ServiceS
8 |
drinkanddrugsnews
| April 2015
T
he situation in drug and alcohol treatment services is becoming
increasingly dangerous. Because of commissioning pressures,
enforced through contracts, services need to increase their number
of ‘successful completions’ – which means many service users are
being discharged from services abstinent from their drug of
addiction and not on any prescribed drug replacement therapy.
While this may seem a good idea on the face of it, in practice it can be
damaging and dangerous. The drive to get patients off scripts and out of services
may be helpful for some, but for a lot more it makes relapse more likely.
Addiction is usually a chronic and relapsing condition that is not easily solved
by a formulaic ‘one size fits all’ approach. We are now starting to see rises in drug-
related deaths and drug use – both of which were previously declining.
Factors which contribute to this include the devolving of commissioning
responsibility for drug and alcohol services to individual local authorities –
many of which are very short of money and need to make significant cuts
across the board.
Therefore, local politicians want to see obvious results for their investment
in services, which many interpret as ‘successful completions’. This is in a climate
where many services are having their funding reduced by at least a third – a
short-sighted move as we know that money invested in drug and alcohol
treatment shows at least a threefold positive yield in the wider economy.
While Public Health England (PHE) oversees the delegation of funds,
including those for community drug and alcohol services, it has no power over
commissioning and can only advise local authorities. It is left to local
commissioners in each council to decide what services to commission. In some
places, clinical commissioning groups also contribute a budget to drug and
alcohol services – often because of a historic arrangement – but this is the
exception rather than the rule.
The endless round of recommissioning every three years or so serves to
destabilise services. The first year is all about taking over the service and
establishing it so it works properly, employing and TUPEing staff and installing
new operating practices. Then the second year settles down a bit, until the third
year where staff and service users start to worry about employment, continuity
and the next unknown provider. This cannot be a sensible way to provide,
sustain and improve services.
There is also a real danger that providers underbid and over promise, then
cannot provide the service needed because of lack of money for infrastructure
and staff.
The Care Quality Commission (CQC) has been thinking again about how to
inspect drug and alcohol services and measure quality, and it is actively working
How can we refocus drug
and alcohol services on
competent compassion,
asks
Dr Joss Bray
We’ve lost that
