Renfrewshire Council

In making its recommendations, the Commission recognises the breadth of work that takes place every day to support people impacted by drug and alcohol use in Renfrewshire.

Many changes to the way in which alcohol and drugs services are provided have been identified by Renfrewshire Health and Social Care Partnership through an independent review, and it is clear that there is ambition from partners to think beyond statutory services and to work in different ways to promote recovery, recognise trauma and tackle issues of stigma and culture in a positive way.

Given the current pandemic and associated impact on communities, it is more important than ever that partners in Renfrewshire demonstrate that they are listening and are prepared to give power to those with lived experience to plan and improve services. Some services in Renfrewshire that support people and their families in relation to alcohol or drug use, are joined up and integrated - this was particularly evident when services were co-located. There are clear plans to work in a more collaborative way with other partners, but this needs to be more ambitious to ensure that the support that is available to people that use drugs and alcohol wraps around people in a more person centred and holistic way. Building-based services need to fundamentally change to ensure these are provided in a welcoming, safe and stigma free environment.

The work being progressed to develop recovery orientated models of care and support needs to maintain momentum and focus, and partners need to ensure that a continuum of support is available across communities, with improved access and information on what is available. The contribution and value of third and community partners should be recognised more strongly in Renfrewshire, and it is vitally important that people with lived experience are valued and involved in the developments that take place locally and that peer support networks are established and properly supported and resourced.

Renfrewshire has a strong recovery community with an ever evolving and expanding range of support and activities. The impact of the recovery community on those with lived experience cannot be overstated and the Commission met with individuals who we identified as 'changemakers' within their community and are making a real difference to people's lives. It is critical that partners in Renfrewshire get ahead of the curve and work with children and young people to change attitudes and culture around access and use of drugs and alcohol. There is a real opportunity for strong leadership in terms of changing the conversation about alcohol in particular, through levers such as licensing.

The importance of preventing and supporting people to deal with mental health issues and trauma is fundamental to partners achieving real change in terms of the impact of drug and alcohol use in Renfrewshire. In making its recommendations, the Commission requires that its report and recommendations are considered and reflected in any service redesign over the next five year period. The Commission also asks that partners undertake to ensure that the work of the Commission is reflected in all service planning, development and delivery and - in particular - in front line practice.

Key recommendations:

Risk of Harm

1. The Commission acknowledges the current work being undertaken to improve drug and alcohol services; however, changes must be made at greater pace and involve local service users and family members to a greater extent. The opportunity to take the review further and implement recommendations from both this Commission and the National Drugs Death Taskforce must not be missed.

Renfrewshire Health and Social Care Partnership

2. Humans are complex and the issues they face are not in isolation. Partners in Renfrewshire must respond to the views of local services users and their families and frontline staff, and adopt a whole system approach whereby support is wrapped around those that need it. This includes mental health, housing, employability, and criminal justice services. 

Renfrewshire Health and Social Care Partnership

3. Support should move away from a focus on a buildings-based model to one that is rooted within communities. Where services and support are accessed within a building - these must be provided in modern, safe, accessible and trauma informed facilities which support front line staff and service users to work together in the most person-centred way. Existing buildings, such as those at Back Sneddon Street, are not fit for purpose and must be improved urgently.

Renfrewshire Health and Social Care Partnership

4. The reach of local alcohol and drugs services needs to significantly increase, and partners must ensure that there is capacity across the whole system to support people experiencing all different levels of harm from their use of alcohol and drugs. Assertive outreach to those experiencing the highest level of harm should be a high priority for services.

Renfrewshire Alcohol and Drug Partnership

5. Specific gaps in provision identified by service users, family members and frontline staff need to be addressed locally. Access to residential rehabilitation services and the availability of 24/7 crisis services were viewed as significant gaps in Renfrewshire, and with enhanced community provision, will ensure a continuum of support is available in Renfrewshire.

Renfrewshire Alcohol and Drugs Partnership

6. Local service providers must involve people with lived experience in the ongoing development of alcohol and drug and mental health services locally and listen to their views. There was a clear disconnect between what supports service users and families thought were available in Renfrewshire, and the views of services themselves. It was clear services do exist but that communication and signposting to these is not working.

Renfrewshire Community Planning Partnership

7. There are potentially high numbers of people experiencing hidden harm from alcohol and drug use in Renfrewshire. Partners should undertake a robust joint assessment of the level and nature of harm and how this is changing over time. This should be undertaken on an annual basis in order to inform the development of services at a local level.

Renfrewshire Community Planning Partnership (led by Renfrewshire Alcohol and Drugs Partnership)

8. Partners need to address gaps in the local data available on alcohol-related harm. This should be prioritised, and it is recommended that partners introduce an annual review of alcohol related deaths now, rather than waiting for this to become a national reporting requirement in the future.

Renfrewshire Alcohol and Drugs Partnership

9. Partners must provide leadership and introduce a programme of naloxone training across partners agencies, to ensure that local responders, service providers and communities are able to deliver life-saving interventions within local communities.

Renfrewshire Community Planning Partnership

10. Services must strengthen work being done to protect those at highest risk of harm from blood borne viruses through drug use. This includes offering rapid testing for HIV and Hepatitis C and supporting those who receive a positive diagnosis to attend appointments and to sustain and follow medical guidance.

NHS Greater Glasgow and Clyde / Renfrewshire Health and Social Care Partnership

11. Partners should support the work of the National Drug Deaths Taskforce and maximise all opportunities to pilot or implement new and innovative approaches recommended by the Taskforce in Renfrewshire to reduce drug related harm.

Renfrewshire Community Planning Partnership 

Mental Health

12. Partners should go further and be more ambitious in terms of establishing the local approach to trauma informed practice. Leaders must champion greater understanding of the impact of trauma and ensure that this is reflected in the way that staff work across all frontline services.

Renfrewshire Community Planning Partnership

13. Services must take action to improve access to and information about the services and supports which are available to people experiencing mental health issues in Renfrewshire. This must extend beyond formal health care services, with investment made in lower level support services that people can access informally at a community level when they need them.

Renfrewshire Health and Social Care Partnership

Prevention and Early Intervention

14. Community Planning Partners must demonstrate leadership in terms of alcohol provision and availability. This should include but is not limited to:

• creating safe spaces within buildings by removing the sale or provision of alcohol
• promoting alcohol free policies and culture within the workplace, including in school and leisure facilities
• supporting staff impacted by the use of alcohol
• promoting awareness of alcohol harm across the workforce
• committing to end alcohol-related advertising on or within partner buildings or sites.

Renfrewshire Community Planning Partnership

15. Renfrewshire Licensing Board should continue to use all of its available powers to limit alcohol related harm in Renfrewshire, and Renfrewshire Council should lobby Scottish Government to ensure that the licensing board can further strengthen its role in terms of improving health and wellbeing.

Renfrewshire Licensing Board

16. Statutory services must continue to ensure that Sheriffs are aware of the range of drug, alcohol and mental health services available in Renfrewshire, eligibility for these and how these can be best utilised to provide support and interventions within sentencing. 

Renfrewshire Council

17. Review local level data on, and approaches to, addressing Foetal Alcohol Spectrum Disorder (FASD) in Renfrewshire to consider how best to reduce the number of children impacted by alcohol prior to birth.

Renfrewshire Health and Social Care Partnership

Young People and Families

18. The work that young people in Renfrewshire are leading to improve Personal And Social Education in schools on issues such as drugs and alcohol and mental health, needs to be implemented as a priority by Renfrewshire Council.

Renfrewshire Council

19. Young people should not be anxious about transferring from their existing service into an adult focused alcohol and drug service. Targeted consultation should be undertaken on this issue and should focus on the beneficial relationships that young people need to address their needs, rather than what age they are.

Renfrewshire Council/Renfrewshire Health and Social Care Partnership

20. Recognising the at times distressing evidence that the Commission heard on the impact of alcohol and drug use for families, partners should undertake a review of existing family support provision. Particular focus must be on the support that is available to children and young people who are impacted by parental drug or alcohol use. In addition, as Renfrewshire considers its response to the Independent Care Review it should explore how the family support model developed reflects fully the principles of The Promise.

Renfrewshire Health and Social Care Partnership/Renfrewshire Council

21. Children and young people need to be able to access the right type of support for any mental health issues including lower levels anxiety and stress. Partners should review current mental health provision for young people and ensure that this meets all levels of need.

Renfrewshire Council / Renfrewshire Health and Social Care Partnership

22. Partners should work with local retailers and communities to effectively target proxy purchase of alcohol in communities.

Renfrewshire Council/Police Scotland

Recovery

23. Lived experience needs to be the beating heart of the approach to recovery in Renfrewshire. This needs to be a strong and meaningful partnership for all, with lived experience being fully embedded into everything that happens - from employment to training to service development and design.

Renfrewshire Health and Social Care Partnership

24. Alcohol and Drug Services should pilot Recovery Advocacy / Rights in Recovery in partnership with the Scottish Recovery Consortium and Reach Advocacy to strengthen Renfrewshire's rights-based approach to recovery.

Renfrewshire Health and Social Care Partnership

Relationships and Connections

25. Recognising the value of lived experience and social connections, local alcohol and drug services should employ link workers and develop a peer support network to assist individuals and families to navigate services, support and activities. Investment must also be made to support the development of local groups and organisations which provide social connection and support recovery.

Renfrewshire Health and Social Care Partnership

26. It is more critical than ever given COVID-19, that barriers to recovery such as loneliness and isolation and stigma are prioritised by partners. Partners should designate 2021 as Renfrewshire's year of connection, and plan a year of action with all partners and communities involved in some way.

Renfrewshire Community Planning Partnership

28. Partners must act robustly to eradicate stigma and have positive recovery conversations with communities and the workforce, including through engagement with local media. People with lived experience in Renfrewshire must play a leading role in the planning, development and delivery of this work.

Renfrewshire Community Planning Partnership

Next Steps

Commission members are clear that they do not want this report and its recommendations to sit on a shelf. The recommendations have largely been informed by the voices and experiences of local people, families and frontline staff and it is important that these are acted upon and that opportunities are provided for the people that the Commission has engaged with to shape future changes.

These recommendations are made to the Community Planning Partnership, and whilst the Commission recognises the current focus of all partners on responding to the COVID19 pandemic, the Partnership is urged to retain its ambition on improving outcomes for local people impacted by drugs and alcohol.

It is for the Community Planning Partnership to identify the governance and funding that is required to implement these recommendations. It may also need to engage further with stakeholders to prioritise the actions that it takes forward in light of the constraints on resources and capacity arising as a result of the capacity. Commission members will continue to engage with Renfrewshire Community Planning Partnership and to offer support.