OPPORTUNITIES AND CHALLENGES TO PREPARE FOR IN 2014
Leading personalities in the field of addiction treatment and recovery share some of their expert, inside information to help you identify and thus prepare for major developments which could affect you in the year ahead.
Download AddictionToday146 – 2014 challenges
RUPERT OLDHAM-REID leads the Centre for Social Justice research into drug/alcohol policy, part of Breakthrough Britain II, and authored No Quick Fix: Exposing the depth of Britain’s drug and alcohol problem.
It is easy to be pessimistic about the year ahead. With localism and the continued medical-bias of national guidance for commissioners, too few people suffering with addiction will get a chance to move into full recovery. A lack of forward thinking, combined with pressures on housing stock, also means that the lack of dry, move-on housing – so crucial for sustaining recovery – is unlikely to improve. Health officials refer to the ageing heroin population in a tone of hopelessness, implying the best to be hoped for is ‘managed decline’. Add to this the fact the UK is a global hub for emerging NPS or ‘legal highs’ and soaring alcohol-related admissions to hospital, and it is hard to be upbeat about the coming
In Westminster and Whitehall, Chris Grayling’s Rehabilitation Revolution offers the prospect of transformative treatment for addicts to help them into recovery. The danger, as was seen with the 2010 Drugs Strategy, is that the documents contain the right language but the same old faces end up delivering services. Sadly, this means that the recovery sector must be vigilant and proactive in securing this ‘revolution’ so that it delivers what it promises.
Yet, away from officialdom, there are signs of a breakthrough which offers hope to drug addicts and alcoholics trapped in dependence. Momentum is gathering in the number of high-profile ‘champions’ coming forward to fly the flag for abstinence-based rehabilitation and recovery. They include Matthew Perry of Friends fame, Kevin Kennedy of Coronation Street and even Bake-Off finalist Kimberley Wilson, all breaking down the stigma of addiction in the public mind as well as promoting the value of rehab (while highlighting the fatalism of methadone maintenance). Reducing stigma has been pioneered by the Duchess of Cambridge, Action on Addiction’s patron.
All this points to a growing realisation that, given a chance to achieve abstinence, addicts can recover and make a full contribution to society. With such amazing work done by those in the civic sphere and strong foundations laid by those in the UK recovery movement over the decades, there is an atmosphere where perhaps, finally, politicians will match these efforts with financial backing. With an economic recovery underway, it is time to foster recovery from addiction.
Local budgets will continue to be squeezed but there is a compelling case, one that the Centre for Social Justice will make loudly in Breakthrough Britain II, that investing in full recovery more than pays for itself. Rather than 15 years on methadone, dependent on welfare and slipping in and out of the criminal-justice system, residential rehab and decent aftercare offer the prospect of abstinence, employment and engaged citizens. This makes sense to the head as much as to the heart. It will be our task to ensure that this message is heard by all. This way, 2014 might just be remembered as the year recovery came to all parts of the UK.
HUSEYIN DJEMIL is a freelance commissioner and director of Green Apple Consulting and Towards Recovery.
The drug and alcohol world changed in April 2013 but you would be forgiven for not noticing. New commissioning structures, resulting from changes in health and social care legislation, went live and began to bed-in. But the impact has been largely delayed or deferred, as those new structures and/or organisations get to grips with their new responsibilities. So it will be April 2014 which will see realisation of those NHS and Social Care changes.
From a commissioner’s perspective…
>> Substance-misuse/Daat-partnership commissioners previously split across Local Authority and PCT structures have been relocated into Local Authorities. Changes to NHS and social care legislation, and the creation of police and crime commissioners has meant it can feel like a continuous ‘moving-day’ for all concerned.
>> Some commissioners are in new Public Health Department teams as substance-misuse commissioning leads while others sit in a Community Safety structure. All are moving toward being in a Public Health Team within a top-tier Local Authority. So moving-day and competition for limited commissioning posts are what commissioners will face in 2014.
>> They will also need to plan for, implement and monitor the substance-misuse treatment system in their area while trying to re-orientate or dovetail that system to be more recovery focused.
>> Another feature of 2014 will be tendering of services to simplify the commissioning landscape, save money, protect services from inhouse/local-authority-driven spending reviews and develop links to local recovery networks. Some of this might also be driven by compliance with Local Authority Standing Orders, where treatment services have not been put out to competition for sometime – or, in some cases, ever.
All these impact service delivery and service providers as they feel the stress down the line – for example, in lack of meaningful engagement with the commissioner because the latter is in a state of change, because local structures changed and make communication more cumbersome, or where existing service providers are required by the commissioner to give data for a tender process.
From a service provider’s point of view…
Regardless of what type of service you are involved in providing, it always makes sense to:
>> stay close to the service user, keep adding value
>> “play to the whistle” – be clear who has the budget and responsibility for the service you deliver
>> understand and meet contractual requirements.
Services wishing to defend or expand need to:
>> learn to tender (more details in February issue)
>> re-learn the art of fundraising
>> embrace social enterprise (to act as ‘donor-vehicle’)
>> ensure sustainability beyond the reliance on government-based contracts or funding.
>> Payment by Results might mean providers end up in a quasi-commissioning role.
Tier-4 or residential treatment is still largely commissioned on an ad hoc basis, rather than a multi-year budget planning process. There is a trend for commissioners to use ‘framework agreements’ so that service providers bid for the “right to provide” as part of a “pre-approved” list where their residential treatment is matched to client need. This is the equivalent of a zero-hours contract – no guaranteed client placements.
Public Health England is promoting the status quo for clinical and psychosocial treatment whereby clinical=get medically stable and psychosocial=talk to someone about why you do what you do. Then advice to commissioners is that clients are assertively linked to a positive social network. This is excellent advice – but, unless the interventions along the client treatment journey are of adequate weight, depth and intensity (usually where an appropriate stay in a residential facility comes into its own), we risk repeating the mistakes of the past in a new context.
MARK GILMAN is strategic recovery lead for Public Health England.
In the coming year, we are expecting to see widespread and high-level acceptance of the vital role of mutual aid in achieving and sustaining long-term recovery. Mutual-aid organisations, including Alcoholics Anonymous, Narcotics Anonymous and Smart Recovery, should prepare for a steady influx of newcomers from treatment services.
Supportive peer relationships with individuals who are themselves on the journey to recovery are a vital element in helping someone to build and sustain their own recovery from drug or alcohol addiction. So Public Health England is calling on the treatment sector to strengthen its links with mutual-aid organisations, to ensure that everyone in treatment can benefit from this support.
A new toolkit of resources for use by partnerships, treatment providers and keyworkers will help them to understand what links are in place between local treatment services and mutual-aid . It should also help them to do more to encourage clients to attend and participate as part of their recovery journey. Partnerships can use the new self- assessment tool to understand what mutual-aid groups exist locally, local barriers to access and whether or not the local treatment workforce supports participation by clients.
There is a strong evidence base for the effectiveness of mutual aid in supporting people’s recovery. Nice recommends that treatment staff should routinely provide people who have shown an interest in attending with information about mutual-aid groups and encourage and facilitate all their clients to engage with mutual aid.
There are significant gains to be had – for instance, adding just one abstinent person to a drinker’s social network raises the probability of abstinence in the next year by 27%.
DEIRDRE BOYD is CEO of the Addiction Recovery Foundation, editor of Addiction Today, cofounder of UK/European Symposia on Addictive Disorders.
First of all: a prosperous and fulfilling new year to all those best-practice organisations which save not only the lives and quality of life of addicts wishing to recover, but also their families. You deserve to blossom in 2014.
What might the year offer? There is space here only for bullet points, but we will elaborate on them in future issues and with interested parties.
The value of mutual-aid organisations, which this journal/charity has championed since 1989, will be increasingly supported by government – sadly, in some cases, to replace treatment but overall a cost- and clinical-effective strategy. Their free life-long support has a solid evidence base.
Small organisations which depend on statutory funding could continue to decline – 24 such rehabs closed at an average rate of one per month before the general election in May 2010, and 18 addiction-treatment units closed since.
Some treatment organisations will try to avoid closure by merging – eight made merger announcements in the past six months and more are expected this year.
Since January 2012, the sector became more fractured and competitive as some organisations’ leaders sought power/revenue in unhelpful ways – one received influential favours to help expunge abstinence as a NDTMS outcome measure, one wrote to commissioners offering to undercut all agencies (with resulting financial deficit and loss of contract due to poor service and outcomes), one wrote to CQC and other inspectors to pay unexpected visits to competitors, some misled influential politicians utterly about events so that resources were diverted from optimum value. And too many people were bullied into silence in the name of “unity”, perpetuating poor practice.
Divisive behaviours such as the above pitched harm-reduction agencies against abstinence-based ones – but like against like even more so, as the latter are seen as more-direct competition. The greatest gap in the alcohol/drug-treatment field remains not harm reduction ‘versus’ abstinence but bad-quality vs better-quality services. Good/improving organisations work more closely across the spectrum of care – for example, Addaction referring clients to Action on Addiction’s rehab.
Sadly, the lack of unity over the past two years might continue, due not only to disinformation but also because of the lack of a common purpose, such as drafting the 2010 drug policy gave.
Private-pay rehabs will continue to raise their quality and offerings – One40 and The Manor are examples – while too many of those dependent on public moneys will continue to cut corners.
Having said that, some larger organisations known in the field for poor-quality ‘treatment’ have raised their game. Many are also linking to mutual-aid groups to help more people to recover in the true meaning of the word.
Organisations will have to deliberate whether to deliver a traditional clinical model of treatment, or move towards a more social model and/or become subcontractors to corporates bidding for county-wide government contracts and/or compete for outsourced contracts.
Organisations looking to the long term should also gaze internationally, using business plans more like the private than statutory sector.
At some stage, mandatory minimum standards and re/accreditation for ‘gold standard’ drug and alcohol-recovery workers/agencies must be introduced Europe-wide, and inadequate lowest-common-denominator guidelines exposed.