Vision

To help people in Perth and Kinross live their best lives free from the harms of alcohol and drugs.

Introduction

Perth and Kinross ADP (Alcohol and Drug Partnership) is a multi-agency partnership responsible for tackling alcohol and drug issues for individuals, families and communities throughout Perth and Kinross and promoting recovery.    

Membership of the partnership includes Perth and Kinross Health and Social Care Partnership (HCSP), NHS Tayside, Perth and Kinross Council, Police Scotland, Scottish Prison Service (SPS), Scottish Fire and Rescue Service (SFRS), third sector organisations, living and lived experience representatives and carers' representatives.  

Together, our local Recovery-Oriented System of Care (ROSC), which is a co-ordinated network of services, helps people to start and sustain their recovery, see diagram below. 

Figure 1. Example ROSC model

Perth and Kinross ADP is tasked by the Scottish Government to coordinate local alcohol and drug services through partnership working.  A schematic of the ADP reporting lines can be found below.

Figure 2. ADP reporting lines

The population of Perth and Kinross is 153,810. This is divided across localities into:

Perth and Kinross contains 73,261 households and is broken down into 186 data zones in the Scottish Index of Multiple Deprivation. The 2020 edition shows that 11 are within the 20% most deprived in Scotland. This equates to 5.6% of the population in Perth and Kinross living within the 20% most nationally deprived areas in Scotland 35% of households have single occupant tax discount.  

(Source: NRS Mid-year estimate 2019/ NHS locality profiles)

The work of the ADP is guided and shaped by both national and local strategic frameworks and service delivery plans. These include nationally:

• Rights, Respect and Recovery 2018
• Alcohol Framework 2018  
• National Drugs Mission Plan: 2022-2026
• Changing Lives - Final Report 2022  
• Medication Assisted Treatment (MAT) Standards 2021  
• Families Affected by Drug and Alcohol Use in Scotland: A Framework for Holistic Whole Family Approaches and Family Inclusive Practice 2021
• Alcohol and Drug Partnerships: delivery framework 2019  
• Drugs and alcohol workforce action plan 2023 to 2026

And locally:

• Tayside Drug Death Review Group Annual Report 2022
• Perth and Kinross HSCP Strategic Commissioning Plan 2022-25
• Perth and Kinross Council Corporate Plan 2022-23 to 2027-28
• Perth and Kinross Community Justice Outcomes Improvement Plan 2023-28
• Perth and Kinross Community Mental Health and Wellbeing Strategy 2022-25
• Tayside Plan for Infants, Children, Young People and Families 2023-26
• Tayside Multiagency Suicide Review Group Annual Report 2022 

Despite these challenges, the ADP has made significant progress in meeting the aims and priorities of the previous 3-year strategic delivery plan.

This is highlighted by key developments across all the priorities outlined in the plan and evidenced by relevant performance data.   

Prevention and early intervention

Key developments:

• the establishment of a multi-agency Near-Fatal Overdose (NFOD) Pathway to identify and offer support to individuals who have experienced a near-fatal overdose.
• a steady increase in the number of Take Home Naloxone (THN) kits to reduce the risk of fatal overdose.
• an increase in the number of Alcohol Brief Interventions (ABI) carried out to reduce problem alcohol use.
• providing funding to support several projects addressing the impact that substance use is having on young people.    

Performance data:

Number of suspected NFOD reported by Scottish Ambulance Service (SAS) - 2020/21 - 175, 2022/23 - 89.

Number of THN kits - 2020/21 - 339, 2022/23 - 658.

Number of ABIs provided in P&K - 2029/21 - 122, 2022/23 - 438.

Recovery-Oriented System of Care (ROSC)

Key developments:

• an expansion of the network of recovery cafes throughout Perth and Kinross.
• the development of several new recovery groups including fishing, cooking, walking and a women's group.
• hosting the National Recovery Walk in 2021.
• the establishment of a Living Experience Group.
• organising the first annual RecoverMay programme of events, to celebrate recovery throughout Perth and Kinross.  
• the formation of the Integrated Alcohol and Drugs Recovery Team (iDART) to enhance support for people with substance use issues.
• the establishment of a revised process to facilitate access to residential rehabilitation.
• the implementation of MAT Standards 1-5 to enable the consistent delivery of safe, accessible, high-quality drug treatment services.
• dedicated funding for specialist advocacy support for people with substance use issues.

Performance data:

Percentage of people referred to community services who begin treatment within 21 days of referral is now consistently above 90%.

There have been 21 residential rehabilitation places approved.

There are now 3 types of opioid substitution therapy available with 75% being prescribed Methadone, 12.5% receiving short-acting oral Buprenorphine and 12.5 receiving injectable Buprenorphine (Buvidal). 

Getting it right for Children, Young People and Families

Key developments:

• providing funding to support the Family Mentoring Service test of change which uses a Whole Family Approach and goal focussed mentoring.
• providing funding for a substance use worker to be part of the First Steps (formerly Change is a Must) multiagency partnership which offers intensive family support for families of infants affected by parental substance use, mental health issues and domestic abuse.
• providing funding for a project worker for the Families Empowering Communities project in Letham and Crieff which aims to reduce disadvantage and inequalities for families and improve outcomes.   

Performance data:

In 2021/22, 8.7% of S4 pupils in Perth and Kinross reported having ever taken illegal drugs. This is lower than that reported in Dundee City or the national average.

Public Health Approach to Justice

Key developments:

• working with the Community Justice and Safety Partnership (CJP) to support the development of a Custody Arrest Referral Service to support Perth and Kinross residents in police custody in Perth and Dundee.
• establishing and developing a new Voluntary Throughcare model for Perth and Kinross residents leaving HMP Perth and HMP Glenochil.
• co-funding the Complex Needs Co-ordinator test of change to provide support to the small but significant number of people who have complex needs that involve multiple services.
• co-funding the Specified Persons test of change to enhance the provision of Community Payback Orders (CPO) for people who have alcohol and/ or drug treatment requirements.

Performance data:

Drug-related crime rate in Perth and Kinross has been lower than the Tayside and national averages since 2017-18, and a lower proportion of Perth and Kinross residents perceived drug or dealing to be a problem in their neighbourhood in 2021 than in other Tayside areas.

Enablers

Significant progress has also been made in meeting the aims and objectives of the cross-cutting priorities identified in the previous Strategic Delivery Plan 2023-26. These include:

• the establishment of a Living Experience Group to provide the ADP with feedback about its key services from people who are currently using them.
• contributing to the National Collaborative which aims to facilitate and support change and save lives in the alcohol and drug sector.
• supporting the pan-Tayside Language Matters campaign which challenges the use of negative language towards people who use substances.
• the development of a performance framework for the MAT Standards.
• supporting the delivery of motivational interviewing training for ADP partner organisations.
• joint-working with local trauma champions to develop trauma training opportunities for all ADP partners.    

To identify local priorities, ADP officers sought the views of a wide range of partners and individuals from statutory, third sector, living/ lived experience and carers groups throughout Perth and Kinross.

Their views are reflected in the actions under each Priority and Outcome in the plan.

We have adapted the Scottish Government's National Mission on Drugs Outcomes Framework to structure our Strategic Delivery Plan.

Underpinning our plan are the Quality Principles for Drug and Alcohol Services and the supporting Recovery Philosophy which were developed to ensure anyone looking to address their problem drug and/or alcohol use receives high-quality treatment and support that assists long-term, sustained recovery and keeps them safe from harm. 
The Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services - gov.scot (www.gov.scot)

Priority 1 - Prevention and early intervention

Key outcome:

Fewer people develop problem alcohol and drug use.

Relevant data:

• A higher proportion of Perth and Kinross secondary school pupils reported drinking alcohol at least weekly in 2021/22 than in other areas of Tayside.
• Rates of common assault and vandalism (which are associated with excessive alcohol use) have both been slowly increasing in Perth and Kinross over the past few financial years, with the 2021/22 rate of common assault the highest it has been since 2014/15.
• Fifteen maternities with drug use were recorded for 2017-18 to 2019-20 financial years. This equates to a rate of 12.68 per 1,000 maternities.

Priority 2 - Reducing the harms caused by alcohol and drugs

Key outcomes:

Risk is reduced for people who use alcohol and drugs.

People at most risk have access to treatment and recovery.

Relevant data:

• The average alcohol-specific death rate has been increasing in Perth and Kinross over recent years, with the rate amongst males twice as high as females in 2021.
• The 2021/22 alcohol hospital admission rate in Perth and Kinross was higher than any other year since 2012/13, with rates 5 times higher amongst people living in the most deprived areas, compared with the least deprived.  
• The average drug related death rate in Perth and Kinross remained consistent between 2021 and 2022. However, it is still 5 times higher than that reported in 2010, with three times as many deaths amongst males than females.

Priority 3 - Developing a Recovery Oriented System of Care

Key outcomes:

People receive high quality treatment and recovery services.

Quality of life is improved by addressing multiple disadvantages.

Relevant data:

• There were 35% more referrals to substance use services in Perth and Kinross in 2022/23 than in 2021/22.
• Over half of new referrals in 2022/23 resided in SIMD quintile 1 or 2 (equating to the 40%) most deprived neighbourhood, compared with less than a quarter who reside in SIMD 4 or 5 (the least deprived 40%).
• Treatment waiting times improved within community substance use services in Perth and Kinross throughout 2022/23, exceeding the target by the end of Quarter 4. However, performance decreased within prison services over the year.

Priority 4 - Getting it right for children, young people, families and communities

Key outcome:

Children, families and communities affected by alcohol and drug use are supported.

Relevant data:

In 2021, the rate of child protection cases in Perth and Kinross where known parental alcohol misuse was identified for children on the register was 6.89 per 10,000. The rate has remained above the national average since 2017.

In 2021, the rate of child protection cases in Perth and Kinross where parental drug use was identified for children on the register was 8.0 per 10,000 population, which was higher than that recorded in other Tayside areas or nationally.

Enablers

The following cross cutting priorities have been identified which will enable the priorities above to be addressed. 

Placing Lived and living experience at the heart

Key outcome:

The ADP will have a visible connection to people with lived and living experience, who will play a key role in service development.

Equalities and human rights

Key outcome:

ADP policies and practice will reflect the voices and rights of people with lived and living experience.

Tackling stigma

Key outcomes:

People with lived and living experience of alcohol and drug use in Perth and Kinross experience less stigma. People working in alcohol and drug services experience less stigma.

Surveillance and evidence

Key outcome:

The work of the ADP is informed by evidence-based, robust data

Resilient and skilled workforce

Key outcome:

The Perth and Kinross alcohol and drugs workforce have the right skills and knowledge to support services users.

Psychologically informed support

Key outcome:

Alcohol and drugs services in Perth and Kinross are psychologically informed.

The recurring budget and expenditure plan for Perth and Kinross Alcohol and Drug Services, including the Alcohol and Drug Partnership (ADP) is outlined in Table 1 below.

Table 1

The Core budgets for Alcohol and Drug Services include funding, either in whole or in part, for the following services :- 

• Integrated Drug and Alcohol Recovery Team (IDART)
• 3^rd Sector Funding
• Change is a Must within Education and Children's Services
• Prison Healthcare
• Public Health Support
• Psychology Support

The Reducing Drug Death/National Missions budget of £557k funds the expansion of the workforce within IDART, Education and Children Services, 3^rd Sector funding and Psychology support as well as a residential rehabilitation budget which provides improved access to residential rehabilitation.

The Programme for Government allocation funds, either in whole or in part: recurring posts within IDART; 3^rd Sector Funding; Prison Healthcare and Public Health Support. 

The Stabilisation Fund funds the expansion of assertive outreach work and the expansion of the workforce within IDART.

The MAT Standards allocation funds the multi-disciplinary workforce within PKC, IDART and Public Health to allow implementation of the standards.

The ringfenced funding streams discussed above included back-dated uplifts during 2023/24. This funds cost of living increases for 2022/23 and 2023/24.

In addition to the recurring budget detailed above, the IJB (Integration Authority Joint Board) holds reserves on behalf of the Alcohol and Drug Partnership (ADP) as detailed in Table 2 below.

Table 2

Perth and Kinross ADP has a reserve that has accumulated, over several years, from in year underspend against core budget.  This has been protected and transferred into a reserve for future expenditure.  In addition, slippage accumulation on Scottish Government funding for reduction in drug deaths and to implement MAT standards remains within the reserve.  Funding was allocated for a whole financial year and accumulated slippage whilst plans were developed, and recruitment progressed. The slippage in expenditure has been transferred into the reserve to support future service delivery.

The non-recurring funding is being used to meet short term needs, however there may be ongoing pressures that will need to be included in future financial planning

ADP Funding Context

Since 2018 the Scottish Government has increased the level of funding available to ADPs through several ring-fenced funds which are non-recurring (temporary) in nature. This increased the resources available for drug and alcohol services but has also created a situation of financial uncertainty where partnerships have made financial commitments but rely on an annual funding allocation process. As at May 2024 the level of funding available for 2024/25 has not yet been confirmed. The result of this is financial risk to ADPs and HSCPs, when investing the ring-fenced, non-recurring funding partnerships have had to consider the impact of potential future funding reductions. The current challenges to public sector budgets hinder the ability of HSCP partners to further invest in drug and alcohol services. Because of this it is considered likely that the ADP financial position will become more difficult in the medium term.

Priority 1 - Prevention and Early Intervention

Key outcome:

• Fewer people develop problem alcohol and drug use.

Priority 2 - Reducing the harms caused by alcohol and drugs

Key outcomes:

• Risk is reduced for people who use alcohol and drugs.
• People at most risk have access to treatment and recovery.

Priority 3 - Developing a Recovery Oriented System of Care

Key outcomes:

• People receive high quality treatment and recovery services.  
• Quality of life is improved by addressing multiple disadvantages. 

Priority 4 - Getting it right for Children, Young People, Families and Communities

Key outcome:

• Children, young people, families and communities affected by alcohol and drug use are supported.

Enablers/Cross Cutting Priorities

• Placing Lived and living experience at the heart
• Equalities and human rights
• Tackling stigma
• Surveillance and evidence
• Resilient and skilled workforce
• Psychologically informed support

Key outcomes:

• The ADP will have a visible connection to people with lived and living experience, who will play a key role in service development
• ADP policies and practice will reflect the voices and rights of people with lived and living experience
• People with lived and living experience of alcohol and drug use in Perth and Kinross experience less stigma
• People working in alcohol and drug services experience less stigma
• The work of the ADP is informed by evidence-based, robust data
• The Perth and Kinross alcohol and drugs workforce have the right skills and knowledge to support services users
• Alcohol and drugs services in Perth and Kinross are psychologically informed

This framework comprises several headline metrics which are used to measure performance nationally and which link directly to relevant outcomes within our four local priorities. The outcomes associated with the six cross cutting priorities are embedded within the local priority outcomes and metrics. These performance measures will be used, along with supporting narrative and wider contextual information, to provide the necessary assurance that appropriate progress is being made. Where this isn't the case, or isn't possible, we will set-out what further actions we seek to take.