Presentation.

The Committee considered a presentation introduced by Julie Webster, Head of Public Health. The report update had been requested by Members further to a previous report to the People Overview and Scrutiny Committee meeting in November 2016. The original report had focussed upon a response to concerns regarding the number of deaths in service in the drug and alcohol treatment  service managed by Change, Grow, Live (CGL).

The Head of Public Health informed that the recovery focused service in Wirral now had, due to work undertaken many years ago to bring  drug and alcohol misusers into treatment, a high number of ageing patients with complex medical and social problems. In Wirral 62% of opiate users had a drug using career of over 21 years, compared to a national average of 40%. In contrast Wirral also had the lowest percentage of service users (17%) with 4 or more treatment journeys, against a national average of 27%, reflecting long term engagement with the treatment service.

The Head of Public Health explained that recommendations from the November 2016 report into the service included:

• Greater focus on general health and wellbeing of service users;
• Improved access to physical healthcare and psychiatric care; and
• Balance approach in the treatment service to ensure those that need treatment receive it and those who wish to embrace the recovery model get the help and support that they need.

The Committee was apprised that since publication of the report a number of actions had taken place, namely:

• Enhanced health assessment for all service users;
• Seasonal flu and pneumococcal vaccination campaigns
• Engaged with the respiratory service; COPD pathway developed;
• Joint work with ABL (smoking cessation service);
• Work with Professor Wilson and the Alcohol Acquired Brain Injury team at Cheshire and Wirral Partnership Trust
• Close engagement with the Integrated Community Care Teams;
• Dual diagnosis pathway and follow up; and
• Naloxone pathway - a medication used to reverse the effects of opioids overdose.

Members questioned the Head of Public Health on the procedure for discharging people from the system and help with access to mental health services. The Committee were informed that the priority was to ensure people were best equipped to cope, and a good peer review system with easy access existed. Patients would not be discharged until conditions were absolutely right. The Committee was also informed that, given the long term use of drugs and alcohol and age of those in treatment, the statistical evidence showed the complexity of medical problems experienced i.e. Wirral Ways to Recovery reported 72 deaths of drug and alcohol users in contact with specialist drug and alcohol treatment service from 1 February 2015 to 31 August 2016, of those:

• 44 in treatment for drug misuse, 21 for alcohol misuse and 7 registered for drug and alcohol misuse;
• (15) aged 44 or under; (37) aged 45-54; (19) aged 55-64; and
• Wide range of causes of death reported with the most common known causes being respiratory disease (14 deaths) digestive disease (13), cancer (12), and external (12) [where external includes suicide, injury and poisoning, 5 of  these were thought to be drug overdoses].

Members noted Wirral’s cautious approach to the treatment of individuals and that Wirral had achieved national recognition as a result. Members also noted that the chaotic lifestyle and complex medical conditions of some service users meant that cause of death was unknown to the G.P. or the service. A Member commented that such lifestyles often resulted in death from fire, and offered to raise the matter at the next meeting of the Mersey Fire and Rescue Service – to identify service users as possible targets for safety checks.

Resolved – that the report be noted.