REDCAR AND CLEVELAND ADULT DRUGS JOINT COMMISSIONING GROUP

Minutes of meeting held September 11th 2008

ATTENDED

Terry Doyle Service User Co-ordinator

Sue Cash PCT Public Health Lead PCT

Helen Armstrong SCP Co-ordinator (Drugs)

John Liddell NTA Deputy Regional Manager

Susan Pashley Service Development Manager, R & C PCT

Jacqui Parker PCT Finance

Russell Portues Assistant Director Probation

Deborah Ward Data Manager, Safer Middlesbrough Partnership

1. APOLOGIES:

Simon Dale Chair of R & C Safer Communities Partnership and Chair of JCG

Peter Price Director of Public Health PCT

Viki Whelan Joint Commissioning Manager, R & C PCT

Pauline Lisle Supporting People

Rob Orrell Young Persons Manager

Richard Parker Reducing Re-offending Manager

Mary Mohan Local Authority Commissioning (Mental Health)

Ken McGladrie Local Authority Commissioning (Mental Health)

Introductions were made and Sue Cash chaired the meeting as Vice chair in the absence of Peter Price. Sue Cash requested that Finance to be moved to agenda item 6.

2. MINUTES OF LAST MEETING

Agreed

Viki Whelan has contacted the Police and Darren Birkett has forwarded this to the superintendent who will then notify the JCG of the new police representative.

Two meetings had been set to discuss the commissioning team structure, however Simon Dale had been unable to attend on both occasions. Another meeting will be re-established and the proposed structure will come to the next JCG. Action: Sue Cash. Peter Price has already met with GONE and NTA for their thoughts. Due to the delay, arrangements to extend Deborah Doherty's and Viki Whelan contracts to either December 08 or March 09 will need to be undertaken. Action: Sue Cash

Peter Price suggested that Viki Whelan engage with the Practice Based Commissioning Groups as an avenue to gain feedback. Viki Whelan has now been invited to the Langbaurgh and Eston Practice Based Commissioning GP meetings in October 2008.

Dual Diagnosis: Viki Whelan has met with Ken McGladrie and Viki now has a contact name within the Creative Support team to discuss care pathways/referral routes.

Under item 7, the lease is ongoing between Redcar & Cleveland BC and the PCT.

Regarding Intensive DIP status, this proposal was well received at the SCP. It will be submitted to the LSP on Friday 12^th September 2008.

Susan Pashley to check with Viki that John Stamp was invited to the JCG as he did not turn up for the meeting. Action: Susan Pashley.

All other matters appear on this month's agenda.

4. ELECTION OF NEW CHAIR

Sue Cash felt that it was not appropriate to elect a new chair given the lack of representation at the JCG. She reiterated that Peter Price had already agreed to be chair of the JCG. JCG members agreed that the group will formally nominate and confirm Peter Price as the chair at the next JCG meeting. Action: Sue Cash.

5. ALCOHOL PAPER

The paper was circulated which aims to raise awareness around the responsibilities of the JCG around the treatment agenda for alcohol. A few key areas were highlighted: there are no monies currently allocated for residential rehabilitation for 2008/09, there is a shortfall of £40,517 in the current adult treatment alcohol budget and a potential minimum £166,000 shortfall for 2009/10. Also noted was the £35k for an alcohol commissioning team.

The recommendations of the report are as follows: for the JCG to accept and ratify the alcohol budget, the JCG to accept the overview of commissioning adult alcohol services, to consider the procurement of a new service and to secure future funding.

Sue Cash stated that the JCG need to have a discussion about the local model that we want to see in place and that any new service must be needs based.

Helen Armstrong suggested that an alcohol treatment plan similar to the drugs one would be useful. Terry Doyle highlighted that service users were unhappy that there are currently no complimentary therapies for alcohol clients. For the next meeting, Sue Cash suggested to put together a paper on a proposed model of care for alcohol based on the needs assessment. Action: Peter Price/Sue Cash to discuss paper to develop a plan for the next JCG

6. FINANCE- JACQUI PARKER

Please see attached report for detail. The following areas were highlighted:

Jacqui circulated the correctly formatted finance report at the JCG and stated that Viki had circulated the internal PCT report. JCG members agreed the format of the report. The report highlights the main forecasts with supporting detail which will be produced on a quarterly basis.

The underspend at the end of the year is likely to be £74k including £42k from 2007/08. This links into the bidding application document for the underspend. The underspend is predominantly slippage from vacant posts and there are no risks on the DAT budget.

Helen Armstrong queried the £100k difference. Jacqui Parker to clarify budget with Helen outside of the meeting. Action: Jacqui Parker.

There is a pressure shortfall of £65k on the alcohol budget with £165k recurring budget. This projection is based on best case scenario. At the year end though, it may only be circa £9k as there could be slippage from the North East alcohol service. Peter Price has agreed that this slippage can go towards offsetting the pressures.

David Jackson has got the information on the proposed LES contract for alcohol. There should be more clarification around the LES at the next JCG. Action: Jacqui Parker/Susan Pashley.

Funding Proforma

The funding proforma was circulated to JCG members for approval prior to distribution to agencies. Jacqui Parker suggested that project completion time should read by 31^st March 2009. Deborah Doherty requested clarification around the difference between `needs assessment' being an eligible use of funding to research projects being ineligible.

Sue Cash felt that the JCG should be directing money at what areas are underperforming and suggested that the proforma is too loose and not focus enough.

John Liddell suggested improving the indicators around harm minimisation, namely three areas: Hep C, care plan discharges and healthcare assessments. Providers could then be asked how they would then meet these objectives. Deborah Doherty felt that some of this was around filling in NDTMS forms appropriately.

Hep C campaign was felt to be a good idea by the JCG as it has already been raised at the regional service user meeting. Terry Doyle felt that there is also a need to encourage people to fully engage in treatment by funding peer mentoring. He felt that peer mentoring could be undertaken through CRI's structure and that it is in everyone's interest to deliver. Terry Doyle thought that they could work innovatively with CRI but that there would have to be careful performance management. Three proposals/priorities are to be distributed to seek ideas to deliver improvements in the following areas: Hep C testing take up rates, peer mentoring and reducing the high number of unplanned discharges.

At the DRR process mapping event, gaps in service provision were highlighted. Susan Pashley is to liaise with Russell Portues, draw up a paper with objectives (for spending the £74k confirmed slippage) and circulate for comment to JCG members prior to distribution to agencies. Action: Susan Pashley/Russell Portues. A deadline for agencies to respond by must be detailed so that it can be brought back to the October JCG. John Liddell did state that it is difficult to put in a single issue to address unplanned discharges as this is a reflection of the entire system. Hence only two priorities now to be detailed: Hep C and peer mentoring.

CRI Accommodation

A proposal paper by CRI was circulated detailing a shortfall in funding for their new premises.

CRI has already been awarded circa £27,000 set up costs from last year's underspend (07/08) to originally refurbish accommodation at East Avenue. This project fell through and they have subsequently secured accommodation on the High Street in Redcar. CRI has received three quotes for refurbishment, the cheapest quote being circa £47,000. The report requests assistance from the JCG in two ways. Firstly, they have identified £10,700 underspend in their budget against service development and the manager's salary. They have requested the JCG to agree the use of their underspend for the refurbishment and are asking to bid for an additional £15,531 shortfall from this year's pooled budget underspend to cover refurbishment costs.

CRI cannot start the work until the funding is agreed. If they have some indication from the JCG that they might be successful in their bid, then they would be able to start some work.

Money is still detailed for IT equipment as their current server is not compatible with POPPIE. There is also a hold on the recruiting of the part time Supporting People post. Helen Armstrong requested clarity around the status of the Supporting People posts at the next JCG. Action: Viki Whelan. There has been service user and agency disquiet regarding the workers.

Sue Cash requested to know the current funding arrangements for CRI.

CRI's current contract is for circa £264k, however year to date they have received the following additional funds: £27k 07/08 underspend for set up costs, £35k for counselling (Albert Centre), £45k for housing workers, £10k for POPPIE and £27.5k for psychosocial support.

John Liddell stated that service providers should share risk, i.e. accommodation and that there is a need to sit down with CRI and look at what they should be delivering and why they are still requesting more funding. Their ability to deliver was raised by the JCG. CRI is currently housed in Lifeline's building.

The issue of lack of NDTMS data was raised as a barrier to evidencing performance. Currently CRI has 182 on the caseload, most clients are retained in treatment, waiting times are not a problem and there are few unplanned discharges. There has been resistance however from other treatment agencies to work with them in partnership. The JCG felt that it is not an issue of money but about getting the system to work.

CRI now has a local Manager as Matt Lancaster has resigned. The NTA said that the Commissioning Manager needs to take a hard line with CRI contractually. Action: Viki Whelan.

The JCG response to CRI's request for funding is as follows: the JCG's considered response it to only approve the use of CRI's slippage. Action: Susan Pashley to draft a stern letter to CRI detailing that they can use the slippage as long as the service is not jeopardised and send to Peter Price/Sue Cash for approval prior to distribution.

The JCG requested regular reports on the performance management of CRI and the NTA stated that they would be happy to attend such meetings with Viki Whelan. Action: Viki Whelan.

Regarding moving forward with the young person's funding shortfall, Sue Cash requested a paper from Mark Gray detailing the proposed use of £15k and how it would compliment services. Action: Helen Armstrong to inform Mark Gray.

7. LSP PERFORMANCE PLANNING REPORTING

The JCG has a duty to report to the LSP via the Safer Communities Performance Planning Group (PPG). The report has been circulated for the JCG to agree to the new reporting format and give their consent/authority to report all required info/data to the PPG.

Since the circulation of this report, the PPG have met and have now suggested a twice yearly in depth presentation/themed report on cross cutting issues. Action: Helen Armstrong to speak with Dave Sneddon to seek clarity on whether there is a monthly data requirement from the JCG to the PPG.

8. TREATMENT PLAN - EXCEPTION REPORT

Please see attached copy of the circulated treatment plan exception report. The following issues were raised.

Page 2, relocation: Sue Perkin wants the rooms back as she now has an additional two smoking cessation workers to house. Sue Cash suggested Susan Pashley to ring Malcolm Bridon for an update on the lease signing. Action: Susan Pashley.

Page 3: Tier 4 update to be a priority at the next JCG. Action: Susan Pashley.

Page 4: Action: Susan Pashley to clarify with Viki Whelan the need to develop training needs action plan for Tiers 1 and 2.

Helen Armstrong requested that the National Drugs Strategy local treatment action be inserted into page 19 of the drugs treatment plan. Action: Susan Pashley to liaise with Helen Armstrong.

9. HEALTHCARE COMMISSION AUDIT RESULTS

Details of the provisional HCC results report for diversity and Tier 4 were circulated to JCG members for information.

The results allow local partnerships and tier 4 providers to review them against the scoring methodology, check the data and submit any ratification/extenuating circumstances request.

Redcar & Cleveland Partnership has received a provisional `good' status with us scoring almost equal scores for diversity and Tier 4.

John Liddell pointed out that the system uses a sliding scale and that it is worth checking the scores. Action: Susan Pashley to liaise with David Jackson.

10. PERFORMANCE MONITORING

The NTA Q1 review/performance report was circulated. The NTA in the report commented that Redcar has made a positive start to 08/09 in terms of progress against the treatment plan, HCC Action plan and planning grids. They highlighted the temporary structure of the commissioning team as a barrier to delivery and poor DRR performance.

There are currently an indicative 714 PDUs in treatment although we have no data as yet to support this statement.

Section 4 details mixed results with poor performance against Hep C testing and healthcare assessments.

The PPG is a bit concerned about the lack of NDTMS data. John Liddell said that by quarter 2 the data should start to come through to partnerships. The current figures are only indicative based on last year.

Deborah Doherty explained that the Q1 report is last year's data. The percentage retained for twelve weeks or more is 75% with 38% completed care planned discharge rate and 97% of clients waiting three weeks or less. There have been 85 individuals in the first three months undertaking a new treatment journey. Data concerns still remain around BBV data, particularly Hep C. 55% of clients have had a Hep B vaccination but only 25% have had a Hep C test. Data problems still exist around healthcare assessments which currently stand at 42%. Care plans started stand at 100%, however there is a need to look at quality. Action: Viki Whelan.

DIP CASELOAD AND COMPACT TARGETS

Intensive DIP status.

A report was given to the SCP Executive group who gave their support prior to it being submitted to the LSP. There is no further update as Richard Parker is on annual leave.

DRR - RUSSELL PORTUES

A process mapping event took place on 29th August 2008 around the care pathway processes and DRRs with a view to increasing DRR numbers.

DRR performance still remains poor, particularly around starts with only an actual cumulative total of 9 to the end of August 2008. It is doubtful that the ground will be made up to achieve the end of year target of 90 starts. From 1^st October 2008, Richard Parker will take over the management of DRRs.

There is better news on completions with an accumulative total of 10 against a target of 14. The target completions for the year are 35. There have been previous data errors with some DRRs being recorded as Middlesbrough instead of Redcar & Cleveland. One of the sticking points with local DRRs is Guisborough Court. Nationally, courts have been targeted with improving timeliness and therefore they have been moving offenders straight to sentencing.

Viki Whelan had asked Susan Pashley to raise that anecdotally DRR stats had been incorrect for the last two years. Russell Portues stated that DRR stats are correct now.

11. SERVICE USER UPDATE - TERRY DOYLE

Terry Doyle's service user and co-ordinator report was circulated with the agenda. Terry gave an update against the report highlighting the following areas/issues.

Terry Doyle is impressed with the development of service user groups following the recent regional meeting in the North East.

He highlighted that national independent research had been undertaken to show that service users change when they want to change with minimal interference. He did however feel it appropriate for people to be encouraged.

He is optimistic that when ReCovery move in with CRI that things will improve as they will have a drop in facility. Being referred onto the support group/peer support could be part of a planned discharge.

The Helen Project is still waiting to move in with Lifeline.

12. AOB

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Mark Gray Young People's lead is to be invited to attend future meetings in the absence of Rob Orrell. Action: Viki Whelan.

Results of the Darzi practices public consultation can now be viewed on the Redcar & Cleveland PCT website.

A regional harm reduction event will take place at Hardwick Hall on 13^th November 2008 which is the same date as our November JCG. Partnership representatives are encouraged to attend.

Alcohol user representation on the JCG has been raised within local support group networks for discussion.

The next regional carer event will take place in Eston City Learning Centre at 11am on 25^th September 2008. All are welcome. The Chairperson of the group Mandy Czimer wishes to attend but is not able due to lack of holidays/financial work commitments. She requested if the JCG would pay the day's wage so that she is able to represent the Helen Project at the regional carer forum being held in our partnership area.

The annual Drug and Alcohol Awareness day (DAAD) will take place in Redcar High Street on Saturday 20^th September 2008.

NEXT MEETING TO BE HELD AT 1PM ON THURSDAY 9^TH OCTOBER 2008 IN THE BOARD ROOM AT LANGBAURGH HOUSE, GUISBOROUGH