'LEAGUE TABLES' FOR ADDICTION-TREATMENT PURCHASERS AND PROVIDERS
REVIEW IS NOT BASED ON PATIENT RESULTS
A national review of drug treatment networks, published today by the Healthcare Commission and the National treatment Agency, could help to explain how poor commissioning led to the closure of about 15 addiction-treatment centres in as many months.
In some areas the commissioning of residential rehabilitation services is not integrated with other drug treatment commissioning," it recognises. "49% of partnerships did not integrate the budget in this way. Less than half (44%) of local drug partnerships increased funding for providing residential services above the rate of inflation in the last five years. This is concerning considering the significant increase in budget for these services."
Also of concern is the Drug Action Team area which scored "good" (3 out of 4) for "users have prompt and flexible access to Tier 4" and "fair" (2 out of 4) for "effective commissioning and/or purchasing processes for Tier 4 residential rehabilitation" -- this particular area handed over all its commissioning to one organisation rather than partnering with local providers, spent its Tier 4 budget by last November, and did so without referring one single person seeking help to such residential rehabilitation. If this commissioner's score has been so elevated, it throws doubt on accuracy of the whole.
One explanation lies in the fact that Drug/Alcohol Action Teams get an overall score for processess, policies, contracts etc in both diversity and tier4 services. The tables should have included an element on actual commissioning: % of budget, % new treatment journeys and maybe even average length of stay. The landscape might look very different if they had...
The results for treatment centres are also not based on the one measure which Addiction Today considers most vital: do they work? What are the success rates for clients both in the medium- and long-term?
Not all treatment centres are included in the league tables; if you need to access treatment, click on the impartial list of Treatment Centre Resources.
LINK TO THE REPORTS
THE REVIEW
The full text from the Healthcare Commission is available here and below.
“Since 2005/06 we have worked with the National Treatment Agency for Substance Misuse (NTA) to review the key aspects of providing and commissioning effective services for the treatment of substance misuse in England,” it reports. This is the third and final review in the joint series.
“For this review the key outcome and quality measures were developed around two separate themes:
1. How well services meet the needs of a diverse range of people (diversity). It is vital to ensure that drug treatment is able to meet the needs of people from diverse communities or groups appropriately and effectively. Commissioning and providing drug treatment must be compliant with statutory requirements concerning disability, race, gender, sexuality, religion and age. How well commissioners and providers of services understand the diverse needs of their local communities, and then commission and deliver services that meet these needs, is central to this theme.
2. Commissioning and providing inpatient detoxification/stabilisation and residential rehabilitation interventions (known as Tier 4 services). Tier 4 services can provide effective responses to the needs of those with the most severe drug problems, enabling drug misusers to move towards long-term abstinence when appropriate. Inpatient drug treatment usually involves short episodes of hospital-based (or equivalent) medical treatment. This normally includes 24-hour medical cover and assisted withdrawal from illegal and substitute drugs. It can also assess and stabilise chaotic service users. Residential rehabilitation services deliver programmes designed to support service users to live drug-free lives, focusing on the coping strategies and life skills required to achieve this.
"The review was also delivered with the cooperation of the Commission for Social Care Inspection. CSCI inspect and regulate many inpatient and residential services and have fully endorsed and supported this review.
In England, drug treatment is provided by a network of services commissioned by 149 local partnerships of statutory agencies. These local drug partnerships (or drug action teams) include primary care trusts, local authorities, the police and the probation service.
"We assessed the performance of all 149 local drug partnerships within the two themes above. Each partnership received an overall scored on a scale of 1 to 4, using "weak" (1), "fair" (2), "good" (3) or "excellent" (4). Inpatient services and residential rehabilitation services were also given individual scores as part of the review.
KEY FINDINGS
“The Healthcare Commission and NTA have now published the national report and the final results of the 2007/8 joint service review.
Findings reveal widespread good practice with 15% of local drug partnerships rated as "excellent" and 72% "good" overall. Thirteen percent were rated "fair" and no partnerships had an overall score of "weak". There was also a similar pattern of results for providers of inpatient and residential rehabilitation services.
The review showed the majority of partnerships understood the diverse needs of their local community: 99% carried out needs assessments which addressed diversity issues, 99% met statutory obligations regarding diversity and 91% of services had access to a range of interpretation services. However more work is needed to make sure partnerships maintain this focus on diversity when developing plans for drug treatment, and to consult more broadly with groups not currently accessing treatment.
Similarly, there was widespread evidence of good practice in providing and commissioning both inpatient and residential rehabilitation services. The review found that the vast majority of these services provide treatment in safe environments staffed by competent practitioners. But more could be done to improve the integration of care pathways between community-based services and inpatient and residential services. There was also significant under-reporting to the National Drug Treatment Monitoring System (NDTMS) by these services on their activity..
Further information is also available on the NTA website, including the results for inpatient and residential rehabilitation services and more information on the review's methodology.
“We remind commissioners that the review was a topic-based assessment against a specific assessment framework, and not an assessment of every aspect of a service... Local drug partnerships should not make commissioning decisions based solely on the scores awarded to Tier 4 services. These scores should only be a part of broader intelligence on the quality of services.
Commissioners should seek assurances from those Tier 4 service providers that failed to submit data, that they are compliant with the review's assessment framework.
USEFUL SITES
What should not get lost is the fact that the review acted as a platform against which all local drug partnerships and Tier 4 services can improve their commissioning and service provision. It has escalated the Tier 4 agenda considerably in the field and prompted widespread action to address the issues it identified. The NTA Regional Teams have been working with all partnerships where the review identified any shortfalls in provision. The NTA Standards and Inspection team have been working intensively with the lowest performing partnerships and Tier 4 services. Tier 4 services have also been action planning and working with commissioners to address issues identified by the review.
I cannot comment on the specific local drug partnership mentioned above, and I do not have any knowledge of such a scenario. Any specific issues should be raised directly with the partnership and the relevant NTA regional team.
The assessment framework of the review was based on current guidance and national requirements. Reviews of this nature can only assess organisations against standards and guidance where there is clear and established expectation that they are compliant. The indicators mentioned above, such as percentage of budget, or percentage of new treatment journeys, were not indicators against which partnerships could be scored on a national basis, as each would vary depending on the area and they should be determined by local need. Such indicators were in very early drafts of the assessment framework but did not stand up to the robust methodological tests applied in the development of the review. This is because they would have unfairly discriminated against some areas and therefore left the process open to a legal challenge.
Processes, policies and contracts were not the only basis for the review scores. Completion rates; budgets; monitoring mechanisms; waiting times and community care assessments were also used as indicators. Furthermore, some of the policies used were vital to the safety of service users, such as unplanned discharge policies.
The review used the only indicator of success rates available to it: NDTMS data on successful completion rates. The review could only use data from a national validated data set and was therefore limited to NDTMS data in relation to service activity. One of the key problems with this, as the review highlighted, was that a large proportion of Tier 4 services did not submit complete data or any data at all to NDTMS. In future TOP will provide a far more accurate measure of treatment outcomes. The review is a clear example of the importance of participating in national monitoring systems, as they can provide an invaluable platform against which to assess, plan and improve.
The residential rehabilitation services included in the review were all nominated by local drug partnerships to participate. Local drug Partnerships were asked to nominate all the services they funded from April 1st 2007 to 31st December 2007. The review was not therefore a review of all residential rehabilitation services. The primary unit of assessment was local drug partnerships and the scores of all the services they funded during that period were aggregated back to them in proportion to the amount they used the service.
Posted by: Pete Burkinshaw, Standards & Inspection Lead, NTA | February 06, 2009 at 10:01 AM