitioners in 2007.

3.5.6 Since 2002 STRADA has commissioned the Scottish Leadership Foundation ( SLF) to provide leadership development to ADATs across Scotland. SLF offers a customised development programme for ADAT partners in areas of leadership and partnership working. The objectives are to develop partnership working at a local/area level, and to create strategies and action plans to enable them to deliver their goals. The training also helps to develop a shared set of standards by which performance is evaluated as well as accountability arrangements for stakeholder organisations. The programme aims to develop a shared knowledge base on all areas of substance misuse and provide practical tools and techniques to support partnership working. It has a core framework, which can be tailored to the needs of individual ADATs and comprises an initial development day, a two-day leadership programme and a follow up day after 6 months to review the action plan. To date eighteen ADAT areas have been involved in the leadership development programme to at least the first stage.

3.5.7 Members of the ADATs involved rated the SLF programmes very highly in terms of developing a shared understanding of the issues and a clearer understanding of the constraints of individual organisations, as well as having time to reflect with colleagues. ADAT support staff felt that these courses were excellent in terms of team building and helping them to understand their role, and that they assisted staff to know where they fit into the ADAT structure, providing some knowledge of the wider context.

3.5.8 For ADATs to be as effective as possible, the Chair, members and staff need to have a clear and shared understanding of its aims and objectives and of partnership working. Leadership skills are particularly important for ADAT Chairs and team leaders. Training has a key role in ensuring that the necessary skills are present. ADATs should assess their training needs, particularly in the light of any structural changes, and put in place arrangements to meet those needs.

Recommendation 15: A Training Needs Analysis should be undertaken for all members and staff of ADATs and a timetable set for addressing those needs.

Research, Information Sharing and Communication

3.5.9 Some ADATs had research and information officers. Those that did reported that they were an extremely valuable resource and some that did not have them felt the lack of such a role within the support team. These post holders provided a wide range of support including:

• Local data collection and dissemination.
• Local research projects.
• Information for the local provider network which assisted them to work more effectively together.
• Linking with colleagues across Scotland and at the Scottish Executive and ISD to help develop national data bases and inform the research agenda.

3.5.10 The IT infrastructure available to ADATs was variable and there were issues of compatibility with other local systems. However, the underlying issues here were around information sharing and confidentiality which have been identified in other reports about joint working as requiring high level action. In several ADATs, considerable attention was being given to the issue of information sharing across agencies, mostly in the context of achieving single shared assessment.

3.5.11 Many ADATs were working on a Single Shared Assessment ( SSA) model but none of these were fully operational. The design of the SSA varied from ADAT to ADAT. Some ADATs were developing a fully electronic system and were encountering problems with IT compatibility. Others were developing a paper based approach with the aim of moving to an electronic system in due course. Some ADATs were including voluntary organisations in the SSA, others had decided that voluntary organisations should not participate, or at least not initially. Among both voluntary and statutory organisations there were reservations about sharing client information and concerns that there would be a breach of confidentiality.

3.5.12 It seemed to us that while many ADATs had a strong commitment to an SSA approach, some organisations used reasons of system compatibility or client confidentiality to slow down the development of an SSA when in reality the reluctance to share information was much more about cultural differences and about retaining ownership. It would be helpful to ADATs if the major statutory organisations such as health, local authority and police made a clear commitment to SSA and backed it up with endorsement and resources at a local level.

3.5.13 We looked at the extent to which ADAT partners shared non-client based information between themselves. There were some good examples of individual organisations seeing that their actions could impact on another organisation. For example, a number of police authorities had adopted the practice of informing the ADAT when they had made a significant seizure of drugs or when contaminated drugs were in circulation. The ADAT was then able to alert the other partners so that health and social work services in particular were prepared to deal with the consequences. The recent report Common Knowledge issued by H.M. Inspectorate of Constabulary for Scotland contains some very helpful recommendations about information sharing at all levels which, if implemented, would be helpful to ADATs.

3.5.14 ADATs communicated with the wider public through a variety of means including web based information, leaflets and the media. This is considered in Section 5.

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