INCLUSION: Public Health interventions in substance misuse Faculty of public health conference, 2017 Welcome

Inclusion’s Vision We offer the governance of the NHS, with the innovation often credited to the third sector. Our aim is to achieve the best possible outcomes each service user and community we work with. We are called Inclusion because we value diversity and the contribution of service users and our stakeholders. We know it has not been your choice to come to work to us. But we value and will empower you. Hampshire Staff and the people present in this room offer us a fantastic opportunity to realise this vision

Inclusion – our services SUBSTANCE MISUSE SERVICES Telford & Wrekin Cambridgeshire Hampshire Buckinghamshire Sandwell Reading Thurrock IAPT SERVICES Thurrock (& Recovery College) The Wirral PRISON MENTAL HEALTH & SUBSTANCE MISUSE HMP Isle of Wight HMP Birmingham HMP Foston Hall and Sudbury Thames Valley Cluster Staffordshire & Worcestershire Cluster Yorkshire Cluster

Community Alcohol and Drug Services – 2016/17: 8500 Service Users are in our community services at any one time Inclusion National Average % of Successful Completions Opiate 9.52% 6.63% Alcohol Only 39.36% 38.29% Non-Opiate 38.61% 31.13%

Take Home Naloxone Project To reduce the risk of overdose amongst Opiate using clients by; Developing a culture where ongoing drug use is openly talked about Explain the risks and encourage positive engagement with treatment Taking account of the new legislation increase the supply of Naloxone so that if overdose happens lives can be saved Engage families, carers and other professionals

What We Did IDENTIFY THE NEED POSITIVE OUTCOMES LONG TERM IMPACT SI reports showed a rise in overdose Inclusion-wide concern needing an organisational response Looked at options to address this e.g. Naloxone POSITIVE OUTCOMES Rolled this out across the community projects Deliver training to over 300 staff as part of pilot Developed a draft protocol with key stakeholders LONG TERM IMPACT Reduction in overdose and related SI’s – Organisational learning and response Reviewed effectiveness & shared protocol with others Based on the success-started pilot work in prisons & hostels

Its Effective Its easy to use We have given out over 3000 kits We know we have directly saved over 233 lives For every £1 spent on naloxone the health economy saves £24.60 It has saved the NHS over £700,000 SO FAR…. 2014 to 2016 it contributed to a 50% reduction in overdose within Inclusion Services

Naloxone experiences

Buckinghamshire Hep C Pilot Study Prior to April 2016; all clients in OST treatment who tested positive for HCV antibody were signposted to their respective GP for PCR testing; If PCR positive (confirming chronic infection), clients were then expected to attend a further appointment at their GP surgery for additional blood tests and would then be referred to a Consultant Hepatologist for assessment and possible treatment. Engagement was poor. We know it has not been your choice to come to work to us. But we value and will empower you. Hampshire Staff and the people present in this room offer us a fantastic opportunity to realise this vision

Buckinghamshire Hep C Pilot Study Initial positive screening at our service, to referral to Consultant Hepatologist for assessment / treatment. If PCR positive, clients were then seen in service for full ‘work up bloods’. ‘Work up bloods’, were then assessed by the Consultant Hepatologist in scheduled Hep C In-reach clinics held in service. During their assessment, a mobile fibro scanner was utilised to assess liver damage. To encourage attendance at these clinics, OST prescriptions were coordinated to coincide with these clinic appointments. If Hep C treatment advocated, STARS have supported the clients by co-ordinating their OST prescriptions around all the appointments required throughout the Hep C treatment process. We know it has not been your choice to come to work to us. But we value and will empower you. Hampshire Staff and the people present in this room offer us a fantastic opportunity to realise this vision

Buckinghamshire Hep C Pilot Study 2 clients have thus far been successfully treated for Hep C and have achieved a Sustained Virological Response (SVR). 2 further clients are currently undergoing treatment which was commenced in March / April 2017. There is a plan in place to treat the remaining Genotypes (1 and 4) within the next 6 months. One client was of no fixed abode and therefore could not be authorised for Hep C treatment due to concerns regarding storage of DAA medication. The service worked collaboratively with housing services to secure him housing. For those clients with Genotype 3 (currently 7 remain in treatment with STARS) new DAA treatment (non interferon) has very recently become available. Those clients will now be offered treatment within the next 6 months. We know it has not been your choice to come to work to us. But we value and will empower you. Hampshire Staff and the people present in this room offer us a fantastic opportunity to realise this vision

Peer to Peer (P2P) Hepatitis C Peer Mentoring Project Hampshire

The Hepatitis C Trust Utilising existing networks of volunteers within substance misuse services in order to expand the delivery A sustainable healthcare intervention Currently across 10 sites Increased testing Increased engagement with care

Establishing Credibility Difficult to initially engage hepatology units and clinicians Analysis of data – quarter 2 in 2013-14 579 accepted test but no evidence of testing carried out Proposal to carry out testing roadshow in partnership with The Hepatitis C Trust £5 incentive for testing Talk about challenges of getting Solent nhs staff and nurses on-board – speak appropriately

Love Yourself – Get Tested Run over Valentine’s week 2014 10 sites visited over 5 days Hepatology Nurse Specialist attended 4 events 220 screened, 182 tested 31 (17% of those tested) antibody positive All followed up by P2P

Next Phase So we had increased our testing rates…. Through this event and subsequent events we diagnosed over 93 patients… Is this where our duty of care ended?

Of course not… Since the project started we have supported over 111 patients and in the last year 24 patients have undergone or are in the process of undergoing HCV treatment. We have actively taken those 24 to hospital appointments and keep in regular contact with them.

Any Questions? danny.hames@sssft.nhs.uk grace.whitehouse@sssft.nhs.uk Tel: 01785 221 662