PUBLIC HEALTH ENGLAND: ANY RECOVERY?
For the first time, public health will be measured against a framework which sets out 66 health measures, so councils and government can compare progress against them. From April 2013, councils will be given a ringfenced budget – a share of £5.2billion – and choose how they spend it. Recovery providers must start campaigning NOW to get a fair share, Deirdre Boyd explains.
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From April 2013, public health will be measured against a framework of 66 health measures, for which local councils will be given a ringfenced budget – a share of about £5.2billion based on 2012/13 funding – which they can choose how to spend based on needs of their population. Those who make the most improvements will be rewarded with a cash incentive.
But to read the Department of Health press releases, you would not think there was a drug/ alcohol/ addiction problem in this country – as they are not mentioned.
Instead we are told that “The results this progress will be measured against include: fewer children under 5 will have tooth decay, people will weigh less, more women will breastfeed their babies, fewer over 65s will suffer falls, fewer people will smoke, fewer people will die from heart disease and stroke… It’s also about tackling the causes of ill health. That is why the new measures also look at school attendance, domestic abuse, homelessness and air pollution”.
What this means is that providers of addiction-recovery services will be competing for the ‘ringfenced’ budget against more services than ever before, in other areas of health.
HEALTH AND SOCIAL CARE BILL: CHANGES AT A GLANCE
* GPs to take responsibility for £80billion of NHS spending from managers from 2013
* Responsibility for public health to be handed from NHS to local councils
* The 152 NHS primary care trusts and 10 strategic health authorities to be abolished. Over 20,000 managers redundant.
* A super-quango, the NHS Commissioning Board, to take over day-to-day running of the NHS, from the health secretary
* HealthWatch will scrutinise complaints.
PUBLIC HEALTH OUTCOMES FRAMEWORK
The new public health outcomes framework sets out desired outcomes for public health and how these will be measured. The framework concentrates on two high-level outcomes to be achieved across the public health system:
— increased healthy life expectancy
— reduced differences in life expectancy and healthy life expectancy between communities.
A set of supporting public health indicators will help focus understanding of progress year by year nationally and locally on those things that matter most to public health. The indicators, which cover the full spectrum of public health and what can be currently realistically measured, are grouped into four ‘domains’:
1: improving the wider determinants of health
2: health improvement
3: health protection
4: healthcare public health and preventing premature mortality.
The DoH states that it “intends to improve this range of information over the coming year and the framework also sets out how it intends to do that, with the continued engagement and involvement of its partners at local and national levels”. So providers of addiction-recovery services must not only be ready with evidence on return on investment in their services, but be out and about proactively engaging with their MPs, for example, to put pressure on local GPs and others who can refer vulnerable clients to them.
WHICH OF THE 66 OUTCOMES RELATE TO DRUGS RECOVERY?
Let us look first at the DoH document Improving outcomes and supporting transparency, Part 1. Under the domain of Health Improvement comes “successful completion of drug treatment” – a term which has wildly erratic interpretations, as readers of Addiction Today know well. It is one of only 24 indicators under this domain.
“Alcohol-related admissions to hospital” also comes under this heading.
“Mortality from causes considered preventable” is mentioned under the fourth domain of Healthcare Public Health and Preventing Premature Mortality. Perhaps we can take it to include deaths from drugs and alcohol, as these are not mentioned elsewhere?
Indicators include mortality from cancer, liver disease, respiratory disease and communicable diseases. If there is an understanding that drugs including alcohol misuse contribute to these, then it is tacit.
Alcohol and drugs are not mentioned at all in the other two domains.
FIND THE BREAKDOWN DETAILS
There is more detail in Annex C of the framework document, which gives a Breakdown of indicators: Local disaggregation, inequalities and qualities characteristics. Without referring to drugs/alcohol, it does list characteristics which professionals can link to their misuse. Under domain 1 of improving the wider determinants of health, NYGoodHealth, come sub-indicators such as pupil absence, entrants to youth justice system, 16-18 year olds not in education/employment/training, people receiving secondary mental-health services in settled accommodation, people in prison with a mental illness, employment for those with a long-term health condition, employee sickness, car accidents, domestic violence, homelessness and social connectedness.
Under domain 2, Health improvement, on page 42 we at last see direct mention of drug/ alcohol sub-indicators, as below.
2.15: Successful completion of drug treatment
2.16: People entering prison with a substance dependence issue who are not previously known to the treatment community
2.18: Alcohol-related admissions to hospital.
Uh… that’s it.
TECHNICAL SPECS OFFER MOST INFO
More details is given in Improving outcomes and supporting transparency, Part 2: Summary technical specifications of public health indicators. Here, the first mention of drugs is on page 20 under point 1.13 Re-offending. “Tackling a person’s offending behaviour is often intrinsically linked to their physical and mental health, and in particular any substance misuse issues… The consequences of tackling [this] will therefore benefit a wide range of services agencies”.
We then go to 2.8 Emotional wellbeing of looked after children. “Without an indicator covering this group, there would be a risk of an even greater increase in rates of undiagnosed mental health problems… alcohol and substance misuse…” it states.
2.10 Hospital admissions as a result of self harm also mentions “With the risk of deaths by suicide being considerably higher among people who have self-harmed, and with their high rates of mental health problems, and alcohol and substance misuse, it is essential that professionals address the experience”.
2.15 Successful completion of drug treatment provides the key information for providers, and is reproduced in full below.
“Individuals achieving this outcome demonstrate a significant improvement in health and wellbeing in terms of increased longevity, reduced blood-borne virus transmission, improved parenting skills and improved physical and psychological health.
It aligns with the ambition of both public health and the government’s drug strategy of increasing the number of individuals recovering from addiction. It also aligns well with the reducing re-offending outcome [Indicator 1.13] as offending behaviour is closely linked to substance use and it is well demonstrated that cessation of drug use reduces re-offending significantly. This in turn will have benefits to a range of wider services and will address those who cause the most harm in local communities.
The indicator definition is ready: Number of drug users that left drug treatment successfully (free of drug(s) of dependence) who do not then re-present to treatment again within six months as a proportion of the total number in treatment.
Numerator: Number of adults that successfully complete treatment in a year and who do not re-present to treatment within six months.
Denominator: The total number of adults in treatment in a year.
The data source is ready: National Drug Treatment Monitoring System.
Published monthly by the National Treatment Agency for Substance Misuse by Drug/Alcohol Action Teams: www.ndtms.net/Reports.aspx.”
That is it: one key outcome measure, which has a history of being misinterpreted.
You can also find mention of treating drugs and alcohol at 2.16 People entering prison with substance dependence issues who are previously not known to community treatment. “There is significant evidence that treatment interventions for the management of substance misuse can help to reduce re-offending,” the paper acknowledges. “This indicator will be a measure of successful outcome of treatment interventions in the community. It will also serve as a measure of primary and secondary prevention work on the development of problematic substance misuse among vulnerable groups.”
Work is ongoing with the Ministry of Justice and National Offender Management Service to develop this indicator. First data are expected to be available from June 2012.
Relevant DoH documents are listed below, so that you double-check the information in this article. I hope that the tiny space allocated to recovery from drug/alcohol addiction spurs readers to a realisation that you must act now to secure your fair share of funding and referrals.
FIND THE RELEVANT DOCUMENTS
Improving outcomes and supporting transparency – Part 1: A public health outcomes framework for England, 2013-2016 introduces the overarching vision, the desired outcomes for public health, and the indicators.
Part 2: Summary technical specifications of public health indicators gives the more detailed indicators.
Finally, there is a Public Health Outcomes Framework summary factsheet.
Deirdre Boyd is CEO of the Addiction Recovery Foundation, editor of Addiction Today, organiser of the UK/European Symposia on Addictive Disorders and convener of the Concordat of abstinence-based providers. She was awarded the Directory of Social Change 'Influencer of the Year' award by public vote in 2011.