Q: WHEN IS £54MILLION NOT £54MILLION?

A: When the NTA recycles a two-year old press release with an unusual juxtaposition of words and figure.

Read related blog here.

 “Abstinence-based drug treatment will grow by more than 2,000 places a year following over £54 million of government capital funding,” stated a press release issued by the National Treatment Agency for Substance Misuse on 26 November.

“The places in 42 residential treatment and supported housing centres throughout England will work with addicts to help them to overcome their drug dependency and support them in leading drug-free lifestyles.”

Readers taking these words at face value would be forgiven for thinking that £54million funding had been given to abstinence-based residential treatment centres. It is unlikely they would interpret the figures as a maximum 142 rehab beds with funding of perhaps £4.5million – at most £17million.

Readers would also be forgiven for thinking that this is a new initiative. Also wrong.

In October, before the latest release was issued, I requested a breakdown of the £54million originally publicised in 2006, then again in May 2007. NTA communications manager Jon Hibbs replied that the breakdown was provisionally allocated as follows:

·         14 residential rehabilitation schemes, £17million (142 beds)

·         9 NHS inpatient detox schemes, £16million (132 beds)

·         16 supported housing schemes, £13million (185 beds);

·         1 prison development, £8million (128 beds).

NHS detox, supported housing and prison are not necessarily part of a drug-free continuum, and significant funding went to their refurbishment and remodelling rather than new places, so more transparency is needed to understand how the tier-4 funds were allocated. Also, the vast bulk was not allocated to organisations with a proven history of abstinence-based care. But make your their own assessment by clicking here; or try to extract a picture from the Department of Health announcement (click here).

In an earlier communication to Addiction Today editor Deirdre Boyd, Hibbs wrote that: “I fully accept that as an arm of government the NTA is often going to take the role of the whipping boy in debates within the drug treatment field, but it is in all our interests that this is done on the basis of facts and figures about what the NTA is doing rather than perceptions and misconceptions”.

I hope that this breakdown of figures supports him in doing that. 

xxx

FACING THE REAL ISSUE.

Even if £17million or £54million had been awarded to abstinence-based treatment, referrals to such treatment are so low – 2% of patients – that 15 residential rehabs have closed in just over a year. The remainder have empty beds. Some have made staff redundant. Some fear closure. And this is in the face of patients pleading to be admitted.  

The NTA must address this referral crisis or let others take the lead. There is a role for both abstinence and harm reduction: the driver must be the patient’s recovery and not “how do we keep ourselves in jobs and the patients dependent on us as well as the drug”. Only when good practice starts to become established will distracting arguments about abstinence “versus” harm reduction abate, as practitioners become true colleagues and partners across integrated care plans.

xxx

THE SCOTTISH WISDOM.

When the Scottish government wanted to set up a range of abstinence projects in Scotland – of which the Leap project is one – it bypassed local Drug Action Teams and invited bids specifically for abstinence projects. The received message was that DATs would spend additional money doing the same things they had been doing all along (overprescribing), abstinence services had to be commissioned directly.

This is the opposite of what has happened in England. If the tier-4 capital funding is to be filtered through the very organisations which failed to support residential treatment and abstinence in the past, then the money could disappear into the black hole of local finance.

When Keith Hellawell was UK drug czar, he concluded that the hardest task he faced was finding out where the money was going. Perhaps the NTA, Department of Health, PCTs and LAs will prove him and us wrong, and they will provide full and transparent accountability for the funds, so it is clear to understand where it is being disposed.

Comments

[Peter O'Loughlin]

Well spoken Deirdre.

It's the usual case of spin over substance, and the bulk of the NTA budget will continue to be spent on those treatments which have failed.

What is left will go on self serving 'Alice in Wonderland' publicity materials, attempting to justify their stance, whilst ignoring the increasing death rates of methadone users, together with the increasing blood born diseases among Injecting Drug Users.

[Rachel Clarke]

EATA questions figures regarding NTA’s Tier 4 capital investment programme
1 December 2008

The European Association for the Treatment of Addiction (UK) has expressed its concerns that figures announced by the NTA regarding the Tier 4 Capital Investment Programme fail to add up.

While EATA welcomed the £54 million government capital funding programme, confusion is growing over what the NTA now says will be the outcome of the cash injection for the sector.

When bids were invited from the sector in 2006, guidelines explained that the capital funding programme aims to both upgrade existing residential centres as well as provide more than 500 extra beds for residential and inpatient drug treatment, which, with an average stay lasting three months, means additional capacity of over 2000 treatment places a year.

But the NTA announced on 26 November 2008 that “abstinence-based drug treatment will grow by more than 2000 places a year” as a result of the funding.

EATA questions this statement for two reasons. With the evidence provided how can the NTA demonstrate that the capacity for more than 2000 “abstinence-based” places will be created when the original bid criteria never specified this as the outcome? Therefore, in order to put their statement in context and understand the data provided, we would like more clarification about what the NTA means by abstinence-based treatment.

Secondly, does this statement take into account the places that are currently being lost as a result of the number of rehabilitative providers that have closed or have announced their closure throughout the country in the last year? EATA is calling on the NTA to understand the seriousness of this situation and address the pressures that have lead to these closures.

Sharon Carson, EATA’s Chief Executive, said, “The figures do not add up. We understand that the NTA wants to communicate to the sector that this investment has been carried out and progress is being made. However, we believe it is important that the NTA support this statement with greater clarification.”

Notes
1. For further information, contact Rachel Clarke, EATA Communications and Development Officer.
Email rachelclarke@eata.org.uk or tel 18002 020 7553 9583. This is a text direct telephone, so please dial the number in full.
2. The European Association for the Treatment of Addiction (EATA) is a membership body whose aim is to ensure people affected by substance dependencies get the treatment they need. EATA does this through its representation of the treatment sector. EATA is the main representative body for voluntary and independent treatment services. EATA works with government bodies and policy makers representing the views of the sector to improve access and quality in the rehabilitative treatment of substance dependency.

[Tom Kirkwood]

I think the NTA statement is misleading. The simple fact of the matter is that Tier 4 residential rehabilitation is in terminal decline in England. At TTP we speak with Social Service referrers and DAT commissioners on a daily basis and the most commen phrase we hear is "there is no demand for residential rehabilitation. Clients do not ask for it"
An interesting comment in and of itself. You then ask them what they do to publicise the availability of residential rehabilitation or to link their service user groups to rehabs or Recovery Communities like TTP's and they answer "nothing, its not our job". Now I am exaggerating a little as their are some really great treatment systems in England, like Wirral and Bournemouth, but sadly they are few and far between.
Most key workers I speak to do not believe rehab is available for their clients as there are little or insufficient budgets or the route of approval is long and arduous.
Personally I believe rehab will move to the TTP model of community based Recovery Housing with local abstinence based treatment provided in a day setting. And this will mostly be driven by cost and outcomes.
I dont think I am being the bearer of bad news when I say I personally believe 25% of rehabs will close in the next 18 months. And if you are a traditional rehab your route to survival is to specialise in complex needs and dual diagnosis.