Planning and Provision of Drug Misuse Services
National Strategic Objectives and National Priorities for Tackling Drug Misuse
1. This section provides the context for the guidance on effective planning and provision at Part2, reviews the relationship between the guidance and national objectives and priorities, and sets the guidance against the background of the Scottish Health Service Management Executive's planning and performance management process. Although Part 1 is therefore primarily aimed at the health service, it should inform the action by other agencies where drug related activities impact on their work.
2. Drug Misuse has gained a strong hold in Scotland. There is a serious impact on health, crime and on local communities. Drugs are reported to be easily available, with large proportions of young people reporting being in situations where drugs are used and having been offered them themselves. The 1996 Scottish Crime Survey revealed that 39% of 16-19 year olds had ever used any drug, and 23% of all respondents. As well as substantial damage to health, the links to crime are substantial and complex. Some police forces now operate on the basis that 50 to 70per cent of crime they deal with is drug related.
3. Over the last few years there have been major changes in the arrangements for the planning of drug misuse services as a result of the setting up of Drug Action Teams (DATs). DATs are required to produce and implement a strategic plan for tackling drug misuse within their area and, in turn, this plan needs to complement community care, child care, criminal justice, and health improvement programmes.
4. This guidance is issued at a time when new arrangements for the allocation of funds for drugs and AIDS/HIV services are being considered. The prime objective will be to allow Health Boards the freedom to allocate earmarked resources at their own hand following due consultation with partners in the DAT. With the issue of this guidance - which aligns the mechanisms for drug service provision and accountability arrangements more closely with those for other health and social services - it follows that Boards should be given greater control over the use of these resources.
5. A working group is currently considering the options for a formula based approach to allocation of resources - replacing the existing arrangements administered by the National Services Division of the Common Services Agency.
6. Greater freedom on resource use will require revised arrangements for accountability. The delivery of drug misuse services will therefore be subject to the Management Executive's planning and performance management process. To facilitate this, it is necessary to establish a clear strategic framework for drug misuse services designed to meet national objectives. These in turn should inform the planning and delivery of local services. The development of more effective planning and the delivery of appropriate local services will in turn feed into the achievement of the national strategic objectives.
7. Health Boards' achievement of their objectives in relation to
drug misuse will be
monitored through the normal performance management arrangements. Local authority
arrangements for the provision of social support and services for people who misuse drugs,
and those affected, are assessed as part of the monitoring of local community care plans.
8. National strategic priorities for tackling drug misuse agreed with the Scottish Advisory Committee on Drug Misuse are at AppendixA. Corresponding key performance and activity indicators are also listed ( see para 15 below). These reflect the recommendations of the Ministerial Drugs Task Force report of 1994, recent policy developments, some emerging priorities, and the underlying objectives of the Scotland Against Drugs Campaign. The emphasis here is on what objectives should be achieved in implementing national policy. How the national objectives should be achieved through the delivery of local services is a matter for local agencies and those delivering services.
9. The strategic objectives span the key areas of activity on drug misuse in the fields of health, social work, education, police and prison services. These national objectives go beyond service considerations alone, although Health Boards and local authority social work departments will clearly be primarily interested in those related to health risks and services. But the nature of drug misuse is such that the various objectives are interrelated. Success in service delivery can have a significant knock on effect in the achievement of objectives which are not related to service delivery in the narrower sense. For example, substitute prescribing can have a beneficial impact on the reduction of drug related crime; and success in reducing drug related crime generally has the capacity to reduce pressures on health and social services in a number of ways. Lots of other links of this kind can be made to demonstrate the interrelated nature of the various objectives. It is vital therefore that those involved in decisions on the planning and delivery of drug misuse services take account of their capacity to assist achievement of wider national and local objectives. Interests, particularly in the DATs, should not be compartmentalised.
10. Where appropriate, the relevant Scottish Office departments will set national priorities underpinning the strategic objectives. Locally set objectives and priorities should reflect the national objectives and priorities as well as local service needs and priorities.
NATIONAL APPLICATION OF OBJECTIVES
11. At national level the strategic objectives will inform:
- the setting of priorities;
- the treatment of drug misuse in the Scottish Office Department of Health's planning and performance management process;
- the Scottish Office Department of Health's consideration of DAT strategic plans and action programmes;
- the setting of national performance indicators for drug misuse activity;
- the monitoring and measurement of national progress in tackling drug misuse;
- the drugs information strategy for Scotland;
- the assessment of funding applications from research, voluntary and other bodies.
LOCAL APPLICATION OF OBJECTIVES
12. At local level the strategic objectives should inform:
- the preparation of DAT strategic plans and action programmes, which should provide the basis for the planning and delivery of drug misuse services in the local area;
- local health improvement programmes;
- Joint Community Care Plans;
- Criminal Justice Social Work plans;
- contracts or service agreements with those delivering services;
- Children's Service Plans;
- targeting of local service provision and spending priorities;
- the setting of key performance indicators by commissioners and those delivering services for use in monitoring contracts and service delivery;
- the setting of priorities for research and information; and
- assessment of local funding applications from research, voluntary and other bodies.
13. While it is accepted that the particular local circumstances of individual areas should be taken into account in the delivery of local services, agencies are expected to demonstrate a measurable improvement in the local service delivery underpinning strategic objectives.
14. The respective roles and responsibilities of agencies and DATs are dealt with in Part2.
KEY PERFORMANCE AND ACTIVITY INDICATORS
15. Key performance and activity indicators related to the national strategic objectives are included at Appendix A. These have been agreed with the Scottish Advisory Committee on Drug Misuse and the Information and Statistics Division (ISD) of the Common Services Agency. These indicators provide appropriate measures of achievement of the objectives concerned and reflect actual or potential availability of the supporting data. Not all the data to support these objectives is currently available, but it is intended that this will be built up and refined over time as part of the Scottish Drugs Information Strategy being implemented by ISD on behalf of The Scottish Office Department of Health. Local agencies should take account of these performance indicators in addressing local information needs in support of service delivery. The further testing and refinement of the key performance indicators will be part of on-going work by ISD during implementation of the Scottish Drugs Information Strategy (see paras10 and 11 of Part2).
DRUG MISUSE PERFORMANCE INDICATORS
FOR LOCAL CONSIDERATION AND DEVELOPMENT
16. It is essential that commissioners, DATs and those delivering services are in a position to evaluate their own progress in supporting the implementation of national policy. To do this they need to develop local performance indicators for strategy implementation and service delivery to supplement the national performance indicators used for monitoring overall progress on the strategy. The performance indicators listed at Appendix H are intended to be helpful to local agencies in determining their own measures. These can be drawn on, adapted or discarded in the development of local indicators in support of national objectives and service delivery. It is for local consideration whether indicators should be produced at DAT, Health Board or other levels. Whilst it is ultimately the responsibility of those planning and delivering services to determine the information which should be collected in support of their activities, consistency between the national and local performance and supporting information sources is clearly desirable (see para15 above) to allow comparisons and avoid disparate collection of data, particularly over the longer term. This will be a matter for further consideration by ISD in developing the Information Strategy.
17. The Scottish Office Department of Health, in conjunction with the Scottish Advisory Committee on Drug Misuse, will shortly be drawing up a research strategy for drug misuse. This strategy is expected to be wide ranging in scope and application, addressing some of the issues resulting from the evolution of drug misuse policies since the Task Force reported. These will include the work on the development of national objectives and key performance indicators for drug misuse, the increasing emphasis on evidence based strategies, and the broadening base of interest in tackling drug misuse.