Alcohol and Drugs Consultation Summary report

This report presents the results of a consultation carried out with professional and non- professional stakeholders in Stockton-on-Tees on the subject of alcohol, substances and treatment services. The study was commissioned by Public Health Stockton and it was conducted by an independent social research organisation¹ between December 2018 and March 2019. The consultation used a mixed methodology comprising qualitative and quantitative approaches. Quantitative methods consisted of questionnaires² developed by Public Health and distributed to three stakeholder groups across Stockton between January and February 2019: professional organisations; general public; and local councillors. Qualitative methods consisted of focus group and one-to-one interviews, face-to-face and telephone, which were held in local venues across Stockton with a range of identity and interest groups and their representatives, e.g. service users, carers, BAME, LGBT and older people.

¹ Barefoot research

² Copies of the questionnaires used can be provided on request (they are not attached as appendices as a result of their length). 

To summarise findings from the quantitative professional stakeholder consultation data, the following points emerge:

• Knowledge of services: respondents were more aware of drug compared to alcohol services. Just over one third of respondents from the professional stakeholder group felt informed about alcohol services in the community; and just under two thirds reported that they did not feel informed. The most well-known services were those of drug treatment, with 60% of stakeholders being informed of what was available.
• Service performance indicators: most key indicators for adults, such as making a referral and waiting times, were reported to be satisfactory, with the exception of feedback, for both services, which was unsatisfactory. Feedback was reported to happen more often in services for young people.
• Service strengths and weaknesses: there were relatively high satisfaction levels for service location, confidentiality and staff, and lower levels for childcare and age appropriate nature of services.
• Method of information delivery/communication: there was a preference for web-based communications but respondents were also supportive of a range of methods and media types including leaflets and radio.
• Service delivery method: the three most popular delivery methods were face-to-face, telephone and text. The most preferred method was face-to-face and the least was video- link.
• Service delivery venues:there was support for delivery of services from a number of venue types, although there were differences in venue choice between alcohol and drugs: with the former showing the highest support for GP delivery, followed by other locations in the community; and the latter showing high support for delivery in the community, including from youth services, pharmacies and GP practices. Respondents also added outreach in their 'other' free text category in the questionnaire.
• Service integration: for respondents who delivered services, it was reported that alcohol and drug services were integrated into existing services. The data showed a more positive response from alcohol compared to drug services.
• Working together: a significantly higher number of respondents reported that they were working together with other organisations, in relation to sharing information, producing a joint care plan and providing joint support, as opposed to not cooperating.
• Meeting needs of groups with protected characteristics: although there were a relatively high number of respondents who felt unable to comment, many stakeholders felt they were meeting the needs of groups with protected characteristics which included women, disabled people, LGBT and BAME (this is not the same as the qualitative findings).
• Training needs: there were felt to be training needs amongst respondents with just over 50% of respondents requiring alcohol training and 60% of respondents requiring drug- related training. There was an even response from respondents about the format of training, with approximately 30% of respondents preferring multi agency, bespoke team and online alcohol and drugs training, and approximately 20% requesting printed training material.

Using the quantitative consultation data from the general public(incorporating elected members) questionnaires, we make the following findings:

• Councillors and constituents: two thirds of all councillors who responded said that alcohol-related issues were raised by their constituents, and 90% of elected members said that drugs-related issues were raised. The majority of the alcohol-related issues related to youth disorder and antisocial behaviour; and the drug-related issues included antisocial behaviour, drug dealing and violence.
• Information and support:most people access information about problematic alcohol or drug use from the Internet, followed by the current treatment provider, which is followed by work colleagues. In relation to accessing support, respondents reported the most likely place they would go, included GP practices, the current treatment provider and pharmacies.
• Service barriers: the largest barriers causing people not to use services, were people not knowing about what services were available, followed by the stigma associated with alcohol and drug use, which was followed by a long wait for an appointment time.
• Improvement proposals:there were two main proposals from the general public about how to improve services. The first of these was more preventative work through education and awareness raising about the effects of problematic alcohol and drug use, and the treatment services available. The second proposal was publicity on the range of treatment services available and where and how to access them.

From the thematic analysis of the narrative data produced from the indepth focus group and one-to-one interviews, we make the following findings:

• Knowledge of services: all of the interest groups who were consulted reported that they had limited knowledge of which services existed, where these were and how they could be accessed. Increasing this awareness was one of the most popular recommendations for continuing service.
• Experience of services: there were a range of experiences expressed by current, past and possibly future service users and their carers/families in relation to the current treatment provider. A high proportion of service users consulted, reported being satisfied with servicesthey receive from the current provider. Contrasting this, was the view from ex- service users, those not in treatment and other carers. Feedback has been taken on board by commissioners as part of service improvement planning.
• Mental health: a theme throughout the consultation has been the link between alcohol and substances and poor mental health and respondents reported how strongly connected and widespread both issues were in local communities. Feedback was mixed with regard to dual diagnosis and satisfaction with provision once clients have accessed mental health services. Areas for improving access to care were identified.
• Partnership working and communication:there were a number of discussion points relating to the level of involvement and cooperation between partner organisations. It was felt that there were several shared objectives and areas of mutual advantage between partner agencies, e.g. health, housing and criminal justice. There were a number of reports of positive experiences of cooperation. However, there was a particular strand within this theme of problems with information sharing. Respondents reported that much would be gained from improving feedback and communication, and current mechanisms could be inadequate.
• Prison-related issues:during this consultation, prison-related issues were raised on several occasions. The first of these were concerns raised by prison-based services about continuity of carefor vulnerable people leaving prison. There were also expressions of concern about substitute prescription transitions. However, it was reported that a new, multiagency taskforce had been set up, to look into this issue.
• Raising awareness: during the consultation, stakeholders were asked for their proposals and suggestions about how to improve service and the situation. Raising awareness of serviceswas first on most people's suggestions in order to address gaps in knowledge and understanding of what is available, both for the general public and for professionals. Most stakeholders reported the need to invest in educationand prevention, both in schools and the wider community, about the effects of alcohol and drugs
• Service improvements: there were a number of suggestions for service improvements, starting with outreach: It was felt that incorporating elements of outreach and home visiting could make the service more inclusive and enable it to be brought to more isolated and/or excluded people, e.g. those with mental health problems, and any others who are discouraged from attending the current delivery venues. This may also address a difficulty of accessing people outside existing treatment services, where there is currently a deficit. There were calls from a number of different stakeholders for an extension of service hoursto beyond the standard nine to five.
• Training: there were several knowledge deficit areas that were identified, which respondents felt could be addressed through training. Training was proposed for pharmacy staff in alcohol awareness and cessation; frontline workers (including doctors) in health and treatment services in both mental health awareness and implicit (or unconscious) bias.

The consultation has received input from a diverse range of stakeholders and there has been a positive engagement response, i.e. groups were enthusiastic about being involved and were grateful to have been consulted. Stakeholder groups are invested in the topic as a result of its relevance to individuals and communities across the borough. The effects of alcohol and substance misuse are perhaps more visible in Stockton compared to other areas as a result of the prison, treatment services and hostels in close proximity to the city centre, which provides concentrated populations of people with treatment needs. There are also other local characteristics relating to substance misuse, not shared by other North East localities, such as a street sex market which is mostly driven by substance misuse (i.e. sex for money for drugs). As well as groups with significant treatment needs, e.g. substitute prescriptions, there is also alcohol and substance misuse in populations of disadvantage, which contributes to the creation of local health inequalities. There may also be a personal imperative from stakeholders who may have issues themselves, or have a family member or loved one who may have treatment needs. There is therefore a selection of needs from a range of communities, which additionally includes the needs of groups with protected characteristics. The challenge is to adequately and effectively provide for those range of needs, which is unlikely to happen unilaterally.

The consultation actively sought out and engaged with alcohol and drug users, living in hostel accommodation and accessing local treatment services. During the discussions, it was identified that the localities which hold these populations, provide as much as an opportunity, for treatment and recovery, as they do a threat, from alcohol and drug-related antisocial behaviour/public disorder. As there is limited service user involvement in current treatment services, we think it would be worthwhile for service development to further look into the opportunity that this presents with service users. This should use a participatory development/coproduction framework and an asset-based, community-centred approach, to investigate needs and response, and importantly to stimulate a service user response.

The views expressed in this report are those of Dr Christopher Hartworth of Barefoot Research and Evaluation and may not necessarily be those of Public Health Stockton on Tees.