Transcript Document

Updating the NICE NSP Guidance
Chris Carmona, Public Health Analyst
Centre for Public Health
Plan
• Rationale for the update
• The draft NSP recommendations
• Changes from the original guidance
• Implementation issues
• Questions.
UPDATING THE GUIDANCE
Process
• Guidance was published in Feb 2009 and was
reviewed in Apr 2012
• An expert group considered whether any new
evidence or significant changes in policy and
practice would be likely to lead to substantively
different recommendations.
• The proposal of the expert group was consulted
on publicly.
• On the basis of consultation and expert opinion,
NICE decide whether or not to update the
guidance.
Decision
The review process concluded that:
• There was no new evidence to contradict
the current recommendations
• There was new evidence that could add to
existing recommendations
• There was new evidence that could
expand the previous work to more fully
meet the scope
• NICE decided to undertake an update of
the existing NSP guidance.
• Following the expert group and
consultation, the update focussed on:
– New evidence related to existing
recommendations
– Vending machines, outreach, drop boxes.
– NSP provision to PIED users
– NSP provision to under 18s
Drafting the giuidance
• CPH commissioned reviews of the
evidence.
• A public health advisory committee
(PHAC) considered the evidence.
• On the basis of the evidence and public
consultation they drafted new
recommendations and updated old
recommendations.
ORIGINAL
RECOMMENDATIONS
Recommendation 1 Planning, needs
assessment and community engagement
• Look at local need and local data on use
and geographic spread (including
estimating coverage)
• Make sure NSPs are configured to meet
this need both temporally and spatially
• Do all of this in consultation with PWID
and local communities
Recommendation 2 Meeting need
• Commission a range of generic and
targeted services that aim to increase
coverage (ideally to over 100%)
• Develop strategies for disposing of dirty
needles safely
• Encourage syringe identification schemes
• Audit services
• Integrated care pathways.
Recommendation 3 Types of service
• Set up a 3-tier model of service provision
• Make sure services are co-ordinated to
provide good temporal coverage in each
24 hour period.
• Make sure people who are on OST can
also get clean needles and syringes.
3 tier model of NSP provision
– level one: distribution of injecting equipment either
loose or in packs, with written information on harm
reduction (for example, on safer injecting or overdose
prevention)
– level two: distribution of ‘pick and mix’ (bespoke)
injecting equipment plus health promotion advice
(including advice and information on how to reduce
the harms caused by injecting drugs)
– level three: level two plus provision of, or referral to,
specialist services (for example, vaccinations, drug
treatment and secondary care).
Recommendation 4 Equipment and
advice
• Provide people with as many needles and
syringes as they need, without arbitrary
limitation.
• Provide them with sharps bins
• Provide them with other equipment they
need to safely take drugs
• Provide them with information and a
gateway to services
Recommendation 5 Community
pharmacy-based NSPs
• Make sure staff are appropriately trained
for the level of NSP work they’re doing
• Collect used sharps bins
• Offer staff Hep B vaccination
Recommendation 6 Specialist NSPs:
level three services
In addition to the above,
• Offer a range of needles, syringes and equipment.
• Provide harm-reduction services
– advice on safer injecting practices, assessment of injection-site
infections,
– advice on preventing overdoses and
– help to stop injecting drugs.
• Where appropriate, offer a referral to opioid substitution
therapy services.
• Offer (or help people to access) a range of health and
welfare services.
WHATS NEW?
Caveat
The updated guidance is still not fully signed
off so I am unable to share with you the
exact wording and content, and anything
that I say today may change during the final
sign off processes within NICE.
The final decisions will be made in mid Feb
and the guidance will be published on March
26th 2014.
Whats new?
• There are two completely new
recommendations.
• There are some notable additions to
recommendations.
• The early recommendations have been
reorganised to make them more logical.
Developing a policy for young
people aged under 16
•
•
Requires local areas to develop and implement a policy on providing NSP
and related services to young people aged under 18 (including young
people under 16).
Asks how local services will achieve the right balance between the
imperative to provide young people with injecting equipment and the duty to
safeguard them and provide advice on harm reduction and other services. It
includes:
–
–
–
–
•
•
the young person’s capacity to consent
the risks they face
the benefits of them using services
the likelihood that they would inject anyway, even if equipment was not provided.
Provide NSP as part of a package of care (esp to under 16s) where
possible.
Offers some ideas about the things local areas will need to consider, for
example consent, parental involvement, specialist substance misuse
services for YP, training needs
Provide equipment and advice
to people who inject IPED
• Ensure needle and syringe programmes:
– Are provided at times and in places that meet the needs of people who
inject IPED. (For example, outside normal working hours or outreach in
gyms.)
– Provide the equipment, information and advice needed to support these
users.
– Are provided by appropriately trained staff
• Specialist NSPs with high numbers of IPED users should provide
specialist services for them. It includes:
– specialist advice about IPED and side effects (stacking/cycling etc)
– advice on alternatives (for example, nutrition and physical training as an
alternative to AAS)
– information about, and referral to, sexual and mental health services
and to specialist IPED clinics, if these exist locally.
Notable additions
• “Not discourage secondary distribution”
• “Where possible, provide low dead space
syringes”
• More points about data collection and
monitoring.
• Consider drop boxes (in consultation with police
and communities)
• Consider whether NSVM might be appropriate
IMPLEMENTATION
NICE Guidance support
• Costing and Commissioning tools
• Press and dissemination
• Linking with national policies and systems
- potential collaboration with PHE
• Good practice case studies
Communications support
• Filming – in house filming of a needle exchange program
for the NICE website.
• Interviews with experts for the NICE website
• Opportunities for the press to film on location
• Press work with national media channels
• Press release
Contact [email protected]
Lyndsey Unwin: Media Relations lead
Into practice: case studies
Please contact: [email protected]
Senior Implementation Adviser
Please let us know about any local work underway where:
1. It has generated consultation with:
BME communities; or men who have sex with men; or emerging
populations e.g. people injecting ‘legal highs’
2. Local policies/protocols addressing NX provision for young people
3. Services are delivering needle exchange (NX) for IPEDs users
4. NX in settings: custody suites; GUM clinics; or A&E depts.
5. Community pharmacies are integrated into local planning and
pathways for NSPs
Thank you.
Chris Carmona: Lead analyst
[email protected]
Mandy Harling: Senior Implementation
Adviser [email protected]
Lyndsey Unwin: Media Relations lead
[email protected]