PAYMENT by RESULTS PILOTS: RESISTING REFORM
“Drugs Recovery PbR is to be tested out through eight pilot areas to run for one year from 11 October 2011. Problems are inherent from the start,” stated a report by the Centre for Policy Studies‘s Kathy Gyngell.
The PbR plans are intended to be a template for the country in implementing the drug strategy and reducing the annual £3.6billion cost of taxpayers of keeping addicts dependent on drugs instead of helping them to quit. Government’s stated goal is to help individuals recover from their addiction; and to contribute to society instead of being a cost to society – contrarily, rehabs and their experts in getting addicts drug-free have been excluded from these templates.
CPS CRITIQUE OF PbR PLANS
The eight PbR pilots are: Bracknell Forest, Enfield, Kent, Lincolnshire, Oxfordshire, Stockport, Wakefield and Wigan. It is up to local commissioners/Drug Action Teams to decide how much of their significant budgets will be given over to PbR, and whether it will be applied equitably and proportionately across approaches.
Bracknell is not applying “Payment by Results to their Primary Care Prescribing, the Needle Exchange Scheme or the Supervised Consumption Scheme”. Instead, these will be paid “by activity” without visible evaluation. This begs two questions: what budgets will be left to be assigned to psychosocial or recovery interventions; and what chance will the area pilot have to work when a substantial proportion of clients will be retained on methadone prescribing because there are no incentives to get them off?
Enfield similarly is restricting the scope of PbR to its mentoring scheme, service user programme, and residential treatment components of delivery.
Wigan proposes to restrict PbR ‘eligibility’ to clients in ‘structured tier three drug treatment services only’ plus dependent alcohol users. Its aim for them appears to relate more to resettlement services – housing, education etc – than providing innovative recovery treatment.
Kent proposes to run “an integrated recovery system” through all the existing treatment tiers, but plans to divest the responsibility of how to do this to a ‘prime provider’ who is likely to be a major drug charity or NH provider.
The resistance to innovation is also demonstrated by the statement from Wakefield that they have been using an outcomes-focused system for the past two years that “can be quickly adapted to our proposed PbR model”.
Oxford, too, looks to be reluctant to engage in any fundamental change or new and innovative commissioning since it has decided that all its current structured drug and alcohol interventions will simply be re-commissioned under a “Recovery Framework.” It plans also to continue to commission needle exchanges (currently in approximately 40% of pharmacies across the county) on a payment by activity basis. Having said that, it recently opened up communications with a range of providers.
The strength of negativity towards rehab driven abstinence-based recovery is also shown by the example of NE Lincolnshire’s DAAT strategy manager. At a National Treatment Agency round-table discussion of the new strategy, he announced that he had no rehab within 50 miles and “in any case ‘service users’ show no wish to go”. This is despite surveys showing the opposite.
None of the pilots involve change of commissioning personnel – leaving the old guard in charge of ‘reform’.