Glasgow’s cat people

The social and financial cost of substance misuse is huge.
Socially, alcohol and drugs are often at the root of abuse,
domestic violence, youth offending and crime. Financially, the
Royal College of Physicians estimated in 2001 that alcohol-related
illnesses and injuries cost the NHS up to £3bn a year on
hospital services.

Inevitably, joint-working “initiatives” and “approaches” have
sprung up everywhere in attempts to tackle the problem. However, a
fundamental and radical rethink of needs and services in one city
looks like having a widespread and long-term effect.

With problem drug use almost twice as high as the Scottish
average and alcohol misuse extensive, it’s understandable that
Glasgow Council wanted to do something different. Two years in the
planning, it now has a comprehensive and integrated addiction
service that may well be the first of its kind, centred around
community addiction teams (CAT).

“The status of addiction services in Glasgow has changed,” says
John Legg, head of performance, standards and strategic management.
“In the early days it was a resource to support children and
families or community care work. But it’s now a core service – it
crosses into mental health, homelessness, children and families.
That’s a huge difference. You don’t think of addiction as a project
or something marginal.”

According to area services manager, Ann Marie Rafferty,
integration had to be better: “Social care workers were spending an
inordinate amount of time trying to access resources from health,
housing and so on – and the other way around. And people didn’t
understand the other’s role,” she says.

One year in, the council’s commitment to joint working is paying
dividends. “We haven’t had any problem here about staff being
managed by health or social care staff,” says Jim McBride,
community addiction manager for east Glasgow. “For health care
staff, each CAT has a nurse team leader and they also have the
option for outside clinical supervision.”

The integrated structure has helped improve practice and
resources. Says McBride: “We used to have problems trying to get
assessments – never mind accessing treatment. We had to go through
GPs and psychiatrists. Now we have a seamless, one-stop service. It
means we can ensure that the people with the most complex needs are
getting the most appropriate treatment options. Folk often used to
fall between social care and medical interventions – and never the
twain would meet. Not now.”

However, because of its own success, integration has seen an
increase in referrals, particularly those related to alcohol. “We
knew full well that alcohol was having a major impact on the
community and the role it plays in child protection and criminal
justice. In many ways, if we’re honest, the drug agenda here,
although substantial, looks quite small compared to the level of
need that alcohol generates,” concedes McBride.

Indeed, there is staff concern that the east area CAT carries
around 1,100 cases. “The number of referrals is phenomenal now –
we’ve reached saturation point. We’re allocating cases weekly as
there is such demand,” says senior addiction worker Anne Slaven.
Charge nurse Jim Dodds agrees: “The volume of referrals is very
high to deal with – we’ve got a waiting list for home detox and
most things. It does seem to be relentless but manageable given the
new investment.”

Despite the increasing workloads McBride is confident that
commitment remains strong: “The big issue for us now is not only
about managing crises and reaching stability in people’s lives but
about how we exit those people out of service-land. And that had
never been an issue before. A lot of our new investment is about
employment training, moving on, relationship building, family
support and so on,” he says.

And integration is making this a likely reality. “It’s the right
way: that isolationist approach was serving no purpose to anybody
and sadly the people who were suffering the most were service
users,” says McBride.

Lessons Learned

• Things that were thought incidentals proved to be major things
  for staff, such as where they sit.
• People are now assessed just once, through the single shared
  assessment.
• Programmes fit people now rather than the other way around.
  “This means our retention rates are much higher and we minimise the
  revolving door scenario,” says McBride.
• Reception areas are more open and welcoming. Says Rafferty: “We
  used to have grills up that basically said ‘Don’t come in here’.
  Being more open has paid off – people like to come in.” McBride
  adds: “It’s all about folks being valued.”