Customers at the heart of Total Place event 18th March 2010 Workshop A - Steve Rose Birmingham City Council

1. Birmingham Total Place Pilot Drugs and Alcohol Customer Insight Steve Rose – Birmingham City Council Simon Dickinson – Aperia Neil Mackin - CACI

3. Birmingham Total Place Moving beyond treatment to recovery: “ Unemployment, poverty, and homelessness make up the soup on which addiction and criminality feed. Work, prosperity and decent homes are aspirations which encourage abstinence and honesty” Paul Hayes, NTA Birmingham, Sept. 2009

6. Steve Rose – Birmingham City Council Simon Dickinson – Aperia Neil Mackin - CACI Customer Insight IDeA Funded Project Drugs and Alcohol Customer Journey Maps and Recommended Pilots

7. Health Substance Services Public Services Emergency Services Justice Police BCC Drug & Alcohol Service Providers NHS Business Services Hospitals PCTs GPs Probation Prison DIP Arrest DAAT Crime Arrest Out of Hours Calls Fire Incidents DIP Referrals Opinion Survey Children (CareFirst) Housing (SX3) WMPHO BHWP Needle Exchange Commissioning Service Provider Commissioning Case Management Case Files Prescribing Data Aggregate Hospital Episodes Monitoring NDTMS Hospital Records Case Files for Patients A+E Admissions flagged for Substance Offender Assessment (OASys) Accredited Programmes (IAPS) Prison Records SPOC Call Centre Revs / Bens (Northgate) Adults (CareFirst) Public Health Mortality Files Courts Sentencing Records Mental Health Trust Drugs and Alcohol Data Map

8. Health Substance Services Public Services Emergency Services Justice Police BCC Drug & Alcohol Service Providers NHS Business Services Hospitals PCTs GPs Probation Prison DIP Arrest DAAT Crime Arrest Out of Hours Calls Fire Incidents DIP Referrals Opinion Survey Children (CareFirst) Housing (SX3) WMPHO BHWP Needle Exchange Commissioning Service Provider Commissioning Case Management Case Files Prescribing Data Aggregate Hospital Episodes Monitoring NDTMS Hospital Records Case Files for Patients A+E Admissions flagged for Substance Offender Assessment (OASys) Accredited Programmes (IAPS) Prison Records SPOC Call Centre Revs / Bens (Northgate) Adults (CareFirst) Public Health Mortality Files Courts Sentencing Records Mental Health Trust Drugs and Alcohol Data Map

10. Drugs - Cost Consolidated Cost Index arising from Drugs Misuse: 1) Birmingham Opinion Suvey - Proportion who say that people using/dealing drugs in the local area is a big problem 2) Police Data - Instances of Drug Possession crime 3) HES Data - Inpatient Admissions for Drug Misuse

11. Alcohol Harm Department of Health Harmful drinking – high admission segments

12. Alcohol- Cost The Consolidated Cost Index arising from Alcohol Misuse. 1) Birmingham Opinion Suvey - Proportion who say that people being drunk or rowdy in the local area is a big problem 2) Police Data - Instances of ARV crime (Alcohol Related Violence) 3) HES Data - Inpatient Admissions for Alcohol Attributable Reasons

13. Service Journey Measures operations e.g. throughput Not have we achieved what the customer wants

15. Drugs – Hopes and Fears DRUGS Not getting treatment Wish my past would stop being brought up by the same people in social services (people can change). The past is what w e are trying to move on from JOBS To get out of Birmingham and get a good life Get a girlfriend & job with a good wage Not becoming an addict again To get a car Not being funded to get a tier 4 place Not getting the help you need To have enough money To be abstinent from all substances – legal and illegal Of a lapse and taking an overdose and dying from it I am going to rehab. I just hope I can complete and get to be drug free and start living my life again Of staying in Brum and leading the same life as the last 20 years – and no job Treatment plan / centre not equipped for my needs Day care centre to run for 6 months – it is only 3 now My past being constantly brought up That things change in the right places To fail and be on drugs for the rest of my life People to better understand rehabilitated users Family and friends finding out you are on drugs When someone is not prepared to listen To get my own flat To regain contact + build relationships with loved ones To get fitter / more active Being in the wrong place at wrong time and end up using Relapse into drug abuse Help other people like me help themselves To receive help + treatment from services Having too much money to spend on wrong thing To gain qualification through service provider To become valued member of society That I’ll be judged on my past Will never be able to get into a well paid job again Wont be able to gain employment because of my past

16. DRUGS Not getting treatment Wish my past would stop being brought up by the same people in social services (people can change). The past is what w e are trying to move on from JOBS To get out of Birmingham and get a good life Get a girlfriend & job with a good wage Not becoming an addict again To get a car Not being funded to get a tier 4 place Not getting the help you need To have enough money To be abstinent from all substances – legal and illegal Of a lapse and taking an overdose and dying from it I am going to rehab. I just hope I can complete and get to be drug free and start living my life again Of staying in Brum and leading the same life as the last 20 years – and no job Treatment plan / centre not equipped for my needs Day care centre to run for 6 months – it is only 3 now My past being constantly brought up That things change in the right places To fail and be on drugs for the rest of my life People to better understand rehabilitated users Family and friends finding out you are on drugs When someone is not prepared to listen To get my own flat To regain contact + build relationships with loved ones To get fitter / more active Being in the wrong place at wrong time and end up using Relapse into drug abuse Help other people like me help themselves To receive help + treatment from services Having too much money to spend on wrong thing To gain qualification through service provider To become valued member of society That I’ll be judged on my past Will never be able to get into a well paid job again Wont be able to gain employment because of my past Hope I can get off drugs, but fear I might not Fear that treatment wont work for me Hope I can get a job and a life Past may stop me getting a job To be given a chance to move on Break away from Birmingham Give something back What others think of me Drugs – Hopes and Fears

17. Parents send me to Brum – stayed clean for 18 months Several drugs services experiences in diff places – usually positive I self-referred to Azaadi and havent looked back Had very good care from mental health Counsellor Azzadi has been a great help to me Pregnancy – went to GP who referred me into mother+baby Forced into detox in Dublin (or kids taken away) Self-referral thru’ parents DIP referral worked well for me Mother+baby team helped me get clear before – excellent dedication of team DIP housing good – got my flat Good relationship with my drug worker I got clean and felt positive and happy in prison for 8 months Found 12 step was very beneficial – 9months gave me long enough to find a new way to live without drugs Referral by DIP was the start DIP worker was brilliant Phoenix futures, day structure – helped me with new skills+tools (but not child friendly) Safe proj and Anawim – support me with everything Mum passed away – self referral into Azzadi Addaction – very positive and good follow-up Threats again to take my kids Day care services give u structure and something to do Methadone helps in that can survive without stealing DRUGS – What helped?

18. Parents send me to Brum – stayed clean for 18 months Several drugs services experiences in diff places – usually positive I self-referred to Azaadi and havent looked back Had very good care from mental health Counsellor Azzadi has been a great help to me Pregnancy – went to GP who referred me into mother+baby Forced into detox in Dublin (or kids taken away) Self-referral thru’ parents DIP referral worked well for me Mother+baby team helped me get clear before – excellent dedication of team DIP housing good – got my flat Good relationship with my drug worker I got clean and felt positive and happy in prison for 8 months Found 12 step was very beneficial – 9months gave me long enough to find a new way to live without drugs Referral by DIP was the start DIP worker was brilliant Phoenix futures, day structure – helped me with new skills+tools (but not child friendly) Safe proj and Anawim – support me with everything Mum passed away – self referral into Azzadi Addaction – very positive and good follow-up Threats again to take my kids Day care services give u structure and something to do Methadone helps in that can survive without stealing Self-referral, parents played a role (death or force) 12 step Methadone Individual key worker was the key Its the service that counts Clean in prison Pregnancy and my parents DRUGS – What helped?

19. Job Centre – didnt help Summerhill terrace – RRAT dont treat individual Moving from JSA to ESA can be frustrating Methadone Came out of DIP – not enough support DIP East – no follow up around relapse control Government owned services are less capable Chest infection – got codeine and started to seek drugs again Waiting to go to Mum+Baby rehab – delayed by child+fam Doctors dont listen and seem to want control. They are happy to keep you on script for as long as possible Getting back with other users Aftercare coming out of prison was poor. Worked hard for 3.5yrs, but no support Rehab was forced on me – I wasn’t ready for it Doctors don’t want to cut down meths Found other people using drugs (went looking for them) Waiting time after DIP is too long Other things other than methadone (morphine, pills/amps, Df118s) Too much free money – unlikely to get job that will pay enough to make it worthwhile Give a straight detox in prison Swansell – drug worker changed, things went downhill Prison was too easy – no deterrent, not enough help from CARAT team Prison – lack of help from drug services, no rehab Social services – tried to take kids and then dropped me No dry houses for women Penalised if you have kids Workers in the system get moved around – not enough professionalism DRUGS – What hindered?

20. Job Centre – didnt help Summerhill terrace – RRAT dont treat individual Moving from JSA to ESA can be frustrating Methadone Came out of DIP – not enough support DIP East – no follow up around relapse control Government owned services are less capable Chest infection – got codeine and started to seek drugs again Waiting to go to Mum+Baby rehab – delayed by child+fam Doctors dont listen and seem to want control. They are happy to keep you on script for as long as possible Getting back with other users Rehab was forced on me – I wasn’t ready for it Doctors don’t want to cut down meths Found other people using drugs (went looking for them) Waiting time after DIP is too long Other things other than methadone (morphine, pills/amps, Df118s) Too much free money – unlikely to get job that will pay enough to make it worthwhile Give a straight detox in prison Swansell – drug worker changed, things went downhill Prison was too easy – no deterrent, not enough help from CARAT team Prison – lack of help from drug services, no rehab Social services – tried to take kids and then dropped me No dry houses for women Penalised if you have kids Workers in the system get moved around – not enough professionalism Back with wrong people Methadone and the way it is prescribed DRUGS – What hindered? Waiting for rehab – not enough space Aftercare coming out of prison was poor. Worked hard for 3.5yrs, but no support Flexibility in prison ?- support after More help coming out of DIP Waiting – rehab, mother/baby and after DIP Changed worker Codeine for chest Relats and frustrations with benefits Govt owned services less good What’s my incentive? RRAT not individual Not ready for rehab Social services and families

22. Example Journey’s Tightrope/balancing act It’s a roll of the dice Disaster awaits, perhaps feels inevitable

23. Example Journey’s The clock is ticking… … is time running out No chances, ‘dark clouds’ There is a ‘system’ but hard to break into it With barriers along the way

24. Customer Journeys Ups and downs of the customer experience Key journey steps Agency Touch-points 1991 2000 2008 2010 Suicide Attempt, A+E Admission Relapsed upon release from hospital Suicide Attempt, A+E Admission Relapsed upon release from hospital Suicide Attempt, A+E Admission; detoxed Relapsed upon release from hospital Medication treatment from GP Off sick with depression Started drinking JD with current partner who's alcohol dependant Arrest and sent to hospital due to sickness and shakes Forced 9 day Detox Social Services Intervention around child 1st session; Search for activities (dance) 2nd session Book appointment at GP for depression Argument with Neighbours Relapsed over weekend Controlled drinking; Abuse from neighbours ongoing; Seeking help from Housing Seek additional support for son Arrange transfer meeting Child in Need meeting with Social Worker Depression Unsure if employer support her Depression – drink to cope with life Depression Humiliated Motivated to sort life out Worried about son’s care Hospital Hospital Hospital GP Police Hospital Alcohol Services Social Services Education Housing 38 yrs old. Female, Lives with 7yr son Older 18yr son who’s left home 2005 Drank with friends at home; family drink dependent Caught in Abusive Relationship Argument with rowdy neighbours who stop her sleeping after night shifts Alcohol Services Social Services Alcohol Services Social Services

27. The True Cost of Drugs in Birmingham – Per Annum Benefits Hospital Admissions Criminal Justice System Other Spend DAAT £27.8m £33m £15m £2.3m £??m

31. Drug/Alcohol assessment against TP principles Shared clarity of objectives  Health and Crime engaged  Minimal input elsewhere Performance measuring against genuine outcomes  Totally lacking Pooled budgets  For treatment  Not for prevention Shared responsibility and accountability for outcomes  NI indicators for LSP  Limited cascade to drive outcomes Joined-up commissioning of services  For treatment  Not for prevention Services wrapped-around customer needs  Health management focused, not need or outcome driven Sharing of information  Parochial record keeping, is this in the customers’ best interests Personalised for efficiency and effectiveness  Limited, predominantly one-size fits all

33. Service Redesign Pilots Ideas….

34. Future System? Strategic assessment of Service Demand and Provision Insight into location, volumes and people’s wider Prevention Service Provision Emerging Need Severe or Acute Need Baseline Evidence Targeting Monitoring Pilots

35. Health Substance Services Public Services Emergency Services Justice Police BCC Drug & Alcohol Service Providers NHS Business Services Hospitals PCTs GPs Probation Prison DIP Arrest DAAT Crime Arrest Out of Hours Calls Fire Incidents DIP Referrals Opinion Survey Children (CareFirst) Housing (SX3) WMPHO BHWP Needle Exchange Commissioning Service Provider Commissioning Case Management Case Files Prescribing Data Aggregate Hospital Episodes Monitoring NDTMS Hospital Records Case Files for Patients A+E Admissions flagged for Substance Offender Assessment (OASys) Accredited Programmes (IAPS) Prison Records SPOC Call Centre Revs / Bens (Northgate) Adults (CareFirst) Public Health Mortality Files Courts Sentencing Records Mental Health Trust Drugs and Alcohol Data Map

41. Birmingham Total Place Pilot Drugs and Alcohol Customer Insight Steve Rose – Birmingham City Council Simon Dickinson – Aperia Neil Mackin - CACI