The 4 Tiered model of care is used to describe the different aspects of addiction treatment services:

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1 FREQUENT ASKED QUESTIONS What is the purpose of this consultation? The Health and Social Care (HSC) Board has reviewed hospital based Addiction/Substance Misuse treatment services to identify a more effective and evidence based service model regionally these services are commonly referred to as Tier 4 services. The purpose of the consultation is to ask people for their views on the proposed changes. When will the consultation take place? The consultation will commence on the 27 th September and finish on the 20 th December Who will you consult? The HSC.Board is consulting with a wide range of stakeholders, using a variety of communication channels. This includes those who use these services, the general public, the wider Health and Social Care and statutory sectors, and the Community/Voluntary sectors. What is the 4 Tiered model of care? The 4 Tiered model of care is used to describe the different aspects of addiction treatment services: Tiers 1 & 2 services comprise community based advice and counselling, e.g. for people who are starting to have substance misuse problems or at risk of becoming more dependent. Tier 3 services are provided by specialist teams and professionals and are for people with more harmful or dependent misuse. Tier 4 care refers to specialist detoxification/stabilisation treatment within a hospital/in-patient setting and/or rehabilitation care within a specialist residential facility. The specific focus of this consultation paper is the hospital/inpatient based part of Tier 4 services which in future would mainly undertake detoxification/stabilisation care.

2 What services do people with dependent substance misuse require? In summary, people with harmful/dependent substance misuse generally require (a) initial detoxification and a period of care to stabilise them followed by (b) longer term rehabilitation and support. Most people can be treated successfully in the community Tier 3 setting without the need for admission to a Tier 4 hospital or specialist care setting. Who requires Tier 4 services? A small number of people with more complex issues or who are higher risk, may not respond to community based Tier 3 care. In these cases Tier 4 care can be provided within a hospital or specialist residential facility to provide care within a more structured setting. Where are Tier 4 addiction services currently available? There are currently 4 in-patient based Tier 4 addiction treatment units within HSC Trusts in N.Ireland. These are: Northern Trust Holywell Hospital, Antrim (10 beds) South Eastern Trust Downshire Hospital, Downpatick (14 beds) Southern Trust St. Luke s Hospital, Armagh (10 beds) Western Trust Tyrone & Fermanagh Hospital, Omagh (8 beds) There is no dedicated Tier 4 in-patient addiction treatment unit within Belfast Trust. In addition to the above, the HSC sector commissions Tier 4 rehabilitation care from 2 Independent sector providers, i.e. Carlisle House, Belfast (has contracts with the Northern and Belfast Trusts) and the Northlands Centre, Derry/Londonderry (has contracts with Northern and Western Trusts). Why is there a need to change the existing Tier 4 arrangements There is considerable variation between the HSC Tier 4 units in terms of what they do and provide. For example, some units operate only 4 nights per week (i.e. closed over the weekend); some focus upon detoxification/stabilisation, some upon rehabilitation. There is no access to

3 dedicated Tier 4 detoxification/stabilisation services for the residents of either the Belfast or Western Trust areas. This variation does not reflect evidence based practice and is not in the best interest of people who need access to Tier 4 services. A more consistent and regionally agreed service model is required that can be accessed by all the residents of Northern Ireland. What is being proposed? The HSC needs to address the situation where there is no consistent access to dedicated Tier 4 detoxification/stabilisation services across Northern Ireland. A regionally agreed service model is required that can be accessed by all residents. To provide the required consistent model, it is proposed that the Tier 4 detoxification and stabilisation phase of care should be undertaken within the HSC sector and Tier 4 rehabilitation provision mainly within the Independent sector. Working within a Regional Addiction Treatment Network both the HSC and Independent sectors would work closely together to provide Tier 4 care for all Northern Ireland residents. Given the proposed HSC focus upon detoxification/stabilisation provision, future HSC Tier 4 provision would be based upon a total of 24 beds regionally: this reflects the existing level of HSC detoxification/stabilisation service provision. An option appraisal demonstrated that to provide high quality clinical care and provide reasonable geographical access, these beds should be provided across two sites. If the proposed 24 beds were divided across a larger number of sites (e.g. 3 or 4) this would mean there would be fewer beds per site which is considered less effective/not evidence based. Where would HSC Tier 4 services be located? While subject to the outcome of this consultation exercise, the regional Network arrangement would comprise 10 specialist beds in Holywell hospital, Antrim and 14 specialist beds in the Downshire hospital, Downpatrick, i.e. a total of 24 beds. The units would work in partnership with the Independent sector in the regional Network arrangement to serve all of Northern Ireland.

4 Does the new regional model envisage that centres will close? If the proposals in the consultation are agreed given that specialist Tier 4 detoxification/stabilisation care would be concentrated within two units, it would mean that the Southern (St Luke s, Armagh) and Western Trust (Omagh) treatment units would discontinue service provision this would be in early 2014/15. The new regional model would address the previous various in services and achieve our objective to provide regionally consistent care across all of Northern Ireland. How will staffing be affected? It is anticipated that if these proposals are taken forward the total number of Tier 3 and Tier 4 staff will increase regionally. HSCB will work with HSCT s in regards to any possible impacts on staff. What if I still want to go to an inpatient centre? Can I choose? If you require access to Tier 4 services, as part of the new regional Network arrangement, staff from your local community Tier 3 team will explain all of the potential care options available to you. Working in partnership with you they will arrange admission to the unit best suited to your individual care needs. This will also include help with transport for you, your family & carers, where required. What other changes will be made as a result of this consultation? As outlined above, most people can be treated successfully in the community Tier 3 setting without the need for admission to a Tier 4 hospital or specialist care setting. The HSC.Board therefore wants to enhance locally based Tier 3 services - investment ( 789,000) is being provided over the period.

5 Benefit of Proposed Changes for those People who Use Tier 4 Services Our aim is to ensure that, if required, you have access to both specialist Tier 4 detoxification/stabilisation care (within the hospital setting) and also Tier 4 rehabilitation care (within a specialist Independent sector provider) on a 7 days/nights per week basis. As noted in this document, access to these services varies considerably across the region (with some units only operating 4 nights per week). Subsequent to implementing the changes noted in this consultation document, access to services would be available as follows in each Trust area: If you live in the Belfast Trust area: you do not currently have access to specialist Tier 4 detoxification/stabilisation care beds. Subsequent to the changes proposed in this document you will be able to access specialist detoxification/stabilisation care beds in the Downshire hospital. Access to Tier 4 rehabilitation care will continue to be provided in Carlisle House. If you live in the Northern Trust area: you will continue to have access to specialist Tier 4 detoxification/stabilisation care beds in Holywell hospital and will continue to have access to Tier 4 rehabilitation care in either Carlisle House or the Northlands Centre. If you live in the South Eastern Trust area: you will continue to have access to specialist Tier 4 detoxification/stabilisation care beds in the Downshire Hospital. If you require access to Tier 4 rehabilitation care, the HSC will arrange this care for you to be provided in Carlisle House. If you live in the Southern Trust area: if you require access to specialist Tier 4 detoxification/stabilisation care this is only available on a 4 nights per week basis in the St. Luke s hospital unit. In future, specialist Tier 4 detoxification/stabilisation care would instead be provided in the Downshire Hospital (and be provided on a 7 days/nights per week basis). You do not currently have access to specialist Tier 4 rehabilitation care beds. If this is required, the HSC will arrange this care for you within either Carlisle House or the Northlands Centre. If you live in the Western Trust area: you do not currently have access to specialist Tier 4 detoxification/stabilisation care beds. Subsequent to the changes proposed in this document you will be able to access specialist detoxification/ stabilisation care beds in Holywell hospital.

6 You will continue to have access to Tier 4 rehabilitation care in the Northlands Centre. In addition to the above proposals for Tier 4 services, the HSC.Board also plans to strengthen locally based Tier 3 community services.