Improving Clinical Responses to Drug-Related Deaths – A Collective Voice and NHS Substance Misuse Providers Collaboration (NHS SMPA)

For the last three years drug related deaths in the UK have increased.

They are now at the highest levels since records began in 1993. This is more individuals whose lives are cut short and denied the opportunity to realise a brighter future. More families blighted by the pain and bereavement losing a loved one causes.

Every effort has to be made by all stakeholders to do all they can to change this statistic, and this will involve action in all contexts in which drugs are used and among all drug users. However, as providers of services to the most vulnerable sections of the population, we have particular expertise in the delivery of effective evidence based treatment and harm reduction services which both PHE and the AMCD have identified as fundamental to addressing this crisis. The focus of this document is therefore to pool and share our expertise to maximise the treatment sector’s contribution to minimise early and avoidable deaths.

To this end, Collective voice and the NHS substance misuse providers alliance have worked together to produce a set of recommendations for providers with the aim of ensuring that everything that can be done is done by service providers to help reverse this damaging trend. This demands a challenging balancing act, retaining a focus on the importance of harm reduction and safety whilst not undermining the opportunity and ambition for recovery of many people we work with.

The document covers a number of subject areas, but detailed below are the key recommendations we believe providers and those commissioning services should commit to: 

1. Every service should review its information systems to enable data relevant to risk of overdose to be captured and deployed to inform individual treatment plans. 

2. Treatment plans should be consistent with the 2017 clinical guidelines and should be individually tailored to balance the protective benefits of OST with the opportunity to safely progress towards recovery. Providers and commissioners should guard against forced reductions or premature removal from treatment in a desire to achieve targets. 

3. All providers should establish clear protocols for managing the risk of overdose and ensure their staffs are competent to implement them. This should include ensuring Naloxone is widely available. 

4. Commissioners and service providers have a responsibility to maximise their contribution to addressing all the physical and mental health needs of service users, ensuring these are met either within their own services or by effective engagement with timely and appropriate access to primary care and specialist services in the NHS. This includes ensuring that more people are tested for and treated for Hepatitis B and C. 

5. Commissioners and treatment systems need to increase local penetration rates to reduce deaths among those who are currently not engaged in treatment or in contact with harm reduction services, fundamental to this is supporting and ensuring the use of needle exchange is promoted and access increased. 

The constituent members, (both Voluntary Sector and NHS providers) of Collective Voice and NHS SMPA have contributed and shared expertise with the aim of increasing expertise and practice across all organisations. A subject as important as this demands openness and transparency to ensure every opportunity is taken by service providers to help save a life, as such the organisations we represent will take a lead in promoting these aims. 

We thank the individuals and organisations who have contributed to this document and ask all those who commission or provide services take the time to read it and apply the recommendations it makes and hopefully benefit from some of the innovative practice included.

Danny Hames and Karen Biggs
Chair – Collective Voice Chair – NHS Substance Misuse Providers Alliance