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Dave

March 07, 2012

NDTMS: STILL FAILING TO MEASURE UP

The National Treatment Agency states that pooled treatment budgets have a revised formula “to ensure funding goes to those areas successfully treating more people” – but how can this be done on an equitable or effective basis when the system to measure success is unreliable, even by the NTA’s admission?

Fotolia_7006618_Gino Santa Maria“Successful completion of drug treatment will be a key measure of improvement in population health when local authorities take over responsibility for public health next year,” confirms the National Treatment Agency for Substance Misuse.

“The drug treatment indicator is based on the number leaving treatment free of their drug of dependency, who do not then re-present to treatment again within six months. This would be expressed as a proportion of the total number in treatment. The data for calculating this is already collected through the National Drug Treatment Monitoring System, currently run by the NTA.”

The most obvious flaw with the indicator above is that it has retains the phrase “free from drug of dependency” instead of the ambition used in the Drug Strategy: “free from dependency”. In other words, symptoms not causes are being addressed, and patients will continue to cross-addict from one drug to another.

The second most-obvious flaw is that the data is being collected through the NTA’s discredited NDTMS data gathering system – which has not been corrected in the way that ministers might have hoped.

MONEY TO THE WRONG AREAS?

The money has not been awarded yet, so there is a brief time to get this right... but will they?

From April, local commissioners will be incentivised to provide services which sustain recovery. Allocations to local partnerships from the £406.7million pooled treatment budget for 2012-13 will be made in March, “according to a formula which includes a recovery incentive [“recovery” remains undefined] for the first time. The adult budget has been maintained but the formula revised to ensure funding goes to areas successfully treating more people”. To be specific, “a proportion of the national contribution to local funding for adult drug treatment in 2012-13 will be allocated according to the number of adults who successfully completed and did not come back into treatment anywhere in England for at least six months,” the NTA states.

However, NDTMS data shows a treatment unit at the top of what we cannot call the NTA ‘league table’ of rehabs, which the previous paragraph indicates should get most money. The snag is that this unit was in existence for only a few months of the three-year outcomes measured in other, nonNHS rehabs – in its brief existence, there would be no time for patients to leave and re-present. Will it get the lion’s share of budgets or will the anomaly be fairly recognised?

At the bottom of this table was an admired rehab whose ranking was so grossly inaccurate that it had to threaten legal action against the NTA to get a chance to be more equitably measured.

To its credit, the NTA has gone back to rehabs asking them to re-submit data for the past two years.  But this has a deadline which lags after the budget allocations. The Addiction Recovery Foundation, the charity which publishes Addiction Today, has given details to government.

PAYMENT BY RESULTS

Aside from this, the eight Payment by Results pilot schemes for drugs and alcohol recovery – which have refused to involve drug-free rehabs – are developing a similar but more complex metric as “one of several indicators that ensure providers are paid for the outcomes they achieve”. The PbR pilot schemes, which go live in April, will measure freedom from drug of dependency – as opposed to freedom from drug dependency – with the same indicator as above but with patients not re-presenting 12 months after treatment.

WHAT WILL GO WRONG?

It is interesting that the NTA’s Value For Money guidance states on two pages that death will be counted in NDTMS as “sustained recovery”... We also know of a treatment unit with the funding to pay for its own NDTMS expert to input good outcomes – but that counsellors in the area are rescuing its relapsed clients.
Incongruencies aside, finding a solution to making NDTMS more accurate for budgets and measuring PbR outcomes requires a simple, more widespread and general solution – if only the NTA would implement it.

For Addiction Today – and the country – the most important single factor in getting accurate data to ministers and officials and funders is  that all providers, the NTA, NDTMS data gatherers and thus government and funders all understand the same meanings from the same words and phrases in NDTMS datasets and related documents. At a NTA/RP gathering on 26 January, this would have been ARF/Concordat’s strongest message, if we had not been lost from its agenda.

We have worked with the NTA and others since last November because it planned to issue a press release in December stating that rehabs had only a 21% success rate and thus the cost per patient was non-viable when averaged across all “failures”. This would have led to misplaced loss of confidence in rehabs, loss of referrals and perhaps closures and redundancies, and loss of lives. After challenging figures which even NTA CEO Paul Hayes admitted were not to be trusted, this success rate was slightly more than doubled to 43%. However, this is still too low as experience tells us the figure should be nearer 65%.  By definition, those who have declined to even commence treatment should not be included in completion statistics; removing this disproportionately high 24% or so would raise the "successful completions" in line with experience, anecdotal evidence and worldclass empirical research which indicate a success rate of about 66% for rehabs.

We must also amend the NTA definition of rehabs as they currently include non-abstinence units. It is inequitable that success rates be artificially lowered, depriving desperate patients of a recovery lifeline.

Comments

Ann Stoker

Words still fail me (and many others). The phrase 'lies, damned lies and statistics' come to mind. Thank you Deidre for keeping on keeping on - there are many, many people who so desperately need genuine drug treatment, and who are never going to get it if the current deployment of scarce resources continues to go to the wrong place. The perfect examples of how a whole
meaning can be negated is the simple inclusion of the word 'of' - instead of
drug dependency, drug of dependency. This hi-jacking of meanings of words is a continuation of many earlier examples - i.e.
'recreational drugs', reduction of harm,
prevention of misuse of drugs....... and so on. When will those with power and influence listen to you on behalf of the most vulnerable and needy ?
Ann Stoker

Matthew

The section "Money to the wrong areas" is based on a misunderstanding. As it correctly says, as of yesterday (1st April 2012), areas - geographical areas, usually local authority boundaries - will receive funding allocations based on a formula affected by performance over the previous year (including how many people successfully completed treatment drug free).
It then goes on to talk about various "rehab units" being allocated this money. This part is incorrect. The rehab unit would not be allocated money based on performance. The areas which had sent referrals to these units would. They would then carry the risk if the "units" did not succeed and the benefits it they did. The local area could then reinvest in these units, or not (which they might do based on their success or otherwise).

Service providers themselves, residential or community, are not subject to this allocations system as the NTA makes allocations to geographical areas- as the section rightly points out at the beginning, this risk is applied to local commissioners.

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