BRADFORD NEEDLE EXCHANGE SCHEME

Improving the quality and effective monitoring of

needle exchange services through

information technology

John Bolloten

Needle Exchange Co-ordinator

Bradford Metropolitan Council

Multi-agency partnership – Commissioned and funded by Bradford PCT

– Co-ordinated by Bradford Council

History – Established May 1987

– 1st Pharmacy-based NX service in the world

Scale – 45 participating outlets:

• 38 community pharmacies

• 2 street drug agencies

• 5 other agencies

Bradford Needle Exchange Scheme

The service is • Free

• Anonymous

• Confidential

• Open to all injecting drug users whether

using street drugs or Performance &

Image Enhancing Drugs (PIEDS)

Figures • See over 2000 injectors each year

• Issue 50,000 needles and syringe sets

each month in about 3000 transactions

• 75% street drug users (primarily

heroin/crack)

• 25% PIEDS users

The Bradford NX Scheme

• Rated joint 1st in the U.K. for harm reduction

• Maximum score 16/16 for good practice

(National Treatment Agency for Substance Misuse – Good Practice in Harm Reduction Report, October 2008)

(Health Care Commission – Improving Services for Substance Misuse Report, May 2008)

Undoubted Success

• No HIV epidemic in the UK

• HIV rates amongst injectors up to 70% where no NX

programmes exist

• Small investment for big public health benefit

• Brings drug users into mainstream services

However….. despite 20+ years:

• Wide variations in quality and

standard of provision across the UK

• Very poor data collection

• Lack of clear national leadership/steer

Up to Summer 2006

• Very basic recording form

• Client details collected every occasion

• Filled in by hand

• Every transaction recorded in isolation to

another

• No possibility to record notes

Previous Recording System

• Transactions re-entered onto simple

Access database

• Time-consuming and costly

• Poor handwriting/Spelling errors

• Gaps in data

Problems With Previous Data Limited Value

• Double counting

• Out of date

• Accurate in terms of issues/returns – nothing else

• Fragmented information

• No coherent picture

• No clues as to effectiveness of service

How to move forward?

Challenge

Our Objectives (1)

• Monitor interventions from outlets

• Collect clear and accurate data

• Identify weaknesses/gaps in provision

• Identify trends in injecting drug use

Our Objectives (2)

• Interactive service provision

• Monitor and map where service users access the service

• Contribute to needs assessment work

• Enable targeted harm reduction information to be disseminated

Solution

Develop a real-time web-based system that would capture and manage clear and accurate data (entered by outlets at point of delivery)

• An interactive real-time system where all

participating outlets are effectively part of the same

network

• Outlets can record notes and act on notes recorded

by others, in particular in relation to the urgent

health needs of service users

• At a glance transaction history of each service user

New Database System (from March 2007)

Our Partnership Team • Needle Exchange Co-ordinator

• Joint Commissioning Manager for Substance Misuse

• Bradford PCT IT Team

• Local Pharmaceutical Committee

• 2 local street drug agencies

Regular meetings

Numerous smaller working groups

Initial Challenges (1)

• Identify funding

• 3 stakeholders having to visit all outlets to

research/assess their individual needs

• Numerous technical IT issues

• Server side: Database construction, hosting,

access and encryption

• Outlet side: Space, hardware and connectivity

Initial Challenges (2)

• Engage contractors to undertake physical work

• Security/safety issues in outlets

• Explain the process of change to every outlet

• Work to a deadline

How will service users react to change?

Main Menu Screen

Search/Add Screen

Transaction Screen

Roll Out

• Phased introduction of new system

• Inform service users of changes

• Produce leaflets/guidelines

• Install PCs in pharmacies

• Training of staff

• Produce extensive training materials

• Continual back up and support

Benefits of New Database

• Very accurate data

• Notes and Alerts – swift information distribution

• Ability to problem solve regarding drug litter

• Monitor outlet performance

• Quick rectification of errors

The Future • Database V2.0

• Effectiveness Monitoring

• Harm Reduction Assessments/Scoring

• Revised data recording

• Recording of interventions

• Complete overhaul of layout/design

• Flag up issues/concerns

Contact

John Bolloten

Tel: +44 (0)1274 434206

john.bolloten@bradford.gov.uk

mailto:john.bolloten@bradford.gov.uk