Warwickshire Drugs Needs Assessment (2022) - Publications

There was little awareness amongst most participants in this exercise about local police action to restrict the supply of drugs across Warwickshire. However, we were continuously told during interviews and the survey that county lines are a prevalent issue in Warwickshire, as is ‘cuckooing’.

We were told by police that Warwickshire is currently believed to be predominantly an ‘importer’ of county lines, with lines from larger cities being run into Warwickshire.

While Warwickshire Police have made noteworthy progress in tackling county lines in recent years, when considering areas for improvement, participants felt the police could do more to address drug dealers higher up the supply chain – highlighting the important role the Regional Organised Crime Unit (ROCU) for the West Midlands should have in breaking drug supply in Warwickshire and the wider surrounding region.

It is important to acknowledge that breaking drug supply chains is a wider issue than just policing and requires a full partnership approach to ensuring that vulnerable children, young people, and adults are not embroiled in criminal exploitation by key agencies working together to disrupt county lines and protect individuals at risk of exploitation.

Despite Warwickshire not having prisons within the local authority area, within the wider West Midlands region there are currently seven HMPPS run prisons. All have access to the regional resource, intelligence, and security hub, as well as a large dog unit which can be regionally deployed. Additionally, they all have the latest X-ray body scanners installed to confirm whether or not a suspected prisoner is hiding contraband inside their body and initiatives are in place to limit illicit substances entering the prisons through mail, ‘throw overs’ or ‘drone drop offs’.

Warwickshire Police were open to exploring more proactive ways they can work with prison security departments to monitor known organised crime group nominals, aiming to disrupt any drug dealing they continue to orchestrate from prison.

To deliver the priorities set out within the Warwickshire Serious Violence Prevention Strategy related to county lines and drug supply markets.

Warwickshire Police to consider developing and running a series of communications campaigns around the positive and proactive work being undertaken to break drug supply chains and county lines, to raise awareness, and to build trust and confidence.

Warwickshire Police to consider ways to strengthen their work with the West Midlands Regional Organised Crime Unit, with a focus on pursuing drug dealers higher up the supply chain.

Warwickshire Police to explore ways to work more closely and proactively with prison security departments to monitor known organised crime group nominals, aiming to disrupt any drug dealing they continue to orchestrate from prison.

Training could be offered to frontline workers, including education providers, to encourage ‘professional curiosity’ around exploring the signs of child criminal exploitation and increase referrals to appropriate safeguarding teams. This work could be extended to parents and carers also.

At a strategic level, Warwickshire was praised by stakeholders for having already established a local Drug and Alcohol Strategic Partnership. This was said to have helped foster good working relationships between key stakeholders within the County Council and other commissioning bodies, such as the Office for the Police and Crime Commissioner.

The most commonly raised barriers to accessing or engaging with support included: lack of awareness of what help is available; restrictions due to capacity and waiting lists; the associated stigma; and lack of assertive outreach to promote inclusivity amongst individuals with protected characteristics.

There is a particular need to increase referrals for individuals from LGBTQ+ and minoritised ethnic communities.

We identified a number of gaps in terms of specific support for some key at risk groups. We were consistently told that dual diagnosis pathways are not working effectively, and commissioned services face significant challenges when a service user has a co-occurring mental health condition.

Similarly, there is no specialist support on offer for those with learning disabilities or cognitive impairments and no specific training available to workers on how to tailor provision.

Likewise, while there is a pathway in place, no specialist support exists for pregnant service users and there is no dedicated help for sex workers.

CGL and Compass both have Criminal Justice teams, which are working well but require expansion to enable workers to go into prisons more regularly to complete pre-release work so that prison leavers are better supported ‘through the gate’ and increase the continuity of care from prison to community.

We were consistently told there is a gap in the existing support offer in terms of the need to better support the partners, carers, children and loved ones of those misusing substances.

Commissioned services require increased funding to drive the recruitment and retention of staff needed to build an experienced workforce, with reduced caseloads, and increased treatment places on offer, in order to increase the quality and quantity of support available. Consideration to be given to:

• Varying methods of recruitment, that emphasise the importance of personal qualities required rather than desired qualifications
• Making use of internships, apprenticeships, and pathways with colleges and universities
• Developing a robust induction package for new starters
• Enhanced provision for continuing professional development
• Offering mandatory clinical supervision to all staff and developing a pathway to offer support to staff who may experience vicarious trauma through their work
• Continuing to advertise opportunities for internal promotion, expanding this to national positions, and considering opportunities for secondments
• Exploring opportunities to offer consistent salaries and enhanced terms and conditions across substance misuse services

Within the context of aiming to reduce caseloads and build capacity, the following recommendations are to be considered when additional funding becomes available:

The partnership to consider investing at a strategic commissioning level, to improve decision-making, enhance oversight, and ensure more meaningful performance monitoring and management occurs.

If commissioned services are to upscale their offer and build capacity, both in terms of staffing numbers and service users in treatment, they may require better equipped buildings that are accessible to all.

Relevant support services to work together to consider all barriers outlined within the report, affording consideration to corresponding proposed solutions, and aiming to develop an action plan to address these.

Commissioned services to increase promotion of their treatment options to clients, staff, and external stakeholders to ensure everyone is aware of them and can fully utilise the range of support available.

Commissioners and service providers to increase referrals by:

• Increasing the use of Test on Arrest
• Encouraging Warwickshire Police to continue supporting drug and alcohol users into treatment with seamless referral pathways and exploring more co-location with the police
• Streamlining referrals from court-mandated Alcohol Treatment Requirements
• Promoting awareness of services available to external partners to drive up direct referrals
• Proactively challenge and collaborate with community and ‘by and for’ organisations to consider how they can reach out to more diverse communities and have a genuinely inclusive approach

Service providers to look to streamline the initial stages of access into treatment in order to reduce wait times, reduce the number of different practitioners and times people have to repeat their information to.

Commissioners and service providers to review assessment processes, with a shift to emphasising relationship building within a trauma-informed approach.

Commissioned services should offer a flexible approach to support (including location and timing), with options to continue working more flexibly built into future contracts through a hybrid model of support (including in person face-to-face contact, and virtual support).

Commissioned services to increase provision of alternative positive activities for service users, aiming to develop a sustainable recovery community and build individual recovery capital.

Nationally, there is a need for increased residential rehabilitation and in-patient detoxification places, with reduced waiting times. Locally, stakeholders believed that replicating the West Midlands detox framework for rehab applications could be beneficial.

Commissioners to explore what can be done to increase the capacity of pharmacies in the local area to meet the demand for dispensing.

Commissioned services to expand harm reduction provision (including training to administer naloxone), delivering training more widely to those not in treatment, their partners/family/carers and external professionals. This is to include highlighting and reminding service users of the importance of carrying naloxone kits.

Explore support available within primary care.

Needle exchange services to work to increase their reach to ‘new clients’.

Commissioned services to proactively seek to engage individuals with ‘additional needs’ or protected characteristics by:

• Establishing partnerships with ‘by and for’ organisations
• Improving dual diagnosis pathways
• Exploring the possibility of recruiting in-house psychologists
• Raising staff awareness of learning disabilities and how to adapt support appropriately
• Building better working relationships with LGBTQ+ organisations
• Ensuring staff have appropriate cultural safety and awareness training with availability of appropriate interpreters/translators as needed for anybody whose first language is not English
• Considering a specialist midwife role to co-ordinate support for pregnant service users
• Developing a dedicated form of support or pathway for sex workers
• Expanding ‘prison in reach worker’ roles
• Introducing dedicated family support, and upscaling Family Drug and Alcohol Court (FDAC) provision.

Commissioned services to ensure a robust step-down support pathway is in place leading up to, and at the point of discharge from treatment, this could include:

• Increasing prevalence of mutual aid meetings across Warwickshire, with representatives from the 12 Step fellowship coming into services to introduce themselves to clients and support visible recovery
• Improving awareness and availability of self-help resources (such as Breaking Free Online), where possible these should be offered online and/or in apps

Commissioned services to increase opportunities for service users to provide feedback and engage service users in co-design, building on initiatives such as the Experts by Experience panel. This could be enhanced by considering and reviewing key performance indicators with commissioners.

There was an appetite for earlier intervention and prevention, and a desire for substance misuse treatment to become more innovative and proactive within a trauma-informed model.

The majority of participants considered education to be the fundamentally most important aspect for preventing problematic substance misuse.

Specifically, participants wanted to see education that teaches people about the realities of drug dependence and addiction, focusing on: the short- and long-term mental and physical health implications; the impacts on all other aspects of an individual’s life; and the wider negative repercussions to friends, family, and society in general.

Simultaneously, we were told this could usefully include the opportunity to raise awareness of harm reduction techniques to promote safer consumption if people do decide to use substances.

Linked to education, participants spoke about the need for local and national campaigns and media adverts to raise awareness to the public about substance use, the associated impacts and harm, and where to find support.

This was seen as important as it was felt that some individuals may not realise their behaviour constitutes problematic use or may lack understanding of the repercussions their use is having on their health, lives, or society.

Additionally, participants wanted to see more support for children and young people of parents misusing substances. They wanted this to be delivered through a whole-family approach, as it was agreed that these individuals are at risk of going on to misuse substances themselves if they do not receive necessary support.

Warwickshire’s Drug and Alcohol Strategic Partnership to explore ways to contribute to the development and monitoring of school curriculums to incorporate age-appropriate education, exploring the risks and dangers of substance use and raise awareness of harm reduction techniques.

Young people to be taught healthy coping strategies, building their resilience so they have sufficient lifeskills so as not to need to resort to substance use as a form of coping.

Consideration to be given to the role of the local Drug and Alcohol Strategic Partnership in establishing partnerships and pathways between those responsible for offering diversionary activities to children and young people.

There is a need for local and national campaigns and media adverts to raise awareness to the general public about substance use, the associated impacts and harm, and how they can find support.

The future Children and Young People’s Drug and Alcohol Service provider to continue working with the Youth Justice Service on the ‘universal referral pathway’ as a preventative measure and to explore expanding this provision to children and young people not in touch with the criminal justice system.

Increase provision of support for children of parents misusing substances through a whole-family approach.

Family Drug and Alcohol Court provision must be evaluated and be rolled out long-term if successful.