Dundee drug services ‘not fit for purpose’

‘No blame’ approach needed to fix drug prevention, treatment and recovery services in city, expert commission says

Friday 16th August 2019

An expert commission is today calling for a ‘no blame’ approach to fix drug treatment services in Dundee that are ‘not fit-for-purpose’ and struggling to cope with rising drug deaths.

In a challenging report, specialists on Dundee Drugs Commission say individuals are working hard to save lives in the city but find the ‘system’ for drug prevention, treatment and recovery is confused and bureaucratic.

In 2018, 66 Dundee residents lost their lives to drugs, up from 57 in 2017 and 38 in 2016.

The report has been welcomed by the council, health authorities and police groups, with council leader John Alexander pledging “radical” changes.

Since 2014 the city has had the highest average death rate for Scotland, which has the highest drug death rate in Western Europe.

An analysis of deaths in the city found higher levels of deaths among 25-34 year-olds and more deprived groups than elsewhere in Scotland.

The 20-strong expert group included NHS doctors, police officers, charities, alcohol treatment workers and local politicians.

Beginning its work in May 2018, it has now presented Dundee council and other agencies dealing with drug use with a ‘challenging’ call for change.

Leadership in the city is described as ‘disjointed, inconsistent and ineffective’ and the commission says different agencies were not holding the alcohol and drugs partnership to account.

‘The ‘system’ in Dundee’, the report states, ‘is currently heavily focused on a bureaucratic, centralised model, narrowly delivering Opioid Substitution Therapy at the expense of delivering a more joined-up integrated system of care,’ the report states.

Dundee’s main drugs service is also criticised for ‘long waits for treatment and high drop-out rates’. The authors go on to warn many people are suspended from the programme for not complying with rules that are ‘too rigid’.

Many of the commission’s 16 recommendations revolve around making the different services provided by the NHS, council, charities and voluntary groups more joined up, including better links between drug treatment and mental health support.

There are also calls for more involvement of people of first-hand experience of problems with drugs and a greater willingness to learn when things go wrong.

The commission says: ‘This will require an honest and transparent acknowledgment of the failings that have taken place in the delivery of drug treatment services (in a ‘no-blame’ environment), and the willingness and determination to learn and exploit the lessons that are evident from these failings.’

Council leader Mr Alexander described the report as a “turning point”. He said: “We cannot sit by and let more people die. This report is a wake-up call for everyone and shows us a new way forward.

“This will not be an easy task but we are determined to make a difference and will show the leadership across the partnership to achieve better outcomes for people in this city.”

Simon Little, recently-appointed independent chair of the alcohol and drug partnership, added: “The Commission has identified historic weaknesses in leadership, accountability and governance and they are clear that significant and sustained improvement in these areas will be essential if the city is to reverse the trend of rising drug deaths and high prevalence rates for substance misuse.”

Mr Little continued: “Proposals that will improve the functioning of the DADP should be approved very soon; the membership will be strengthened, lines of accountability clarified, and structures simplified.

“There will also be an expectation that those with lived experience, carers and communities will be listened to, respected and offered genuine opportunities to influence decisions.”

Health Secretary Jeane Freeman said: “This is a substantial report and I want to thank the Commission for their continued work, which is not only important for Dundee, but also has relevance across Scotland. We will consider the recommendations for government carefully and work with partners to implement them.

“Minister for Public Health, Joe FitzPatrick, has also convened a national Drug Death Taskforce to advise on what further changes, either in practice or in law, could help save lives and reduce harm. A key aspect of its work will be to look at ways in which treatment services can adapt to better meet the needs of those most at risk.”

“Mr FitzPatrick has already met with the Chair of the Commission to discuss their work and some of their earlier findings, and we will continue to work together to tackle this. The findings from the Commission will also be a focus of the new Taskforce.”