How Was It For You? - A Drug Policy Review of the Year (Part 1)
Saturday/29/Dec 2007 Filed in:
Publications and
News
2007 was a busy year for drug policy with funding, legislative amendments and some major policy reports dominating the agenda. Cannabis hit the headlines again ... and again... and again. Everyone wondered what a new Prime Minister - or even a general election - might mean for drug policy. In Scotland big questions began to be asked about the purpose of drug treatment - and methadone in particular. Another issue being looked at closely was the effectiveness of drug education - of course it would have helped if everyone could have agreed what it was meant to do in the first place ...
We began the year waiting for the new drug strategy with baited breath. Ideally, to fit in with the timetable for the Comprehensive Spending Review (and so make sure we had the right Public Service Agreement and enable the appropriate integration of drug strategy into the rest of our public services and policy) we needed to be hitting the ground running with the new strategy going out to consultation for the statutory 12 weeks at the beginning of January 2007 ......
JANUARY didn't bring us a new drug strategy. It did bring us the reclassification of Methamphetamine
The Misuse of Drugs Act 1971 (Amendment) Order 2006
and a commitment made by the Home Secretary to leave cannabis as a Class C substance. There was also the launch of a new PR campaign by the Home Office to link drugs treatment and crime prevention more firmly in the public mind - the "CHANGING LIVES MAKING COMMUNITIES SAFER" Campaign.
The Home Office published Matrix's evaluation of the young people's Tough Choices-style pilots which concluded that arrest referral was quite a good idea, DTTO's might or might not work for the under 18s but they couldn't really say for sure and that drug testing was ineffective and a waste of money. Possibly most interesting however about the pilots is what is described in a draft report on the redoubtable Findings site as:
"... serious procedural irregularities. Though mandatory, appropriate adults were recorded as present at only three-quarters of tests and just 11% involving 17-year-olds. Home Office checks elicited the questionable explanation that most such incidents were due to data entry error"
Read more at http://www.findings.org.uk/docs/bulletins/Bull_7_1_08.htm#patch
Late January also brought us the announcement of a substantial cut in the Pooled Treatment Budget. You'd be forgiven for not realising this because in true "Thick of It" style, it was announced as an increase. Back in 2005, DATs had been given an indicative three year budget
dh.gov.uk…idcplg?IdcService=GET_FILE&dID=27370&Rendition=Web
and told to plan on the basis of these figures. However on the 29th January 2007 came the news that rather than looking at a 20 - 30% increase in funding, some DATs would be looking at a reduction and many would be looking at a standstill budget
nta.nhs.uk…nta_ptb_announcement_phletter_290107.pdf.
Instead of £442 million, the actual allocation would be £398 million. The timing of this announcement couldn't have been worse - coming as it did AFTER the submission of the treatment plans, and AFTER local budgets had been agreed - AFTER spending had been planned and committed on the basis of the announced figures. Pandemonium ensued, with many commissioners needing to cut back on service investments at very short notice. This didn't stop Caroline Flint confidently stating
‘Today’s announcement demonstrates drug treatment remains a key priority for funding for government’
In FEBRUARY similar cuts were anticipated across young people's budgets. At the same time rumours began to spread that none of the non-intensive DIP areas would be made intensive as they'd been thought - again due to funding. This made a lot of people (particularly police) very unhappy. Many areas and partnerships believed that a key issue for non intensive DIP areas was the displacement of drug related crime from DIP Intensive areas - and had been lobbying hard for a more uniform approach. Unfortunately the two tier approach has persisted.
On the positive side, in February came the announcement of the successful bidders for the £54 million single capital grant for tier 4 services. While welcoming the investment that would provide critical support to the residential drug treatment services by enabling them to modernise in line with new criteria for residential social care (ensuring facilities include adequate sanitation and catering facilities for example) it was felt by some in the field to be unhelpful to make capital grants available with no commitment to continuous funding. Critically, many across the field said that the real issues that needed to be tackled were less funding and more system design and commissioning at tier four. The NTA responded by promising new guidance to encourage a "step change in Commissioning practice" in April. A draft of this guidance was published in June 2007 for consultation.
nta.nhs.uk…improving_tier_4_quality_and_provision_consultation_draft.pdf
NICE (The National Institute for Clinical Excellence) launched their review of Drug Treatment - a move welcomed by most across the field as yielding a fresh view of the evidence for clinical practice. The findings have of course since been published as the new guidelines.
February also brought us the review of progress against the objectives of the ACMD report "Hidden Harm " that said that while progress had been made across the UK - particularly in the devolved adminsitrations - it was not consistent. Hidden Harm - Three Years On
drugs.homeoffice.gov.uk…HiddenHarm20071.pdf?view=Binary
In a rare foray for this blog North of the border, we find that February was the month when controversy over methadone reached fever pitch in Scotland. In what's still a hot topic (Methadone fails 97% of drug addicts - Scotland on Sunday) the question of what drug treatment is for and what it should achieve came under close scrutiny. Following the death of a two year old toddler from methadone poisoning the previous December, in late February First Minister Jack McConnell announced a review into Scotland's methadone prescribing. This coupled with the "shock finding" (to be exposed again later in the year by BBC Home Affairs Editor Mark Easton) that methadone is not a particularly effective way to stop people using opiates (being a harm reduction measure rather than a cure) brought the risks as well as the benefits of methadone prescribing into the political arena. There's a useful overview of some of this debate by Mike Ashton at
The New Abstentionists
and you can read the report of the review here Review of Methadone in Drug Treatment: Prescribing Information and Practice.
More analysis of the political opportunities and threats around drugs in Scotland is available on the indispensable SDF comment pages at Scottish Drugs forum - SdF Comment.
MARCH was a busy month. On the 7th The Royal Society for the Encouragement of Arts, Manufactures & Commerce (RSA) published the final report of their commission into Illegal Drugs and Public Policy. Drawing strongly on the experience of those on the Commission as well as the work of others in the field, the RSA made a number of recommendations that explored issues such as commissioning, person centred approaches and mainstreaming. However, predictably the key finding for the media was the call for an overhaul of the Misuse of Drugs Act. BBC NEWS | UK | Drug laws 'need major overhaul'
Take a look at how the RSA plan to take their work forward at rsadrugscommission
Later in the month, the Lancet published David Nutt and Colin Blakemore's work on a new framework for quantifying the harm of various substances..Read the report here . Unsuprisingly this rational approach rated alcohol as far more damaging than either ecstasy, cannabis or LSD. However largely ignoring not just this piece of work, but pretty much everything including common sense, the Independent on Sunday - that most didactic of all newspapers published its famous Cannabis Apology
Cannabis: An apology - Independent Online Edition > Health.
Recanting its 1997 call for decriminalisation the paper instead suggested that the Government consider reclassifying cannabis as a Class B - or even Class A drug. Closer inspection of course reveals that the paper was primarily basing its claims on NDTMS reports of people entering treatment for "cannabis addiction", and was assuming a correlation between higher legal status and reduction in drug related harm.
In the middle of the month a rather glitzy event was held at Congress House at which the Minister for Drugs Vernon Coaker answered some questions about drug policy in general and a range of civil servants from the NTA and the Home Office told us what they thought the successes from the past year had been. Dubbed "The Future of the Drug Strategy- Where next in Tackling Drugs to Change Lives?", the event was by invitation to a selected group of individuals. The issue of the paucity of young people's provision was raised - hardly suprising given the climate of alarm around budgets at this time. The minister made a commitment to tackle this issue.Similar events were held elsewhere (however none I believe had such a fine selection of canapes!).
Shortly afterwards the Scottish Drug Forum published their review of Drugs and Poverty. This invaluable work went largely unnoticed by many outside Scotland, but with its overview of the clear linkages between improving outcomes for people experiencing problems with drugs and mainstream anti poverty and social inclusion initiatives it should be required reading for anyone who believes all you need is a script ....
sdf.org.uk…Drugs%20and%20Poverty%20Literature%20Review%2006.03.07.pdf
Right at the tail end of the month, in response to gathering criticism of the new version of NDTMS that demanded services provide much more information about each client entering treatment, Paul Hayes authored a humorous comment piece for Drink and Drug News. Paul drew the scenario of an interview with Jeremy Paxman on Newsnight) where the Prime Minister is asked to account for what happens to people in drug treatment and what value the public were getting for the investment. He is unable to do so and the result is an amusingly embarrassing episode on a prime BBC news programme.
drinkanddrugs.net…260307.pdf
Prescient as this may have been, Paul Hayes was right - the extension of NDTMS to include the additional data was a critical step in the implementation of the Treatment Outcome Profile (TOPs). TOPs is system whereby the progress people in drug treatment are making against a series of centrally defined outcomes can be measured. In some areas this is being established alongside person centred outcome systems as well - giving a comprehensive if occasionally cumbersome overview of what impact treatment is having. Interestingly for service users this is coming at a time when greater emphasis is being put centrally on the importance of the care plan - and there's a challenge for key workers to make sure that data collection doesn't replace assessment (as some have suggested it can tend to do with the DIR) . The critical issue for service providers is to ensure that all this work can take place without reducing the quality of the individual relationship between key worker and service user, while increasing the numbers of people retained in treatment beyond 12 weeks - and as we drive unit costs downwards.
In APRIL a number of senior policy figures, academics and researchers from the drugs field joined together as Commissioners of the newly launched United Kingdom Drug Policy Commission. The UKDPC's first action was to publish a review of UK Drug Policy by Peter Reuter and Alex Stevens
An Analysis of UK Drug Policy
which concluded that UK Drug Policy was having little if any impact on the levels of drug use in the UK, and that greater emphasis was needed on research and evaluation in our approach to tackling drugs. media coverage of the report emphasised the elements of the analysis which, rather than exploring whether the drug strategy had reduced the harm of drug use, focussed on whether the drug strategy had reduced drug use itself. In this way the report contributed to the ongoing debate about the value and risk of interventions whose prime focus is harm reduction rather than reducing levels of drug use itself. The report was also highly critical of drugs education programmes saying that they hadn't prevented an increase in the numbers of young people engaging in risky behaviour - which sparked this response from Andrew Brown at the Drug Education Forum blog:
"Drug education can't inoculate against drug use. What it can do is help support each young person’s belief in themselves and their worth, and ensure they know how to take care of themselves, or ask for help if they need it. What it can do is help young people develop and practise the skills they need in order to cope with a range of situations in a world where there are drugs. It can ensure they build a sound, reliable understanding of where hazards lie, and help prepare them to be fully accountable for their actions. What it can and should be expected to do is add to the mix of things that help reduce the risks that lead to problematic drug use, and help promote the protective factors. It can also create a climate in which it is possible to identify those at greatest risk, and provide them with targeted support. What it must also do is empower children and young people in the decisions they make and in a way that helps them to enjoy their learning."
Read more at Drug Education Forum Blog: April 2007
The National Institute for Clinical Excellence published new guidelines about community based interventions for vulnerable young people at risk of developing substance misuse problems. They highlighted the clear need for the emphasis to remain on early intervention and on initiatives that focus on the young person and their range of needs rather than just their drug use. This should be an invaluable contribution to an area of policy that at times has felt forgotten in the rush to prioritise young people's "treatment".
nice.org.uk…PHI004quickrefguide.pdf
At the same time, cuts to the Young People's Substance Misuse Budget were revealed in the final allocations. DrugScope asked for comments from DAT staff and service providers - identifying a 10% cut nationwide.
Drug and alcohol services for young people face cuts. Martin Barnes sounds the alarm... - 03/04/2007 - Communitycare.co.uk - the website for social work and social care professionals
On April 2nd a letter was sent out by the Home Office that outlined the timetable for the consultation on and publication of the new national drugs strategy. It stated that an external consultation document would be published in May, that the strategy would be finalised after consultation in September/October and that a final strategy would be published in October or November.
On the 16th April the NTA published 17 new briefings and research findings - including papers on Contingency Management, Drug Related Deaths, and the final results of the National Crack Evaluation Study.
NTA - Latest news: New publications from the NTA
Also during this month DrugScope launched a major national consultation. Talking to over 600 individuals made this the largest direct consultation held in 2007 around drug policy. The process involved a series of expert groups and regional workshops and sought engagement from everyone with a direct interest in drug policy. Issued discussed included the future role of DrugScope itself and some key issues for the drug strategy. You can find some more information about what we found out by reading the DrugScope response to the strategy consultation - conveniently available here Sara McGrail - Articles and Reports
In MAY the Drug Strategy Consultation was not published, but as the drive towards mainstreaming continued, a drug service provider kicked back at the decision of one group of commissioners to provide drugs treatment through primary care rather than a specialist service.
BBC NEWS | Wales | South East Wales | Drugs charity fears 'crime rise' .
This is probably the kind of situation - and response - we can expect to see more of through 2008 - and it will be interesting to see if Martin Blakeborough's predictions for rising crime rates as a result of this come true.
Gordon Brown, still PM in waiting in May announced that he wanted to see a radical overhaul of Britain's drug strategy. This suprised everyone - not least, one suspects, those responsible for drawing together the new drug strategy which had been widely leaked as being "no change" . In a speech from the hustings Brown called for earlier treatment for addicts, education schemes that start at primary schools and more positive role models. Gordon Browns interest in drugs shouldn't really have suprised anyone as he was instrumental in the development of the Communities Against Drugs programme in the early part of the century. His intervention at this point led many to hope that the new governments focus on integrated community level solutions would mean a shift away from the output driven crime focussed drugs strategy of the Blair years towards a more sophisticated approach.
Also in May the NTA published the Harm Reduction Action Plan. This 5 page document
dh.gov.uk…idcplg?IdcService=GET_FILE&dID=140605&Rendition=Web
was heavily criticised for containing no clear targets, objectives, actions or in fact a plan. However as it came off the back of Ministerial interest in the level of drug related deaths and the growing discomfort in public health circles about the levels of hepatitis C and HIV among injecting drug users it could be seen as an indication of future direction. Sure enough at a conference on the day of publication the Department of Health minister Caroline Flint announced an additional £1.9million would be invested in the action plan to fund improved data collection, training, health promotion campaigns and a regional roadshow. Some of this funding would also be used to help those areas identified as providing a poor response to harm reduction issues in the Healthcare Commission Reviews undertaken in partnership with the NTA. A tiny bit of cash, spread very thinly across an ill-defined programme of activity - but bounty undreamed of by comparison with what Government has been doing on harm reduction over the past 10 years.
In JUNE the Drug Strategy Consultation was not published, but the update to the 2004 National Alcohol Harm Reduction Strategy was. Despite being a well developed piece of analysis in many ways, Safe Sensible and Social - The Next Steps In the National Alcohol Strategy lacked two key things - adequate resources and in the light of this, a realistic framework for implementation. Though DATs were given the lead for implementation, there was no identified budget nor a set of ringfenced outcomes against which local budgets could be identified and committed. The Pooled Treatment Budget remained out of bounds and the opportunity to develop a person rather than substance focussed strategy is likely to remain a forlorn hope given the distinct developments of the two strategies (well, the alcohol one at least - there not being a drugs one .... yet). Some of the outcomes seem to have made it into the national indicator set, but most haven't. Without any effective local or national leverage to pull resources and commitment to the DAT table, the next steps may well be trickier than they appear from an initial read.
The Treatment Outcome Profile was rolled out from mid June - more of a whimper than a bang in the end. Though big news for those fed up with waiting times and retention for 12 weeks being the only nationally measured outcomes of drug treatment.
A debate about the ability of people involved in drug services to speak out openly about what's going on in the field reached a saddening conclusion in the pages of Drink and Drugs News where an anonymous letter writer said:
"... But what neither the NTA nor regional government offices want is intelligent, questioning, reflective, challenging workers and commissioners. What they actually want is political and technical compliance with centrally driven policy agendas – because that is how they, in turn, are performance managed. Anyone identified as openly criticising current policy or practice (from within the field) is seen as a boat-rocking saboteur by those at the centre ... There is no freedom to deviate, innovate or protest; and one’s job security in the field (including, I suspect, Paul Hayes’) is directly related to one’s willingness to shut up and do as one is told. As the NTA recently announced in a presentation on young people’s services: ‘We are the experts; resistance is futile’. "
Was that boat-rocking or vote-rocking?
The Joseph Rowntree Foundation published its Review of the Evidence on Consumption Rooms concluding that it is an option for control of the drug using population that should be explored
The Report of the Independent Working Group on Drug Consumption Rooms.
In JULY the Drug Strategy Consultation was finally published and the Home Secretary asked the ACMD to review the evidence around the harms of cannabis .... again..... but more of that in part two next week.