NTA Overview for National Needle Exchange Forum July 2006

1. NTA Overview for National Needle Exchange Forum July 2006 Annette Dale-Perera Director of Quality

2. Reinvigorating harm reduction

3. Increasing Harm • Increasing infections • Increasing BBV Hep B mean 20% • Hep C mean 40% some areas higher - many unaware • HIV increasing • New, worrying patterns of drug taking: Nexus of risk re crack use in the context of injecting • More drug users with serious long term health problems • But some good news …….Overdose deaths fell but not enough to hit target

4. Most injectors in contact with drug treatment? • Structured drug treatment: approx 180,000 people in 05/06 – about 100,00 current/past injectors • Needle exchange services: 105,000 people (overlap unknown) • Estimates of injectors in England: 150,00 people • Also populations being drawn in via DIP & prison work • DIP 3000 assess per month, most not had treatment, 35% injected in last month – high reported levels of sharing • Prison work 70,000 individuals 05/06 drug interventions

5. What are we trying to achieve? Harm reduction as core activity in all drug treatment • Harm reduction interventions to help injectors reduce harm: • Raise awareness amongst drug injectors • Safer injecting techniques to stop spread of Blood Borne Viruses, infection, etc • Injecting equipment dispersal and return • Overdose prevention inc alcohol treatment, naloxone, first aid etc • Reduce initiation into injecting • Opiate substitution treatment: at the right dose • Reduce and ideally stop injecting • Continuity of drug treatment • Alcohol interventions to reduce OD risk and prevent liver disease (Hep C) • Reduce risks to others from injecting e.g. disposal • More attention to poly drug use nb role of crack in risk and OD

6. NTA/HealthCare CommissionImprovement Review Main lever 06/07 Harm reduction services 06/07 • National criteria (standards) and programme developed 05/6 • Every area screened against criteria and data: Oct/Nov 06 • Every area receive a report Jan/Feb 2007 • 10- 15% “inspected” (including peer review) By March 2007 • Each area with an action plan to improve harm reduction • Good practice “benchmarked” and identified • Action to improve commissioning, monitoring and provision

7. Improvement reviews • Partnership: Healthcare Commission = Regulator/ Inspectorate National Treatment Agency = Specialist Sponsor • Assessment Framework Must relate to the DH standards Developed via engagement with the field Identify key issues from the perspective of service users experience and outcomes Assess and distinguish between different levels of performance Enable improvement

8. Harm Reduction Criteria • Harm reduction services are commissioned in line with Models of Care: Update 2005 to meet identified local needs • Service users have prompt and flexible access to needle exchange services that are responsive and appropriate to their needs • Service users have prompt and flexible access to vaccination, testing and treatment for BBV • The Partnership takes action to reduce the number of drug-related deaths • Services have sufficient staff with the required competences to deliver effective harm reduction services.

9. Improvement Review • Use of existing data from surveys, audit, treatment plans, NDTMS, etc • Bespoke data collection from all DAT partnership areas • National service user survey extra questions • Mental Health Trust specific questions • All areas & MHTs found to be falling short will be asked to action plan to improve

10. Briefing published following 10 cohorts of injectors Focus on those also using crack and injecting Training CD Rom based on video ethnography plus extra footage on how to inject safely Video Ethnographic work

11. Action Plan to reduce BBV and OD deaths • Action plan by October 2006 for minister • Reconvene advisory group on reducing drug related deaths • Intensive work: commissioned papers, expert group asked to help develop action plan • Look at what we are doing and what else we may need to do • NTA seeks input from NNEF