APPLE OF OUR EYE

A major report by the NW Drug Treatment Commission calls for “massive investment” in treatment. and aims to “influence government thinking”. Deirdre Boyd finds its advocacy tempting.

This article was first published in March 2002, Addiction Today issue 75. Its forward thinking still stands in good stead today.

  “The level of funding for the provision of accessible and effective treatment services for drug users is totally inadequate, given the prevalence of drug use and the serious social consequences that result from it.” 

The statement might seem obvious to people who work in the field of alcohol and drug abuse – but, crucially, it was made by the independent North West Drug Treatment Commission. This was set up last May to evaluate the operation of drug treatment services and offer “practical and imaginative recommendations for their improvement”, according to the commission’s chair, Manchester Central MP Tony Lloyd.

“Drug misuse is one of the most acute and intractable problems facing our society, and we must be honest and realistic in dealing with it. There has been some improvement in fast-tracking access to treatment for people in the criminal-justice system. But in most areas, the waiting times for detoxification and rehabilitation services is unacceptably long. The only long-term solution is the provision of sustained extra resources. In the meantime, we advocate an immediate blitz or ‘waiting-list initiative’ to begin to make an impact, and show that society can manage this problem.”

Offering A Tomorrow, the commission’s report, reflects over 12 months’ work, during which it took evidence from drugs agencies, service providers, health and criminal-justice professionals, politicians, academics, drug users and families. Recommendations include:“

• radically improved cooperation” between government departments, local agencies and statutory, voluntary and private service providers

• a  much more holistic approach to treatment, aimed at rehabilitating users back into mainstream society

• more bespoke services for young people, women and ethnic-minority users, often deterred from treatment

• more systematic evaluation of services and treatment outputs

• and  a nationally recognised qualification and career framework for professional drugs workers.

“This report will hopefully influence government thinking on the role and operation of the National Treatment Agency,” Lloyd said. “We encountered many positive instances of good practice and innovation. But services’ effectiveness is hampered by a shortage of resources and the currently fractured structure of services.”

At the national launch of the report in the House of Commons, John Denham MP who works with the Home Office minister for drugs, Bob Ainsworth, stated that more effective interdepartmental cooperation was a realistic goal. “The same people meet one week to discuss criminal justice, the next week to discuss health, the next to discuss social welfare and so on — they could tackle all these overlaps where drugs are concerned.”

VISION

One of the critical motivations for establishing the North West Treatment Commission was the publication in 1999 of The Big Issue In The North report, Drugs At The Sharp End. It ignited a passionate, sometimes acrimonious, debate and raised unsettling questions in key organisations...

These included “What are drug treatment services for? What outcomes are they seeking to promote?”.

With the personal and financial backing of Norman Stoller OBE, then lord lieutenant of Greater Manchester, and the support of the NW Shires Policy Unit and the Regional Assembly’s Economic Development Key Priority Group, the commission came into being. It advocates three broad principles:

• people have a right to live their lives free from the negative effects of drug misuse

• society should promote the message that people should not damage themselves by taking drugs

• and those who misuse drugs have a right to good-quality, accessible, adequately resourced services.

RESOURCES: PRIORITISING TREATMENT

“Drug treatment services remain chronically underfunded,” states  the commission’s report. “The main  expenditure has been on enforcement rather than treatment. This government is committing extra resources to treatment but this is tied almost exclusively to initiatives in the criminal-justice system.

“The implication is that drugs are a problem only when drug addicts cause crime, and it helps foster a misleading and unhelpful image of drug users. The government needs broader arguments to promote and justify additional expenditure on treatment services.”

Improving and increasing treatment provision should be linked to strategies for social inclusion and health inequality. Extra or re-focussed expenditure could support key social-inclusion aims by helping people to move into productive employment and addressing a major cause of family breakdown.

“As well as a long-term commitment to increase funding, there should also be an immediate injection of resources to break the cycle of apathy and fatalism that often appears to underpin drugs policy,” the report urges.

STRUCTURE

The commission believes that delivery of effective treatment services will need leadership at national and local level. “The establishment of a UK anti-drugs coordinator was a positive move but it failed to resolve problems that inevitably arise when three government ministers each retain significant responsibility for areas of drugs policy,” it explained. “Any new operational structure must involve greater direct responsibility for resources and clearer lines of political responsibility.”

The commission saw the establishment of drug action teams as positive. But they also saw “evidence of uneven performance, and that their effectiveness was hindered by the absence of a common template, lack of high-level commitment from partner agencies and no direct control over resources”.

The commission is also in favour of “a body to sit in the space between the NTA and local Dats. The role of a Regional Treatment Agency should be to set local service specifications, monitor services, provide training and commission research. NTA regional managers should have dual accountability to this.

RECOMMENDATIONS

When this journal analyses a policy document, we usually pinpoint key suggestions, omitting others which are not relevant. In this case, the recommendations we disagree with are so few and the worthwhile — even inspirational — recommendations are so many that we print them all.  We hope not only that the government heeds them but also that treatment providers and purchasers find them a useful tool. The commission recommends:

1. Support for the government’s initiatives that address crime and drug misuse

2. But the primary focus for treatment should be to extend services for all who misuse drugs not only those who commit crime

3. Drugs issues should be given greater priority by policy makers. A coherent vision about the future role and structure of treatment service is needed, based on re-appraising the effectiveness of current structures and methods, and it must be properly resourced

4. At local level, there must be greater cohesion and synergy, broader agreement on aims and priority, and more tolerance and mutual respect. There must be ‘zero tolerance’ for defensiveness, hostility and a disjointed approach

5. In drugs services, there is a need for greater accountability, transparency and leadership

6. Drug users should not have treatment options restricted because they cannot afford to pay, and statutory services must offer a range of approaches

7. Treatment services must be about supporting drug users back into mainstream society and, consequently, providing a holistic approach

8. Harm-reduction programmes could be enhanced; for example, extending opening hours and preventing discarded needles being left in public areas

9. More injecting rooms should be considered

10. There is still a need to explain more clearly the differences between drugs and the harm they cause

11. Argue the case for decriminalising cannabis (AT argues the case for more information to the general public on the health risks first)

12. More could be done to promote the case for effectively resourced drug-treatment services

13. The NTA must be supported by a substantially increased budget to copy with the social, economic and health problems of drug misuse, but there must also be a more rigorous approach to guaranteeing value for money in the operation of services

14. In supporting the NTA, performance must be measured and an effective return on public investment guaranteed by devising a mix of hard and soft outcomes, including the promotion of drug-free goals, reduced use of drug of choice, reduced criminal activity and more involvement in education/training

15. There must be an immediate injection of resources to turn the tide in dealing with the array of drug-related problems

16. There should be a ‘waiting list initiative’ to seriously improve immediate access to services, detoxification, rehabilitation and relapse prevention must also be a priority

17. The Care Standards should be resolved (this has been done — see AT Jan/Feb 2002)

18. A New Deal initiative should have a specific focus on drug users

19. Extend access to services for users from the region’s minority ethnic communities

20. Develop bespoke community-based and residential services for young users

21. There should be a separation in service between those using and those not using street drugs

22. More effective and comprehensive outreach services must be developed

23. There should be 24-hour crisis centres, where very chaotic users access immediate stabilisation and help to quickly reduce their use of street drugs, even if do not actively want a drug-free state

24. There is a demonstrable need to develop more services to tackle the abuse of stimulants

25. Methadone has a part to play, but it should be part of a structured care plan which views the user’s needs holistically. Harm minimisation should remain an integral part of drug services

26. Methadone should be dispensed in ways appropriate to the individual. If a daily script, low threshold access or gradual reduction programme is needed, it should be delivered

27. More effort should be put into offering a wider selection of substitutes to better match treatment approaches with client needs

28. Dat strategies must include an explicit commitment to supporting and developing the potential of the voluntary sector

29. Alternative therapies should be used where it can be established that they have a positive therapeutic effect and give value for money

30. There should be less reliance on a purely medical model; an a la carte treatment regime, including social, personal and economic goals in a client’s care framework will enhance the effectiveness of treatment and the long-term rehabilitation of users

31. People involved in shared-care initiatives need greater training and support if they are to help promote more joined-up and holistic services

32. Shared care must be implemented consistently, with all those involved feeling comfortable about the service they deliver and the service they receive

33. Relapse prevention might be more successful if drug treatment has a personal and social dimension at every stage. An integrated package which avoids ‘referring’ people on, and does not rely solely on medical staff, will help to meet all the user’s needs

34. Family should be involved in treatment, with more access to information, support and counselling

35. In central government, there should be a single budget under the control of a lead minister, thus providing greater direct responsibility for resources and a clearer line of political accountability

36. There should be a more stable and sustainable funding structure for treatment services

37. Dats should operate a strong joint commissioning role, and greater consistency in local services should be achieved between Dat areas

38. Local government must have a more explicit role in the leadership of Dats

39. A strong regional body which can work in a national framework set by the NTA is needed to agree local service specifications, evaluate and monitor services, arrange training and commission research. This could have dual accountability to the NTA’s regional managers and proposed regional government

40. A regional drugs body could be established in the NHS regional executive, but a better location would probably be in the Regional Integrated Public Health Team in Government Office North West

41. A coordinating body, to promote cross-cutting initiatives, should not be in the ownership of the police, health authorities or local government

42. There is a strong argument for giving greater leadership responsibility to representative bodies at both local and regional level

43. Services must seek to set agreed standards and methods of evaluation which measure a number of outcomes and ensure that services are achieving  standards of best value

44. There is a need for more formal training for drug staff, with nationally recognised and accredited qualifications. Drug workers must be offered proper rewards and a career structure comparable to other health and caring professions.

“On a more symbolic level, it would be pleasing to see the efforts of drugs professionals recognised in the honours system and through civic awards,” the report concludes. “Improving the effectiveness of treatment services must entail raising the status, quality and professionalism of those involved in the delivery of this vital public service.”

DETAILS (at the time)

The NW Drug Treatment Commission is at
18 Bluecoat Chambers
School Lane, Liverpool L1 3BX
Tel: 0151-709 3778
Email: nwdtc@hotmail.com

Tony Lloyd MP: tonylloydmp@msn.com