Published: 09 May 2008
Need to Improve Drug Addiction Treatment
Healthcare watchdogs are calling for a continued drive to improve drug addiction treatment, to ensure services are delivered consistently across the country.
A report released by the Healthcare Commission and the National Treatment Agency (NTA), shows results from the second of three annual reviews to assess the performance of substance misuse treatment services.
Focusing specifically on how services are commissioned and harm reduction service provision, the findings reveal the majority of services are performing well within acceptable levels across these categories.
The number of people receiving specialist drug treatment has increased, with 195,400 in treatment during 2006/07 - up from 85,000 in 1998/99. Estimates for 2007/8 show 210,800 people will receive treatment.
The review showed that there had been considerable improvement in the commissioning & performance management of drug treatment services, resulting in more service users receiving better treatment.
However, there were significant deficits, particularly in the provision of vaccination for hepatitis B and testing and treatment for hepatitis C. As 90% of all hepatitis C diagnoses are associated with injecting drug use, this is a key area of concern.
The review covered 149 ‘local drug partnerships’ in England.
Drug treatment is provided by a network of services, commissioned by local partnerships of statutory agencies within a particular locality, rather than being provided by individual organisations.
These networks or ‘local drug partnerships’ are aligned to local authority boundaries. They bring together representatives of local organisations involved in the delivery of the drug strategy, including primary care trusts, local authorities, the police and the probation service.
Partnerships were asked 45 questions across 10 criteria. Each area was then scored on a scale; “weak”, “fair”, “good” and “excellent”:
- 34% of local drug partnerships had an overall score of “excellent”
- 45% were “good” and
- 21% were “fair”
No partnerships had an overall score of “weak”, however the review revealed the majority of partnerships had deficits in key areas.
The review confirmed widespread good practice in relation to commissioning performance management, but also showed that many areas did not have an adequate understanding of local need through systematic assessments.
Since the review the Commission and the NTA have issued guidance and supported action plans to address this issue.
Partnerships also made significant progress in relation to care planning and treatment discharge systems, with nearly all (99%) achieving or exceeding 70% of their local target.
A good standard of financial management was found across the sector, with 60% of partnerships achieving the maximum score for this area.
Anna Walker, Chief Executive of the Commission, said:
“Substance misuse affects not only the individual concerned but their families, friends, and the communities they live in.
As the UK has one of the highest recorded drug-related death rates in Europe, it is a clear national priority to minimise the impact of substance misuse.
It’s very encouraging that thousands more people are now getting the treatment they need, and this review shows there is much to celebrate about the progress that has been made.
However, it is worrying that the majority of hepatitis C cases are associated with injecting drugs, yet we know access to testing and treatment for the disease is patchy across the country. Similarly, access to clean needles provided by out of hours exchanges varies considerably. These are the areas that need to improve if the health of those who inject drugs is to be tackled effectively, and drug-related deaths reduced.
Partnerships must now concentrate on driving improvements in the key areas highlighted by the review, in order to provide an equal service to all patients across the country.
It is also important that partnerships really understand the needs in their area for these services and provides them accordingly.”
Paul Hayes, the Chief Executive of the National Treatment Agency for substance misuse, said:
"Effective commissioning underpins effective drug treatment delivery. The improvements in commissioning shown by this review are very welcome.
However the review also highlights inconsistent practice across the country in key areas of delivery such as testing for and treatment of hepatitis B and C.
The NTA will be working with all partnerships to spread best practice more consistently and has agreed action plans for improvement with the poorest performing areas."
Following the results of this review, work has been carried out by the Commission and the NTA with the 25 lowest performing partnerships. Action plans were to developed to improve performance and good progress has already been made implementing this.
The Commission and the NTA will follow up this report with a third and final review into this sector. This will look at diversity and residential services and will complete what has been a comprehensive review of the provision of substance misuse treatment.
The National treatment agency is engaging the sector in a range of initiatives and programmes to address the deficits identified by the review.
The joint NTA/Department of Health action plan, Reducing drug-related harm was published in May 2007, and includes a national campaign aiming to tackle these and other harm reduction issues to begin in October this year.
In relation to commissioning, the NTA continues to support the work of local areas in relation to treatment planning and needs assessment. 2008 will also see the publication of new guidance initiatives to enhance commissioning practice.
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