NTA'S PAUL HAYES REFUSES TO MAKE OUTCOME MEASURE "FIT FOR PURPOSE"

Talk as we await the Drug Strategy in early December is that treatment and recovery providers will be paid by results/outcomes rather than their services per se - so an accurate and transparent measurement tool is vital to assess what works and what does not, what saves lives or denigrates them, what saves money or does not.

Perhaps in anticipation that politicians recognise this need, the National Treatment Agency for Substance Misuse recently issued a press release about how its TOP measurement tool would be transparent and accountable. Sadly, although the NTA issued another press release about CEO Paul Hayes' monologue at the All Party Parliamentary Drugs Misuse Group this week (numbers boosted by the NTA PR team), it omitted that Hayes refused before Members of the Commons and Lords to improve its discredited TOP so it might become accurate and accountable.

At the APPG, following queries by Lord Rea and Andrew Griffiths MP, Addiction Today CEO Deirdre Boyd asked him if, to be accountable as he promised, TOP would be independently audited rather than self-report. Hayes said no. She agreed with Hayes' statement that "there is no point moving from heroin abuse to vodka abuse" and asked if he thus agreed there was no point moving from heroin abuse to methadone/cannabis/benzodiazepine abuse? She pointed out that TOP did not measure these addictive psychoactive drugs so hid cross-addiction, that Hayes' figure of only 34,000 people on methadone for over four years could not be accurate if TOP did not measure methadone use, that his figure of 25,000 people becoming "free of dependency" also could not be accurate if TOP did not measure all drugs of dependency being used (for analysis, key "dodgy dossier" into our web search box).

Also, TOP does not measure whether patients coming into contact with the treatment system are casual users, biochemically dependent, or had mental-health disorders, thus needing different care. And TOP does not reveal where successful results come from (although the 2-4% of drug-free people is almost identical to those entering rehab).

Hayes stated that TOP was already "fit for purpose".

This had been scientifically verified, he stated.  Boyd reminded him that TOP was assessed as "fit for purpose" only in that there was no ambivalence in answers (eg, "have you committed crime - yes or no?") but not that it aided recovery, or asked the right questions.

"It is fit for purpose," Hayes reiterated.

Comments

[John Jolly CEO Blenheim CDP]

TOP is not without its limitations but it still represents the worlds most credible attempt to capture outcome data across an entire treatment system.

The focus on drug and alcohol use whilst understandable hides the amazing data on improvements in quality of life, health, mental health, risk of homelessness, and reductions in risk behaviours. Even the crime indicators show a reduction in offending.

My concern is that the data is not being used adequately to promote the impact that services are having on service users changing their lives. At Blenheim CDP we have put our resources behind our concern and annually publish our TOP outcome data in an accessable format. Not perfect but better than we have ever had before.

[Laurence McM]

If Top is the world's most credible system, God help all those who need help.

The NTA never put a measurement tool out to tender, in order to get the best. Instead, it demanded what amounts to a 24-hour turnaround to come up with something.

Many places still use CISS, which had to be replaced with Top. That is far better, and if adapted for today's needs would offer a better tool.

[Daniel Collicott]

I believe we need to develop a holistic & universal (yet subjective) measure of what makes a healthy & happy person. At the moment, we simply don't have the tools. It might be better to patiently develop these tools first and then when we have, we would be in a better position to measure the relative effectiveness of each treatment. I suspect that this is a project which will take far longer than the whimsy of intellectual fashion and government policy. Unfortunately in the meantime we will just have to make do.