Transcript Slide 1

Birmingham Total Place Pilot
Drugs and Alcohol Customer Insight
Steve Rose – Birmingham City Council
Simon Dickinson – Aperia
Neil Mackin - CACI
Total Place Birmingham
• One of 6 themes. Also: mental health, learning
disabilities, guns and gangs, early intervention,
total community, leadership & governance;
• Drugs and alcohol:
–
–
–
–
Drug recovery programme
Reducing alcohol-related hospital admissions
Alcohol availability and pricing
Customer insight
• The emerging threads
Birmingham Total Place
Moving beyond treatment to
recovery:
“Unemployment, poverty, and homelessness make
up the soup on which addiction and criminality feed.
Work, prosperity and decent homes are aspirations
which encourage abstinence and honesty”
Paul Hayes, NTA
Birmingham, Sept. 2009
Drug Recovery Programme
• Every £1 spent on treatment
saves £9.50 in the criminal
justice system
• Every £1 spent on recovery
orientated treatment and
community reintegration
should save Birmingham
considerably more
Alcohol: reducing admissions
• In Birmingham the equivalent of 1
hospital ward is occupied all year by
patients suffering from alcohol
specific conditions
• About 12 wards are taken up by
patients with conditions which are
linked to alcohol use to some
degree
• One person was admitted 24 times
in a year and cost £34,000 to treat
• Total hospital service cost in
Birmingham is £5.7m
Customer Insight IDeA Funded Project
Drugs and Alcohol
Customer Journey Maps
and Recommended Pilots
Steve Rose – Birmingham City Council
Simon Dickinson – Aperia
Neil Mackin - CACI
Drugs and Alcohol Data Map
Prescribing
Data
Case
Management
Case Files
A+E Admissions
flagged for
Substance
Aggregate Hospital
Episodes
NHS Business
Services
Drug & Alcohol
Service Providers
Hospital
Records
Public Health
Mortality Files
Hospitals
PCTs
Health
DAAT
Substance
Services
Mental Health
Trust
Monitoring
NDTMS
SPOC Call
Centre
Needle Exchange
Commissioning
BHWP
WMPHO
Service Provider
Commissioning
Public
Services
BCC
Revs / Bens
Housing
(Northgate)
(SX3)
Adults
(CareFirst)
GPs
Case Files for
Patients
Opinion
Survey
Prison
Courts
Prison
Records
Sentencing
Records
Children
(CareFirst)
Justice
Probation
Emergency
Services
DIP
Accredited
Programmes
Fire
Police
Arrest Out of
Hours Calls
(IAPS)
Offender
Assessment
(OASys)
DIP
Referrals
Incidents
Crime
Arrest
Drugs and Alcohol Data Map
Prescribing
Data
Case
Management
Case Files
A+E Admissions
flagged for
Substance
Aggregate Hospital
Episodes
NHS Business
Services
Drug & Alcohol
Service Providers
Hospital
Records
Public Health
Mortality Files
Hospitals
PCTs
Health
DAAT
Substance
Services
Mental Health
Trust
Monitoring
NDTMS
SPOC Call
Centre
Needle Exchange
Commissioning
BHWP
WMPHO
Service Provider
Commissioning
Public
Services
BCC
Revs / Bens
Housing
(Northgate)
(SX3)
Adults
(CareFirst)
GPs
Case Files for
Patients
Opinion
Survey
Prison
Courts
Prison
Records
Sentencing
Records
Children
(CareFirst)
Justice
Probation
Emergency
Services
DIP
Accredited
Programmes
Fire
Police
Arrest Out of
Hours Calls
(IAPS)
Offender
Assessment
(OASys)
DIP
Referrals
Incidents
Crime
Arrest
Drugs - Demand
The Consolidated Demand Index
arising from Drugs Misuse:
1) DAAT Needle Exchange
Volumes - Pharmacy Level
aggregated to Ward
2) NHS Business Authority - Spend
on prescriptions relating to
Opiate Dependence
3) Police Data - Drug Possession
Offenders
4) Probation Service OASys - Drug
Offenders with Criminogenic
Need
5) Demographic Propensity derived from ACORN profile of
Drug Offenders
Drugs - Cost
Consolidated Cost Index arising
from Drugs Misuse:
1) Birmingham Opinion Suvey Proportion who say that
people using/dealing drugs in
the local area is a big
problem
2) Police Data - Instances of
Drug Possession crime
3) HES Data - Inpatient
Admissions for Drug Misuse
Alcohol Harm
Department of Health
Harmful drinking – high
admission segments
Alcohol- Cost
The Consolidated Cost Index
arising from Alcohol Misuse.
1) Birmingham Opinion Suvey Proportion who say that
people being drunk or rowdy
in the local area is a big
problem
2) Police Data - Instances of
ARV crime (Alcohol Related
Violence)
3) HES Data - Inpatient
Admissions for Alcohol
Attributable Reasons
Service
Journey
Danny
SEGEMENT:- Drug Addict
GENDER:- Male
AGE GROUP:- 25-40
RELIGION:- n/a
STATUS:- Single
DEPENDANTS:- 1 child
Danny
SEGEMENT:- Drug Addict
GENDER:- Male
AGE GROUP:- 25-40
RELIGION:- n/a
STATUS:- Single
DEPENDANTS:- 1 child
How do we
measure his
outcomes?
How do we
measure his
outcomes?
Measures operations
e.g. throughput
Not have we achieved
what the customer
wants
Drug Workshop
•
•
•
•
Hopes and Fears
Their aggregated journeys
What does the system look like
What would they change
Circles of Need® - all content is © Aperia
14
Family and friends
finding out you are
on drugs
To regain contact
+ build
relationships with
loved ones
Drugs – Hopes
and Fears
Help other
people like me
help themselves
To become
valued member
of society
To get out of
Birmingham and
get a good life
Of staying in Brum
and leading the
same life as the last
20 years – and no
job
Being in the
wrong place at
wrong time and
end up using
That things
change in the
right places
Not being
funded to get a
tier 4 place
Not getting
treatment
Day care centre to
run for 6 months –
it is only 3 now
Of a lapse and
To fail and be on
taking an
drugs
for the rest
overdose and
of
my life
dying from it
Relapse into
DRUGS
drug abuse
I am going to rehab.
To be abstinent
I just hope I can
from all
complete and get to
substances –
be drug free and
Not becoming
legal and illegal
start living my life
an addict again
To get my own
flat
When someone is
not prepared to
listen
To get fitter /
more active
JOBS
To have enough
To get a car
money
Get a girlfriend
& job with a
good wage
Having too much
money to spend on
wrong thing
Treatment plan
/ centre not
equipped for
my needs
Not getting the
help you need
To receive help +
treatment from
services
To gain qualification
through service
provider
Wont be able to
gain employment
because of my
past
Will never be
able to get into a
well paid job
again
That I’ll be
judged on my
past
My past being
constantly
brought up
Wish my past would
stop being brought up
by the same people in
social services (people
can change). The past
is what w e are trying to
move on from
People to better
understand
rehabilitated users
Family and friends
finding out you are
on drugs
What
To regain
contact
others
+ build
relationships
think of with
me
Drugs – Hopes
and Fears
To become
loved ones
valued member
Help other Give
of society
people like me
something
help themselves
back
To get out of
Birmingham and
get a good life
Break
away from
Of staying in Brum
and leading the
Birmingha
same life as the last
m – and no
20 years
Not getting the
help you need
job
To receive help +
treatment from
services
Being in the
wrong place at
wrong time and
end up using
Treatment plan
/ centre not
equipped for
my needs
That things
change in the
right places
Fear that
getting
treatment Not
wont
treatment
Day care centre to
work
for– me
run
for 6 months
Not being
funded to get a
tier 4 place
it is only 3 now
Of a lapse and
To fail and be on
taking an
drugs
for the rest
overdose and
of
my life
dying from it
Relapse into
DRUGS
drug abuse
I am going to rehab.
To be abstinent
I just hope I can
from all
complete and get to
substances –
be drug free and
Not becoming
legal and illegal
start living my life
an addict again
Hope I can get
off drugs, but
fear I might not
When someone is
not prepared to
listen
To gain qualification
through service
provider
To get my own
flat
To get fitter /
more active
JOBS
Hope I can get a
To have enough
To get a car
moneyand a life
job
Get a girlfriend
& job with a
good wage
Having too much
money to spend on
wrong thing
Past
may Will never be
get into a
stop meablewelltopaid
job
again
getting
a job
Wont be able to
gain employment
because of my
past
My past being
constantly
brought up
That I’ll be
judged on my
past
Wish my past would
To
bebrought up
stop being
by the same people in
social services
given
a (people
can change). The past
is what w e are
trying to
chance
to
move on from
People to better
move on
understand
rehabilitated users
DRUGS –
What helped?
DIP worker was
brilliant
Safe proj and
Good relationship
Anawim –
with my drug
support me with
worker
everything
I self-referred
to Azaadi and
havent looked
back
Counsellor
Addaction – very
positive and good
follow-up
Azzadi has been
a great help to
me
Phoenix futures, day
structure – helped me with
new skills+tools (but not
child friendly)
Found 12 step was
very beneficial –
9months gave me long
enough to find a new
way to live without
drugs
DIP housing good
– got my flat
Referral by DIP
was the start
Had very good care
from mental health
Several drugs
Day care services
services experiences
give u structure and in diff places – usually
something to do
positive
I got clean and felt
positive and happy in
prison for 8 months
Pregnancy –
went to GP
who referred
me into
mother+baby
Methadone helps in
that can survive
without stealing
Mother+baby team
helped me get
clear before –
excellent
dedication of team
Forced into
Parents send me
detox in Dublin to Brum – stayed
(or kids taken
clean for 18
away)
months
DIP referral
worked well for me
Threats again to
take my kids
Self-referral
thru’ parents
Mum passed
away – self
referral into
Azzadi
DRUGS –
Self-referral,
played a
What helped? parents
role (death or
I self-referred
to Azaadi and
havent looked
back
DIP worker was
brilliant
Safe proj and
Good relationship
Anawim –
with my drug
support me with
worker
everything
force)
Individual
key worker was the
Counsellor
Azzadi has been
key
a great help to
Found 12 step was
very beneficial –
9months gave me long
enough to find a new
way to live without
drugs
12 step
me
Addaction – very
positive and good
follow-up
Phoenix futures, day
structure – helped me with
new skills+tools (but not
child friendly)
DIP housing good
– got my flat
Referral by DIP
was the start
Had very good care
from mental health
Several drugs
Day care services
services experiences
give u structure and in diff places – usually
something to do
positive
Its the service that
counts
I got clean and felt
positive and happy in
prison for 8 months
DIP referral
worked well for me
Clean in
prison
Pregnancy –
went to GP
who referred
me into
mother+baby
Methadon
e
Methadone helps in
that can survive
without stealing
Mother+baby team
helped me get
clear before –
excellent
dedication of team
Pregnancy and my
parents
Forced into
Parents
send me
detox in Dublin to Brum – stayed
(or kids taken
clean for 18
away)
months
Threats again to
take my kids
Self-referral
thru’ parents
Mum passed
away – self
referral into
Azzadi
Getting back with
other users
Found other
people using
drugs (went
looking for them)
Methadone
Other things
other than
methadone
(morphine,
pills/amps,
Df118s)
DRUGS – What hindered?
Doctors dont listen and
seem to want control.
They are happy to keep
you on script for as long
as possible
Doctors don’t want
to cut down meths
Chest infection –
got codeine and
started to seek
drugs again
Social services –
tried to take kids
and then dropped
me
Aftercare coming out
of prison was poor.
Worked hard for
3.5yrs, but no
support
Give a straight
detox in prison
Prison – lack of
help from drug
services, no
rehab
Prison was too easy
– no deterrent, not
enough help from
CARAT team
Came out of DIP
– not enough
support
DIP East – no
follow up around
relapse control
Swansell – drug
worker changed,
things went downhill
Workers in the
system get
moved around –
not enough
professionalism
Government
owned
services are
less capable
Waiting
time after
DIP is too
long
Waiting to go to
Mum+Baby rehab
– delayed by
child+fam
Summerhill terrace
– RRAT dont treat
individual
Too much free money –
unlikely to get job that
will pay enough to make
it worthwhile
Moving from JSA to
ESA can be
frustrating
Job Centre – didnt
help
No dry houses for
women
Penalised if you
have kids
Rehab was
forced on
me – I
wasn’t
ready for it
DRUGS – What hindered?
Getting back
with
Back
with
other users
wrong
Found other
people
using
people
drugs (went
looking for them)
Methadone
Other things
other than
methadone
(morphine,
pills/amps,
Df118s)
Doctors dont listen and
seem to want control.
They are happy to keep
you on script for as long
as possible
Doctors don’t want
to cut down meths
Govt owned
Workers in the
system get
servicesmoved
less
around –
goodnot enough
Government
owned
services are
less capable
Methadone and the
way it is prescribed
Codein
Chest
infection –
got codeine
e for and
started to seek
drugs
again
chest
Give a straight
detox in prison
Too much free money –
unlikely to get job that
will pay enough to make
it worthwhile
my
incentive
?
Prison was too easy
– no deterrent, not
Aftercare coming out
enough help from
of prison was poor.
CARAT team
Worked hard for
Prison – lack of
3.5yrs, but no
help from drug
support
services, no
rehab
Came out of DIP
Flexibility
in prison ?support
after
Change
d
worker
Swansell – drug
worker changed,
things went downhill
Moving from
Relats
andJSA to
ESA can be
frustrations
frustrating
Job Centre
– didnt
with
help
benefits
professionalism
RRAT
Summerhill terrace
not
– RRAT dont treat
individual
individua
l
What’s
More help
– not enough
DIP East
– no
coming
out
support
follow up around
of DIP
relapse control
Waiting
time
after –
Waiting
DIP is too
rehab,
long Waiting for rehab –
Waiting to go to
not enough space
mother/baby
Mum+Baby rehab
Rehab was
– delayed
forced on
andbyafter DIP
Not
child+fam
me – I
readywasn’t
for
ready for it
rehab
No dry houses for
SocialSocial
services –services
women
tried to take kids
and
families
and then dropped
Penalised if you
me
have kids
Alcohol Workshop
• Their aggregated journeys
• What does the system look like
• What would they change
21
Example Journey’s
Tightrope/balancing act
It’s a roll of the dice
Disaster awaits,
perhaps feels inevitable
Example Journey’s
The clock is ticking…
…is time running out
No chances, ‘dark clouds’
There is a ‘system’
but hard to break into it
With barriers along the way
38 yrs old. Female, Lives with 7yr son
Older 18yr son who’s left home
Customer Journeys
Ups and downs of the customer experience
1991
2000
2005
2008
Drank with friends at
home; family drink
dependent
Suicide
Attempt, A+E
Admission
Depression
Depression – drink
to cope with life
Argument with
rowdy neighbours
who stop her
sleeping after night
shifts
Medication
treatment from GP
Suicide Attempt,
A+E Admission;
detoxed
Unsure if
employer
support her
Depression
Relapsed upon
release from hospital
Caught in Abusive
Relationship
Humiliated
Arrest and sent to
hospital due to
sickness and shakes
Child in Need
meeting with
Social Worker
Motivated
to sort life
out
Worried
about
son’s care
Argument
with
Neighbours
Forced 9
day Detox
Relapsed upon
release from hospital
Seek additional
support for son
2nd
session
Book
appointment
at GP for
depression
Off sick with
depression
Relapsed upon
release from hospital
Controlled
drinking; Abuse
from neighbours
ongoing; Seeking
help from Housing
1st session;
Search for
activities
(dance)
Started drinking JD
with current partner
who's alcohol
dependant
Suicide Attempt,
A+E Admission
Key journey steps
2010
Social Services
Intervention
around child
Arrange
transfer
meeting
Relapsed
over
weekend
Agency Touch-points
Hospital
Hospital
Hospital
GP
Police
Hospital
Alcohol
Services
Alcohol
Services
Alcohol
Services
Social
Services
Social
Services
Social
Services
Housing
Education
Initial Views – the system
• No clear shared understanding across the system of what
works and what doesn’t work
• No clear relationship between customer outcomes and
service measurement / management
• No visibility of performance across the stakeholders
• and no Risks and benefits are not shared across partners
• Users believe there is a system, but providers / stakeholders
do not perceive a system
• Very heavy skew towards tier 3 – only about 5% is spent on
prevention
• Reliance upon fixed cost resource solutions, rather than
networking, training and information
• No pathways
• Very service and contract placement led
25
Initial Views – customers
• Using Advocate as a gateway to long-term recovery planning and
broader into public-service
• More flexibility in service consumption – allowing users to design
recovery pathway
– One size doesn’t fit all
– More aggressive reduction from methadone (drug-free wings in
prisons?)
– Encouraging more service user leadership and self support
(alcohol)
• Time / target interventions around life events such as bereavement,
child-birth and family break-up
• “Use my fear / pain”
• Earlier referral into the system – by GPs, Adult Social Care, Housing
• Use initial contacts to build relationship, rather than “fast-track”
• Evidence base for controlled drinking
26
The True Cost of Drugs in Birmingham – Per Annum
£15m
£??m
£33m
£2.3m
DAAT
£27.8m
£13.1m
Drug Treatment Provision
Pooled
Treatment
£5.6m
PCTs
£5.3m
Drug Intervention
Programme
£1.3m
Birmingham City
Council
£3.7m
•Police
•Adult Social
Services
•GPs
•Families
•Schools
•Mental
Health Trust
•Acute Trust
•Probation
•Prisons
•Housing
Advisory
Tier 1
Tier 2
•Single
Point of
Contact
•DATUS
Peer-led
Advocacy
•DIP (BCC)
•DIP
(ARW)
•Needle
Exchange
•Outreach
•Inreach
•Addaction
•DIP
CARAT
•Midland
Heart
•SADIE
•KIKIT
•BBV
Tier 3
Tier 4
•Community
Outreach
•GP
Prescribing
•CDT/DIP
Prescribing
•Swanswell
•Turning
Point
•Safe
project
•EESPro
•DRR
•Mother &
Baby
•Residentia
l Rehab
•Detox
•Structured
day care
£15.6m
£1.4m
£1.3m
DoH Tier 4 Grant
£357k
Other
£1.08m
£3.4m
Alcohol Treatment Provision
Tier 1
£3.8m
PCTs x 3
£250k
Safer Birmingham
(ring fenced)
£500k
•Social
Service
•GPs
•Housing
SPOC
•YOT
•Self
Referred
•Probation
•Police
•Community
•Alcohol
Team
•Mental
Health Trust
•Acute Trust
Advisory
•Freephon
e
•Pharmacy
•Support
Services
•Alcohol
Concern
•Self Help
Sessions
•(NACRO
& RAPT)
•GP
Screening
Birmingham City
Council
£???
£170k
Tier 2
Tier 3
Tier 4
•Community
Support
Sessions
•BNE
Erdington
Outreach
Worker
•Norman Imlah
Centre
•Arrest
Referral
Scheme
•Primary Care
Services
(alcohol
workers in GP
clinics
•Alcohol
workers in
hospital wards
•Aquarius
•Birmingha
m & Solihull
Mental
Health
Foundation
Trust
•In-patient
detox and
rehab
services
£1.2m
£2.4m
£738k
Summary Findings
• Limited insight into what works and what
doesn’t work
• No shared visibility of performance
• Service / contract system, not focused on
outcomes
– Does system drive cyclical dependency? – less than 5% is
spent on prevention
– We control the money…..No customer insight or control
over service consumption
– Budgets don’t relate to need, drugs disproportionately
greater than alcohol funding
Drug/Alcohol assessment against TP principles
Shared clarity of objectives
 Health and Crime engaged
 Minimal input elsewhere
Performance measuring against
genuine outcomes
 Totally lacking
Pooled budgets
 For treatment
 Not for prevention
Shared responsibility and
accountability for outcomes
 NI indicators for LSP
 Limited cascade to drive outcomes
Joined-up commissioning of services
 For treatment
 Not for prevention
Services wrapped-around customer
needs
 Health management focused, not need
or outcome driven
Sharing of information
 Parochial record keeping, is this in the
customers’ best interests
Personalised for efficiency and
effectiveness
 Limited, predominantly one-size fits all
Key Recommendations – Drugs and Alcohol
• Make sustainable and incremental
improvements in Drugs and Alcohol services,
moving towards Total Place approach
– Establish outcome tracking and service demand
– Drive transformation through a number of pilots
– Undertake review and tightening of all contracts
and the DAAT operation
Service Redesign Pilots
Ideas….
Future System?
Baseline Evidence
Prevention
Emerging
Need
Service
Provision
Severe or
Acute
Need
Targeting
Strategic
assessment
of Service
Demand
and
Provision
Insight into
location,
volumes and
people’s
wider
Pilots
Monitoring
Drugs and Alcohol Data Map
Prescribing
Data
Case
Management
Case Files
A+E Admissions
flagged for
Substance
Aggregate Hospital
Episodes
NHS Business
Services
Drug & Alcohol
Service Providers
Hospital
Records
Public Health
Mortality Files
Hospitals
PCTs
Health
DAAT
Substance
Services
Mental Health
Trust
Monitoring
NDTMS
SPOC Call
Centre
Needle Exchange
Commissioning
BHWP
WMPHO
Service Provider
Commissioning
Public
Services
BCC
Revs / Bens
Housing
(Northgate)
(SX3)
Adults
(CareFirst)
GPs
Case Files for
Patients
Opinion
Survey
Prison
Courts
Prison
Records
Sentencing
Records
Children
(CareFirst)
Justice
Probation
Emergency
Services
DIP
Accredited
Programmes
Fire
Police
Arrest Out of
Hours Calls
(IAPS)
Offender
Assessment
(OASys)
DIP
Referrals
Incidents
Crime
Arrest
Advocates to Join Up Services toward Desired Outcomes
Prevent
Detect (incl. CJS)
Treatment
Positive Outcomes
Present
•
•
Mis-users bounce around the public sector with great inefficiency and ineffectiveness
Sorting out their wider issues helps address their substance mis-use problem
Keyworker as
advocate to broadest
service offering
Future
Benefits
Shorten treatment
cycles by addressing
contextual factors
Increase Efficiency and Effectiveness of Service Delivery
Effort
Social Media Support Network
Prevent
Detect (incl. CJS)
Treatment
Positive Outcomes
Present
•
•
Alcohol misusers develop dependency on Tier 3 service consumption
Long term clients absorbing too much resource
Commissioning on Outcomes
e.g.
•
•
Bonus for anniversary of positive outcomes
Reducing payments for very long term
clients
Social Media Self-Help
Mutual support network for the
alcohol mis-user community
Future
Benefits
Reduced dependency
based service cost
Effort
Self Directed Personalised Support - drugs
Prevent
Detect (incl. CJS)
Treatment
Positive Outcomes
Present
•
•
•
Failed treatment cycles
Lack of personalisation
Reduced ownership
Self design
packages of
support
Future
Benefits
Increase ownership
and reduce number
of failed cycles
Effort
Service Redesign Pilots
• Advocates to Join Up Services toward
Desired Outcomes
• Social Media Support Network - alcohol
• Self Directed Personalised Support - drugs
• Life Event Triggered Interventions around
Customer Need
• Local Commissioning to Drive Service
Efficiencies
• Local Culture Change to Drinking
Next Steps
• Total Place Continues
– Progress ‘Birmingham Budget’
– 5 principles
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•
•
•
•
Transformation
Prevention
Personalisation
Collaboration
Self sufficiency / reduced dependency
• Specific to Drugs and Alcohol
– Drugs – “In Control” Manage change and design how to
make flexibility an intrinsic part of the ‘system’.
– Alcohol – Social Media
Birmingham Total Place Pilot
Drugs and Alcohol Customer Insight
Steve Rose – Birmingham City Council
Simon Dickinson – Aperia
Neil Mackin - CACI