Background: The World Health Organization target is to provide at least 200 needles and syringes annually per person who injects drugs in order to control infections. However, there is a paucity of evidence evaluating the monitoring of Needle and Syringe Programme (NSP) delivery in different settings. Data from the NSP monitoring system in Cheshire and Merseyside (Integrated Monitoring System, IMS), together with survey responses from NSP staff, were used to explore how NSP delivery affects the quality of monitoring data and to evaluate factors that could impact on coverage.

Methodology: A questionnaire was distributed to all 110 sites involved in NSP delivery. Topics covered service provision, interaction and engagement with clients, opinions regarding the client groups accessing services, and changes in service use over time. Responses were matched to data captured in IMS.

Results: Responses were received from 64 service providers. Almost three-quarters (72%) felt that clients mostly provided correct or consistent personal identification information when using NSPs. Asked about changes in service usage, less than one-third (29%) of providers recognised the increase in client numbers, observed in the IMS data. Opinions regarding injected substance correlated with the IMS data, and supported distinct patterns of service use by people injecting steroids. The majority of services (91%) implemented at least one restriction on service provision, with 45% placing restrictions on the amount of equipment obtained.

Conclusion: Restrictions on NSP provision may present barriers to service access, and result in less than optimal equipment distribution and coverage. Findings support previous data indicating the substance used impacts the types of NSP accessed. Findings indicate that monitoring data quality is sufficient for assessing coverage. Further research is recommended to ensure services are responsive to the needs of people who inject drugs, and to assess impact of restrictions on harm.

Issue: Drug related deaths (DRD) are a major public health issue, and have been increasing in many countries including the UK. In England and Wales, DRD are at their highest level since records began in 1993, with deaths from overdose being particularly prominent.

Setting: In response, seven of the nine local authorities within Cheshire and Merseyside region established a review process to examine DRD in order to explore common themes, identify recurring issues and to share findings. The system follows Public Health England recommendations for good practice; reviews all deaths of individuals in drug treatment, not just those officially classified as DRD; and engages the coroner and non-treatment agencies in the review process. A collaborative regional system involving multiple local authorities ensures better opportunities for cross-learning and also economies of scale.

Project: DRD monitoring is coordinated by the Public Health Institute (PHI), who collate information from sources including: service-led internal reviews; the monitoring of drug treatment (NDTMS), needle and syringe programmes (IMS) and criminal justice drug assessment (DIP); social services and coroner records. When a death occurs, it is logged on to the system by either the drug treatment service or the local coroner via PHI. Public Health commissioners are then automatically alerted that a death has occurred, so that they are able to access the record of the death prior to quarterly stakeholder panels. These panels review and scrutinise the cases and identify learning opportunities.

Outcomes: The system has examined over 460 cases to date and has informed improvements to patient care which include: the development of new care pathways involving specialist services in areas such as respiratory and palliative care; exploring medicines management; and focusing on disguised compliance, whereby individuals who appear well engaged with addiction treatment may be masking underlying drug use. Implementation issues will be discussed.

The Integrated Monitoring System (IMS) is commissioned by nine local authorities to collate data from pharmacies and drug& alcohol agencies across Merseyside and Cheshire, a region in the north west of England with a population of 2.4 million. The information collected pertains to interventions related to drug and/or alcohol use outside of care-planned treatment and which does not get reported by existing national systems. Services might include needle and syringe programmes delivered in both a drug team and a pharmacy setting, and by services offering brief interventions to particular groups of individuals such as recovering drug users, sex workers and homeless people.

This poster presentation provides an overview of the Integrated Monitoring System (IMS) which is commissioned by Local Authorities across Merseyside and Cheshire, a region in the North West of England. The service landscape for problematic drug and alcohol users in the region is complex with a high level of low threshold and specialised delivery, including needle and syringe programmes (NSP) which are not monitored at attributable level nationally. IMS enables all alcohol and substance use service providers to record information on presenting clients in a consistent manner, irrespective of their service specific monitoring system.

When a client presents to a service provider or pharmacy, information on the presentation is entered onto the IMS data collection tool, which is then collated and presented to providers, commissioners and public health leads, reporting on both activity and outcomes. The poster highlights the benefits of such an integrated system, including cross matching of data with national datasets to provide a comprehensive overview of the number of individuals presenting to any stage of treatment, allowing commissioners to understand the totality of people in contact with services. Its local development in partnership with commissioners and providers ensures that the system is responsive to local needs and captures information relevant to the local landscape.

The poster also highlights the practical side of its implementation, by using established data collection tools alongside the bespoke system, in order for its reach to be comprehensive, with integrated online mapping allowing commissioners to view data at a detailed level. It also assists in building up a picture of drug related deaths across the region, allowing death review panels to examine evidence supplementing the structured treatment data which may compliment or provide new evidence of an individual’s injecting status or alcohol use prior to their death.

The Integrated Monitoring System (IMS) was recognised as a shortlisted finalist in the ‘Best example of advancing local NHS systems for innovation’ category at the 2015 North West Coast Research and Innovation Awards. The North West Coast Research and Innovation Awards is a collaborative celebration event between the North West Coast Academic Health Science Network, and CRN: North West Coast.

IMS Online is a complete web based solution for services to record activity not covered by the National Drug Treatment Monitoring System (NDTMS) dataset such as brief intervention, recovery support and syringe exchange provision. Developed by a specialist team within Liverpool John Moores University’s Centre for Public Health, it complies with national recommended standards and provides a comprehensive suite of reports which agencies are able to use to monitor performances and activity and which can be accessed in aggregated form by local public health commissioners and other designated professionals.

Types of services currently using IMS:

Needle and Syringe Programmes: IMS Online provides a complete solution to syringe exchange services with an online web based tool for data capture which captures every information field as recommended by the 2014 NICE guidelines including demographics, equipment distributed and returned, wellbeing, outcomes and testing data. With a live visual representation of return rates over the last six months and the lifetime of the client’s contact with your service, prompting for assessments after a specified period of time and a full suite of reports for any given time period – plus the ability to generate an individual client level report. IMS Online is already utilised in numerous syringe exchange services.

Low Threshold Drug and Alcohol Services: IMS Online allows services who deliver low threshold brief interventions or extended brief interventions to service users to record their activity in a similar way to NDTMS but recording details of every intervention, along with demographic information, a TOP-like assessment form and wellbeing information based on the widely used WEMWBS scale. A full suite of reports is available for any given time period including activity, demographics and wellbeing reports – or you can generate an individual client level report with a summary of all information held on the client and any recent activity.

Non-Specific Support Services: IMS has been utilised by services dealing with but not specialising in drug and alcohol use, allowing them to report on client groups potentially affected by drug and alcohol use while not exclusively so – services which offer things like housing support or family help. So long as the client’s attributors (initials, date of birth and gender) are recorded along with the date of any intervention, the tool can be used to record all kinds of activity from different kinds of services.