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On the question of job
availability in the current economy,
Wilkie-Jones told the conference
‘what we can’t do is deliver loads of
extra jobs, but we can better equip
people to compete for the jobs
available’ – through reviewing the
Rehabilitation of Offenders Act and
Criminal Records Bureau checks, as
well as through employer
engagement. The public sector also
needed to play a role, particularly
through volunteering opportunities.
‘I want to bust a myth here,’ he
said. ‘Volunteering can be done, full
time, on all benefits.’ There would
also be no sanctions for refusing
treatment, he stated. ‘But there will
be if, as a consequence, you are
unable to fulfil the normal require-
ments of benefit entitlement. We
won’t penalise you, but we’re not
going to make excuses for you
either.’
Accommodation services were
also vital to success in drug treat-
ment, said director of practice and
regions for Homeless Link, Mark
McPherson. Homelessness services
had not been protected in the same
way as the drug treatment budget,
he said – Supporting People
funding had been cut and many
agencies were dependent on the
service priorities of local authorities.
The strategy’s recovery focus
was ‘the right thing’, said RAPt
chief executive Mike Trace, but it
was important not to lose the
progress of the last ten or 12 years.
‘It’s good that the government
refers to a rebalancing of the
system rather than a replacement –
we’ve ended up with the right set of
words.’ The commitment to get a
handle on outcomes was also
welcome, he said, along with the
distribution of resources to local
areas, but the problem with localism
would be local commissioning
capacity – ‘trying to do everything
with one man and his dog’. ‘For a
localised system to really work, the
money needs to be flowing and the
straitjacket – the waves and waves
of guidance and required form-filling
– needs to be removed.’
The government also needed to
explicitly state what the new out-
comes were, he said. ‘There’s a
communication problem here. It’s
not fair to ask commissioners to
commission to outcomes if you
don’t tell them what they are. I’d
like the government to tell us what
they’re going to be, because every
month that goes by, people are
commissioning to other stuff.’ The
‘easy ones’ were crime reduction
and benefits, he said, although
there was a risk of being overly
simplistic in the latter case.
‘Recovery’ was trickier, as were
things like social functioning. It was
essential that payment by results
did not become an incentive for
people to work within their own
narrow pathways, added
McPherson. ‘Integration is key – if
hostel providers aren’t being paid to
reduce drug use, for example,
they’ll gradually stop doing it.’
It was also important that
measurements of quality and
patient experience – ‘the softer
stuff’ – was not lost, stressed
director of the Royal College of
General Practitioners’ substance
misuse unit, Dr Linda Harris, while
Trace said there would need to be
an ‘entirely new way of thinking
about commissioning’. External
verification would be essential, he
said, with ‘separate, objective’ case
management systems. ‘I think it can
all be done, but I’m worried – ten
months after the election – about
the speed at which we’re moving to
a localised, outcomes-based
system,’ he said. There would be a
lot of ‘hybrid commissioning’ over
the next couple of years – ‘trying to
understand the new world, but still
being dragged back into the old
one, and my fear is we get the
worst of both’.
The old delivery framework
mattered because the 2010 strategy
wanted to build on what had gone
before, said NTA chief executive
Paul Hayes. ‘The only way we’re
going to get recovery, and get it
now, is to use the structures around
us – 143 out of 149 areas will not
be piloting PbR and it’s essential we
get our heads around that.’ There
were already very significant shifts
on the ground, he said, with thriving
recovery communities closely linked
to treatment services.
‘There are very real things that
are happening – they need to be
captured and built on, and the
current set up is how we do that.
Directors of public health won’t
have their own real budget until
2013/14 which is why it’s important
to use the levers available now.’ The
new treatment landscape was
emerging, he said, but parts of it
would be relatively slow to emerge.
‘Two years is a long time to wait,
especially if you’re a service user.’
Public Health England, however,
would be the perfect vehicle for
bringing together the commissioning
process for drugs and alcohol, he
said, and there were already
significant moves to integrate drug
treatment in prison and the
community. He acknowledged,
however, that although there was a
ring-fenced public health budget,
drugs and alcohol were not
necessarily big priorities for many
directors of public health, and would
have to compete with issues like
smoking and obesity. ‘We will be
engaging with them over the next
few months on what for many of
them will be a fresh challenge, as
some may perhaps have a narrow
view of the public health agenda.
There’s a real selling job to make the
case at local level – we need to
demonstrate that treatment can
deliver on things like health and
wellbeing and community safety.’
The PbR pilots would be identified
by April 2011, he told delegates, to be
co-designed with the areas delivering
them, start in October 2011 and end
in 2013, followed by independent
evaluation. Proposed outcomes so far
were freedom from dependency,
employment, reoffending and health
and wellbeing. ‘There won’t be a firing
gun and people expected to roll out
PbR. The assumption is that people
will see that it works and will want to
opt in. It won’t be rammed down
people’s throats – that’s not how this
government intends to do business.’
Concerns over the strategy’s
recovery focus were misguided,
reader in criminal justice at the
University of the West of Scotland,
David Best, told the conference.
‘Recovery is not only possible, it’s
probable.’ Aftercare could drama-
tically enhance post-treatment
outcomes but it was provided to
‘remarkably few people’, he said.
‘We offer an awful lot of front-end
interventions, and we talk about
revolving doors of treatment when
we have, in part, created those
conditions.’ There was also a
‘professional culture of learned
helplessness’, he said. ‘We’ve fallen
over ourselves lowering the bar and
lowering expectations of recovery.’
Methadone provided stability
and a ‘public health, public safety
gate’, but would not ‘deliver
recovery’ he said. ‘Recovery as a
philosophy is not about taking
people with a bundle of symptoms
and making them asymptomatic. It’s
about growth and quality of life.’
The purpose of a drug worker
remained the same – supporting the
client through acute treatment – but
their most important role was to link
people with recovery communities,
he said, as recovery was not
something that services imposed.
‘If you want somebody to
recover, the best way is to change
their social network. Social
networks create the norm, the value
systems, the rules.
‘Abstinence spreads in a conta-
gious social manner in social
networks. There were 1,500 people
at the recovery weekend in Glasgow
last year. People said “you’ll never
have all that – recovery walks,
recovery cafes, serenity cafes – in
Glasgow. It’s Californian nonsense.”
But we do.’
DDN
A profile of Dr David Best will be
in April’s
DDN
7 March 2011 |
drinkanddrugsnews
| 23
www.drinkanddrugsnews.com
News focus |
Drug strategy
Dr David Best: ‘If you want
somebody to recover, the
best way is to change their
social network. Social
networks create the norm,
the value systems, the rules.’