NO WAY TO DISPENSE PUBLIC MONEY

by Kathy Gyngell
Chair - Prisons and Addictions Forum
Centre for Policy Studies

Read the complete blog here.
Summary below.

The NTA’s poor and unfair practices mean it cannot be trusted. This £19million+ a year public-health authority should be wound down now, not in two years' time.

It is bad enough when we find that huge sums of public money have been wasted, as in the case of the NTA’s management of the last government’s damaging mass methadone prescribing exercise. (The latest UK drug death figures published this week revealed that drug deaths involving methadone rose by another 8% this year and that methadone is now the second highest cause of drugs deaths after heroin and morphine). It is outrageous when we find basic standards of procedure over allocation of capital sums have been ignored.

This appears to be the case with a particularly shoddy process the National Treatment Agency has just overseen. On July 22nd, Drug Action Teams were sent an invitation to bid for £8million of capital – a potential lifeline for rehabilitation centres which have been disinvested in, to the point of closure, over the last 12 years. These are the centres on which the success of government’s new treatment approach will largely depend. But here comes the catch...

They were given less than a week to submit their bids for money on which their survival might depend. In some cases, DATs did not even invite providers to take part in the bidding. The closing date for bids was July 29th so any bids had to be drafted - and the support of one or more statutory bodies to the DAT partnership secured - between July 22nd and July 29th (which included a weekend and was the start of the school summer holiday).

On the basis of the NTA’s past performance, services guiding addicts to drug-free lives would be forgiven for believing that being an abstinence service had a lot to do with their rejection.

For the NTA’s past form on capital allocations does not give comfort. Last time round in the bidding for a capital pot of £54million, the majority of small abstinence rehabilitation providers did not even get a look in, regardless of their track records of getting at least 65% of their clientele totally drug free, into education and training and on the way to employment.  For details of how deeply unsatisfactory this past process was, see Addiction Today’s report at the time.

It is not clear why the Department of Health decided to give this deeply unsatisfactory body a two-year life extension, especially given the Public Accounts Committee’s recent devastating critique. Ministers may come to rue this decision.

The decision has left the NTA operating as usual, with control over spending by Drugs Action Teams and Primary Care Trusts. For both are still required to submit their drugs treatment budget/spending and care plans for approval to the NTA in January 2011. These plans are due to be passed in March, yes by the NTA, for the year to come. This will most likely block any real change till the end of 2012. By then, as one concerned colleague commented to me last week, “no doubt the NTA hierarchy will have embedded themselves in the DH and still be able to destroy and wreck lives by putting whatever spanners in the works of treatment reform they disagree with.”

Comments

[Ed]

Plus, methadone is bright green and very sweet - which is why every so often it kills a child.

[Communications]

Mark Gillyon, NTA head of delivery, said: "The NTA is disappointed you did not seek to check any facts before making unfounded allegations about our stewardship of public money.

We were asked last month by the Department of Health to advise on the allocation of £8m of capital investment that had unexpectedly become available for drug treatment. Despite the short notice, this extra funding had to be spent this financial year, so there was an element of urgency to the exercise.

The allocation was for capital funding, to be spent on improving or developing buildings and equipment before April 2011, which means it cannot be used for revenue purposes. NTA regional managers contacted local partnerships to establish whether they had local priorities that would benefit from the investment and (where relevant) had the revenue commitments to support it. They also revisited those projects that were not able to be funded in the last capital round, and took soundings from local stakeholders, before submitting a list of more than 200 bids.

The decision was made by a national panel following national priorities, including ensuring the successful projects had a good geographical spread across England, covered the full range of treatment types, and supported the government’s recovery agenda. The latter meant there was a particular focus on residential provision and abstinence-focussed services. The NTA is in the process of informing applicants about the outcome of the exercise, and will shortly publish the list of successful projects.

Clearly in any exercise where demand outstrips the amount of money available, a number of bidders will be disappointed. The fact that one disgruntled provider contacted you and complained does not invalidate the whole exercise, which was conducted properly in line with normal government procedures and overseen by the Department."

[Laurence McM]

"Element of urgency" - there are nine months left before the end of the financial year!

This should have been openly advertised, giving a fair playing field for all.

If the DoH has so little expertise that it must turn to the abolished NTA, it is well overdue that drug treatment and recovery is handed over to a cross-ministerial group consisting not merely of the inexpert DoH but also Ministry of Justice, Home Office, Treasury, Children and Education.

[Disillusioned]

Readers should read this document from a NTA board meeting, where it formally states it waives/bypasses the procurement process: www.nta.nhs.uk/uploads/bd2_2010_134contractsreport.pdf

Hardly representative of recovery as a direction of travel!

The reasons given for not tendering are:

o The timescale genuinely precludes competitive tendering;
o Specialist expertise was required and is available from only one source.

The first reason is really poor planning who spends £80k without planning how to spend it? The second reason is plain wrong - do they expect anyone to believe there is not widespread expertise in this field or was it that they had selected the providers beforehand or possibly there weren't many/any other providers willing to carry out the opiate substitution trial??

The justification seems to be that the NTA have a set of standing orders that can be 'waived' given the CEO's agreement. What about EU procurement rules that say all public tenders over £50k need to be tendered?

What about any vested or conflict of interest?

NTA staff have the nerve to say there is not enough evidence that rehab works (!) - they pay for evidence to be found, if possible, in prescribing but do not financially support rehabs to evidence their superior and more cost-effective results.

Thanks for bringing this to our attention.

(Commentator's name and contact details given to Addiction Today; not publicised due to possibility of job reprisal)

[Angie Sparrowhawk]

I have worked in the substance use field for nearly 30 years and have always felt that my knowledge and experience and that of colleagues has never ever been requested or acknowledged. Maybe this should have taken place before the initial drug stategy was put in place and now there is an opportunity to go back to the coal face and start asking people working in the field.
I do not think that the NTA has been useful or helpful merely a bureaucratic machine generating useless paperwork. Obsessed with outcomes when experience shows that one size does not fit all - a range of treatments should be available. The fact that substance misuse varies from one person to another, everyone is different makes the issue so complex and difficult to address.
The issue of methadone again is a complex issue - I loathed its use as it adds another addiction to the already addicted opiate user. Heroin prescriptions would be a better option - it cuts out the dealer and all the industry associated with illicit substances. It would also cut deaths associated with methadone as this can be caused by topping up with heroin whilst in a methadone 'script'. I despise comments from people who want to have time limited scripts and treatment - some clients cannot and do not want to stop opiate use but can and do function whilst dependant on opiates. Drug dependancy treatment must never get into punitive arena, it should be supportive, empowering, enabling and explore lifestyle choices. Working towards people improving their lives and building confidence,self esteem and a positive trusting relationship with their counsellor/social worker or drug worker. People can change their lives and once the client is engaged and begins to make changes the obvious question of reducing and coming off drugs completely becomes a possibility, but only after this work is begun. People vary and some come to this conclusion quickly and others take much more time - there is never a quick fix [pardon the pun].