The HSE similarly welcomes the opportunity to update the committee on issues raised in the Comptroller and Auditor General's report and subsequently when the HSE appeared before the committee in July. I will give an update on five issues. First, in regard to case management and key working in addiction services, the national rehabilitation co-ordinator on my left, Mr. Joe Doyle, has undertaken an analysis in the four regions of the HSE, Dublin mid-Leinster, Dublin north east, the HSE south and the HSE west, to identify where formal case management key working approaches are in place in the addiction services. This analysis showed that a key working system is in place in the majority of addiction services in three of the four regions. Formal case management systems are not a commonly utilised tool in the health services. This is a useful baseline for the national rehabilitation co-ordinator who, as part and chair of the National Rehabilitation Implementation Committee, is due to deliver a national framework for rehabilitation early in 2010, which will address the issue of case management and key working in the addiction services.
Second, in regard to Suboxone, an expert group set up by the Department of Health and Children to examine the use of Suboxone recommended the introduction, in the short term and as a feasibility study, of the prescribing and dispensing of Suboxone in specialist addiction clinics with pharmacies and supervised dispensing on site and in a selected number of community settings, namely, level 2 GPs and community pharmacists. The study would run for a year and prescribing and dispensing at the study sites would be evaluated before a decision was made on whether to extend prescribing and dispensing to the entire community. Pharmacists and GPs have been recruited to be part of the study spread across different addiction services. The study will be evaluated in February or March 2010. The numbers of clients active in the study currently is 43. The study commenced in June.
In regard to needle exchange services, the report of the NACD-NDST working group on needle exchange provision in Ireland in November 2008 assessed the role of needle exchange in harm reduction and the extent of provision in Ireland. The report stated that worldwide, "A substantial number of drug injectors have been attracted to these programmes and have been provided with a range of services which cannot be suitably offered by other health services". It showed how needle exchange provision in Ireland reflected the areas where most injecting took place and estimated 44,663 exchanges in 2007 predominately in the Dublin area. The report also pointed out the lack of needle exchange services in the north east, the south east, the west, the south and the north west. The Comptroller and Auditor General's report had also identified the north east and south east as two areas which had no needle exchange services. The NACD-NDST report recommended piloting the provision of needle exchange services through community based pharmacists. Following discussions between the HSE and the Irish Pharmacy Union, 65 needle exchange services will be put in place in rural towns in 24 counties through a pathway of rural pharmacists, co-ordinated and led by a national liaison pharmacist.
This initiative has secured funding from the Elton John AIDS Foundation which has been active in Ireland for several years with small projects to prevent the spread of blood borne illness. The pharmacists will be trained in February 2010 and the programme will be rolled out during the course of next year. Pharmacists will advise injectors on their general health needs and the health consequences of injecting and they will encourage injectors to take up treatment. This will be done on a one-to-one basis.
In regard to providing additional treatment services to respond to the increase in heroin use outside of Dublin, additional facilities and clinics are required in the south east, the south, the north east and the midlands and reconfiguration of the facilities in the mid-west is also needed. The provision of additional clinics requires new facilities or the upgrading of existing facilities, recruiting additional level 2 GPs with the back-up of nursing and counselling staff, which is essential, and proactive engagement with local communities. It is a significant challenge to put in place additional services through the reframing of existing services and resources, nevertheless, plans are in place to develop service capacity in Gorey, Wexford, Waterford, Cork, Tralee, Limerick, Dundalk and Drogheda throughout next year. We also intend to develop capacity in Mullingar and Portlaoise, which may require capital funding.
With regard to the national overdose prevention strategy, a group is currently meeting and is finalising its recommendations on best practice in regard overdose prevention. This will draw on international literature and use the reports of the national drug related deaths index as background materials. Once the recommendations are agreed and published, engagement will take place with wider stakeholder groups, including the HSE drugs services, community and voluntary sectors, local and regional drugs task forces, the Garda Síochána, ambulance services, the Family Support Network and representatives of services users. This engagement will take place with a view to maximising the chances of the recommendations being implemented. I hope this is helpful to the committee.