Dáil Éireann Debate, Wednesday - 29 September 2004
953 Ms Shortall asked the Minister for Health and Children if he will report on those actions for which he has responsibility, namely actions 38, 39, 40, 41, 42, 44, 45, 46, 47, 48, 49, 50, 51, 54, 55, 56, 57, 59, 62 and 63, under the national drugs strategy; and if he will make a statement on the matter. [22807/04]
View answerThe Department of Community, Rural and Gaeltacht Affairs has overall responsibility for the National Drugs Strategy 2001-08. This Department published a critical implementation path, CIP, earlier this year which acts as a road map outlining how the 100 actions contained in the strategy are being delivered.
My Department is specifically responsible for implementing actions 38, 39, 40 and 41, with joint responsibility with the Department of Education and Science for action 42. Actions 44 to 66 are the responsibility of the regional health boards. Significant progress has been made on these actions. Action 38, for example, calls for an ongoing national drugs awareness campaign. This campaign was launched in May 2003 with the aim to increase awareness amongst the general population about problem drug use and its consequences across society. To date, phases one and two of the campaign have targeted the general population and parents respectively. Phase three will focus on the increasing use of cocaine among the 18 to 35 year old age cohort and will be launched in October 2004.
With regard to action 39, my Department is consulting with health care and other representatives on the adequacy of present training programmes with a view to producing a report with recommendations to address any gaps. My Department has consulted with the health boards to develop performance indicators in line with action 40. The most relevant indicators have been identified and a common minimum set has been devised. These indicators have been used in service plans. During 2004, indicators are being reviewed with the relevant agencies to establish if the necessary information is being captured. Key performance indicators will continue to be developed.
The report of the benzodiazepine committee was finalised and published in December 2002, as called for in action 41. A number of the recommendations of this report have been implemented, including the publication of good practice guidelines for clinicians, and work has commenced on the development of good practice guidelines for pharmacists. My Department and the Department of Education and Science have joint responsibility in conjunction with the health boards for actions 42 and 43.
With regard to action 42, there is regular contact between my Department and the Department of Education and Science to ensure that the SPHE programme in primary and post-primary schools is informed by ongoing research. The health promotion unit is represented on the national advisory prevention sub-committee which has commissioned research into various aspects of drug use prevention. Also, my Department continues to link with the review of parenting support currently under way within the context of best health for children.
With regard to action 43, guidelines to assist schools in the formation of a drugs policy were developed in conjunction with the Department of Education and Science and the health boards and issued to schools in 2002. Ongoing support is provided to schools to assist them in the development of substance abuse policies. All health and education personnel have been provided with training to support them in their work with schools. Many schools have developed policies and more are going through the development process. The Department of Education and Science is monitoring this process on an ongoing basis.
Health boards are at various stages in the implementation of the actions of the national drugs strategy. With regard to action 44, counselling and assessment is available quickly in all health boards. Treatment in a large number of boards is available within one month. However, some boards have not yet reached this target and waiting lists have developed. Health boards continue to work to address this situation. The target set for action 45 was achieved in January 2003 with 6672 people receiving methadone treatment. At the end of August 2004, there were 7091 people receiving methadone treatment. Service user charters have been developed for all health boards in line with action 46.
Work within health boards on developing plans for treatment services on a continuum of care model approach, in line with action 47, is ongoing. In the ERHA, where the services are most developed, a large amount of progress has been made on this action. The area health boards are continuing to develop their services around a continuum of care model. There is no specific grade of "key worker". Where the key worker system has been adopted, an individual worker who is part of the multidisciplinary team, such as nurse, counsellor or the like, takes responsibility as the key person for working with the client.
With regard to action 48, health boards provide a range of residential and day treatment and rehabilitation programmes both directly and through section 65 and mainstreamed local drug task force projects. In the ERHA region, rehabilitation co-ordinators have been appointed and are working to ensure that service users are assisted in developing a planning programme of progression through the addiction services. Work on the continued development of this action will continue throughout the lifetime of the strategy.
Action 49 called for the development of a protocol for the treatment of under 18 year olds presenting with serious drug problems. The Eastern Regional Health Authority, ERHA, established a working group, chaired by an official from my Department and comprising a broad range of statutory and non-statutory service providers and community representatives, in October 2001. This report has been finalised and arrangements for its publication are being made. In anticipation of the group's findings, my Department has this year allocated funding of €500,000 to the ERHA to fund the development of services for this age cohort.
The process of developing quality standards is ongoing in conjunction between the health boards and the national advisory committee on drugs, NACD. A joint seminar on quality standards was hosted by the ERHA and the NACD at the end of 2003. Development of this action — 50 — will continue during 2004 in order to have guidelines in place in each health board from 2005.
With regard to action 51, the three area health boards in the ERHA have drawn up a planned programme for the development of addiction services, including treatment and rehabilitation services, on a yearly basis as part of their planning process. Work will be ongoing during 2004-05 to implement plans in all health boards outside the ERHA. The under 18 report will also influence this action with regard to treatment of young people. Each health board, in line with action 52, has produced and widely distributed a short, easy to read guide to the drug services available within their region with contact numbers for further information and assistance.
In line with action 53, the area health boards in the eastern region have established a management plan and monitoring committees with local communities in the establishment of new treatment and rehabilitation facilities and are continuing the consultation with monitoring committees where they are already in existence. This issue has not arisen in most non-ERHA boards but will be taken on board in the context of the development of any centres in the future. The integration of child care facilities is being taken into account with the development of new services as called for in action 54. Existing facilities present limited possibilities for on-site child care options. A number of health boards have raised issues as regards the appropriateness of on-site integration and are examining other options.
With regard to action 55, the three area health boards of the ERHA and the drug treatment centre board, DTCB, offer a range of alternative medical and non-medical treatment options within their service at various locations. In addition, health boards provide section 65 grants and mainstream funding to some voluntary and community groups to provide alternative therapies within their area. A pilot programme with lofexidine is operating in the Northern Area Health Board and a pilot programme with buprenorphine is taking place in the DTCB.
With regard to action 56, health boards are liaising with general practitioners and pharmacists in order to increase their engagement in the provision of services for drug misusers. At the end of August 2004, there were 219 GPs and 317 pharmacists involved in the methadone treatment protocol nationally. This compares with 164 GPs and 220 pharmacists in December 2000. With regard to action 57, health boards provide a range of residential and day treatment and rehabilitation programmes both directly and through section 65 and mainstreamed local drug task force projects. Work on this action will continue throughout the lifetime of the strategy.
All health boards continually liaise with the national advisory committee on drugs, NACD, in line with action 58. The NACD is currently conducting an ongoing longitudinal study on treatment outcomes, ROSIE report, which will give better information on the most effective forms of treatment for drug users.
With regard to actions 59 and 60, under 18 year olds are prioritised throughout the addiction services in all health boards. Emergency assessment and immediate access to counselling is available to this age cohort. The drug treatment centre board established a dedicated young persons programme in 2001 to meet the needs of young drug misusers. Health boards have appointed suicide resource officers.
Drop-in centres and after care services are provided by health boards and agencies funded under section 65 grants, in line with action 61. The development of these services will continue throughout the lifetime of the strategy within the context of available resources. Actions 62 and 63 call for the development of needle exchange facilities. Since the launch of the national drugs strategy in 2001 additional harm reduction facilities have been developed by the three area health boards of the ERHA directly and in partnership with voluntary and community sectors in Tallaght, Celbridge, Athy, Inchicore, Killinarden, Dundrum, Coolmine, Darndale, Coolock and Corduff. These services will continue to be developed by the ERHA taking into account the recent NACD report on harm reduction.
It is important to note that annual additional funding of €52 million has been provided to health boards to address the problem of drug misuse. This has allowed for the employment of more than 730 people in the delivery of drug addiction services which include: outreach — making contact with drug users not currently accessing services, advising on services, on safer injecting and sex practices, providing needle exchange; education — helping to implement the education component of the national drugs strategy and providing services to drug users, schools, families, local communities and professional groups on drug related issues; treatment — a range of interventions including assessment, stabilisation, harm reduction measures, care planning, methadone maintenance, counselling and detoxification within specialist clinics, residential settings and within community settings; rehabilitation — the provision of a range of options including residential and day programmes and a planning and brokerage service designed to equip drug users with the skills and tools for progression and reintegration; community welfare — a service to assist clients with accommodation and income maintenance needs.
Services provided by a range of voluntary and community sector organisations which are funded and co-ordinated by the health boards include: drop-in services; peer support services; family support; education services; counselling services; rehabilitation and after care services; HIV/AIDS support; training services; personal development training.
Much progress has already been made, although it must also be recognised that there are areas that require development and this must be achieved in the context of available resources. This is an eight year strategy up to 2008 and much more will be achieved in this time frame. As part of the strategy a mid-term review is currently being undertaken by the Department of Community, Rural and Gaeltacht Affairs. My Department is actively involved in this review, which aims to examine progress so far and refocus efforts where identified and required.
