The Isle of Wight
Drug & Alcohol Action Team 

Needs Assessment data for 
Adult Treatment Plan 2010/11

November 2009

“The only Needles we want to see on the Isle of Wight” 
					
Contents:		Page:
	
1.		Overview
	3	
2.		Isle of Wight Demographic data 
                                                                    	7	
3.		NDTMS data                      
                     	9	
4.		Drug Related Deaths Analysis
	12	
5.		Needle Exchange
	13	
6.		Blood Borne Viruses and Pharmacy BBV Project
 	17	
7.		Service User Involvement
	20	
8.		NI 38 - Drug-related (Class A) offending rate
	22	
9.		Drug Police Operations Report
	24	
10.		Citizens Advice Bureau Pilot Project 
	27	
11.		Alcohol Arrest Referral Project
	30	
12.		Alcohol A&E Nurse
	31	
13.		Treatment Bullseye 	Data   
	32	
14.		Treatment Pathways data          
                                        	33	
	Annex 1 – Pharmacy Project Report 
	34	

	

1.	Overview:

1.1	This year’s Needs Assessment has been undertaken in a different format as the Drugs and Alcohol Action Team (DAAT) has been operating without a Commissioning Manager since July 2009. Several methods have therefore been used to develop this report:
•	Through a “virtual expert group” using e-mail correspondence to seek input from various partners
•	Through the support of the previous DAAT Commissioner, working in a consultancy role
•	Contributions by the DAAT partnership
•	An analysis from data provided by the NTA and NDTMS
•	The use of an existing Substance Misuse Action Group and its’ membership to obtain feedback and comments 

1.2.	Several new pilot projects have been undertaken in 2009-10, and the impact of other projects has started to be seen in the current year – these are highlighted below: 
•	Blood Borne Virus (BBV) testing was commenced through 9 Island based Pharmacies, with Hepatitis B testing and vaccination, and Hepatitis C testing undertaken. A report of activity for the initial 3-month period provided through the Community Pharmacy lead shows the excellent results achieved. (included at Annex 1). As a result the service has been extended to provide testing for HIV and Syphilis.
•	The Isle of Wight Citizens Advice Bureau undertook a 3-month pilot project across the Island offering advice on a range of issues including benefits, housing, employment etc. These sessions were undertaken weekly at Treatment Providers and allowed the Service User to obtain advice in a confidential and established location. The recommendation of the pilot is for this scheme to be extended on a permanent basis and for additional Outreach sessions to be offered. 
•	The Service User group – RESULT – have continued to provide a first-rate service however in the first half-year of 2009 the work was falling principally to two of the volunteers (Helen and Anne). In August 2009 a newly recruited Service User Coordinator, Jim Tuckey, commenced in his new role within the DAAT to develop and support the work of the User Group. As shown in his report the Group has been expanded and have identified several areas where additional support can be provided and developed 

1.3	Against these successes, however, there have been some disappointments with anticipated projects not moving forward as projected:
•	The chief amongst these is the failure to provide a Tier 4 provision on the Island, and the return of the funds to the National Treatment Agency (NTA). Despite the best endeavours of the DAAT and the identification of a suitable (and local) provider, the scheme aroused adverse public comment and the provider decided not to go forward with the scheme
•	The Shared Care project to involve General Practitioners in Treatment is currently on hold; the report from independent Consultants was presented to the Joint Commissioning Group in August 2009, however matters have not progressed further   
•	The lack of a Commissioner for the DAAT from July 2009, and of a Performance Manager since May 2009, has had adverse consequences for the Partnership. This is despite the prodigious efforts of other staff in the Partnership who have sought to undertake the Commissioning role and maintain a focus on overall performance and development. Regrettably the lack of a cohesive and full time lead has meant that some work has fallen by the wayside. 
•	The appointment of a Performance and Contract Manager in August 2009 helped in performance monitoring and liaison  with Providers, and enabled some of the workload to be shared. 
1.4.	The issues regarding Service Users on the Island is summarised in the Mind-Map in Figure 1 below, which also highlights potential gaps in Services across the Island. The mapping exercise has reviewed current provision on the Isle of Wight against the 2008 updated Drug Strategy to identify the level of provision and any gaps in the service. The identified gaps have been reviewed by the Expert Panel and the feedback has been utilised in the development of the Adult Treatment Plan for 2010-11.

1.5.	Differences were identified within the updated Strategy against the previous 1998 strategy, and 2002 update. These differences and actions have been summarised as they relate to the work of the DAAT (e.g. some of the actions relate to the CDRP and statutory agencies and these points have not been included):
1.5.1	“The difference that the new strategy brings is that we will
•	focus more on families, addressing the needs of parents and children as individuals, as well as working with whole families to prevent drug use, reduce risk, and get people into treatment
•	Give a stronger role to communities……
•	Target money and effort where we will make the most difference by making sure people are successfully completing treatment and re-establishing their lives, and by focusing on the drug users causing the most harm to communities
•	Work together on shared problems across institutional boundaries – for example, ensuring that children’s social services know about drug-using parents where children are at risk as a result of their drug use……
•	Be clear that drug users have a responsibility to engage in treatment in return for the help and support available”
1.5.2	“On treatment, we will:
•	Clearly prioritise those who are causing the most harm to communities and families, getting offenders, and parents whose drug use may put their children at risk, into effective treatment quickly;
•	Pilot the use of individual budgets to help those successfully completing treatment to access housing, employment, education and training, to support them in re-establishing their lives, free from dependency 
•	Use all emerging and all available evidence to make sure we are supporting the treatment that is most effective, targeted on the right users – with abstinence based treatment for some, drug-replacement over time for others, and innovative treatments including injectable (sic) heroin and methadone where they have proved to work and reduce crime 
•	Involve families and carers in the planning and process of treatment, for young people and for adults; and 
•	Ensure that the benefits system supports our new focus on re-integration and personalisation. In order to ensure that it provides the right level of support and creates incentives for people with drug problems to move towards treatment, training and employment, we will at a minimum:
•	Require drug misusers on out-of-work benefits to attend a discussion with an appropriate specialist treatment provider or partner organisation as part of the Jobseeker Direction or Work Focused Interview requirements; and
•	Encourage closer links between relevant agencies so that drug misusers who are claiming benefits can be referred to specialist services 
1.5.3	“On prevention we will:
•	Expand our approach so that it increasingly focuses on young children and families before problems have arisen
•	Look at the whole family, ensuring prompt access to treatment for drug-misusing parents with treatment needs and particularly those children who are at risk, with assessments taking account of family needs, and providing intensive parenting support alongside drug treatment, and 
•	Ensure drug-misusing parents, and other at-risk parents, including offenders and their partners, are a target group for new parenting experts and in plans to develop Family Intervention Projects….”
1.6.	Additional information relating to possible “gaps” in Services has been provided by the DAAT Delivery Plan for Employment and Education Support (For People for Substance Misuse 2008-2011). The actions and issues raised in the Plan have been refreshed through the use of the SMAG meeting in December 2009, which also considered the implications of the report on Families and Carers issued by the UK Drug Policy Commission in November 2009. 
1.6.1	This report reviews the wider consequence of drug usage by including the impact on family members and carers and the cost of harms as a result. The review only looks at adult family members and does not take into account the impact and costs on children and young people; it also only identifies a minimum estimate. 
1.6.2	By extrapolating the UK results to the Island’s adult population, a crude estimate of the for the Isle of Wight can be identified e.g.
•	A minimum of 3,400 adults will be significantly affected on the Island by a relative’s drug use; in addition there are projected to be c. 700 children of PDU’s on the Island (based on a UK level of 1.5m and 300,000 respectively) 
•	The cost of the harms experienced as a result amounts to c. £4m per annum (based on a UK cost of £1,800m per annum)
•	The support provided by relatives and carers would cost the NHS or Local Authority £1.7m if they were not available (UK cost £750m)
1.6.3	The report also splits the latter two statistics to the cost for each PDU and identifies a cost of £9,497 annual total cost per adult family member and £3,935 “resource savings” to the PCT/Local Authority. 
1.6.4	Actions recommended by the report relate to the increased focus by the NTA  and Drug Policies:
1	The level and quality of direct support to help families in their own right need to be improved
2	The stigma associated with drug dependency needs to be challenged
3	The drug treatment system needs to be made more supportive and inclusive for families
4	Leadership – responsibility for driving forward an agenda to enhance support for families needs to be placed with an identified champion at national and local levels
5	Information/knowledge development is essential for ensuring the adequacy and appropriateness of service provision – currently even the most basic data are lacking (sic)

1.7.	Input was sought from other Agencies and Partners through an existing forum – the Substance Misuse Action Group; the following notes represent the comments made on performance on the 2009-10 Action plan and any identified Needs:  
Family support/carer service - J said moving forward slowly.  The NTA are supporting with £500.00 to go towards the Carers Forum which is being held on the Island in April 2010.  M said there was a Carers Delivery Plan that should be reviewed/re-written next year.  
Multi-agency working – the DAAT and Get Sorted internet websites were set up.  M is updating the website and has requested updates by the end of January 2010 and has already added some recent information on ‘legal highs’.  ACTION:  M to ask GM if he can let us know how many hits the sites have had.  Also to check everything we have promoted through links from Safer Communities website.  

There have been some positive media stories.  G highlighted that regarding communication with service users, pharmacies are changing the information they put into NX packs every 6 weeks.  In terms of data collation, the PCT have commissioned a body to provide a data collection package called ESMAQ for pharmacists to input data which will provide the DAAT with figures they require.  System goes live on 1st January 2010.   Pharmacy project – feedback from Ryde was that they have had to empty both small plastic bins as they were nearly full, that was in one week.  Service users have been very positive about it.  G said that, as a provider, he is lucky if he gets one can back a week.
Access for people with disability – nobody at present to move this forward.  It was an issue raised from last stakeholder event.
Availability alcohol detox beds – no further forward.  M has spoken to SL.  The NTA capital funding that we received several years ago has been sent back as we were unable to establish a provider.  SL has some ideas around expansion at Sevenacres
Referral routes – care pathway work has not been done but regular quarterly reviews continue.
Counselling services – DAAT is providing a large amount of counselling.  Services are being offered by providers but there is a significant gap.  G asked if M’s counselling role was being replaced as she had found it useful but the post is not being replaced at this stage.
Housing provision – RWT can’t expand.  Supported Housing contracts are currently up for re-tender and decision by in July 2010.  Southern Housing Group who hold freehold of units including Butler Gardens are wanting their buildings back as of 2011 (The housing stock also includes Women’s Refuge) - this will cancel income to RWT from managing of property and leave funding shortfall. .  RWT will retain 10 community flats which are move on.  .
Service User Involvement – J has been appointed as Service User Coordinator.  Had some training with OUT (Oxfordshire User Team) who are a very successful and established user group.  They are going to have some advocacy training in the near future.  RESULT have an additional 3 core members.  J said having spoken to other user groups the consensus seems to be better to have 5/6 reliable members rather than 20 unreliable members.  Still involved with Basic Drug Awareness training. Working with Platform 1, IDTS, and Secret Shopper on pharmacies.  G suggesting setting guidelines of when to interact with service users.  A reported that the POWER Group is picking up and has had agreement to be held fortnightly until the end of this financial year.  Z said that the service user group is working really well and is picking up now.
Access to employment – M spoke of the project with the CAB.  M has received feedback from CAB and over the 3 months they saw 107 people with direct queries.  Over half were to do with benefits and the rest were a range of housing, employment and debt advice queries.  They got to see people they wouldn’t normally see.  Would like it to go on a more formal basis.  ACTION M to liaise with IDAS and Cranstoun to obtain some feedback
Safeguarding – ACTION M to check if Cranstoun and IDAS have brought all of their staff up to speed.
Personalisation – M reported that there are currently 7 project sites around the country looking at individual budgets.  There is one running in Hampshire looking at individual budgets but is only in formative stages.  Feedback will take place in 2010.  ACTION Needs to be picked up by new Commissioner.

1.7.	
Figure1
Physical Health 

Mental Health 

Family/Life 

Service User

Get Sorted
Tier 3

IDAS
Tier 3

Cranstoun
Tier 2 

Reduction/treatment  

Up to age 19

PDU

BBV & HIV Pharmacies

Needle Exchange via Pharmacies

Not known to treatment 

CAB Project 

Benefit advice  

Housing Support – Real World Trust 

Dry Hostel

Cranstoun
DIP

Ex-offenders 

Open Access

Tier 4 on IW

RESULT 

Carers Group 

Rent Deposit Scheme

Housing 

Dual Diagnosis 

P.O.W.E.R

Women

Tier 4 Rehab 

Mainland 

Key: 
Existing Provision
Pilot Project 2009-10
Identified Gap
Some impact  

Primary care (General practitioners) 

2.	Strategic Partnership Joint Strategic Needs Assessment (JSNA) 2009

Isle of Wight Population 1998 to 2007

2.1.1	The 2001 Census advised of a resident population of the Isle of Wight of 132,731 with a 48:52 male/female split. This represented 1.7% of the population of the SE region. Mid-year estimates (MYEs) published by the Office for National Statistics indicate a population of 139,482 in 2007 (the latest data available) – a 5.1% growth on 2001. The projected population of the IW for 2009 is 142,500. 

2	The Island’s population is predominantly white with only 1,763 persons of non-white background recorded by the Census. This represents 1.3% of the population as against 4.9% for the SE and 8.7% across England and Wales. The ethnic minority population is mainly concentrated in Ryde and within the prison population in Parkhurst ward.

3	The Island has one of the highest levels of retired age people (65+ for males and 60+ for females) in England with a 2005 estimate of 25.9% - for the first time people over 65 represent a higher number than people under 16.  

4	 Over the next ten years (2009 – 2018) it is anticipated that if the birth rate continues to follow current patterns:

•	The young population (aged 0 – 19) will decrease as a proportion of the total population from 21.6% to 20.4%.
•	The working age population (aged 20 – 64) will decrease as a proportion of the total population, from 55.4% to 53%.
•	The elderly population (aged 65+) will grow as a proportion of the total population, to 26.8%.
•	The estimated number of people living with dementia will increase from 2,500 to 3,600.

5	Health inequalities are differences in health between different groups of people; for example, men and women, and people living in different areas. The Department of Health states that: “such differences are often avoidable and always unjust”’. Health inequalities are closely associated with inequalities in wider influences on health, such as income and employment, education and the wider environment, as reflected in the National Index of Multiple Deprivation. High levels of deprivation are associated with higher prevalence of diseases that shorten life expectancy and healthy life expectancy. Wide inequalities within a district are a challenge to service delivery as individuals with more resources tend to make better use of services, so that inequalities widen.

6	The National Index of Multiple Deprivation (2007), measured at Local Authority and lower Super Output Area (populations of about 1,500) level, is a comprehensive measure of deprivation between and within districts. The Island falls within the 40% most deprived Local Authorities in England (126th from 354) and is within the most deprived quartile of Local Authorities in the South East region. 

2.6.1	At Local Authority level there are six scores rather than one overall aggregate score, and the Island rates are among the 30-50% most deprived districts for these scores – that is to say, worse than the national average but not among the most deprived 20% of districts.
2.6.2	The Island is one of 67 Local Authorities (County, District and Unitary) in the South East Region and when compared against these districts rather than the National average, the Island is among the most deprived 20% of districts for four of the six scores.

2.6.3.	At lower Super Output Area level (populations of about 1,500), in comparison with the National average the Island is most deprived for ‘employment’ and ‘income in families with children’ and least deprived for ‘crime’ and ‘living environment’.
2.6.4.	The Island’s areas of deprivation are widespread, with Super Output Areas representing deprived areas in all of major towns. 
2.6.5.	 Approximately 1 in 5 of our children lives in poverty (equivalent to c. 200 classrooms). Poverty is one of the most significant barriers to achievement and wellbeing in children and young people 
2.6.6.	Whilst the number of working families benefiting from Working Tax Credit (WTC) is increasing (from 13.4% in 2004/05 to 17.3% in 2007/08) we want to continue to improve access to benefits

2.7	The HM Isle of Wight Prison, comprising three individual units, has a capacity of c. 1,800, with a significant proportion of offenders serving long sentences who are already older or likely to enter old age while in prison. Proportionately the Island has one of the largest prison populations per capita in the UK; however the vast majority of offenders are not Island residents and are unlikely to remain on the Island after serving their sentences. 

2.8	In view of the minority of offenders who are Island residents a separate Needs Assessment has been developed by the Prison Service which also includes the Integrated Drugs Treatment Service (IDTS) which will go live within one of the units in 20009/10 and the other two units within 2010/11.     

2.9	The 2001 Census showed that only 3.2% of the Island population were from any minority ethnic group, (a significant rise from 1991 when the figure was 0.7%) of whom 1.3% were from Black, Asian, mixed or other groups; In the 2001 Census 87.5% stated their ethnicity as White British. Recent National estimates suggest that these proportions might now be over 6% and 3.7% respectively - this would still be below the National and Regional average. It is known that there are significant communities of ethnic white communities from Eastern Europe developing on the Island. 

2.10	The Isle of Wight per capita school age population is lower than that of both the South East and the National average. It only grew by 3% between 1995 and 2005, compared to a growth in the working age population of 16%.
3.	
National Drug Treatment Monitoring System data
.
3.1.1	Problem Drug Users - Summary Data age 15-64 
Numbers						
	2004-05	2005-06	2006-07	2007-084	2008-09	
Problem Drug Users 1	471	503	593	593	522	
Upper CI	570	621	727	727	588	
Lower CI	414	432	515	515	483	
add for UCI	99	118	134	134	66	
subtract for UCI	57	71	78	78	39	
						
 Crack Only 2					152	
Upper CI					412	
Lower CI 					32	
						
Opiates Only 2					487	
Upper CI					552	
Lower CI					452	
Rates (per 1000 population)					
	2004-05	2005-06	2006-07	2007-08	2008-09	
Problem Drug Use 3	5.52	5.79	6.92	6.92		
Upper CI	6.68	7.15	8.48	8.48		
Lower CI	4.85	4.98	6.00	6.00		
add for UCI	1.16	1.36	1.56	1.56		
subtract for UCI	0.67	0.81	0.92	0.92		

Notes
1 – In 2008-09 this designation included opiate and crack users 
2 – figures for these drugs were not provided prior to 2008-09
3 – rates per capita were not provided in 2008-09
4 – separate figures were not provided for 2007-08 and the previous years have been copied 	

3.1.1	These numbers are produced from the Glasgow Smoothed Estimates and show a reduction in the numbers of Problem Drug Users (PDU’s) e.g. those using Opiates and/or Crack Cocaine. This reduction is not unexpected and is in line with national trend of reductions in PDU’s across England – effectively the estimates revert to the levels seen in 2005-06. Comparative data per capita has not been provided for 2008-09 but is likely to be similar to 2005-06 levels (it should be noted that the per capita allows for the influx onto the island during the summer season and is not directly comparable to Census figures) 

3.2	Drug Injectors - Summary Data age 15 - 64 
Numbers						
	2004-05	2005-06	2006-07	2007-08	2008-09	
Injecting Drug Users	223	245	305	305	258	
Upper CI	371	367	437	437	433	
Lower CI	171	203	244	244	226	
add for UCI	148	122	132	132	175	
subtract for UCI	52	42	61	61	32	
						
Rates (per 1000 population)					
	2004-05	2005-06	2006-07	2007-08	2008-09	
Drug injecting	2.61	2.82	3.56	3.56		
Upper CI	4.35	4.23	5.1	5.1		
Lower CI	2.00	2.34	2.84	2.84		
add for UCI	1.74	1.41	1.54	1.54		
subtract for UCI	0.61	0.48	0.72	0.72		

3.2.1	A similar position is shown on injecting drug users indicating a fall in the estimated numbers across the island compared to previous years. 

3.3	2008/09 treatment Bullseye (See Section 11)
•	Overall people in treatment represent 313 PDU’s, the majority of which (99%) are opiate users. A high proportion of the PDU population is in effective treatment with only five deemed in treatment but not in effective treatment 
•	The percentage of women in effective treatment remains similar to previous years at 27% 
•	The percentage in effective treatment answering “White” to ethnicity remains similar at 98%, with 1% BME and 1% “Other”.  Additional data provided in 2008-09 shows country of birth data for new presentations and this identifies 97% advising a UK birth; the additional countries of birth cannot be provided in this Assessment due to the levels involved (e.g. to protect privacy) but c. 1% were of European birth, 1% North American and the remainder did not answer. 
•	The age split shows a change to the position in 2008-09, with a reduction in PDU’s aged 15-24 – down to 8% from 27%. This may be a statistical anomaly with several PDU’s attaining the age of 25 during the period. 53% of PDU’s were in the age range 25-34 and the remaining 39% in the age range 35-64.   
•	Injecting status across PDU’s show in treatment shows 49% are currently injecting, 23% have previously injected, and 26% have never injected (3% were not known). 
o	The figure of 223 who are injecting, or previously injected compares with the Smoothed Estimate of 258 (with a range between 443 to 226) identifying a number of injectors who are not known to treatment – ranging from 3 to 223
o	A comparison to Needle Exchange data discussed below, would indicate a figure on the higher end of the Confidence Interval e.g. there are on average 245 Needle Exchanges made each month across the island       
•	The figure estimated as ‘not known to treatment’ based on the Glasgow Smoothed Estimate is 107 (the range between UCI and LCI is between 68 and 173 not known to treatment) – this figure is lower than in previous year’s however the comments made in 3.1.1 are also pertinent here

3.4	2008/09 Treatment Pathway: (see Section 12)
•	Data provided this year breakdowns between “treatment naïve” – those not on the NDTMS database since it commenced in 2005; and “not treatment naive” – those who have been registered on the database and therefore have been in treatment with an agency at some point in this period. 
o	In total there were 175 referrals within 2008-09 (similar to 2007-08 when the total was 172) and the principal referrals sources were: “self” - 113 people (65% of referrals) and “Criminal Justice” (including CARAT/Probation etc.) – 18 people (11%). A comparison to the position in 2007-08 cannot be accurately made as the previous years figures were  distorted by a high percentage of “Other” referrals 
o	The split between agencies for these 170 referrals was 66 (39%) to IDAS – the Tier 3 Provider and 109 (64%) to Cranstoun – the Tier 2 and Drug Intervention Programme Provider; this was a slight change from the previous year when the percentage split was 44/53
o	Of the total referrals 88 were identified as “treatment naïve” (split 75% male and 25% female) and the principal sources of referral were “Self” (49 = 56%) and Probation (14 = 16%); these referrals were split between Providers with 75% referred to Cranstoun and 25% to IDAS - a similar position was seen with regard to 2007-08 with a high level of “Other” referral sources   
•	YPSM services have maintained a high level of referrals from a wide range of referral sources. A further breakdown of details is found in the IOW YPSM Needs Assessment 2009 document. 
•	Referrals between IDAS and Cranstoun have been maintained e.g. Cranstoun act as the Open Access point and refer onward to IDAS after triage, where necessary. After treatment has been undertaken a proportion of IDAS clients are then referred back to Cranstoun for low-level support 
o	35 transfers were made from Cranstoun to IDAS in 2008-09 (all of whom were PDU’s and required Tier 3 support) 
o	 There were 12 referrals back to Cranstoun
•	Planned discharges have continued to increase with 57% of the 134 exits during 2008-09 being “planned”, and a further 11% “referred on”. For the “unplanned discharges” 17% dropped out of treatment, 4% were sentenced to prison terms during treatment and 13% were under the heading “other” (this would include “deceased”, “moved away”, “discharged by Provider” etc.)   

3.5	Time in effective treatment 
•	For the first time in 2008-09, information has also been provided on the length of time that individuals have been in treatment, split down in several bands. This identified whether there is reluctance for discharge from an Agency, or a high ongoing need for support. 
•	The bands are shown in the following Table, together with information for the DAAT and for Providers:

	In treatment 2008-09	In treatment 2-4 years 	In treatment 4 years+ 	
	no.	Intervention 	no.	Intervention	no.	Intervention	
Partnership 							
IDAS	369	Prescribing – 366
Pyschosocial – 364 	87	Prescribing – 87
Pyschosocial – 77	135	Prescribing – 130
Pyschosocial - 34	
Cranstoun 	199	Prescribing – 2
Pyschosocial – 196
Day Programme -44	0		0		
Get Sorted1 	18 	Not indicated 	0		0		
Notes:
1 – Get Sorted represents YP over 18; these may be 18-19, or have specific issues (YPSM services are able to support up to age 24 for LD and MH clients) 	

3.6	Unit Costs 
•	Information was provided through the NDTMS to assess the cost of intervention by Provider, using information supplied by Provider agencies. However the information supplied by IDAS was inconsistent and did not provide a full breakdown which meant that a benchmark against other Agencies across the country could not be made
•	Information provided for Cranstoun did allow an analysis to be undertaken and this shows that the Provider is in line with regional and national averages against “days in treatment” and “service users in treatment” 
•	More work is to be undertaken in 2010-11 with Providers after a full analysis of this data to identify any possible cost savings ideally through joint working   

4.	
Drug Related Deaths Analysis

4.1	The tables below show data obtained from the National Programme of Substance Abuse Deaths (np-SAD) produced annually by St. George’s University, London – International Centre for Drug Policy. The latest statistical information covers the period from January to December 2008 – this information is, however, based on Coroner’s verdicts and the actual date of death may have been in an earlier period 

4.2	Drug Related Deaths on the Isle of Wight between 1997 and 2006 totaled 49 and were predominantly male and aged between 25-44 years. Of the 49 people, 25 were said to have had a ‘drug addiction’; only one had a drug injecting status; 28 were deemed suicides; most had a fixed place of residence and most were unemployed

4.3	The latest date from St George’s identified 3 np-SAD deaths in 2008; statistically this is one of the lowest levels over the last ten years e.g. in 2007 the figure was 6, and 8 in 2006 (the previous low was 2 in 2004) In 2007 the rate per 100,000 population was 5.17 i.e. over twice as high as in 2008 when it fell to 2.58; also the deaths in 2008 by “usual area of residence” was 1.72, as 1 of these deaths was of a non-IW resident 

4.4	For the 3 deaths in 2008: 
•	2 were male and one was female 
•	1 was in the age range 25-34; 1 was 45-54; and one was 64+
•	2 were White ethnicity and the other was not known
•	Heroin was the main drug implicated in 1 death; Cocaine was implicated in 1 death 

5.	
Needle Exchange Data 

5.1	Information supplied by the NDTMS, as shown on the Needle Exchange Monitoring System (NEXMS) database, was not considered robust as the data was drawn from the relevant database prior to an update undertaken in August 2009 by the new Performance and Contracts Manager. Information on the NEXMS performance has therefore been taken from an Excel document produced that analysed information from 2008 and 2009 

5.2	NEXMS data recording was not commenced until April 2008 and therefore data is not contemporaneous with the calendar year, as it represents a financial year. Information for the 12 months ending March 2009 show:
•	A monthly average of 7,374 needles provided through the Pharmacy outlets (19 Pharmacies across the island are involved, however as discussed below, many have little input)
•	In addition a monthly average of 7,095 medicated swabs were handed out, and 149 condoms 
•	Returns of used needles was poor; indications are that over the 12 months nearly 550 bins were provided to users, however only 16 were returned to Pharmacies

5.3	The following charts show the usage of the Scheme over the 12 month period from April 2008 to March 2009 – the first sheet shows the level of needles distributed each month; the second shows the number of individuals using the scheme (it should be noted, however, that this number may not provide a true reflection as in some cases an individual may collect needles for several users)  

5.4	Actions have been identified in 2009 to encourage returns of used needles with a pilot commencing in December 2009 at two Pharmacies – Boots in Newport and Boots in Ryde. The DAAT have responded to an offer from Boots by purchasing two needle return cabinets that will allow safe and anonymous returns to be made. The cabinets have been tested within other DAAT areas – the total cost has been funded by the DAAT with Boots providing floor space in the Pharmacy area. To encourage usage heavy direct publicity has been undertaken through the Pharmacies with leaflets given out at each needle exchange in December. 
    
5.5	Additional users of needles have also been targeted e.g. diabetics and steroid users, to enhance the use and acceptability of the cabinets. If the numbers show a significant and consistent increase, the intention is for more cabinets to be introduced in Pharmacies across the Island. A further phase would be to provide an external, 24/7 drop-off system and the Tier 2 Provider in Ryde has offered to locate such a system in their premises. This phase is more open to possible adverse comment and feedback and would therefore need to be undertaken with the benefit of successful data to highlight public safety benefits.     
   
5.6	The document below is a report prepared from the data imputed into NEXMS, that brought the database up to date, and highlights the level of usage across the island     

Needle Exchange – report on data from April 2008 to July 2009

15 September 2009

Synopsis

All data provided by the Island Pharmacies has been input into the NEXMS database and the information for the 16 months since commencement of the database has been analysed. Key comments and issues are detailed below. Those pharmacies that are significantly involved in the Needle Exchange service have been identified, including a geographical spread; it is noticeable that there has been some move between pharmacies in Sandown over a period and it may be useful to identify the reasons behind this. 

Overall the monthly averages for the service are c 7,000 fixed head needles per month; 1,400 barrels and 8,000 needles; 7,000 swabs and 150 condoms. Client numbers average 245 each month.

“Hot-spots” and Zero returns   

The highest numbers of exchanges are shown in Table 1 below; these figures represent the average monthly usage across the 16 month period of returns to date; in some months zero returns were made but subsequent returns appear to have compensated for these
   
Looking at specific trends within the reported figures: 
•	A recent shift has seen clients move from Alliance Sandown to Boots Sandown in Q4 2008-9 and Q1 of 2009-10
•	Lloyds East Cowes provided a nil return for April 2009, but no compensatory level was seen in later months 
•	Lloyds Newport also had a similar position in May 2009 with a zero return but no reflected increase in subsequent reports   

Table 1 – average monthly numbers for period April 08 to July 09 – “Hot-Spots”   	

Client Numbers 	
Fixed Head Needles	
Barrels	
Needles (Brown/Orange/
Green/Blue)	
Swabs	
Condoms	

Lloyds Carisbrooke	
62	
1050	
266	
173	
1123	
8	

Boots Ryde 	
53	
2178	
352	
262	
2289	
45	

Regent Shanklin 	
42	
1125	
255	
164	
1092	
25	

Lloyds East Cowes	
30	
545	
48	
33	
517	
0	

Boots Sandown	
26	
569	
158	
146	
503	
13	

Lloyds Newport	
21	
320	
31	
24	
305	
3	

Day Lewis Cowes	
18	
300	
109	
92	
322	
21	

J P Blakely Ryde 	
14	
994	
260	
103	
738	
12	

Alliance Sandown 	
10	
330	
106	
59	
497	
5	

Totals 	
276	
7411	
1585	
1056	
7386	
132	

Table 2 shows those pharmacies where some clients attend but on at low client numbers; these show the total usage for the whole 16 month period

•	Gibbs & Gurnell reported zero returns for the first 6 months but have then provided returns for every month since
•	Lloyds Ventnor provided returns for 6 periods out of the 16, but these were concentrated towards Q4 of 2008-9 and Q1 of 2009-10
•	Lloyds Sandown reported in 7 periods but in 2 of the last 4 months reported high levels of usage as shown in the Table  

Table 2 – total numbers for period April 08 to July 09 – “low numbers but regular” 	

Client Numbers 	
Fixed Head Needles	
Barrels	
Needles (Brown/Orange/
Green/Blue)	
Swabs	
Condoms	

Lloyds Sandown 	
11	
175	
10	
10	
175	
0	

Gibbs & Gurnell Ryde 	
3	
329	
53	
41	
67	
3	

Boots Newport 	
4	
38	
26	
19	
50	
6	

Lloyds Ventnor	
2	
88	
12	
4	
78	
2	

Table 3 shows those Pharmacies where zero returns have been seen on a majority of periods and client numbers have been minimal where reports have been provided

•	Boots Shanklin and Day Lewis Shanklin reported zero returns for all months across this period
•	Boots Ventnor reported zero for the first 11 months, but have reported in three out of the next five months, albeit low numbers
•	Lloyds Ryde provided a return in June 2009 only for 3 clients – further reports will indicate if this  was a “one-off” or whether provision continues 
•	Tesco’s have only reported in 7 out of 16 periods, however numbers on a monthly basis have peaked at 34 clients per month in April 2009; this may, however, be reporting for several periods and they may be a regular but low number provider  
   
Table 3 – average monthly numbers for period April 08 to July 09 – “no/occasional  returns” 	

Boots Shanklin 	
Day Lewis Shanklin 	
Alliance Bembridge	
Seaview Pharmacy	

Lloyds Ryde	
Alliance Freshwater	
Boots Ventnor	
Tesco’s Ryde 	

Geographical Issues

What is evident from the returns is the low volumes of exchanges in specific parts of the island e.g. Freshwater, Bembridge and Ventnor. 

It would be a useful exercise, if data was available, to identify the prevalence of drug misuse across the Island to check whether the minimal levels seen were due to a low prevalence of potential users; a conscious decision to visit other pharmacists “out of area”;  or poor local knowledge of the scheme. 

Apart from Shanklin, and viewing Cowes and East Cowes as one area, each major town has two sites that provide needle exchange services, allowing an alternative option for users.  

The hot spots are concentrated in the 5 main conurbations (again taking Cowes and East Cowes as one area) i.e. Ryde, Shanklin, Sandown, Newport (including Carisbrooke) and Cowes; this picture is not unexpected. However it is interesting that the highest pharmacy by client numbers is the closest to one of the Treatment Providers e.g. Lloyds Carisbrooke and IDAS. 

Future Work

Now that NEXMS data is up to date a quarterly review will be undertaken with the next due in October 2009, covering Q2 – July to September 2009 (current data only covers the period to July 2009). 

Mike Ackrill 
Performance and Contracts Manager 
Isle of Wight Drug Action Team 

6.	
Blood Borne Viruses and Pharmacy Project 

6.1.	Data provided by the Public Health unit of the Isle of Wight PCT, shows the prevalence of HIV and BBV known to services – the most recent figures are shown below:  

ISLE OF WIGHT - DIAGNOSED HIV-INFECTED INDIVIDUALS					
Numbers of diagnosed HIV-infected patients seen for care, by LA of residence	
 	2002	2003	2004	2005	2006	2007	2008	
number of patients	19	24	22	28	30	33	40	
NB: these figures include IW residents receiving treatment off-Island	

								

								

								

								

								
Data Source:  Survey of Prevalent HIV Infections Diagnosed (SOPHID)				

ISLE OF WIGHT - DIAGNOSED HIV-INFECTED INDIVIDUALS	
Numbers of diagnosed HIV-infected individuals by probable route of HIV infection, sex/ survey year.²	
	2008 Nos.				
Sex between men	27				
Sex between men and women	10				
Blood/blood products recipient		withheld - number is under 5	
Injecting drug use		withheld - number is under 5	
Other/Not known		withheld - number is under 5	
Mother-to-child transmission		withheld - number is under 5	
Total	40				

					

					

					

					

					
Data Source:  Survey of Prevelent HIV Infections Diagnosed (SOPHID)			

6.2.	Information has also been provided on the prevalence of Hep C, based on the numbers of tests undertaken at the Pathology Lab at St. Mary’s Hospital 

Isle of Wight Pathology Lab - Hepatitis C Tests & Results – 2008	
				
 	 	OF WHICH	OF WHICH	
Location Category	Number of Tests	Anti-body Positive	PCR - RNA Positive	
A&E	*	 	 	
GP	283	19	12	
Gynae	16	 	 	
Hospital - Misc	15	*	*	
Hospital In-Patients - Misc	6	*	*	
Hospital Out-Patients / Clinic - Misc	85	*	*	
Hospital ward	75	*	*	
IDAS	31	*	*	
Maternity	9	 	 	
Medical Assessment	36	*	*	
Mental Health	*	*	 	
Occupational Health	149	*	*	
Other	*	 	 	
Paediatrics	10	 	 	
Prison	54	10	7	
Renal	101	 	 	
Sexual Health Services	563	30	24	
Total	1441	78	55	
* Numbers suppressed as below 5 	

Isle of Wight		Hepatitis C data	2008			
(all data from St Mary's Pathology Lab unless stated otherwise)					
Number of Tests:	1441						
							
OF WHICH							
							
Number of Anti-Body Positive Tests:	78	but 	68	different dates of birth	
Number of PCR / RNA Positive Tests	55	but 	46	different dates of birth	

NB: assumed that all PCR/RNA positives are also Anti-Body Positives				

6.3.	The DAAT held talks in early 2009 with the Community Pharmacy Lead and the Local Pharmaceutical Committee representative. The aim of the meeting was to explore how Community Pharmacies could contribute further to the care of injecting drug users (IDUs) accessing needle exchange services & those who attend for substitute prescribed medication. 

6.4.	Nationally, the Hepatitis C Trust invited pharmacies to participate in a ‘Pilot’ of Dried Blood Spot testing for hepatitis B & C in pharmacy settings. This would be for a 3 month period and be offered to anyone who may have put themselves at risk of contracting a Hepatitis infection.  It was agreed that the DAAT would fund this project but take the opportunity to expand the service and fund vaccination training for the pharmacists enabling them to administer Hepatitis B vaccinations to IDU’s and others who they identified as being at risk within an agreed Patient Group Direction.

6.5.	The service has performed well with good uptake of both tests & vaccination courses being completed. (See Annex 1) The DAAT in partnership with the Isle of Wight NHS Trust have agreed to further funding to expand the service of the test cards to include testing for HIV and Syphilis. Further partnership working has been utilised to ensure that correct training and support is available for staff and that the care pathways are in place for any individual with a positive test result. 
 
6.6.	Historically the Island Drug & Alcohol Service (IDAS) had been offering dried blood spot testing & Hepatitis B vaccinations. The uptake was poor and there were concerns recently about the efficacy of the test cards used. To resolve these concerns IDAS have utilised the test cards as used by the pharmacists.  It is hoped that IDAS will also be introducing the HIV element of testing to their service later in the year once they have completed the required training.   

6.7.	IDAS have utilised the service that the pharmacies have been delivering by notifying them of Service Users that have had their initial vaccine with them but have not returned in the opportune time to have subsequent vaccinations enabling the pharmacists to approach these individuals when they next attend the pharmacy to offer to complete the course. This approach has led to a good relationship between IDAS & pharmacies with effective communication streams. 

6.8.	The figures from pharmacies & IDAS vary significantly (Annex 2) but it is hoped that IDAS will be able to promote their testing & vaccination service more effectively now they have regained confidence in the testing card they are using. The service has been affected by staff shortages in recent months and it is hoped that the recent recruitment drive and appointment of staff will allow more dedicated time for effective testing and vaccination.

6.9.	The service delivered by the pharmacists has been welcomed by service users & staff alike, it has proven to be value for money and the DAAT obtain data from the project to allow for performance and adherence to contracts to be monitored. This project has already won a local award and is entered in the finals for a national award. 

6.10.	On 1st December 2009 there will be a launch of the HIV testing in pharmacies on the Island by Keith Ridge, the Chief Pharmaceutical Officer for England. 

7	
Service User Involvement

7.1	Contribution by RESULT Service User Group
In September 2009 the DAAT employed a new Service User Coordinator to develop and promote user involvement within the Isle of Wight’s drug treatment system. The following is his report on progress since his appointment, and the work that was undertaken by the RESULT Group in 2009 prior to this. 

“Over the past few months the Coordinator and existing members of RESULT have began recruiting voluntary service user representatives with a view to establishing the service user group. We have so far had 7 people interested in joining and they are in the process of having CRB checks completed.  Our aim is to be able to have Mentors/ Advocates in Cranstoun and IDAS at set times to ensure consistency.

Training - RESULT have enlisted the help of Oxford Service User Group ‘OUT’ to provide training for key members.  This will improve existing knowledge and understanding of service user involvement.

RESULT’s main aim is to look at things that ‘work’ and what needs attention in treatment provision on the Isle of Wight.

The NTA are keen to see people move forward in their treatment journey; 4 years +, however do the clients actually know what their options are?

RESULT aims to work alongside IDAS & Cranstoun to provide aftercare services for those coming to the end of their journey, to support returning to/ beginning, education, training and employment e.g. a Music Group runs every Friday at Cranstoun from 10 am until 3pm - guitars, drums, mixing decks etc.

Referrals - RESULT also wish to contact local services for example, Probation, CARATS, Mental Health etc. and explain RESULT referral pathway for their clients who they feel can benefit from our service/ support.

We wish to find out what people are presenting with? Our aim is to look at current trends.

Secret Shopper – A questionnaire has been finalised and we have enrolled volunteer service users to gather evidence from the Pharmacies involved in the Needle Exchange Scheme over the next few months. A report of findings will be prepared and shared with the DAAT and the PCT.

P.O.W.E.R. – ‘Providing Opportunities for Women and Ensuring Respect’, is the motto for our female substance misusers group. The women’s alternative therapy days are going really well e.g. over 20 have been attending on the first Friday of each month. However, we wish to expand on this and request a block booking for the Quay Arts Centre to run fortnightly.  It has been suggested that we have the 4 therapists offering relaxation treatments develop a rolling programme over the fortnight.  

Basic Drugs Awareness (BDA) – Our aim is to help parents/ carers and other professionals:
•	Become better informed about drugs. 
•	Why and how used? 
•	How to communicate effectively and to make informed choices? 
•	To examine their own beliefs, attitudes and behaviour.  
Helen has been working alongside Matt Lockyer and Chris Mills to deliver full day training to staff.  Both Helen and Anne have been involved in numerous training and community events this year and always very well received.

Integrated Drug Treatment Service (IDTS) – RESULT are currently working alongside the IW Prison to gather views of offenders, through the use of a questionnaire.  We have also produced a leaflet informing offenders how the new scheme will work.

Carers Conference – this is scheduled to be held on the Isle of Wight in April 2010.  The Family Intervention Coordinator at IDAS has been supporting RESULT and is a proactive advocate for the needs of carers.” 

Jim Tuckey
Service User and Carer Involvement Coordinator
8.	NI38 Performance Measure 

8.1.	This National Indicator (NI) measure representing “Drug-related (Class A) offending rate” has been adopted as a Local Measure as it directly relates to the level of PDU’s inn effective treatment. The Measure is update annually, and is based on a cohort of Offenders, and the tracking of the offences committed over a 12-month period- this cohort is statistically low due to the overall population of the Isle of Wight 
 
8.2.	A mid period update has been provided in December 2009, for the period January to March 2009. This shows that actual offending against projected offending is below 1 (a level below 1 indicates good performance and over 1, poor performance) at 0.67, however the trajectory is not in line with the requirement to meet with the Island’s target. 

8.3.	The measure is affected by various Actions undertaken by partners within the Crime and Reduction Partnership (CDRP), including the DAAT, Hampshire and IW Police and Providers as shown in the following Table

Actions (Initiatives)	Milestones (Tasks)	Date Started		Lead Organisation	
Operation Augustus	Targeting drug abusers committing burglary to feed their habit	Ongoing	Continuing	Police	
Drug Intervention Programme (DIP)	- Adults with whom initial contact (as defined in the DIR guidance) is made and who are not already on the caseload - assessed by the CJIT);
- Adults assessed as needing a further intervention - taken onto the caseload;
- Adults taken onto the caseload engaged in treatment.	Ongoing	Continuing	IW Council (Community Safety services)	
Prolific and Other Priority Offenders Programme (PPO)	DIP/ PPO alignment
Delivery of wrap around services	Ongoing	Continuing	Police/IW Council (Community Safety services)	
Enforcement campaigns to disrupt supply of Class A drugs.	- Operation Augustus
- Operation Regina (Prisons)
- Operation Sheridan	Ongoing	Continuing	Police	
Bronze Action	Identifying drugs networks & supply routes through use of appropriate techniques and technology.	Ongoing	Continuing	Police	
DAT Supported Accommodation		Apr 09	Mar 10	IWC/DAT	

8.4.	The last Action, in regard to DAAT Supported Accommodation did not go forward in 2009, despite the bet endeavours of the DAAT and other partners, and the Capital funding allocated by the NTA has been lost and utilised for other purposes by the Regional Team. 

8.5.	A Risk Analysis has been undertaken to complement the actions and as shown in the following Table, one of these risk factors may have an increasing impact in the current economic climate e.g.   

Risk Management – a reflection on the activities listed above.  
Where no action to avoid/minimise risk can be taken, this may mean accepting the risk/s attached to that activity.
Risk	Risk Owner	Date	Impact (1-4)	Probability (1-4)	Current Exposure (IxP)	Actions required to avoid/
reduce risk	Date for completion	Target Exposure	
Risks associated with changes to the grant for Drug Treatment – reduction in amount or loss of control of funding arrangements for community based services (transfers to health priorities).	Zoryna O’Donnell - Pending recruitment	Apr 09	3	3	9	By negotiating budget allocations with appropriate agencies	Review six monthly	2	
Failure to facilitate effective partnership / multi-agency working	Zoryna O’Donnell - Pending recruitment	Apr 09	3	2	6	By ensuring effective contract monitoring and providing support to DAT partnership	Review six monthly	2	
Increase in offending related to economic downturn	Ian Langley / Nikki Shave	Jan 09 ongoing	2	3	6	none	ongoing	6	

9.	
IOW Police Drug Operations

Operation Augustus Combined 1st and 2nd Quarter Report 2009

9.1	Below is detailed a report covering the 6-month period from 1st April 2009 to 1st September 2009.  The report details all substance misuse actions conducted by Police and Partner agencies in the given time frame on the Isle of Wight.  

Number of Arrests for Drugs Offences

	1st Quarter
01/04/2009 – 30/06/2009	2 Quarter
01/07/2009 – 30/09/2009	Combined
01/04/2009 – 30/09/2009	
Class A Possession	99	135	234	
Class A Supply	24	30	54	
Class A Total	123	165	288	
Class B Possession	261	223	484	
Class B Supply	17	18	35	
Cannabis Production	15	22	37	
Class B Total	293	273	566	
Class C Possession	2 (all Ketamine)	5 (all Ketamine)	7	
Class C Supply	3 (all Ketamine)	0	3	
Class C Total 	5	5	10	
Uncontrolled Drugs Possession 	0	12	12	
Uncontrolled Drugs Supply	0	13 (started as PWITS Class A MDMA identified as BZP)	13	
Uncontrolled Drugs Total	0	25	25	
Overall Total	421	468	889	
Total Number of Drug Seizures same period 2008	577	691	1268	

Bronze Letter/Actions

Number of letters issued = 0
Number of persons entering treatment = 0 

No Bronze actions were issued in this quarter, RMS research has been conducted as to why no persons fitted criteria and the majority who could be offered this option have already had one in the recent past and/or are already in the CJS/treatment.  Another factor is police taking the option of pro-active response with a search warrant/arrest and investigation of alleged drugs supply.

Amounts of drugs seized and street values 01/04/08 – 30/06/2008

Controlled Drug	Amount Seized	Street Value	
Heroin	31.69 grams	£3169.00	
Crack Cocaine	0	0	
Cocaine Hydrochloride	295.85 grams	£14,792.50	
LSD	12 dots & 25 ml	£148.00	
Psilocybin (Mushrooms)	31 grams	£15.00	
MDMA Pills	519 pills	£1557.00	
MDMA Powder/Crystal	368.05 grams	£14,722.00	
Cannabis Plants	203 plants (12180 grams)	£69,600.00	
Methyl Amphetamine	0	0	
Amphetamine	31.38 grams	£470.70	
Cannabis Resin	615 grams	£1757.14	
Cannabis Skunk	11,424.55 grams	£65,283.14	
Ketamine	5 grams	£50.00	
BZP/MCPP/TFMPP Pills	1691 pills	£5073.00	
BZP/MCPP/TFMPP Powder	0	0	
(There are still 11 seizures pending results from LGC)

Overall Street Value of drugs seized in 1st Quarter of 09/10 = £176,637.48

These seizures of drugs have resulted from a number of pro-active operations which has resulted in a total of 8 positive warrants being executed along with a number of other methods being employed. In total there were 18 targeted operations conducted by Police against individuals on the Isle of Wight to combat drug supply activities.  The IOW Festival took place during this reporting quarter and accounts for a total of £100,236.86 worth of drugs seized and a total of 990 persons searched for drugs and 776 positive searches with 250 being in possession and 526 admitting use of drugs prior to the search.   

Amounts of drugs seized and street values 01/04/08 – 30/06/2008

Controlled Drug	Amount Seized	Street Value	
Heroin	57.52g	£5752.00	
Crack Cocaine	Nil	£0.00	
Cocaine Hydrochloride	1408.31g	£70,415.50	
LSD	26 Tabs & 77mls	£284.00	
Psilocybin (Mushrooms)	Nil	£0.00	
MDMA Pills	2583	£7749.00	
MDMA Powder/Crystal	£430.8g	£17232.00	
Cannabis Plants	174 plants	£59,657.14	
Methyl Amphetamine	13.8g	£828.00	
Amphetamine	520.85g	£10,417.00	
Cannabis Resin	615g	£1757.10	
Cannabis Skunk	13,657.08g	£78,040.45	
Ketamine	109.1g	£3273.00	
BZP/MCPP/TFMPP Pills	1381	£4143.00	
BZP/MCPP/TFMPP Powder	30.31g	£1212.40	
Mephedrone 
(4-mmc/Space E)	31.58g	£536.86	

Overall Street Value of drugs seized in 2nd Quarter of 09/10 = £261,296.50.

These seizures of drugs have resulted from a number of pro-active operations which has resulted in a total of 15 positive warrants being executed (this quarter) along with a number of other methods being employed. In total there were 40 targeted operations conducted by Police against individuals on the Isle of Wight to combat there drug supply activities.  The Bestival took place during this reporting quarter and accounts for a total of £157,941.40 worth of drugs seized and a total of 829 persons searched for drugs & 292 persons arrested for drugs related offences.

Iontrac Operations

At the time of writing the two Iontrac devices are stored at Cowes and await use by the designated Safer Neighbourhood Teams.  There is currently a review being conducted on the force wide use of these devices.  Hampshire has recently signed up to testing cash with the Iontrac following a presentation by Kent Police and the HOSDB.  It is anticipated that following a test trial in January 2010 that the use of the Iontrac for drug traces (Cocaine only) will become standard nationally & hopefully save forces money on submitting cash for Mass Spectrometry.

Early Drug Intervention Initiative Drugs Awareness Sessions

Since April 2009 a total of 28 drugs awareness sessions have been delivered across the IOW in Schools and colleges with in excess of 2848 persons having attended.   These events continue to be very popular with schools and parents and it is planned to continue with this scheme due to the demand.  All High schools (excluding Medina) have elected to implement a training delivery slot for Year 9 pupils over the course of 1 day which has proven to be very worth while for all agencies involved.
The current plan is for the delivery of drugs education to be taken on by the Safer Neighbourhood Teams (SNT); plans are underway to get this moving.

Operation Regina – HMP drug supply investigations: OP COM PC Moyce

To date a total of 11 drugs supply investigations have commenced during this reporting period.  All three prisons are now under the name of HMP IOW, however they do still maintain their own identity and OP Regina continues to be a good example of partnership working. During this period there has been a series identified with Class A Heroin being supplied into Camphill secreted in laminated drugs awareness course certificates (cheeky).  The PCU have this series and are progressing with it. 

Operation Sheridan – Ports of entry disruption plan: OP COM PC Lucy

Operation Sheridan is starting to have a major impact on the supply routes into the IOW with persons currently on bail for varying offences including money laundering and supply of class A drugs (Heroin & cocaine).

Conclusion
To date from the 1st of April 2009 Police on the IOW have detected a total of 10 Class A PWIS offences and have commenced a total of 72 investigations into Class A drug supply (28 have been resulted as either Class B/C/Unclassified once the drugs have been identified or CPS have refused to charge) this leaves a total of 44 live investigations currently under way with suspects on bail to this OCU.

Operation Augustus has contributed to all of the above operations and is an integral part of the Isle of Wight Police and Partners strong stance on the supply and misuse of controlled drugs.  

Finally: Space E a legal high containing 4-Methyl-Methcathinone is fast becoming a popular abused substance with users showing signs of developing a tolerance and even reports of some injecting the drug.  This substance is not controlled under the Misuse of Drugs Act.  Space E is sold from the two Spaced Inc stores on the IOW.  The update on this substance is that it is Mephedrone which is listed to be classified as a Class B drug in December 2009.

PC 3149 Matt Lockyer
2 OCU Drugs Intelligence Officer.
10.	
 Citizens Advice Bureau Pilot 

10.1	During 2009 a 3-month Pilot project was developed with the Isle of Wight Citizens Advice Bureau (CAB) for advisers to attend the offices of the Treatment Providers. This was intended to identify whether the perceived need for specific advice on a range of issues was confirmed in practice. 

10.2	The following is a report prepared by the CAB on the pilot period:    

Isle of Wight Citizens Advice Bureau
DAT / Substance Misuse Pilot Project April to June 2009

Summary
•	The Pilot improved the quality of life for 107 clients by providing independent advice, support and guidance.
•	Clients who accessed the service have an increased understanding of their rights and responsibilities enabling them to better engage with the community, and address isolation and social exclusion
•	Clients were empowered to access and maintain appropriate services and tackle issues by themselves, not depending on others.
•	The Advisors worked with clients and professionals and identify the need for a continuation of service provision. Evaluation of the Pilot will be included in further project planning and delivery.

Introduction
The Pilot was managed by the IOW CAB and supported by the Isle of Wight Local Authority: Drug and Alcohol Service & Under 19 Substance & Misuse Service, Cranstoun Drug Services and Foyer for the Island (Medina Housing Association). 

The Pilot linked to The Isle of Wight DAAT Partnership: Employment & Education Support for people who substance misuse: Delivery Plan 2008-2011. The aim was to assess and address the need for specialist welfare benefits advice and information for people with a substance misuse problem who may or may not have a mental health problem.
Needs for the services were identified as:
•	For a service for their in-house services to refer onto and continue assistance and support
•	A service to capture new clients as current services full.
•	A service, direct to clients, to compliment other services
•	A possible ‘out of hours’ service’.
•	An appointment and drop in service

The Foyer, Cranstoun and IDAS are supporting the service with Admin. 
All Clients accepted by referral.
The provision of the service included 2 outreaches at Seven Acres Mental Health Unit.
The Pilot was not publicised outside of these organisations. 
1.5 Specialist Advisers were employed to provide front line assistance between April and June 2009. Contact and referral details were cascaded to parties involved. 

Evaluation and Statistics
Estimated numbers of problem drug users by DAAT area and gender, South East 2006 reported there were 500 people misusing substance (160 female/ 350 male) residing on the Isle of Wight.

Estimated numbers of people on Main Benefits (total people 400) who are problem drug users, by DAAT area and benefit, South East 2006 reported there were 
100 people claiming JSA
220 claiming Income Support (now ESA)
40 claiming DLA
130 claiming Incapacity Benefit
The Pilot received 107 referrals for assistance at one to one advice & information sessions. Outreach sessions were offered by appointment with drop in sessions at Sevenacres. An out of hour’s service was not feasible due to resources and timescales of setting up this facility.
46.6% of the enquiries were from new clients for initial information/ advice and 21.4% existing/follow up clients with further casework.

Of those recorded:
•	90.9% of clients were recorded at white British; the ethnicity of the remaining 9.1% was not recorded.
•	36% were Male clients; mainly within the 29-49 age range
•	64% were Female clients; mainly within the 35-49 age range
•	68% of clients indicated a disability; 18% were not disabled and the remaining 14% declined to answer or were unknown 

173 categories of enquiry were addressed (some clients presented with more than one issue.
The highest category of enquiries were Welfare Benefits related – 50%

The 2 highest types of benefit enquiry were the new Employment Support Allowance 18% and Incapacity Benefit 18%

Examples of Benefits enquiries:
Female client A, age 50, permanently sick/disabled referred herself to the pilot service regarding benefits issues. The client had received Incapacity Benefit since 1994 but had now failed Personal Capacity Assessment (PCA). Previously the client has passed on mental health grounds (twice been to appeal and successful). The Client felt there were descriptors that the examining doctor had not taken into account. The Adviser identified options for the client which included how to get the PCA decision changed and advice & information about other benefits e.g. Council Tax benefit (CTB) which wasn’t being accessed, and JSA. The Client chose to apply for JSA until the decision re PCA was re examined. The Adviser and client prepared paperwork and medical evidence for reconsideration contacting professionals involved. The Advisor advised the client to request and extension for reconsideration date. The paperwork was then reviewed, signed and sent to the Decision Maker. The Client received a decision notice advising them, following reconsideration, they had not qualified for PCA, JSA and non-dependant deduction for CTB – the Advisor provided further advice and information: how to appeal the decision, how to lodge the appeal, tribunal service procedure.This casework was undertaken during the DAT pilot; as resources for the ongoing casework required ceased the client was referred to the Main Bureau, Age Concern or the Law Centre for further assistance.

Female client B, age 45, unemployed with dependant children and a disability referred herself to the pilot service as her Employment Support Allowance had not been paid for 4 weeks due to the ward clerk not receiving the appropriate sick notes. Her husbands’ employment had been reduced from 30 to 15 hours and they were finding it hard to buy food for the week. The Adviser identified options for the client which included progressing the ESA claim by compiling a letter with details of events and making a complaint. Client was also advised that Working Tax credits would cease as the husbands work hours had reduced below eligibility levels. Advice was also given regarding applying for a crisis loan whilst benefits issues were being sorted out. 

Conclusion & Recommendations
As a result of the Pilot it is recommended:

Participation in partnership working e.g. DWP, Job Centre Plus, and events e.g. Community Alcohol Partnership and Community Safety Action, in order to raise awareness and potential impact in changes of benefits e.g. Employment Support Allowance.

Funding is sought for Outreach Clinics to partner services including dual diagnosis and mental health in order to assist client’s seeking advice and guidance relating to welfare benefits in order to maximise income and financial concerns to reduce the likelihood of debt/increasing debt.

Gay Beal 
Chief Executive
Isle of Wight Citizens Advice Bureau 

11.	
Alcohol Arrest Referral Information 

11.1	An Alcohol Arrest Referral (ARR) Scheme was set up in August 2008 with funding provided by the Isle of Wight Crime and Disorder Reduction Partnership (CDRP). The scheme is operated by Cranstoun, the existing Tier 2 Provider, and operates 7 days a week in liaison with the Custody officers from Hampshire and IW Police.

11.2	The service offers anyone arrested where the incident is classified as involving alcohol, the opportunity to talk to a worker from Cranstoun. Further support is offered through a series of brief interventions – currently this covers three sessions at Cranstoun, to explore alcohol use and relevant factors. This is a voluntary scheme in the main, although it may also be used as a mandatory scheme under Conditional Cautioning, where attendance at the session is a requirement. 

11.3	

•	74 referrals under scheme (data includes 2 self –referrals, and 1 double entry of 77 listed)
o	2 were under 18 and referred on to Get Sorted
o	1 started attendance at Alcoholics Anonymous  
o	3 were sentenced to imprisonment (terms between 4 to 9 months)
o	1 moved out of area
o	1 was referred to Southampton CDA
o	2 were identified as inappropriate referrals 
o	2 were not interested at the outset 
o	3 had no identifiable action on spreadsheet  
•	Therefore base figure for accepted referrals - 59 
•	Of these 29 did not attend for first appointment (despite chasing by Cranstoun)    
•	Of the 30 attendees:
o	15 were discharged with no specified action 
o	1 was referred to “t12” workshop after first appointment 
o	10 are still in the process 
o	6 attended 2 appointments
o	1 was offered “C eng” 
o	2 attended all 3 appointments 
o	1 of these was referred on to IDAS
o	1 was noted as “all okay”  
  
Summary
74 referrals
59 accepted
30 attended
10 ongoing 
4 successes 

Chris Mills
Service Manager
 Alcohol Arrest Referral Service: Cranstoun

Information provided by Cranstoun shows for period 13/8/08 to 7/8/09:
12.	
 Alcohol Nurse Specialist Report

12.1	This post has been part-funded by the DAAT in liaison with the PCT and commenced her role in January 2009 to work within the Accident and Emergency Department at St Mary’s Hospital. This role is based on the “Cardiff Model” and seeks to provide brief interventions for patients attending A&E who present with an alcohol related injury, or if admitted, are subsequently identified with alcohol issues 

12.2	The relevant work commenced in May 2009, after a period of training and development, and the incumbent is located within A&E 2 nights per week, and also undertakes brief interventions through a “clinic” on a regular weekly basis. The scheme is voluntary and as identified in schemes already in operation the drop-out rate can be high. Current figures have been provided below:

Month	Appointments offered	Number of attendances	Did Not Attend	Cancelled/ Rebooked	
May	44	29	12	3	
June	30	8	17	5	
July	18	6	7	5	
August	29	7	15	7	
September	16	2	12	2	
October	50	4	45	1	
Detailed Report for October 2009 .
•	Current or pending Pts on books- 63
•	Pts discharged- 60 (since the start)
•	Appointments offered-50
•	Interventions in the dept- 10
•	Ward Detox Reviews-10
•	Referrals Received- 5
•	Referrals Accepted- 5
•	Inappropriate referrals-0
•	Home Visits- 0
•	Training-  No training sessions offered. No 1:1 sessions taken up by staff. No training opportunities in dept.
•	Waiting List There are currently 24 people awaiting their 1st assessment, and 21 people awaiting appointments following either presentation to ED while I wasn’t on shift or after an emergency detox that I was unaware of 
•	Wards The service with the ward is working very well and they referrals and notifications are now consistent.	

12.3	Regrettably, despite the best efforts of the Alcohol Nurse, the Emergency Department is not referring to the service and the buy-in and uptake is poor. On the whole, the staff attitude is poor, and while they believe the service to be useful they are reluctant to take part in the training. Attitudes have ranged from “its not my job” to “they have unsolvable problems and I don’t want to ask the difficult questions” A new action plan is being developed to improve both the perception of the service, and staff uptake of training. There are a handful of staff and a consultant who refer regularly to the service but even these individuals are reluctant to do the training and are doubtful to how the service can be fully effective in the department.

12.4	The current Nurse Specialist has obtained a new posting within the PCT and it is understood that the PCT will not be re-advertising the post, but utilise the funding to develop brief intervention pathways in other areas. 

In effective treatment now

In effective treatment in financial year

Known to treatment but not treated last year

Not known to treatment 

13.	IOW   bullseye 31/03/09 data -opiate / crack users

Key:
General population
Women
BME groups
Young people 15-24yrs

313

68

34

107

83 (27%)

26 (38%) 

10 (29%)

6 (2%)

4 (4%)

2 (3%)

26 (8%)

8 (12%) 

6 (18%)

DIP/CJ/ CARAT 

GP

Self

Other

Island Drug & Alcohol Service  (IDAS)  

Cranstoun

63   (34)

 50   (15)

7   (3)

9   (4)

5   (4)

17   (11)

Referral

Treatment

Onward referral

IDAS = 368
In treatment 2-4 yrs: 87
In treatment 4 yrs+: 135 

Cranstoun = 181
In treatment 2-4 yrs: 0
In treatment 4 yrs+:  0 

Total Discharge

Planned discharges

Unplanned discharges

Referred on

27                                                                               42

14                                                                                 9

Ed

24   (17)

11                                                                                 0

35

13

Drug Services 

Dropped Out 

52                                                                               74 

 0                                                                                23

Key –
Total referrals
(Treatment naïve)  

Get Sorted = 18
In treatment 2-4 yrs: 0
In treatment 4 yrs+:  0 

     8  
O8

     0

     0
     
     0

14. IW Treatment Map 2008/09

Isle of wight primary care trust	
Community Pharmacy Based Hepatitis B and C Dry Blood Spot Testing and Hepatitis B Vaccination Service	
Service Lead – Kevin Noble MRPharmS – Community Pharmacy Lead	
	
Kevin Noble 	
12/09/2009	

A three month report prepared for Keith Ridge MRPharmS Chief Pharmaceutical Officer, England,  and the Drug and Alcohol Team, Charter House, St Thomas Square, Newport, Isle of Wight	

Community Pharmacy Based Hepatitis B and C Dry Blood Spot Testing Service and Hepatitis B Vaccination Service- Isle of Wight 
Introduction and Background.
This report highlights the achievements of Community Pharmacists working on the Isle of Wight, as part of an integrated service that offers dry blood spot testing and a Hepatitis B vaccination service to injecting drug users, their sexual partners, injecting partners, close contacts and family members.
In February of this year the PCT Pharmacy Lead and the Isle of Wight LPC representative held talks with the Commissioner at the Drug and Alcohol Action Team (DAAT). The purpose of the meeting was to discuss the contribution that Community Pharmacists could make to the care of injecting drug users accessing needle exchange services and those attending Pharmacies to collect daily methadone.
Injecting drug users are highlighted in the Department of Health Green book as high risk of contracting Hepatitis B (HBV) infection. Their lifestyles are often chaotic and the fact that many share needles for injection also puts this group at risk of infection with other blood bourne viruses, including Hepatitis A, C and HIV.
Historically dry blood spot testing and vaccination against HBV had been carried out by The Island Drug and Alcohol Service (IDAS). Clients attended for assessment appointments and at this appointment they were tested and given the first of three Hepatitis B vaccinations. The vaccination schedule adopted was the ultra rapid course that involves giving vaccinations on days 0, 7 and 21. 
The vaccine on day 0 was obviously not a  problem, as the client was at the clinic for assessment, however, administration of vaccines 2 and 3 i.e. those due on day 7 and 21 were problematic as these could only be administered if the client attended. Due to the nature of this client group, and their chaotic lifestyle, the clinic experienced high numbers of Did Not Attend (DNA) for appointments 2 and 3. The team had tried various ways to encourage attendance at their clinic for the second and third vaccine, even paying for bus passes and fares to improve uptake. This did not help, to any great extent and despite best efforts by IDAS, the uptake of Hep B vaccination remained low. 
Poor uptake of vaccine in this client group was obviously a problem and a need was therefore identified.
Providing the Solution
Development of an integrated service to involve Community Pharmacists in this care pathway.
Injecting drug users engaged with IDAS for detox treatment attend Community Pharmacies daily to pick up methadone. Injecting drug users who are not engaged with treatment also attend Community Pharmacies to use needle exchange services. Both client groups develop unique relationships with Pharmacists and have daily contact. Community Pharmacies are often the treatment centre of choice for this group as they will often be reluctant to engage at GP practice and generally try to self medicate in many instances. 
Community Pharmacists were therefore ideally placed to engage in service delivery to this client group as they had daily contact. This meant that clients would be far more likely to attend Pharmacies for services than any other treatment centre.
At the February Commissioning meeting it was proposed that Pharmacists could be trained to vaccinate and administer Hepatitis B vaccinations alongside methadone pick up/ supervised consumption services. The Pharmacists would work in collaboration with IDAS who could identify the need for dry blood spot testing and Hepatitis B vaccination in new clients, and refer such clients to the Pharmacy based service for testing and vaccination. The Pharmacists could also target Needle Exchange service users to improve awareness and understanding of risk regarding blood bourne viral infections, and to offer dry blood spot testing and Hepatitis B vaccination i.e. those clients who were injecting but not engaged with a treatment program.
As the methadone clients would be attending the Pharmacy daily to pick up, there would be far more chance of successful vaccine delivery as the client was far more likely to attend on days 0, 7 and 21 as was required to deliver the ultra rapid Hepatitis B vaccination course . 
Identifying the Areas of Need.
Audit data was available for needle exchange service and supervised consumption of methadone service and analysis of data was simple. This data highlighted those Pharmacies that were engaged with this type of service and hence identified the areas of need for a vaccination service.
Service Development and Training.
A PGD allowing Hepatitis B vaccination by suitably trained Community Pharmacists was developed by the Pharmacy lead. This required a dry blood spot test to be carried out in conjunction with Hep B vaccine 1. As tests took ten days to process, vaccine 2 would then be delivered at 7 days and vaccine 3 would only be administered on day 21 if the dry blood spot test result was negative. For patients testing positive to Hep B a third vaccine would be useless. All patients testing positive were referred to Sexual Health Services who could carry out partner notification and assessment for anti-viral therapy.
A two day training course was developed in conjunction with M and K updates. Completion of this course enabled Pharmacist attendees to reach the required national standard to vaccinate and also provided education regarding blood bourne viral infection, transfer of viral infection, cold chain requirements, needle selection for Intra muscular vaccination, and dealing with needle stick injury. Additionally Basic Life Support and anaphylaxis training was provided by the Isle of Wight PCT Resuscitation team, and the Hepatitis C Trust provided training on dry blood spot test procedure and counselling patients pre and post test. Suitable support documents were produced as a collaborative effort between Kevin Noble, the Pharmacy Lead and Gary Warner, the Island PSNC and LPC representative. (See attached).
Nine Pharmacies were identified in Needle Exchange “hotspots” on the Isle of Wight, and fifteen Pharmacists completed the proscribed training.

The Service.
At IDAS appointments, client key workers identify clients requiring dry blood spot testing and Hepatitis B vaccination. The Key worker for a client then completes the Pharmacy referral form (attached) and faxes this through to the Pharmacy used by that client.
On attendance at the Pharmacy, the Pharmacist is aware of the need and can engage with the client to discuss the spot test and vaccination course. The Pharmacist then, after gaining consent, carries out the dry blood spot test and administers vaccine 1. The Pharmacy notifies IDAS that the spot test has been carried out and the vaccine course commenced. This is required for IDAS National Treatment Agency reporting. The Pharmacist then explains the need to administer Vaccines at day 7 and 21 and that these will be administered when the client attends for methadone pick up. The Pharmacist also provides counselling regarding Hepatitis B and C infection and the impact that a positive result might have on a client regarding lifestyle and future insurance etc.
At days 7 and 21 the client must give further consent to administer the vaccine and a check is carried out to ensure no changes have taken place that could impact upon the safety of the vaccine e.g. Client confirmed pregnant, changes in drug therapy etc.
When the vaccination course is completed the Pharmacist notifies IDAS using the completion notification form.
If a client tests positive to Hep B or Hep C, following discussion at the Pharmacy regarding options, as set out in the hepatitis C Trust information leaflet, they are referred for assessment at the Sexual Health Clinic, St Mary’s Hospital. If a client tests positive to Hep B they do not receive vaccine 3 at 21 days.
A booster is recommended at 12 months.
Clients that provide a mobile phone number are reminded of appointments by an SMS messaging service created by Gary Warner. This involves inputting the mobile number into a computer programme that automatically sends a reminder message the day before a Pharmacy appointment.
IDAS are planning to carry out seroconversion assessments at six months for clients registered with this service. Clients that are not registered with IDAS are advised to attend their GP practice for this assessment.

Results of service- three months from commencement.
To realise the full impact that the integration of Community Pharmacies has had on this service, and the promotion of Hepatitis B vaccination uptake in this client group, we have looked at outcome data for the corresponding quarter this time last year.
With the IDAS based service, despite having engaged with a great many clients and promoting the importance of Hepatitis B vaccination. The service only managed the successful completion of one course of Hepatitis B vaccination. This is not stated to criticise the service, but to highlight the unique nature and requirements of this client group.
The integrated approach to this service delivery has, without doubt paid dividends, and the results of the Collaboration between IDAS and Community Pharmacies are shown in the table on the following page. 
From this page it can be seen that the impact of Community Pharmacy integration has impacted significantly on outcomes.
At the end of August 2009, Pharmacists were engaged with 72 clients. Of these, some are still part way through their vaccination course. 
At the end of August 2009, from a total of 59 courses of Hepatitis B vaccinations that could have been completed 51 have been via the Pharmacy route. Only 8 people had been lost from the service, giving an 86.4% success rate via the Community Pharmacy based service.
Also, at this point, 7 clients had tested positive to Hepatitis C, and 2 had Hepatitis B core antibody. The Hepatitis C positive patients have been referred through to GP practice for assessment (NB: This referral pathway has now changed, and clients are referred through to Sexual Health Services directly to speed up onward referral for anti viral therapy where appropriate). Clients that tested positive for Hepatitis B core antibody did not receive vaccine 3, as this is indicative of historic infection and the development of natural immunity; hence vaccine 3 is not required.

Name of Pharmacy	Number of Dry Blood Spot Tests	Number of Heb B Positive	Number of Hep C Positive	RNA Positive	Genotype	Sex of Client	Hepatitis B Vaccination Administered	Reason For Non attendance at vaccine appointment/ Notes.	
					1	2	3	4	M	F	Vaccine 1	Vaccine 2	Vaccine 3	Courses Completed for IDAS		
Alliance Pharmacy Sandown	8	0	1	0							8	5	2		All Clients still engaged	
Boots The Chemist Ryde	19	0	3	2			2		2		19	16	16		1 Deceased, 1 In Hospital*, 1 lost	
Boots The Chemist Sandown	10	0	1	1	1					1	5	4	4	2 vaccine 3 of 3 administered	1 client moved to mainland	
Boots The Chemist Cowes	6	0	0	0							6	6	6			
Day Lewis Pharmacy Cowes	11	0	1	0							9	8	8	1 vaccine 3 of 3 administered	1 lost	
Gibbs & Gurnell Pharmacy Ryde	10	1	2	2	1	1			2		6	4	3		Hep B positive core antibody client not given vaccine 3	
Lloyds Pharmacy Pyle Street	11	1	0	0							6	3	1		5 lost	
Lloyds Pharmacy Ryde	1	0	0	0							0	0	0			
Regent Pharmacy Shanklin	24	0	4	2	1		1		2		13	12	11		1 lost	
Totals	100	2	11	7	3	1	3		6	1	72	58	51	3		

•	Client admitted to hospital-Pharmacist contacted hospital to inform of Hep B course and vaccine 3 administered by hospital.

Conclusion
In conclusion, this service redesign that integrates Community Pharmacies as injecting sites has produced an exponential increase in outcomes regarding completion of the ultra rapid Hepatitis B vaccination course. 
Not only has the service improved uptake of testing and vaccination by this hard to reach group, it has also been well received by Community Pharmacists offering the service. All Pharmacists involved with this service delivery have commented that it has added value to their role.
Service users have completed exit surveys. The surveys sought opinion on convenience of service, preferred treatment site vs. GP practice, whether the client would recommend the service to any friend that might be at risk, and asked to make any additional comment.
All feedback (36 questionnaires returned) was positive, all clients favoured the Pharmacy based service as it was convenient, and all said they would recommend the service to at risk friends. Additional comments included mention of the professional approach by Pharmacy staff and that the service was offered in a non-judgemental and friendly manner. Many said that they were more informed following the appointments at the Pharmacy.
This service demonstrates that adding Community Pharmacies can often add value to services and improve outcomes. Such services are examples of world class commissioning as they embrace these principles, improving both patient choice and service accessibility.   

This page is intentionally left blank 

Name of Pharmacy	Number of Dry Blood Spot Tests	Number of Heb B Positive	Number of Hep C Positive	RNA Positive	Genotype	Sex of Client	Hepatitis B Vaccination Administered	Reason For Non attendance at vaccine appointment/ Notes.	
					1	2	3	4	M	F	Vaccine 1	Vaccine 2	Vaccine 3	Courses Completed for IDAS		
Alliance Pharmacy Sandown	8	0	1	0							8	5	2		All Clients still engaged	
Boots The Chemist Ryde	19	0	3	2			2		2		19	16	16		1 Deceased, 1 In Hospital*, 1 lost	
Boots The Chemist Sandown	10	0	1	1	1					1	5	4	4	2 vaccine 3 of 3 administered	1 client moved to mainland	
Boots The Chemist Cowes	6	0	0	0							6	6	6			
Day Lewis Pharmacy Cowes	11	0	1	0							9	8	8	1 vaccine 3 of 3 administered	1 lost	
Gibbs and Gurnell Pharmacy Ryde	10	1	2	2	1	1			2		6	4	3		Hep B positive core antibody client not given vaccine 3	
Lloyds Pharmacy Pyle Street	11	1	0	0							6	3	1		5 lost	
Lloyds Pharmacy Ryde	1	0	0	0							0	0	0			
Regent Pharmacy Shanklin	24	0	4	2	1		1		2		13	12	11		1 lost	
Totals	100	2	11	7	3	1	3		6	1	72	58	51	3		

Appendix 2

Blood Borne Virus Testing & Hepatitis B Vaccinations  in IDAS 

Quarter 1
Number of people offered Hep B vaccination: 8
Number immune already: 7
Numbers who have started Hep B vaccinations: 0
Numbers who finished course: 0

Number of people offered Hep C testing: 8
Number refused: 4

Quarter 2
Number of people offered Hep B vaccination: 12
Number immune already: 1
Numbers who have started Hep B vaccinations: 3
Numbers who finished course: 0

Number of people offered Hep C testing: 17
Number refused: 3

Appendix 3
Community Pharmacy Based Hepatitis B and C dry blood spot testing and Hepatitis B vaccination service.

Cost of service provision Quarter 1

Cost Breakdown
Vaccination training M and K Update                                  	  	      £2758.85

Dry Blood Spot Test Consultations x 100 @£15.00                                £1500.00                                            			
Dry Blood Spot Tests x 100 @ £26.00                                                    £2600.00

Hepatitis C RNA test + HCV genotype x 7@£64.00		                   £448.00

Hepatitis B vaccination assessments x 72@ £15.00			       £1080.00

Hepatitis B Vaccine 1 Delivery x 72					       £1075.68

Hepatitis B Vaccine 2 assessment and delivery x 58		       £1318.92

Hepatitis B Vaccine 3 assessment and delivery x 51		       £1159.74

Total cost of service at 31st August 2009.                                           £11941.19

NB: Manchester Royal Infirmary are yet to invoice the PCT for Dry Blood Spot Testing services, so although this cost has been estimated according to their current price list, this particular cost element may vary slightly.