The 10-year drug strategy: Wirral Council

The injection of new funding through the 10-year drug strategy has revitalised Wirral Council's local efforts in combating drug and alcohol abuse. This investment has been particularly directed towards enhancing the community drug and alcohol treatment services. Remarkably, this service has garnered an outstanding rating from the Care Quality Commission (CQC) twice in the past four years. These accolades, achieved prior to the infusion of new funding, underscore the solid groundwork laid by Wirral, which has now been further strengthened by the strategy's financial support. 

In the decade leading up to the implementation of the strategy, Wirral experienced consistent funding cuts, albeit with only minor decreases in overall treatment figures. However, the primary repercussions of these historical funding constraints were observed in the quality of engagement and the available time and capacity within the system. Consequently, caseload sizes were reduced, highlighting the strain placed on resources and service delivery.

Wirral boasts robust partnerships across various sectors, including the local authority, mental health services, NHS providers, probation, voluntary organisations, ethnic minority communities, and housing providers. These collaborations entail dedicated roles within each entity, focusing explicitly on implementing the drug strategy. While these partnerships were already robust before the strategy, they faced strains due to funding pressures. However, the infusion of new funding has revitalised the system's efforts over the past two years.

A notable achievement in Wirral is the successful recruitment drive within the voluntary sector. During the same period when the statutory sector managed to recruit only two staff, the voluntary sector was able to fill 45 new positions. This rapid and substantial recruitment effort demonstrates the agility and proactive approach of key leaders within Wirral's system. Moreover, it ensured that the allocated funding was effectively utilised within the specified timeframes, mitigating the risk of funding loss. The bolstered workforce in the voluntary sector has yielded positive outcomes for service performance, evidenced by improvements in key performance indicators.

Despite the success in recruitment within the voluntary sector, Wirral has faced significant challenges in filling statutory sector roles. These difficulties stem from internal issues within system partners, encompassing recruitment processes, the development of person specifications, job descriptions, and candidate shortlisting. The bureaucratic nature of the statutory sector has led to delays, particularly in publishing job adverts, which poses a risk of losing funds due to unmet timelines. While some progress has been made, such as the establishment of a new post within the local community mental health trust, more efforts are needed to streamline recruitment processes and address the staffing gaps in the statutory sector.

In 2021, Wirral commissioned an NHS community respiratory care team to offer services in local drug treatment clinics, addressing the high prevalence of COPD (Chronic Obstructive Pulmonary Disease) among service users. This initiative has yielded positive outcomes, enhancing the interface between physical health and substance misuse services. By identifying risk indicators earlier, it fosters collaboration between the local authority and health services. This strategic move underscores the importance of senior leadership ownership in driving effective implementation of the drug strategy.

The one-year funding cycles present significant challenges for recruitment and commissioning in Wirral, as there is no assurance of continued funding beyond each cycle. Additionally, there is uncertainty regarding whether partner organisations will prioritise the drug strategy to the same extent as the council. Moreover, regulatory and information governance obstacles often arise when collaborating with NHS organisations, further complicating the implementation process.

The engagement with the police in Wirral has been notably strong, facilitated by the new funding which has alleviated some of the capacity and funding pressures historically faced by law enforcement agencies contributing to local drug strategies. With this funding, Wirral has been able to go beyond the minimum requirements, allowing for more creative thinking about service delivery. This includes effective collaboration among partners and the adoption of a system-wide approach. Strategic delivery meetings have seen robust attendance from all partner organisations, reflecting a cohesive and collaborative effort towards achieving shared goals.

Wirral has observed reductions in drug-related deaths within its service but acknowledges that sustainably reversing this trend requires more than just investment in treatment. There is a recognition of the complexity surrounding the categorisation of drug-related deaths, including distinguishing between drug poisonings, deaths occurring during treatment, and broader drug-related fatalities. Wirral emphasises the importance of clarity in these distinctions to accurately assess the impact of interventions and to inform future strategies effectively.

In Wirral, addressing the challenge of opiate users, particularly those aged 50 years and older, presents complex issues related to long-term drug use and associated health conditions. Despite support over several decades, this demographic is now experiencing additional health complications secondary to their drug use, compounded by lifestyle factors. A partnership with John Moores University has shed light on the mindset of some local heroin users, revealing a sense of hopelessness and apathy towards their own well-being. Many individuals in this group lack familial support and struggle with feelings of helplessness, leading to neglect of their health and increased risk of overdose. These findings underscore the need for targeted interventions that address not only substance abuse but also the underlying psychological and social factors contributing to vulnerability among this population. 

The data collection process in Wirral involves collaboration with various stakeholders, including the coroners and treatment providers, to gather information on drug-related incidents. While the council does not directly receive raw data, partnerships with institutions like John Moores University provide access to comprehensive summary reports and longitudinal data on the local drug-using population. Leveraging the university's expertise and connections, Wirral benefits from valuable insights into addiction trends and patterns. Furthermore, ongoing efforts to commission joint roles within the North-West ambulance service demonstrate a commitment to enhancing engagement and accessing critical datasets, ultimately informing more effective strategies for addressing drug-related issues in the community.

Wirral acknowledges the challenge of increasing treatment numbers, particularly among opiate users, despite overall improvements in treatment uptake. There are concerns regarding the effectiveness of data modelling in targeting specific populations, complicating efforts to reach those in need. While rough sleeping remains a concern, Wirral's focus aligns with national priorities on increasing treatment uptake rather than directly addressing housing issues. Nonetheless, positive engagement with housing associations and hostel providers, supported by previous government initiatives, demonstrates proactive efforts in this area. Additionally, strong police presence in hostels has fostered trust among residents, leading to collaborative efforts such as voluntarily submitting suspicious samples for testing, indicative of a high levels of trust between drug users and law enforcement. 

Wirral boasts an impressive 80 per cent success rate in continuity of care, demonstrating effective collaboration between the council, police, prisons, and health services. Dedicated liaison officers work directly with prisons to support individuals transitioning from incarceration to treatment, ensuring seamless access to care.

In addition to traditional substances, there is a concerning trend among younger drug users, particularly with ketamine and synthetic drugs. Wirral suspects a deliberate effort by individuals within the drug supply chain to steer users towards these alternatives, possibly in response to anticipated reductions in heroin supply. This underscores the need for ongoing vigilance and targeted interventions to address emerging drug trends effectively.

The inpatient detox grant funding program in collaboration with Cheshire and Merseyside has shown significant progress in the last six months. Surprisingly, among all the placements, only 1 has been for opiate users, with the majority seeking treatment for alcohol and various other drug dependencies excluding heroin. This unexpected trend is being closely monitored for further insights and implications in the ongoing management of substance abuse issues.