IS THE NTA FIT FOR PURPOSE?

REHABS CLOSE AS PATIENTS ARE DIRECTED ELSEWHERE

The general public as well as some dedicated specialists do not need convincing of the need for people who are addicted to drugs to become drug free. They see it in the newspapers and, too often, in the lives of those they love. But people are being diverted and demotivated from the opportunity of drug-free treatment at their most vulnerable point: when they seek help.

Government funding for ‘treatment’ is via the National Treatment Agency for Substance Abuse, the NHS special health authority with responsibility for overseeing the UK’s national drug policy. The NTA implements drug policy via 149 Drug Action Teams. Last year, only 3.6% of the patients seeking help from them were given the opportunity of abstinence-based treatment. This year so far, the figure seems to be dying at 2%.

There are waiting lists of people desperate for help and empty beds in rehabs waiting to treat them. Instead, lack of patient referrals also means that the life-saving rehabs are closing. Those which remain cannot plan ahead, to assess patient requirements or staff needs, and thus forward financial planning.

Medically invested DATs (with a handful of worthy exceptions) and Primary Care Trusts are diverting people to methadone maintenance and other harm reduction. Fine for some, if this is seen as engagement, with appropriate psychosocial support including accurate assessment and diagnosis, and an eventual goal of abstinence. Unfortunately, bad practice dominates with people treated as statistical units to serve political targets. As research to be published in Addiction Research & Theory next year evidences, patients get an average of only four hours of meaningful therapeutic activity per year.

Research shows that the vast majority of patients in rehab need experiential and cognitive support to recover from childhood abuse issues, which their use of drugs (including alcohol) buffered. Four hours of therapy a year ain’t going to fix these.

In addition, Addiction Today has heard that just about all of the £54.6million capital funding which the government stated was for ‘tier 4’ (rehab) organisations was awarded by the NTA to Primary Care Trusts instead. We invite the NTA to supply us with the figures for which, if any, rehabs gained from this, and the amounts.

Finally - for the moment - does the general public know how the NTA defines "treatment"? It can be one meeting. "12 weeks retention" in "treatment" can mean that someone needing help to claim back their lives has one meeting then, as the DAT makes them wait 12 weeks for the next one... yes, you got it... 12 weeks retention. We have even heard of a couple of people going to prison yet staying on the statisics as "retention".

REHABS CLOSING - LATEST COUNT

The following rehabs have closed in the past year, no longer offering healthy futures for people desperate to recover from dependency/addiction to drugs including alcohol:

·         Why are DATs not referring patients appropriately to alcohol- and drug-free treatment?

·         Why is the NTA ignoring research evidence of rehabs’ effectiveness?

·         Why are the successful results of abstinence-based organisations not being published by the NDTMS?

·         Why has the NTA spent our taxes on a leaflet supporting a redefinition of “recovery” which excludes sobriety or drug-free lifestyles?

Answers, please, before more people die from lack of appropriate treatment!

• Thurston House, London, is scheduled to close in December
• Pierpoint Women's Unit, Lancashire
• Two Saints, Hampshire
• Phoenix Futures London Residential Service
• Priory Farm Place, Surrey
• Priory Coach House (extended care)
• Barleywood, Somerset
• Murray Lodge, Coventry
• Hebron House Women & Baby Unit (women's unit still here)
• Phoenix Bexhill
• Isham House has stopped treating addictions patients
• Diana Princess of Wales Hospital, Norfolk, is in administration.

Both Paul Hayes, CEO of the National Treatment Agency for Substance Misuse, and Nick Lawrence, head of alcohol, drug and tobacco policy at the Department of Health, are on record as stating that Drug Action Teams should be referring 10% of patients to rehab. But not even a third of this target is being reached; indeed, it could be calculated that not even 2% of patients are in rehab on any given day.

Comments

[neil mckeganey]

Deirdre
The list of residential services closing is a catalogue of governmental and commisioner failiure. We have research showing that there is real benefit for individuals if they are lucky enough to access one of the few residential rehab centres in the UK. In all probability they will not be lucky enough because such centres are in short supply and we now hear that their numbers are further diminishing. We are, as a result, going backwards not forwards in substance abuse treatment in the UK and that should be of enormous concern to all of us working in the field and to the population at large.

[Sue Craven]

The discussions around Tier 4 treatment have been going on for years, and we are still waiting to see real action from the NTA on this problem. Historic research shows that residential treatment has more longevity for service users than any other method, but this obviously holds no value to the referrers. Our experience also shows that many service users on a methadone script are using on top of this, either heroin or alcohol or both. Is this really 'treatment'? Where is the real value in this?

[Mary Brett]

Would it be too cynical to suggest that people are being retained in treatment to preserve jobs?

[dr david hill]

The problem is not the problem but the people who administer the supposed solutions. My institute tried for 3-years without success with the Home Office to get them to accept an invitation from the Vietnam Government to trial their heroin and cocaine treatment which detoxifies in a humane way in just 48 hrs. Even though David Blunkett was involved, the pleas went nowhere and the Home Office refused even to undertake a mere trial. The cost, �200,000 but where thousands of lives thereafter would have been saved and millions who live in drug addicted families, would have had a success story to tell of. In Vietnam this cure is under the control of the Government and where not just over 20,000 hard drug addicts have been cured but also many westerners who were introduced to the communist country through political connections. Some are leading lights, known well and where their daughter or son had become incurable addicts. Indeed, not a great deal is known of this herbal cure (note herbal and therefore not like methadone which is highly addictive, even more so than heroin).

Yesterday I sent an email to Paul Hayes, head of NTA (National Treatment Agency), and where one of his colleagues, a Mr. Hugo Luck replied (copy sent to all readers who are interested). In essence they were not interested like the Home Office and where they would prefer to continue with what they had got ? basically unacceptable failure. Indeed, this means in my common sense understanding that they are living in a parallel universe where failure equates to success. We have seen much of this in the past few weeks with the bankers but where it pervades all areas I am now convinced of Whitehall and their agencies. Indeed, to equate a 3.6% reduction whilst 96.4% are still addicts is a failure on a colossal scale and where if it were in any other area of endeavour the whole of the management board would have by now been sacked.

Overall, there is a cure out there, humane, extremely low cost and totally effective. The problem is that those who are empowered to reduce the problem just do not want to know. A sad world that we live in and where I now believe that vested interests both within industry and government, who appear to be hand in glove here, are the main cause of the problem and not those who are trying desperately to get off hard drugs.
In this respect NICE (National Institute of Clinical Excellence) has a great deal to answer for also as they do nothing to change the system and only increase and perpetuate the dire problem. How, I therefore plead for the people of this dear country, do we get them to listen? For they will not !

Dr David Hill (British resident)
World Innovation Foundation Charity (WIFC)
Bern, Switzerland

[Jenny McAleese]

I write with reference to the above article which revealed the staggering number of rehabilitation facilities for people with drug and alcohol addiction which have closed in the past year.

Dedicated inpatient services for people with both addiction problems and mental health problems are hard to find, despite the fact that research shows that the vast majority of patients in rehab need this type of support to recover. As you point out in the article, it is clear that a few hours of therapy will not adequately support these people.

Here at The Retreat we have seen an increase in these types of referrals and have introduced new specialist services to address this need. Our Complex Mental Health Recovery service now provides a Dual Diagnosis service for these types of referrals. We tackle both aspects at the same time and the programme helps people understand the relationship between use of drugs and alcohol and their mental health problems. They are encouraged to learn better coping strategies so that they reduce the chances of further episodes of illness and they go out feeling stronger with better self-esteem and self confidence.

As a mental health provider which 200 years’ experience, we would stress that dedicated services to address the specific needs of this group of people are required.

We hope our service will help people recover more quickly, establish a richer, more enjoyable life and imagine a future for themselves.

Jenny McAleese
Chief Executive
The Retreat, York.

[neil warburton]

Having worked in rehab for 8 years and community services for 6 years i have come to despair the current situation. The longer the NTA,and local dats continue with the liberal policy of metahdone maintainace and not using the abstinace word service users will continue to get treatment that we think is best rather then litening and engaging with the person needs and requirements.
the medical model has it place as does rehab but all we hear is reduce crime long term high dose methadone. Then there is the data recording, ntdms, tops, and other such things my well contain good data but i feel we are moving more and more to being data collectors. I believe the nta although started positivley and achive many things early on, has begun to show the same poor management and poor output as organisations such as the nhs, probation and local goverment, and as such will continue to let down the poeple who really need the support.

[Colin Bradbury - Jon Hibbs]

Response to Addiction Today

You ask whether the NTA is fit for purpose? Readers of Addiction Today can make up their own minds about that question, but it would help them to have access to some facts about the NTA and drug treatment.

It is nonsense to claim that "last year, only 3.6% of patients seeking help… were given the opportunity of abstinence-based treatment." The 3.6 per cent figure recently highlighted by the BBC refers to the proportion classified as "treatment completed drug free" in 2007/8, out of the record treatment population of 202,666. There are serious issues about whether the numbers collected under this statistical category properly reflect the actual outcome of treatment, but it is an outcome measure, and not an indicator of what options individuals were offered through their treatment journey.

What the official statistics do show is that last year 4,306 individuals were treated in residential rehab, or 2 per cent of the total.

As the National Drug Treatment Monitoring System report made clear, this is an under-estimate of the real level of activity. About one-third of the 100-plus providers of residential rehabilitation services in England do not submit any returns to NDTMS. We wish they would, but as independent, voluntary sector organisations, they are not obliged to, and we have no powers to compel them.

On the figures we do have, it is probably correct to say that on any given day the proportion of people in rehab is 2 per cent of the spot treatment population.

However that is misleading. It tells us no more than comparing the number of people in hospital overnight with the number of people using the NHS as a whole, including day surgery, outpatients, GPs, pharmacies, and NHS Direct. It does not mean that more people should be in hospital.

The article highlights a common misunderstanding that residential rehabilitation offers the only path to abstinence. Residential rehabilitation is one form of treatment that is suitable for some people at certain times in their lives, but is not a one-size-fits-all answer for every problem drug user. It is also only one element in a broad spectrum of treatment delivered in residential or in-patient settings, which include NHS services. And increasingly, innovative solutions for those who need intensive treatment are being offered in community settings, through day-care options.

A survey by the Healthcare Commission in 2005-06 of all prescribing agencies in the country revealed that one-third of those on a substitute prescription were on a reduction regime, and therefore had a care plan goal of abstinence. If you add in all those drug users who are not on a prescription at all, then approximately half of all those in structured treatment are on an abstinence-based pathway.

The NTA is not ignoring research into the effectiveness of rehab, but we do have to take account of the findings of the National Institute for Health and Clinical Excellence - that it is only appropriate for clients in certain circumstances. These include those with mental health and housing problems, those who want to be drug-free, and those who have been detoxed but not benefited from psychosocial treatment. Hence the guidance we issued to commissioners last month, which you reported separately.

The 10 per cent figure you mention was never a "target" but a benchmark for needs assessment. In 2006 we reviewed Tier 4 provision, found use of residential rehabilitation was declining (we then estimated about five per cent of the treatment population), and set about urging commissioners to address this. Our current estimate is that about eight per cent of problem drug users in treatment access Tier 4 services, including supported housing services and inpatient assisted withdrawal.

We have to estimate this because not all residential providers give us accurate, complete and timely data through the NDTMS. We do not, therefore, have a reliable dataset whereby we may accurately ascertain trends in referral patterns and outcomes in the same way we would be able to for equivalent community based services.

This point links to your list of services that have recently closed. Many residential services in the country have healthy occupancy rates and are therefore in demand from local commissioners and their clients. Others are not, and, in a market environment, it would not be fair to subsidise organisations that do not provide services that meet local needs.

You ask for more details of the Government 's £54m capital investment to boost Tier 4 capacity. This is provisionally allocated as follows:

o 9 NHS in-patient detox schemes, £16m (132 beds);
o 14 residential rehabilitation schemes, £17m (142 beds);
o 16 supported housing schemes, £13m (185 beds);
o 1 prison development, £8m (128 beds).

Your suggestion that we have given this money to Primary Care Trusts instead of Tier 4 organisations is based on a misunderstanding of how Department of Health funds are distributed through the NHS. More than 70 per cent of the allocation is to non-NHS bodies, but has to be routed through local NHS Trusts, who are members of the local drug commissioning partnership.

Finally, you ask about the NTA leaflet which was widely distributed after our successful conference in June. This was intended to bring the speeches and discussion to a wider audience.

The NTA does not endorse the draft "recovery" definition proposed for debate by the UK Drug Policy Commission, but neither do we accept your interpretation of it.

Colin Bradbury
Treatment Delivery Manager
National Treatment Agency for Substance Misuse

[Leslie Hopkins]

How do we as citizens and family members of addicts work to make the system responsive to the plight of the addicts they are supposed to help? Every publication I read, outlining how addicts should be treated as human beings, is ignored by those in charge of their treatment or the withholding of it. I have tried to advocate on behalf of my family members, but am met with hostility and disdain. I have six family members who are heroin addicts and the Drug Treatment agency they have been referred to refuses to treat them as a family. They have all had turns at being on methadone, but because they have never all been on it at the same time, they relapse and are kicked off the program. One family member is in jail, one had Hep. C, one has been attacked with knives and metal pipes, resulting in broken bones and severed tendons, and another has blood clots from injecting into his groin. His partner lost their baby in utero due to her drug use and she was given no help for her drug problem, nor was she offered any support to deal with the loss of her child. She was also treated very badly by the nursing staff at the hospital.
Two family members are currently on methadone, one of whom is holding down a job and raising a family. He has begged for some mental health care, but has been told he does not have a mental health problem, only a drug problem!
Please, if you do not see fit to post my comments, I will understand, but please respond to me privately and point me to any organization, group, or individual that might advise me on how to proceed. I will not stand by and watch my family members die.
Most agencies I have contacted deal only with England and Wales. My family is in Scotland.
Thank you.

[steve]

What a relief to see these shortcomings and fabrications of the NTA put in black and white for all to see. As a practitioner i have been witnessing the damage done to the drugs field by the NTA for many years. This has been done through an obsession with gathering statisics to reach targets and bolster senior individuals wages. This is abhorent behaviour, because whilst they fatten their wallets and pat each other on the back for reaching targets clients are dying and suffering, unable to access proper treatment. Instead they are offered 'treatment'in the form of substitute perscribing. This is not treatment, this is 'crime reduction' and should be called so. Its not even 'harm reduction' as some like to call it, as it causes more harm to the individual under close examination. Please, please, please commisioners and those in the NTA, get back to delivering proper treatment - Abstinance based residential and day care centres. In all my years working these are the only places people get well, reclaim their lives and get free of drugs