1. Needle exchange: an NTA perspective 1 July 2009 Hugo Luck

2. Why NEX? Its effective It links us to treatment naïve/resistant populations A cornerstone of harm reduction, the leading public health response to drug use.

3. The current national picture Sharing down to about 25 % of users, though still above the mid-1990s. Groin and crack injecting more common, have become more common. One third of injecting drug users reporting injecting site infection in the last year. Overall almost half of injecting drug users are now infected with HCV and about one in 90 with HIV. There has been a marked increase in the number of injecting drug users receiving the hepatitis B vaccine, with two-thirds now reporting vaccination (how much of this is prison?). Source : Shooting Up 2008

4. NEXMS… Sorry The software has been fixed All is not lost

5. In the meantime… The quality of the data we do have seems quite good For those DATs who have submitted data well be producing an initial report as part of the Needs Assessment Were planning to open the system for an amnesty to submit previously unreported data.

6. For Example Data are not currently public domain

7. 1)Planning, needs assessment and community engagement Use the existing process BUT may need new sources of data What are your links with public health? Are the Local Authority on board?

8. 2) Meeting need Tie directly to needs assessment; Economies of scale for disposal; Formal and informal needle identification; ICPS for all relevant services – what are the gaps and how to fill them Auditing and monitoring – How much do we need to know?

9. 3) Types of service What does balance look like? All Specialist Treatment services – managing using on top Accessibility vs. cost efficiency

10. 4) Equipment and advice No limits – what challenges will this present? Flexibility of disposal/sharps bins Who decides the advice and information given? Talking to users Encouraging/nagging/facilitating

11. 5) Community pharmacy-based NSPs What additional services can pharmacy offer? Is it an appropriate setting? Confidentiality

12. 6) Specialist NSPs Staff competency Wound care Referral services – on site and off site

13. More needed Are you NICE compliant? What isnt covered by NICE? Do we have enough information? Does NEX fit well with existing treatment systems?

14. The role of the NTA Built into existing treatment planning/performance management mechanisms Regional teams to work with commissioners and providers to ensure guidelines understood and implementation process agreed Links to the Harm reduction works campaign Disseminate good practice Get NEXMS right (and use it)

15. More information www.nice.org.uk www.nta.nhs.uk www.harmreductionworks.org.uk