Chapter 8: Comparisons between Scotland and England
Headlines from this chapter
- Specialist services made up 23% of Scottish needle exchanges, compared to 20% in England. In Scotland, pharmacy services comprised 72% of all facilities compared to 79% in England.
- Non-pharmacy needle exchanges in Scotland provided better out-of-hours coverage than similar services in England, but English pharmacy services provided better out-of-hours coverage than those in Scotland.
- Scottish services had more contact with female injectors than English services.
- In Scotland and England, similar levels of syringe distribution were reported by pharmacy and non-pharmacy services, and returns to non-pharmacy services were much higher than returns to pharmacy services in both countries.
- Services in Scotland were significantly less likely than their English counterparts to provide Hepatitis B immunisation on-site. Only one service in Scotland provided tetanus vaccination, compared to 11% of services in England.
- Scottish services were significantly less likely than English services to provide their clients with a list of other needle exchange services in the area. They were also less likely to offer motivational interviewing, key working, structured counselling, GP / primary care sessions, housing / social / legal advice and well-woman clinics.
- Scottish services were significantly less likely than English services to distribute filters, sterile water, stericups and Vit C to their clients. Scottish services were more likely than English services to distribute wipes or swabs. There were no significant differences between Scottish and English services in relation to the distribution of sharps bins, citric acid and tourniquets.
- Compared to Scottish services, a much larger percentage of English services said that there was no limit on the number of syringes they would give out during any one needle exchange transaction. This is because there is no equivalent to the Lord Advocate's guidance in England.
- Scottish services were significantly more likely than English services to report that they would provide injecting equipment to young people aged 16 or 17. However, there was no difference between Scottish and English services in relation to distribution among under-16s.
- English services were more likely to have a written policy on needle exchange among young people, and to have agreed their policy with the local area Child Protection Committee.
This report presents findings of the Scottish arm of the National Needle Exchange Survey. However, it must be remembered that the study was a UK-wide study involving a collaboration between the Scottish Executive, the National Treatment Agency, the Welsh Substance Misuse Policy Development Team, and the Northern Ireland Department of Health, Social Services & Public Safety. At the time of writing this report, analysis of data from Wales and Northern Ireland was still on-going. However, findings from the English data were available.
Therefore, this chapter makes some selected comparisons between Scotland and England, and highlights areas where there were significant differences between the two countries in needle exchange service delivery. The focus here is mainly on interventions provided by non-pharmacy services, since the number of pharmacy schemes participating in the Scottish survey was too small to allow for meaningful statistical comparison in relation to most variables. However, it must also be remembered that there were poor response rates to certain questions on needle exchange activity in Scotland. This was so in England as well. Therefore, some of the findings presented below should be interpreted with caution.
Proportion of pharmacy and specialist exchanges
In this study, the process of identifying needle exchange facilities was different in Scotland and England. In Scotland, a complete list of needle exchange facilities was compiled prior to the survey; whereas in England, the identification of needle exchange facilities took place as part of the DAT survey. Therefore, at the time of this study, Scotland had a total of 188 needle exchange facilities. This represents a national total. In England, just over 70% of DATs participated in the survey (108 out of 149). The total number of needle exchange facilities identified in these areas was 1,326.
Overall, based on these figures, specialist services made up 23% of Scottish services. This proportion was slightly more than in England, where specialist services constituted approximately 20% of facilities (261 out of 1,326). In Scotland, pharmacy services comprised 72% of all needle exchange facilities; whereas in England, pharmacy services made up 79% of services (1,048 out of 1,326). See Figure 8.1.
Opening times
Non-pharmacy services in Scotland were significantly more likely than their English counterparts to be open on weekday evenings, at night and at weekends. On the other hand, Scottish pharmacies mainly operated during Monday - Saturday business hours whereas in England, pharmacy services provided better out-of-hours access to needle exchange than specialist services did.
Needle exchange activity
Contact with women: In comparison with English services, Scottish needle exchanges appeared to have had more contact with women in the period April 2004 - March 2005. The male-to-female contact ratio in Scotland was 2.7:1, whereas in England, it was 3.9:1.
Number of syringes distributed: The number of syringes distributed by pharmacy and non-pharmacy services across Scotland between April 2004 - March 2005 were found to be roughly the same - approximately 1.8 million in each case. Although there are some questions about the accuracy of this data, it is interesting to note that there were similar results in England: both pharmacy and non-pharmacy services distributed approximately the same number of syringes - 4.8 million in each case.
Number of syringes returned: In Scotland, returns to non-pharmacy services were considerably higher than returns to pharmacies, despite there being three times more pharmacy exchanges than specialist exchanges in Scotland. Again, there were similar findings in England - non-pharmacy services reported higher levels of returns.
Interventions provided by needle exchange facilities
On-site BBV interventions: Figure 8.2 shows how Scottish non-pharmacy services compared with those in England regarding provision of on-site BBV interventions. Services in Scotland were significantly less likely than their English counterparts to provide on-site Hepatitis B immunisation (p=0.01). Only one service in Scotland provided tetanus vaccination, compared to 11% of services in England.
It would appear that English services were also more likely to provide Hepatitis A immunisation and Hepatitis B testing, and that Scottish services were more likely to provide HIV pre- and post-test counselling. However, these differences were not statistically significant.
Figure 8.1: Percentage of needle exchange facilities in Scotland and England delivered by pharmacy, specialist and other services (A&E, police custody suite)
Figure 8.2: Percentage of non-pharmacy services in Scotland and England that provide BBV interventions on-site
Other on-site interventions: Figure 8.3 shows a comparison between Scottish and English non-pharmacy services in relation to other on-site interventions. Scottish services were significantly less likely than their English counterparts to provide clients with:
- a list of other needle exchange facilities in the DAT area (p=0.00)
- motivational interviewing (p=0.00)
- key working (p=0.03)
- structured counselling (p=0.00)
- GP/ primary care sessions (p=0.02)
- housing / social / legal advice (p=0.00) and
- well-woman clinics (p=0.00).
Figure 8.3 also suggests that, compared to Scottish services, a larger proportion of English services offered referral to structured treatment, complementary therapies, overdose prevention training and primary care sessions. However, these differences were not statistically significant.
Paraphernalia distribution: There were no statistically significant differences between Scotland and England in the proportion of non-pharmacy services that distributed sharps bins, citric acid and tourniquets. (See Figure 8.4). However, Scottish services were significantly less likely than English services to distribute:
- filters (p=0.01)
- sterile water (p=0.03) and
- stericups (p=0.02)
They were also less likely to give out Vit C (ascorbic acid) (p=0.00) generally associated with crack/cocaine injecting, probably reflecting little demand for it north of the border. On the other hand, Scottish services were more likely than English services to distribute wipes or swabs (p=0.02).
Needle exchange policies and procedures
Maximum number of syringes distributed: Compared with Scottish services, a much larger proportion of English services said that there was no limit on the number of syringes they would give out to clients in any one transaction. Nearly a third of English services said this, compared to just 2% of Scottish services. This is because there is no equivalent to the Lord Advocate's guidance in England.
Similarly, a much larger proportion of English services reported that the maximum number of syringes given out would depend on certain circumstances (43% in England said this, compared to 24% in Scotland). The circumstances were similar in many ways to those reported by Scottish services: the number of syringes given out depended on the number of returns, whether the client was known or not known by the service, whether the client lived in a rural or urban area, and the client's general health. In England, other circumstances that affected the numbers of syringes given out included: whether the client was acting as a point of secondary distribution, whether the client was a chaotic or stable injector, and general stock levels of syringes in the needle exchange.
Assessing client satisfaction: Half of Scottish non-pharmacy services said they had mechanisms for assessing client satisfaction, while 60% of English services reported the same. Pharmacy services in England also appeared to be more likely than those in Scotland to ask their clients for their views on the service - 42% of pharmacy schemes in England versus only two out of 10 schemes in Scotland.
Figure 8.3: Percentage of non-pharmacy services in Scotland and England that provide other harm reduction interventions on-site.
Figure 8.4: Percentage of non-pharmacy services in Scotland and England that distribute items of injecting paraphernalia for free
Needle exchange for young people: Scottish services were significantly more likely than English ones to report that they would provide injecting equipment to young people between the ages of 16 and 17 (p=0.00), but there was no difference between Scottish and English services in relation to distribution among under-16s. See Figure 8.5.
English services were significantly more likely to have a written policy or protocol on the provision of equipment to young people (p=0.02). See Figure 8.6. English services were also significantly more likely to have their policies agreed with the area Child Protection Committee (p=0.00).
Figure 8.5: Percentage of non-pharmacy services in Scotland and England that would distribute injecting equipment to young people
Figure 8.6: Percentage of non-pharmacy services in Scotland and England that have a written policy on needle exchange to young people, and percentage where policy has been agreed with area Child Protection Committee.
