Topic Report: Drugs and alcohol

Buckinghamshire is a unitary local authority in England, with 553,100 people (2021 Census), of whom 63% are aged 15-64 (source: Population and household estimates, Census 2021) . There are 235 schools and academies in Buckinghamshire attended by over 84,000 children and young people.

Buckinghamshire has 2 large towns – Aylesbury in the north of the county and High Wycombe in the south. There are also a number of smaller towns across the county. The majority of the population in Buckinghamshire live in an urban city or town environment, with 32% of the population living in rural town or village communities (source: 2011 Rural Urban Classification lookup tables).

Buckinghamshire has better health overall in comparison to England – life expectancy at birth was higher for both men (81.5 versus 79.4) and women (85.1 versus 83.1) in 2018-2020 (source: Public health profiles). However, the health of residents varies within, and between, local areas. National data show drug and alcohol issues disproportionately affect more disadvantaged populations and are a mechanism contributing to health inequalities. A local programme of work on ‘Levelling Up’ is focussed on the ten most deprived wards in the county – covering Aylesbury, High Wycombe, and Chesham.

In July 2022, 42 Integrated Care Systems (ICSs) were established on a statutory basis across England to bring partner organisations together. Each ICS has two core parts: an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). The ICB is an NHS organisation responsible for managing NHS budget and arranging for health services to be delivered. The local ICB was born from three previous Clinical Commissioning Groups (CCGs) which have since ended – Buckinghamshire, Oxfordshire and Berkshire West (BOB). The ICP is a statutory committee that brings the NHS together with local authorities and other key partners to develop the overall strategy to improve health and wellbeing. Buckinghamshire Council forms part of the BOB ICP. Public health functions moved to local authorities in 2013 therefore Buckinghamshire Council is responsible for commissioning local drug and alcohol specialist treatment services.

Buckinghamshire Healthcare NHS Trust (BHT) provides both acute and a range of community health provision. Acute inpatient services are provided at Stoke Mandeville Hospital in Aylesbury, which contains an A&E department, plus Wycombe Hospital in High Wycombe. However, this only accounts for two thirds (62%) of hospital attendances for Buckinghamshire residents, with care also provided by neighbouring Frimley Health, Oxford University Hospitals and Milton Keynes University Hospital (Figure 1) (source: NHS Acute (Hospital) Trust Catchment Populations).

Drugs and alcohol services take a tiered approach to treatment based on the 2006 national Models of Care guidance (source: Alcohol Misuse interventions report) (source: Models of care for treatment of adult drug users).

A 3 year early intervention programme ‘Risk-Avert’, delivered by The Training Effect, has been available for Buckinghamshire schools until March 2022 as tier one provision for young people. In the first year the programme delivered a universal offer for young people in classroom sessions. In Years 2 and 3 school support staff were trained to deliver a six-session intervention programme for Year 8 pupils requiring additional support.

Health education in schools is now statutory, providing an opportunity to ensure that all young people receive education and advice on the dangers of drugs and alcohol. Plans are currently being developed for a schools-based targeted prevention model to be delivered by the commissioned young people’s drug and alcohol service. This will ensure a seamless transition for any young person requiring a more intensive level of support. A survey of Buckinghamshire pupils found that secondary pupils were most likely to go to a parent if they wanted information about drugs (48%), whereas sixth formers would most likely consult an internet search engine (64%).

Adult tier one alcohol identification and brief advice (IBA) is commissioned within the Healthy Lifestyle Service, alongside tobacco dependency and weight management. 11.5% of Buckinghamshire Healthy Lifestyle Service clients screened in 2019/20 scored 8-15 (increasing risk) on AUDIT. None were recorded with a score of 16+ (higher risk) who would be eligible for referral to tier two services. There will be an enhanced tier one alcohol offer when the Healthy Lifestyle Service is recommissioned in 2023. IBA training is also available for frontline key workers and practitioners in a range of services including social care, housing, mental health, domestic abuse and criminal justice.

Elements of adult tier one provision are also delivered by the specialist drug and alcohol treatment service. This includes training to agencies on drug and alcohol awareness and delivery of information and brief advice. The service is also involved with and actively promotes health awareness campaigns related to drugs and alcohol.

Tier two and three services for 10-18 year olds (and exceptionally up to age 25) are provided by Here4YOUth (delivered by Cranstoun) which, until July 2022, was known as SwitchBucks. Young people were directly involved in this rebranding. The service delivers interventions for young people at both early risk (those beginning to use substances regularly) and at harmful use or substance abuse (active alcohol or drug seeking behaviour despite negative consequences across many areas of life). ‘Hidden Harm’ interventions are provided for young people affected by parental substance misuse in partnership with One Recovery Bucks. The service also supports delivery of the Young People Drugs Diversion Scheme with the police and youth offending service. This provides young people found in possession of small quantities of illegal drugs the opportunity to take part in tailored interventions to address their drug and/or offending issues as an alternative to facing prosecution.

One Recovery Bucks (ORB), delivered by Inclusion, part of the Midlands Partnership NHS Foundation Trust, is the integrated specialist substance misuse treatment service for adults in Buckinghamshire. It delivers services and interventions for drugs and alcohol across tiers 1, 2 and 3 for adults including:

• Clinical service – prescribing OST and detoxification. The service subcontracts with community pharmacies to deliver supervised consumption of OST medication.
• Residential rehabilitation – provides clinical assessments for residential rehabilitation, inpatient detox and, where appropriate, community detox.
• Harm reduction – including access to clean drug paraphernalia and needle exchange provision, naloxone provision to help prevent overdose and reduce drug-related deaths and blood borne virus testing.
• Psycho-social interventions – access to psycho-social therapy, counselling, one-to-one support and a variety of groups.
• Shared care with primary care – 2 GP shared care services support the provision of OST in Burnham and Aylesbury and 27 GP practices support the provision of alcohol abstinence treatment both within tier three.
• Family and carers service – supporting those impacted by a family member’s substance misuse (in conjunction with Here4YOUth) including one-to-one support, group support, information and guidance and referrals to other services.
• Enhanced Recovery Network – creating a soft safe landing from structured services, with the aim of decreasing risk of relapse and representation into tier three services. Activities include delivery of daily Recovery Club and practical support (such as access to housing and finance advice).

ORB operates three main service hubs: Aylesbury, Wycombe, and Chesham. There are two additional engagement and treatment hubs in Burnham and Buckingham. A summary of ORB’s services is shown below (Figure 2).

The most complex and chaotic drinkers in Buckinghamshire are provided with more intensive engagement and support via the pilot three-year Blue Light project, launched in autumn 2021. The pilot will undergo an interim evaluation annually, as well as at the end of the project, and the findings will be added to future versions of this needs assessment.

Residential rehabilitation (tier four) is commissioned on a regional basis, for which Buckinghamshire residents (including those under the age of 18) are eligible.

The UK criminal justice system is collectively responsible for administrating justice and consists of institutions including the police, crown prosecution service, and prison system.

Community Safety Partnerships (CSPs) are statutory bodies created under the terms of the Crime and Disorder Act 1998. This requires all responsible authorities (the police, local authorities, fire and rescue services, the probation trust, and local health providers) to work together to reduce crime and disorder. The Safer Buckinghamshire Board (SBB) is the strategic CSP within Buckinghamshire.

The Buckinghamshire Council Community Safety team supports the work of the CSP including serious violence, domestic violence, modern slavery, Prevent, and antisocial behaviour. This is achieved through the production and implementation of strategies alongside partner agencies, and provision of frontline services including street wardens and public realm CCTV.

Buckinghamshire is covered by Thames Valley Police (TVP), one of the 43 police forces in England and Wales and the largest non-metropolitan force. It covers Buckinghamshire, Milton Keynes, Oxfordshire and Berkshire (East and West). It has 11 local policing areas, each led by a Superintendent, with two for Buckinghamshire – Aylesbury Vale and South Buckinghamshire. There are currently six custody suites across the Thames Valley, with one in Buckinghamshire located in Aylesbury.

The role of the Police and Crime Commissioner (PCC) is to provide a democratic route for residents to input into policing and hold the police to account, including by the appointment of the Chief Constable. PCCs aim to cut crime and deliver an effective and efficient police service within their force area. PCCs hold convening powers and work in partnership across a range of agencies at local and national levels to ensure there is a unified approach to both preventing and reducing crime. The PCC’s published plan identifies “Improving the Criminal Justice System” as one of the key priorities and, as chair of the Local Criminal Justice Board, he utilises his convening powers to provide governance over the breadth of partners who deliver against the Criminal Justice agenda. The Thames Valley PCC directly grant funds local Community Safety Partnerships, of which Buckinghamshire is one of twelve, and holds commissioned and grant funded organisations to account for local delivery.

His Majesty’s Courts and Tribunals Service is responsible for the administration of criminal, civil and family courts and tribunals in England and Wales. Magistrates' courts deal with less serious criminal offences, with more serious offences dealt with by Crown Courts. Within Buckinghamshire there is High Wycombe Magistrates’ Court and Family Court, Amersham Law Court (Magistrates), and Aylesbury Crown Court. In addition, Buckinghamshire has a Family Drug and Alcohol Court (FDAC). This Court is an alternative family court for care proceedings designed to work with parents with drug and alcohol misuse.

His Majesty’s Prison and Probation Service carries out sentences given by the courts, in custody and the community, and rehabilitates people through education and employment.

There are three prisons within Buckinghamshire. HMP Aylesbury is a category C closed prison – previously a Young Offenders Institute (YOI) it has recently been reconfigured as an adult male prison. HMP Grendon is a closed category B prison for adult men, which is jointly managed with HMP Spring Hill on the same site in west Buckinghamshire. HMP Spring Hill is a category D open resettlement prison for adult men. Most of the prisoners held at Spring Hill are long-term inmates transferred from other prisons for the last few years of their sentence. However, the movement of prisoners is not restricted to local authority boundaries. Most male prisoners from Buckinghamshire will first go to HMP Bullingdon in Oxfordshire, a category B closed reception prison. Prisoners will move between prisons during their sentence, so those currently serving in a Buckinghamshire prison may not be released into the community from that prison. There are no female prisons in Buckinghamshire. All female inmates will serve in prisons located outside of the local authority.

The local probation service area covers both Buckinghamshire and Milton Keynes.

NHS England (NHSE) is responsible for commissioning healthcare for people in prisons and young offender institutions in England (with the exception of emergency care, ambulance services and out-of-hours services). The range of services which are directly commissioned for prisons includes primary care and otherwise community services such as substance misuse and mental health services. NHSE have a specification for prison-based substance misuse services which has been commissioned against since 2018.

NHSE also commission healthcare in court custody in conjunction with the Prisoner Escort and Custody Service (PECS). In the South East, SERCO Group PLC are commissioned to deliver PECS, and IPRS Aeromed are subcontracted to provide a range of clinical medical services from triage to onsite paramedic support.

In Buckinghamshire, court custody healthcare is provided by Mountain Healthcare. For HMP Springhill and HMP Grendon, healthcare for prisoners is commissioned by NHSE to Practice Plus, who subcontract substance misuse specialist services to Inclusion, Midlands Partnership NHS Foundation Trust. Inclusion is the largest NHS provider of prison-based drug and alcohol services in England, as well as being the local provider of the Buckinghamshire adult drug and alcohol service – One Recovery Bucks. Healthcare at HMP Bullingdon in Oxfordshire is provided by Practice Plus with substance misuse services subcontracted to Inclusion, Midlands Partnership Foundation Trust (MPFT). For Aylesbury prison, healthcare is provided by Central and North West London NHS Foundation Trust.