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

2. 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

3. 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

4. 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%

5. 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

6. 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

7. 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

8. Naloxone experiences

9. 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

10. 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

11. 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

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

13. 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

14. Establishing Credibility
Difficult to initially engage hepatology units and clinicians
Analysis of data – quarter 2 in
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

15. 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

16. 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?

17. 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.

18. Any Questions?
Tel: