Oldham & Rochdale Joint Substance Misuse Profile and Overview

May 2017

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Overview

Greater Manchester is made up of 10 Boroughs. Oldham and Rochdale are two of these authorities located north east of the City, and have very similar demographics.

Oldham It has a population of 230,823 and spans 55 square miles (142 km2). The borough is named after its largest town, Oldham, but also includes the outlying towns of Chadderton, Failsworth, Royton, Shaw and Crompton, the village of Lees, and the parish of Saddleworth. Although some parts, contiguous with the city of Manchester, are highly industrialised and densely populated, about two-thirds of the borough comprises rural open space; the eastern half stretches across the South Pennines. Oldham has 20 electoral wards.

Table 1: Oldham Metropolitan Borough Population by Gender and Age ONS 2015 Mid-Year estimates Oldham Borough Total Population: 230,823 Total Population: All Males 113,661 Total Population: All Females 117,162

Adult Population (18 years and over) 172,518 Child Population (0 to 17 years) 58,305 Over 65 34,104

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The population of Oldham has grown by 6.2% since 2001 and is becoming more diverse with the BME population growing from 13.9% in 2001 to 24.4% in 2011. Chart 1 below shows that after White ethnicities the next largest concentration is Pakistani (22,686 = 10.1%) followed by Bangladeshi (16,310 = 7.3%).

Oldham’s overall ranking has declined from 37th to 34th worst of 326 Local Authorities. This appears to be associated with a widening in the extent of deprivation relative to other areas, and with declines in health and crime domains in particular. However, more investigation will be needed.

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One LSOA2 in Hathershaw has fallen into the bottom 1% nationally, with three LSOAs (predominantly social housing straddling St Mary’s and Coldhurst wards) maintaining that position. Rochdale Rochdale Borough is located in the southern Pennine Moors and covers 62 square miles (161 km2) of which two-thirds is rural. It is characterised by urban developments of dense housing and industrial areas located along major motorways, surrounded by hilly areas of rural land. The Borough comprises four Townships: Rochdale, Heywood, Middleton and Pennines (includes the Towns of Littleborough and Milnrow). Rochdale has 20 electoral Wards. The population of Rochdale is 214,195 and growing, albeit modestly, but is becoming more diverse. The proportion over 65 is expected to increase by 25% within 10 years.

Table 2: Rochdale Metropolitan Borough Population by Gender and Age ONS 2015 Mid-Year estimates Rochdale Borough Total Population: 214,195 Total Population: All Males 105,354 Total Population: All Females 108,841

Adult Population (18 years and over) 163,340 Child Population (0 to 17 years) 50,855 Over 65 32,040

The BME population increase from 14% to 21% between 2001 and 2011 and there are currently 153 different ethnicities in the borough. Chart 2 below shows the breakdown for each broad ethnic group according to the results from the ONS 2011 Census

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Rochdale Borough is one of the most deprived areas of the country. This is reflected in low economic growth, poor life expectancy, higher crime levels, low skills, high levels of children and pensioners living in poverty and poor physical environment. The borough is ranked 16th most deprived in England.

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Substance Misuse Profile and Overview ALCOHOL Hospital admissions

Table 3: Alcohol –related and specified hospital admissions episodes (with conditions)per 100,000 population in Rochdale, Oldham and England (2014/15) (PHE/LAPE) Oldham Rochdale England Persons admitted to hospital for alcohol- 537.2 585.3 364.4 specific conditions – all ages Admission episodes for alcohol related 695.4 721.7 640.8 conditions (narrow) PHOI 2.18 Provisional rate for 2015/16 651.9 618.0 651.2

Admission episodes for alcohol related Male 1813.3 1974.3 1559.8 cardiovascular conditions Female 837.5 942.9 690.9

Admission episodes for alcohol liver Male 293.2 268.8 152.2 disease condition Female 109.7 112.3 67.9

Admission episodes for mental and Male 144.4 174.3 120.2 behavioural disorders due to use of alcohol Female 64.5 70.7 49.9 Individuals with Alcohol-specific hospital None 331.8 369.5 233.2 admissions in 2014 and number of 1 67.8 74.2 45.2 admissions in preceding 24 months 2 or more 87.0 99.1 56.4 Rochdale and Oldham have significantly higher than National rate of admissions for alcohol specific conditions. Both areas also had a much higher rate of alcohol related hospital admissions, however both areas have improved in the past 2-3 years and provisional figures for 2015/16 show this trend continuing with Oldham on a par with the National rate and Rochdale LOWER. Areas of key concern are higher rates of cardiovascular and behavioural conditions (particularly worse in Rochdale) and significantly higher rates of liver disease. Both areas have high rates of ‘repeat’ alcohol-specific admissions – Rochdale is worse than Oldham Mortality

Table 4: Alcohol-related mortality in Rochdale, Oldham and England (2012-14) Oldham Rochdale England Male 15.6 17.3 12 Months of lives lost due to alcohol Female 8.1 8.9 5.6 Alcohol Specific Mortality (rate per 1,000) 0.16 0.21 0.12 Mortality due to chronic Liver failure (rate per 1,000) 0.19 0.20 0.11 Alcohol Related Mortality (rate per 1,000) 0.65 0.70 0.46 Mortality rates due to alcohol is much higher than National in both boroughs, with Rochdale significantly worse for Alcohol specific deaths

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Chart 3 below shows comparative data for Oldham and Rochdale alcohol units per month amongst Adult alcohol users in Tier 3 Treatment

Key points:  In Rochdale consumption levels of 400-599 units per month were proportionately greater than in Oldham – 23.1% [n=125] compared to 19.6% [n=100].  By contrast those indicating 1000+ units of consumption were proportionately greater in Oldham (14.1% [n=72] than Rochdale (9.4% [n=51]). Waiting times to access treatment for Alcohol

Table 5: Waiting times to access Treatment for alcohol use in Rochdale, Oldham and England (2015/16) Oldham Rochdale England Initial waits under 3 weeks to start treatment 302 84% 408 100% 96% Initial waits over 6 weeks to start treatment 13 4% 1 0% 2% Approximately 12% of Oldham clients either waited between 3 and 6 weeks to start treatment (or data was not recorded) and thise waiting over 6 weeks is higher than national average. In treatment Client Profiles – Alcohol only Both Oldham and Rochdale have similar numbers in treatment for Alcohol misuse and client profiles. The alcohol treatment population in both areas is predominantly White/White British. Oldham has a higher proportion alcohol clients aged less than 30 years old – 13.3% compared to 7.9%. Chart 4 below shows that approximately one in seven clients in treatment has a dual diagnosis. However local data shows that greater

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numbers present to services with mental health/behavioural issues that do not have a Diagnosis. In Rochdale 30% of individuals recorded issues at first point of contact.

Geographical distributions of multi-agency alcohol-related interventions Figure 4.1 below shows the distribution of Oldham’s alcohol-related hospital admissions with concentration mainly clustered around Oldham town centre in Coldhurst, Alexandra and St. James’. Hollinwood and Waterhead are also areas high demand on services.

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Figure 4.2 below illustrates the geographical distribution of Oldham residents by ward in Tier 3 alcohol treatment. Again, concentrations of greater demand almost replicate those shown in Figure 4.1.

Figure 5 below shows distribution of alcohol-related service demand/engagement in Rochdale.

The main areas of concentration for A&E attendance are Castleton, Spotland & Falinge and Smallbridge & Firgrove. The distribution of Rochdale residents in alcohol treatment

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broadly mirrors that for A&E attendances with the exception of Castleton where treatment take-up appears low. Safeguarding Figure 6 below shows the number of alcohol clients who entered treatment in 2015/16 who live with children and the number of children who live with them.

The number of clients entering treatment in both boroughs is very similar (ie Oldham 389 – Rochdale 400) however the differences in relating to recording of children is dramatic. 62% of Rochdale clients are NOT a parent (or have no child contact) – this is much higher than Oldham (35%) and National ( 47%). 36% of Oldham Parents do not live with their children, higher than National. Over the 2 boroughs, 298 children live with Alcohol clients. It is possible that clients are not truthful about child contact. Interventions

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In 2015/16 there were 86 more individuals receiving structured alcohol treatment in Rochdale (See Figure 7 above). A significantly higher proportion received pharmacological interventions in Rochdale, however, the proportion of those that are inpatients is broadly similar. Recovery support in the community is more prevalent in Rochdale than Oldham Residential Rehabilitation In 2015/16, Oldham had 17 alcohol users attending Residential Rehab (3% of treatment population) and Rochdale had 14 (2%). These are low numbers and so the demand and usage is broadly similar. Length of time in treatment

Figure 8: Time in alcohol treatment and unplanned exits in Oldham and Rochdale (2015/16) Oldham Rochdale

On average, Rochdale Alcohol clients spend longer in treatment than they do in Oldham. However the majority in both areas append between 3 – 6 months in treatment. The greatest difference relates to early, unplanned exits with Oldham having double the number dropping out within 12 weeks. Wider complexities

Figure 9: Employment Status and Accommodation Status at start of treatment amongst alcohol clients in Oldham and Rochdale (2015/16) Oldham Rochdale

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Oldham have less clients in regular employment than Rochdale, however the numbers on long term sick are very similar. In relation to accommodation need, both areas have 10% of clients with either a housing problem or urgent (NFA) need. The greatest difference across the two areas is the number of decisions taken by the local authorities (data from government data set tables on homelessness. Chart 5 below shows Accommodation Need status for adults in alcohol treatment (new presentations only) in Oldham and Rochdale (2014/15-2015/16).

Key Points:  Amongst alcohol (only) clients in 2015/16 when combining the accommodation need statuses ‘housing problem’ and ‘NFA – urgent’ proportions were broadly similar across the two authorities although in Rochdale indications of ‘NFA – urgent’ were almost double that of Oldham.  From 2014/15 to 2015/16 the combined accommodation need statuses ‘housing problem’ and ‘NFA – urgent’ almost doubled in Oldham whilst in Rochdale only a small decrease was evident.

Completions Figure 10 below shows that Oldham has a higher number and proportional rate leaving treatment than Rochdale and National, however the numbers completing successfully are broadly the same, reflecting the earlier reference to high numbers dropping out of treatment in Oldham in first 12 weeks.

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Figure 10: Treatment exits and Successful Completions amongst alcohol clients in Oldham and Rochdale (2015/16) Oldham Rochdale National

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DRUGS Drug Related Deaths

Table 6: Drug-related Deaths in amongst Adult Drug Users in Oldham, Rochdale and England (2013-15) Comparison Oldham Rochdale England to England Drug Misuse Deaths 2013-15 Rate LCI UCI Rate LCI UCI Rate LC UCI (all persons DSR per 100,000) 5.8 4.1 8.0 7.0 5.0 9.5 3.9 3.8 4.0

Both Rochdale and Oldham have a higher rate of drug related deaths than the National rate (Rochdale worse). The actual number of deaths over this period was 42 in Rochdale and 37 Oldham. Hospital Admissions

Table 7: Drug-related Hospital Admissions amongst Adult Drug Users in Oldham, Rochdale and England (2013-15) Comparison Oldham Rochdale England to England Hospital admissions for drug poisoning Rate Rate Rate (primary or secondary diagnosis) (DSR per 64.6 61.6 55 100,000) Both boroughs have similar rates for hospital admissions for drug poisoning, and are classed as similar to National. Rochdale is better than other areas with comparative deprivation levels Waiting times to access treatment for drugs

Table 8: Waiting times to access treatment amongst Adult Drug Users in Oldham, Rochdale and England (2013-15) Oldham Rochdale England

Initial waits under 3 weeks to start treatment 453 95% 548 99% 98%

Initial waits over 6 weeks to start treatment 14 3% 5 0% 1%

Table 8 above shows that whilst both boroughs are doing well with over 95% receiving treatment within 3 weeks Oldham has 5% (n= 24) of clients waiting over 3 weeks and a further 3% (n=14) wait over 6 weeks Proportion of Opiate/Crack users in treatment The estimated number of people in each borough who are dependent on opiates and/or crack cocaine (based on 2011 estimates) and the proportion estimated to be in the treatment system

Table 9: Treatment Penetration rate amongst Adult Drug Users in Oldham, Rochdale and England (2013-15) Oldham Rochdale England

Treatment Penetration rate 62.6% 59.9% 51.7 %

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Overall Activity Figure 11 below shows overall activity in drug treatment in 2015-16 compared to 2014-15

Figure 11: Change in the Number of Adult in and New Presentations to Tier 3 Drug Treatment in Oldham and Rochdale ( Oldham Rochdale

In 2015-16 Rochdale had 25% more clients in drug treatment than Oldham and also had 25% more new referrals However Oldham actually engaged slightly more new Opiate clients than Rochdale last year, the total opiate users in treatment is still significantly lower than Rochdale’s. The greatest change is the increase in Non-opiate users in Rochdale

Blood Bourne Viruses (BBV) The data below shows the drug users in treatment who have had a hepatitis B vaccination and current or past injectors who have been tested for hepatitis C.

Figure 12: Hepatitis B vaccination and Hepatitis C testing amongst Adults in Tier 3 Drug Treatment in Oldham, Rochdale and England (2015/16) Oldham Rochdale England

Both boroughs are below the national average for accepting HBV vaccine and completing the course. Testing for Hep C is also well below average in Oldham.

In treatment client profile (i.e. Opiate, Non Opiate, Non-opiate & Alcohol) Chart 6 below offers a demographic profile of adults in Tier 3 drug treatment in Oldham and Rochdale. Also included is the dual diagnosis status of in-treatment population in both boroughs

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Rochdale has a much higher number of clients in treatment for drug use than Oldham and with a greater proportion of 50-64 year olds. During 2015/16 the number of new presentations in Rochdale was almost 25% greater than Oldham, mirroring the difference in the in-treatment population per se. Oldham does have a higher proportion of BME (particularly Asian/Asian British clients). . The number and proportion of clients with a Dual Diagnosis were greater higher in Rochdale – in line with what would be expected based on local knowledge.

Drug Use Chart 7 below shows that Oldham has a higher porportion of clients indicating use of Opiates only whereas in Rochdale clients were much likley to use Opiates and Crack. Oldham has a relatively higher proportion using Crack alone. Rochdale has a higher proportion of Cocaine users. Rochdale has a much higher proportion of clients using Benzodiazepines and prescription drugs, reflective of the dedicated Benzo pilot project on offer in the Borough.

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Chart 7 also shows that approximately 35% of all drug using clients also indicated adjunctive use of alcohol. Geographical distributions of multi-agency drug-related interventions Figure 13 below shows the geographical distribution of adults in Tier 3 drug treatment in Oldham. Concentrations are apparent in Werneth, Coldhurst, St. Mary’s, Waterhead and Alexandra.

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Figure 14 below shows distribution of drug-related service demand/engagement in Rochdale.

The main areas of concentration for drug related A&E attendance are Spotland & Falinge, Milkstone & Deeplish, Central Rochdale, Smallbridge & Firgrove and North Heywood. The distribution of Rochdale residents in drug treatment broadly mirrors that for A&E attendances but with some ‘hotspots’ in Hopwood Hall, West Middleton and Kingsway.

Safeguarding Figure 15 below shows the number of drug clients who entered treatment in 2015/16 who live with children and the number of children who live with them.

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Rochdale has a much higher number of clients entering treatment in 2015/16 than Oldham, however the proportion living with Children is very similar (22% and 23%) and both are higher than national rates. The number who are parents but not living with children is also very similar. The greatest difference relates to those NOT having children – 52% in Rochdale (higher than National) and 41% in Oldham (much lower than National)

The key point is that last year there was a total of 414 children living with drug users across the two boroughs (although it should be viewed as a positive that these clients are now engaging in treatment). Accommodation need – all drug users Chart 8 below shows the proportion of all drug users (new presentations only) indicating ‘NFA – Urgent’ accommodation need status has almost doubled in Oldham from 4.2% [n=16] in 2014/15 to 7.6% [n=32] in 2015/16.

Overall in 2015/16 when combining the accommodation need statuses ‘housing problem’ and ‘NFA – urgent’ indications were proportionately greater amongst Oldham’s adult drug treatment population than Rochdale’s – 19.7% [n=83] compared to 14.6% [n=76] respectively.

Interventions Figure 16 below shows that there are many more clients receiving support in Primary Care on Rochdale than in Oldham. There is a greater proportion of clients in Rochdale receive Recovery Support compared with Oldham.

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Residential Rehabilitation Across the two boroughs only a low proportion receive residential rehabilitation and are on a par with the 3% England average – Oldham 3% [n=30] and Rochdale 2% [n=25] Length of time in treatment

Table 10: Length of time in Drug Treatment amongst Adult Drug users in Oldham, Rochdale and England (2015/16) Oldham Rochdale England Proportion of Opiate clients in 32.8% (n=191) 32.9% (n=231) 40% treatment under 2 years Proportion of opiate clients in 43.6% (n=254) 43.1% (n= 303) 32% treatment for 6 years or more Average years in treatment 6.5 years 6.2 years 4.6 years Proportion of non-opiate & alcohol 28.1% (n = 9) 12.8% (n=16) 7.6% clients in treatment for 2 years or more Rochdale and Oldham are very similar in having a much higher proportion of opiate clients in treatment for over 6 years. Early unplanned exits

Table 11: Early unplanned exits amongst Adult Drug Clients in Tier 3 Treatment in Oldham, Rochdale and England (2015/16) 2015-16 Oldham Rochdale England

Opiate 30 (15%) 23 (12%) 15%

Non Opiate 15(18%) 10 (6%) 16%

Non- Opiate and Alcohol 35 (23%) 39 (23%) 16%

Total and (proportion of all new referrals) 80 (18%) 72 (13%) 16%

Rochdale has a lower number and rate of clients dropping out of treatment in first 12 weeks.

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Completions

Figure 17: Rate of change in Successful Completions from 2014/15 to 2015/16 amongst Adult Drug users in Tier 3 Drug Treatment in Oldham and Rochdale Oldham Rochdale

It is a concern that in Oldham successfull completions of opiate users has fallen whilst representations have increased. Non representations of opiate users in Rochdale has improved by 9% although the rate of success has fallen, clients are at least sustaining recovery. Both areas have seen improvements in sucessful completions of other non- opiate drug users

Successful Completion/Representations The table below shows the successful completion rate as a proportion of the total number in treatment and the rate of representation of the successful completions

Table 12: Successful Completions and Re-presentation by substance use category from amongst Adult in Tier 3 Drug Treatment in Oldham and Rochdale (2015/16) Oldham Rochdale Successful Proportion of Successful Proportion of completion these that completion these that rate represent rate represent Opiate 6.3% 20.0% 4.3% 11.1% Non-opiate 54.3% 3.4% 34.2% 3.4% Alcohol 47.0% 11.5% 42.2% 16.3% Non-opiate & alcohol 49.0% 13.6% 33.8% 11.1% Across all substances the successful completion rate is much lower in Rochdale

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Criminal Justice data

Clients transferred from Prison Table 13 below shows the proportion of adults with a substance misuse treatment need who successfully engaged in community treatment

Table 13: Prison releases with substance misuse treatment need and engagement with Tier 3 Treatment for Oldham and Rochdale (2015/16) Number released with Number successfully Percentage engaging treatment need engaging in tier 3 Oldham 122 34 27.9% Rochdale 111 23 20.7% England Average ~ ~ 30.3% Both boroughs have lower than ‘England average’ proportions of releases engaging in treatment. Table 14 below gives further detail on the Establishments and numbers release from. Forrest bank is the resettlement prison for each borough (Styal for women), however a significant number are still released from various other prisons (including Kirkham, Liverpool, Thorn Cross).

Table 14: Prison releases and engagement with Tier 3 Treatment amongst residents from Oldham and Rochdale by prison establishment (2015/16) Oldham Rochdale Number Number Number Number Released engaged Released engaged Forest Bank 72 22 63 13 Manchester 19 4 18 2 Styal (women) 14 4 15 2 Other (various) 19 4 15 6

Numbers in Treatment Table 15 below shows the proportion of the treatment population in contact with the criminal justice system.

Table 15: Proportion of Treatment Population in contact with the criminal justice system in Oldham, Rochdale and England by substance use category (01/07/2015 to 30/06/2016) Alcohol & Opiates Non-opiates Alcohol Non-opiates Number % Number % Number % Number %

Oldham 178/751 23.7% 29/113 25.7% 51/450 11.3% 58/193 30.1% Rochdale 117/847 13.8% 34/299 11.4% 38/532 7.1% 26/268 10.5% National Average ~ 22.4% ~ 17.7% ~ 7.7% ~ 14.3%

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Again Rochdale has a much lower proportion and number of criminal justice clients in treatment for all types of substance use. Contact with non-opiate users is an area where Oldham is doing well.

CJIT Clients Table 16 below shows number of offenders referred to the Criminal Justice Intervention Team in the community. They include Arrest Referrals, Restrictions on Bail, Prison releases, Court Orders, etc.

Table 16: Offenders referred to CJIT and proportion already in treatment in Oldham, Rochdale and Greater Manchester (as of September 2016) Number Number Number Average Average Number on referred to also in assessed rate already rate of non- Caseload Treatment treatment September in treatment engagement (3 month) Oldham 60 20 (33.3%) 16 10% 19 13% Rochdale 118 45 (38.1%) 17 28% 20 29% GM 545 243 (44.6%) 107 14% 153 20% Rochdale has a significantly higher number on caseload, however similar numbers to the other boroughs being assessed each month.

Drug Rehabilitation Requirements (DRRs) Table 17 below relates to April – October 2016. The caseloads have increased in Rochdale – however the numbers and success rate are very similar to the previous 12 months. The number of new orders has fallen across both boroughs.

Table 17: Drug Rehabilitation Requirements in Oldham and Rochdale

New orders Current Total Successful Success

Period commenced Caseload Terminated Completions rate

Q1 & Q2 2016 24 33 34 14 41.2% Oldham 38 Full year 15-16 86 63 25 39.7% (mid-year)

Q1 & Q2 2016 23 28 12 6 50.0% Rochdale 16 Full year 15-16 29 40 23 57.5% (mid-year)

Alcohol Treatment Requirements (ATRs) Table 18 below relates to April – October 2016 – Whilst commencements remains similar the numbers on caseload have fallen since 2015 – particularly in Rochdale (37 in September last year). The successful completion rate has fallen in both boroughs but remains higher than average in Rochdale.

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Table 18: Alcohol Treatment Requirements in Oldham and Rochdale

New orders Current Total Successful Success Period commenced Caseload Terminated Completions rate

Q1 & Q2 2016 12 18 14 8 57.1% Oldham 24 Full year 15-16 36 32 21 65% (mid-year)

Q1 & Q2 2016 11 20 8 7 87.5% Rochdale 37 Full year 15-16 39 41 38 97% (mid-year)

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