The 10-year drug strategy: Norfolk County Council

Norfolk's drug strategy implementation benefits from both national-level support and local partnerships that focus on addressing both alcohol and drug-related challenges. The absence of an up-to-date alcohol strategy at the national level is noted, but locally, efforts encompass both alcohol and drugs. Norfolk has received valuable guidance from the Office for Health Improvement and Disparities (OHID) regarding treatment and recovery outcomes, facilitating improvements in treatment numbers and continuity of care from prison to the community.

The establishment of effective governance structures, overseen by the health and wellbeing board, provides senior political oversight for the strategy, ensuring robust implementation. Norfolk's previous involvement as a project ADDER site has afforded it a head start in preparation for the 10-year drug strategy implementation, with positive operational partnership working and adapted governance structures to meet the strategy's requirements.

Norfolk received a visit from Dame Carol Black and Claire Murdock, NHSE National Mental Health Director, which included engagements with key stakeholders and service users. This visible leadership played a significant role in energising efforts to improve provision for those with both substance misuse and mental health issues (dual diagnosis) in Norfolk, an element of the national drug strategy. The development of pathways is bolstered by strong support for the dual diagnosis approach from the local integrated care board and other partners, addressing the wider implications and interdependencies between drug use and mental health conditions. 

Ongoing workforce analysis is being conducted, alongside efforts to provide system-wide education and development opportunities, including for a significant number of staff new to drug treatment work. Efforts are underway to ensure that mental health training is provided to drug treatment and recovery workers, and substance misuse training for mental health workers, enhancing their capacity to effectively support service users. Service users have been a key part of this workstream.

Norfolk has faced challenges with drug-related deaths, initially exceeding the national average but showing signs of improvement as they began to align with national averages. However, recent data from the Office of National Statistics indicates a concerning increase towards previous levels. Conversely, alcohol-related deaths in Norfolk are below the national average. These trends highlight the ongoing need for robust strategies and interventions to address substance misuse and related fatalities effectively. Norfolk has taken proactive steps to address drug and alcohol-related deaths by establishing a dedicated panel to identify themes and learn from such scenarios. This initiative underscores the commitment to continuous improvement and learning within the county.

Furthermore, collaborative arrangements have been forged between the council, ambulance service, and police to facilitate data sharing, particularly regarding the emergence of synthetic opioids like nitazenes. Nasal naloxone is also carried by frontline police officers on a voluntary basis. This demonstrates strong partnership working and a rapid response to the evolving landscape of synthetic drugs.

Real-time data sharing has enabled prompt police responses in shutting down supply chains. The comprehensive data work done by the police during enforcement is also used to identify those users who may require support from partner agencies, signposting them appropriately to get help for their substance misuse issues. Despite the politically sensitive nature of messaging around synthetic drugs, there is strong local support within the council to disseminate press releases and raise awareness of the dangers and guidelines associated with these substances, exemplifying a proactive approach to harm reduction.

The collaboration between Public Health, Norfolk Constabulary and the Office of the Police and Crime Commissioner in Norfolk has led to the establishment of a dedicated manager role aimed at providing comprehensive system-wide coordination. This joint funding initiative underscores the recognition of the interconnected nature of drug-related challenges and serious violence. By closely aligning with the serious violence duty team, the manager role facilitates strengthened relationships and the sharing of valuable insights and best practices. Importantly, this approach ensures shared responsibility for the strategy, reducing over-reliance on any single entity, such as public health, to meet all requirements effectively.

In Norfolk, training efforts are primarily targeted at staff working directly on the ground, ensuring they possess the necessary skills and knowledge to effectively address drug and alcohol related challenges. A notable method for implementing cross-training initiatives is through peer-to-peer training across various organisations. This approach fosters a collaborative learning environment where employees can share insights, experiences, and best practices with their colleagues from different areas. By leveraging peer-to-peer training, Norfolk maximises the transfer of knowledge and expertise across its workforce, ultimately enhancing the overall effectiveness of its drug strategy implementation efforts.

Efforts to enhance information sharing between probation services, treatment services, and prison and community treatment services are underway, further strengthening partnership working. While much of the focus so far has been on adults, data analysis and partner engagement have been instrumental in supporting needs assessments. Norfolk's concerted effort to coordinate services reflects an understanding of the strong interlinkages between drug use and other issues such as mental and physical health, aiming for a more cohesive and integrated approach to care.

A dual diagnosis approach is essential to strengthening the interface between mental health and drug treatment services."