Clinical & Policy Updates:
SMMGP Policy Update March-April 2012
|Download the PDF version of this Update here! (PDF*, 272K)|
Home Office Mar 2012. See tinyurl.com/PFRecovery.
In this document, which appeared on the Home Office website at the end of March, the Inter Ministerial Group (IMG) on drugs sets out to provide a roadmap for a new treatment system based on the overarching principles of wellbeing, citizenship and freedom from dependence. It does this by putting into context the ambition for reforming the system via a "purposeful policy programme" and improved outcomes in a locally led system.
There are some positives to note - it recognises the contribution made by the Substance Misuse Skills Consortium, Recovery Group UK and Drugscope, and the role of these organisations ìas key drivers of changeî in providing a voice and channel of communication to the IMG.
The document outlines the purpose of Public Health England (PHE) as a "recovery orientated body", with a vision for an integrated substance misuse treatment sector that includes alcohol. It confirms the major transfer of responsibilities to local authorities who will commission treatment services. Broadening the policy scope to include the welfare of families and securing housing and employment for people in treatment, and an integrated system that includes alcohol treatment, is commendable and of course, necessary.
In summary the core commitments include:
- contextualisation of treatment reforms within the wider social reform agenda;
- transfer of certain functions of the NTA to PHE;
- support for local areas to re-orient and rebalance local commissioning structures towards full recovery;
- support local areas to integrate alcohol treatment;
- inspire and equip the treatment sector to achieve full recovery where possible;
- develop a PbR model to incentivise outcome based reform and deliver value for money;
- establish recovery champions;
- build recovery capital in individuals and communities;
- reform the criminal justice system to tackle reoffending.
The "Putting Full Recovery First" paper is an important looking document, with an introduction by Lord Henley, Chair of the Inter-ministerial Group on Drugs, and endorsed by Department of Health, DWP, Ministry of Justice, HM Treasury, Department of Education, Cabinet Office, and appears at first impression to be aimed - at least in part - at fulfilling the promises of the "Building Recovery in Communities" programme that was consulted on last year. We therefore read it with care and anticipation.
However, on scrutiny, and disappointingly, it is a confusing document that contains several anomalies, e.g. there are several references to 2010/11 - why publish a (seemingly rushed) document at the end of the business year? It describes PHE almost solely in terms of taking over the functions of the NTA ("which will be abolished"), when there are more than 60 outcome indicators for PHE of which drug and alcohol treatment is just one.
The frequent use of the phrase "full recovery" in the paper is also confusing and will probably alarm people in treatment who already fear the threat of time-limited sanctions. It isn't quite clear what is meant by it - whether having full recovery refers to being in treatment plus having a job and a house, or whether it means abstinence is being advocated.
With no clear action points included, it doesn't quite live up to the promise of providing a roadmap, if anything, it loses its way, and may have the effect of needing to stop and ask again for directions before ending up in a dead end, or causing a pile up.
No one would argue with an ambition to improve people's lives by having them recover from dependence on drugs (or alcohol) plus having a job and being housed; that is an ambition shared by most of us who work in the field. This document undervalues the recovery gains that have been made in the current system, and sadly writes it off as having been "full of ...waste".
Recovery is seldom a single event contained within a set period of time. It is usually incremental, often over many years. It can even be spontaneous. What is almost impossible is to describe it in rigorous terms and attach a value to it upon which payments will be made, once people have achieved it "fully". It would be dangerous if there was a rush to commission services based on the belief that this document sanctions time limited treatment or that the underlying goal is abstinence for all.
We agree that a static treatment system benefits no one, and in recent years there have been encouraging community initiatives and recovery networks gaining ground all over the country, which provide a welcome and important means of support for all. But we know that the evidence for drug treatment as it stands, implemented responsibly, backed by sound clinical governance, and working in partnership with the patient, delivers. It delivers on the prevention of death and disease and crime reduction, whilst improving people's lives, health and wellbeing, thereby giving them the opportunity of to recover.
During this time of "business as unusual", we will continue to work hard to champion high standards and ensure quality treatment for all. As reflected on our forums and in other communications, we are encouraged by the resolve of the members of SMMGP and others in the field who work to uphold the gains made in treatment in recent years.
P.S. This document has been widely discussed on various social media, including our forums, and has drawn mixed responses. Comment came from as far afield as Australia on this blog entitled "Full recovery - a flawed policy".
NTA, March 2012. See tinyurl.com/crime-halved.
For the first time on this scale, a study by researchers from the NTA has compared data from NDTMS with conviction records from the Police National Computer to produce the largest empirical study ever conducted in England on the impact of drug treatment on crime. Data was compared for almost 20,000 known offenders - mainly people who used heroin - who started treatment in 2006/07.
Detailed findings from the study showed:
- Individuals who successfully completed a drug treatment programme after at least six months reduced their convictions by 48%.
- Individuals who were retained in treatment for the entire two-year research period reduced their convictions by 47%.
- The most dramatic falls in convictions were for soliciting (59%), and fraud or forgery (57%).
- The biggest single reduction in offences was almost 11,000 fewer thefts, a 24% fall.
- People who used heroin and crack (and who were the majority in the study cohort) were twice as likely to have convictions before treatment as people who used other drugs.
The study observed the differences in conviction rates between the two years before entering treatment and the two years after, and found that convictions reduced by 47% to 48% for those who completed treatment successfully. The longer individuals were retained in treatment, the bigger the drop in convictions.
Previous research has shown that crime reduction as a benefit of treatment starts immediately and continues whilst individuals stay in treatment. This study has made it possible to report on the continuing benefits for people who complete treatment successfully and return to their communities.
This major research study clearly demonstrates the benefits of the current treatment system in terms of reductions in re-offending. SMMGP has in the past joined in the criticism about funding for drug treatment coming into the system via criminal justice, but we acknowledge that - whilst drug treatment alone cannot be directly attributed as having a causal effect on crime - these are nevertheless measurable outcomes of proven benefits to individuals and communities.
As we move into an era where funding for drug treatment will sit firmly within the realms of health, and where outcome measures as yet do not seem to be clear, this is a timely and useful study that clearly demonstrates the merits of drug treatment for those in treatment who have also come into contact with the criminal justice system.
Mar 2012. See tinyurl.com/alc-strategy
This purposeful strategy signals a radical change in approach and promises to:
- Take firm and fast action where universal change is needed e.g. to end the availability of cheap alcohol and irresponsible promotions.
- Give local areas power to tackle problems locally, to reduce alcohol fuelled violent crime by giving local agencies an extensive range of tools and powers.
- Recognise the crucial role of the industry in changing individual drinking behaviour, and securing its support.
- Support individuals to make informed choices about healthier and responsible drinking.
The ambition for the alcohol strategy is unequivocal in wanting the following outcomes:
- Changes in behaviour so that people do not think it is acceptable to drink in ways that cause harm to themselves or others.
- Reduction in alcohol-fuelled violent crime.
- Reduction in the number of adults that drink above NHS guidelines.
- Reduction in the numbers of people who binge on alcohol.
- Reduction in the number of alcohol-related deaths.
- Sustained reduction in numbers involved plus amounts consumed in 11 to 15 year olds.
We have repeatedly joined in calls from the field for a minimum pricing strategy, not least because the evidence shows that it does have a targeted impact on people who cause themselves serious harm through drinking to excess, so the inclusion of this measure is applauded.
How funding will be distributed is now crucial - local areas will receive a ring-fenced public health grant, including funding for alcohol services, and have the freedom to design services to meet local needs. From November this year, directly elected Police and Crime Commissioners will work in partnership with other groups, including Health and Wellbeing Boards, to develop common causes with partners on a range of crime and health issues and address them collectively. This alcohol strategy, with its huge scope of ambition to bring about sweeping changes, includes a number of definite measures that are very necessary. It has been generally well received by the field.
For more reading, there is a useful and comprehensive summary on the Alcohol Concern website
Clare Gerada, a long time champion of substance misuse treatment, ably represented GPs who work in the field by providing evidence to the Home Affairs Select Committee on Drugs during March. In her evidence, she ascribed the reduction in number of heroin users - also from her experience since starting out as a GP - to a focussed and intelligent drug strategy.
She voiced concern that people who use drugs are an "invisible" section of society and that their treatment over the past three decades have been subjected to the shifting sands of politics and the consequent dangers of leaving them with access to fragmented care.
When asked to comment on which method of treatment worked best for heroin addiction, she said that opioid substitution treatment (OST) continues to be the "gold standard" for treating heroin addiction but that other treatment methods must not be summarily dismissed, and that it is crucial due to the complexities of addiction, to offer a full range of treatment. Owen Bowden-Jones, Chair of the Faculty of Addiction, RCPsychs, was also on the panel and supported this opinion.
For a full transcript of this section of the evidence see tinyurl.com/HOComm-evidence.