VITAL CHANGES NEEDED TO NDTMS DISCHARGE CODES
CONCORDAT RECOMMENDATIONS RE OUTCOME DATA
Easter Monday was not the most convenient deadline for rehabs to submit suggested changes which could affect their survival – and that of their vulnerable clients – to the National Treatment Agency for Substance Misuse. But perhaps we should just appreciate that the NTA has, after a decade, acknowledged that “current [NDTMS data gathering/statistical] codes do not accurately reflect the care pathways for people who finish treatment at residential rehabs”. It offered rehabs a chance to comment on related new codes for the National Drug Treatment Monitoring System.
Download AddictionToday136 – NDTMS recommendations
Seemingly banal, these are crucial because rehab areas’ share of future budgets will depend on “successful completions” and related items in these codes. Members of the Concordat of providers of full recovery submitted key points to be collated by convener Deirdre Boyd and sent back to all members for approval, then submitted to a NDTMS edress given by the NTA. The key issues are summarised below. First, let's look at the accompanying Business Definitions.
BUSINESS DEFINITION FOR ADULT DRUG TREATMENT PROVIDERS v 8.03
At least two key changes are vital in the accompanying NDTMS Business Definitions, as follows.
C5 Residential rehabilitation – definition of intervention. The current definition should replace the word including to consisting of, so that definition of residential rehab will read “Drug residential rehabilitation consists of a range of treatment delivery models or programmes to address drug and alcohol misuse, consisting of abstinence orientated drug interventions within the context of residential accommodation”.
This is to end the NTA’s confusion of abstinent and non-abstinent services, so that un/successful outcome data can be more accurately attributed, to give a true foundation for future commissioning, funding and policy.
C7 Structured psychosocial intervention – definitions. This states that psychosocial interventions should be delivered according to NICE guidelines. But the Concordat and others formally responded in early 2011 that the NICE psychosocial guidelines must be reviewed as they endanger lives and increase costs by (a) stating that rehab is a last resort and all other options must be attempted first, no matter how clinically inapt, which has led to patients deteriorating into hospital emergency departments, and (b) the NICE guidelines ignore the ever-increasing body of evidence for 12-step facilitation and linked therapies which are used in rehabs.
DISCHARGE CODES: OUR RECOMMENDATIONS
First, the four additional discharge codes are not adequate, as there is no option to show clients who require urgent inpatient treatment, either for medical or psychiatric problems, beyond the remit of residential treatment programmes. This might be recorded as:
o Transferred – residential programme completed – drug free – hospital inpatient services required
o Transferred – residential programme completed – occasional user (not heroin or crack) – hospital inpatient services required
o Transferred – residential programme not completed – drug free – hospital inpatient services required
o Transferred – residential programme not completed – occasional user (not heroin or crack) – hospital inpatient services required.
The need for such codes was highlighted in the two Concordat reports, The State of Residential Rehabilitation in England – Nov 2011 and Rehabs and NDTMS – Addendum to The State of Residential Rehabilitation in England.
2.2 To maintain consistency with the ‘Treatment Completed’ data items, and to monitor if clients are ‘drug free’ or ‘occasional user’ when leaving a Tier 4 facility, it would be helpful if these options were included across the board. An example might be:
o Transferred – residential programme completed – drug free – more residential treatment required
o Transferred – residential programme completed – occasional user (not heroin or crack) – more residential treatment required.
There should be inclusion of a definition of “drug free” as “free from all psychoactive drugs including alcohol and z-drugs” – otherwise, there will be confusion as to whether clients’ causes of addiction have been addressed or only symptoms, leading to cross-addiction and re-presentation after six months, which will in turn be ‘gamed’ and thus not yield an accurate picture of what works and what does not.
3.2 Reference to benzodiazepines and other z-drugs should be included in discharge codes.
3.4 Recording ‘drug free’ or ‘occasional user’ alongside every discharge option is imperative. For example: A service user could be arrested while in residential treatment for an offence committed prior to rehab. This would be recorded as ‘Incomplete – retained in custody’. He/she might be drug/alcohol free at this point. In another example, a user could be admitted to residential treatment, then decide to leave. This would be recorded as ‘Incomplete – treatment commencement declined by client’ but he/she could be drug/alcohol free.
Training. Training promised by the NTA has not materialised. The Addiction Recovery Foundation and Concordat had urged this at RGUK meetings so that a harmonisation and consistency of reporting/inputting data could be pursued, so that everyone – providers, data gatherers, officials and politicians as well as the public – all understood the same meaning from the same words and phrases.
We asked also that rehabs be contacted not on a one by one basis which can lead to misunderstandings, but via the Concordat, again to increase consistency, similarity of message and thus quality of data.
Dummy runs and error codes. We note that prisons were due to run dummy reports in April to see what error codes pop up as they change from DirWeb to NDTMS dataset I. The Concordat requested the NTA to share in a timely fashion with residential rehab providers any errors which could affect them also, so they can be addressed.
Moving areas and statistics. If clients move from England to other parts of the UK and resume their drug use, it might not be picked up in the english system, so commissioners could payout on an outcome that didn’t happen just because an english drug user went “off the reservation” as it were. We urge that this gap be addressed.