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Appendix H. Greater Glasgow Health Board - North and North West Community Addiction teams
Topics: Mental Health; Substance Misuse
Background
Unmet needs funding was received for two Community Addiction Teams ( CATs) from Greater Glasgow Health Board; North and North West.
Funding allocation
The pilot was allocated £2,800,000
Aim(s)
The aim was to assess whether the North and West CATs were meeting unmet need to a greater degree than before. In order to do this, access to treatment and care was measured.
Although beyond the scope of the general aim of the unmet needs pilots to improve access, the pilot also sought to look at depth of engagement by considering usage of the service i.e. actual attendance, assessment, appropriateness of treatment and reassessment prior to discharge.
Methodology
The pilot adopted a case study approach that saw two unmet needs funded CATs that served more deprived catchment areas (North and North West) compared with two CATs with less deprived catchment areas outside Glasgow City (East Dunbartonshire and the Substance Misuse team in East Renfrewshire). These comparisons were chosen as to eliminate as many confounding variables as possible.
Therefore, the evaluation sought to measure whether the North and North West CATS had increased access to treatment and care for people with the greatest unmet need to a proportionately greater extent than they had increased access by other groups.
Specifically:
1. Proportions accessing the service by deprivation category within each CAT area were compared with the proportions of the population within each Deprivation Category in each area, to see if the amount of service usage by Deprivation Category reflected the population by Deprivation Category.
2. Access by Deprivation Category within CAT areas was compared between separate CATs with overall richer and poorer catchments.
Multiple sources of data were used to measure access. These were Social Work Carefirst systems, NHS Standard Morbidity records and single shared assessments.
Key results
During the evaluation period, the number of clients increased across Glasgow city as a whole. However, the two unmet needs funded CATs saw the biggest percentage increase in total number of clients.
In the North West CAT, clients from the more deprived areas contributed disproportionately to the increase. In the North CAT, any substantial increase in the proportion of clients from more deprived areas was difficult to observe, owing to the already high proportions (over 90%) of clients attending who were from DepCat 7. However, here, a general increase in the volume of new clients was also noted.
In contrast, the East Dunbartonshire CAT saw no increasing trend in the population rate of new clients. Any fluctuations noted were the result of staff changing over to using a different information system to record client access.
In the East Renfrewshire CAT, again no increase in new service users among more deprived groups was noted. In fact, the data showed that the more deprived groups decreased quite sharply as a proportion of new clients, while less deprived groups increased.
The number of types of interventions was higher for the unmet needs funded CATs (38 for North and 33 for North West) compared to the comparison Cats (14 for East Renfrewshire and 22 for East Dunbartonshire). In addition, the unmet needs funded CATs gave more interventions to each client (8.5 for North and 5.6 for North West) than the comparison sites (East Renfrewshire 1.8 and East Dunbartonshire 2.6).
In terms of the variety of interventions, there was more emphasis on cognitive and psychosocial interventions in the unmet needs pilot sites than the comparison sites.
Conclusions
The two unmet needs funded CATs managed to reach more deeply into more deprived parts of their populations which are known to have unmet needs, especially in the area of addictions than the comparison sites.
The evaluation did not investigate the effect of the unmet needs funded CATs in delivering better outcomes for clients. However, it was noted that they did deliver a greater variety of interventions and appeared to focus more on evidence-based cognitive and psychosocial interventions than the comparison teams. They also assessed clients for more individual interventions on average than each of the comparison sites, suggesting a greater input into each client. Therefore, this suggests that the unmet needs funded CAT teams were able to channel additional resources into each individual client.
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