Purpose

The Cabinet Member for Health and Communities approved the allocation of Public Health reserves to Derbyshire Healthcare NHS Foundation Trust for the Adult Integrated Substance Use Treatment Service’s increased costs related to the opiate substitution therapy Buprenorphine for the financial year of 2023-24.

Decision

That the Cabinet Member for Health and Communities is asked to approve the allocation of Public Health reserves to Derbyshire Healthcare NHS Foundation Trust for the Adult Integrated Substance Use Treatment Service’s increased costs related to the opiate substitution therapy Buprenorphine for the financial year of 2023-24.

Reasons for the decision

Additional investment from the Council to Public Health’s commissioned adult substance use treatment provider was required to fund the additional spend on Buprenorphine for the financial year 2023-24.  This had not been a situation that the service provider could control as they were obligated to prescribe according to clinical need and without additional investment there would be a significant impact on the commissioned service, as the provider would find this unsustainable rendering the service undeliverable.

Furthermore, if the service provider was successful in engaging unmet treatment need during this financial year, this could have an impact on the number of clients in treatment for opiates and potentially further increase the additional spend on Buprenorphine.  And in line with previous financial years approved maximum allocations. 

Alternative options considered

As Buprenorphine is a treatment recommended by the National Institute for Clinical Excellence (NICE), the Council is obliged to fund Buprenorphine if deemed clinically appropriate to support people in recovery. As the price increase is not within the control of the service, options are limited.

Do not provide additional investment

This option requires no additional investment from the Council, however, would have a significant impact on the commissioned service, as the provider would find this unsustainable resulting in other service changes or a reduced service.  Risks associated with this option include reduction of clinically appropriate prescribing; potential loss of experienced staff if the service prioritise prescribing appropriately; potential reputational risk for the Council and potential negative impact on the quality of the service provided.

Provide a reduced one-off investment

This option requires a one-off investment of up to £0.170m from the Council and would support the service should there be no significant difference in the number of clients in treatment for opiates.  However, it would not allow any capacity for the service provider to succeed in engaging any unmet treatment need for opiate clients during this financial year.  This would impact on the Council’s ability to directly address the treatment and recovery section of the national drugs strategy and contribute to the national aim to develop 21,000 new places for opiate and crack users by the end of 2024-25.  Further approvals from the Cabinet Member would be required and due to the end of the financial year approaching it is appropriate to agree in principle to a maximum amount that can be supported.