Date Published: 7 September 2006

UK - Drug treatment getting better but still too patchy, say watchdogs

Drug treatment services are getting better, however more needs to be done to reduce variations in care across the country.

This is the main message of a national review published today by the Healthcare Commission and the National Treatment Agency for Substance Misuse.

The joint review of substance misuse services assessed performance against national standards. The review looks at whether local services prescribe drugs safely and appropriately, as well as plan treatment and coordinate services well.

The national review covered 149 drug action teams (DATs). DATs are partnerships responsible for drug treatment services in England and are made up of representatives from NHS trusts, social services, the police, the probation service, and the voluntary sector. All 56 mental health trusts and 303 primary care trusts within those DATs have also been given a score.

71% of DATs were rated as ?fair?, 23% as ?good?, 5% as ?excellent”and 1% as ?weak?.

The trust level results can be broken down as follows:

  • Excellent: One mental health trust and 13 PCTs (4% of the total) received a score of ?excellent”
  • Good: Twenty-one mental health trusts (38% of the total) and 73 PCTs (24% of the total) received a score of ?good”
  • Fair: Thirty-four mental health trusts (61% of the total) and 211 PCTs (70%) of the total) received a score of ?fair”
  • Weak: No mental health trusts and six PCTs (2% of the total) received a score of ?weak?

The Healthcare Commission will use the review in its annual rating of mental health and primary care trusts.

Access to and the capacity of substance misuse services has improved dramatically in recent years. Around 160,000 people joined treatment programmes in 2004/2005 compared with 85,000 in 1998/1999, a rise of 89%.

Government investment has triggered a significant expansion in services that has cut waiting times, down from an average of 9.1 weeks in December 2001 to 2.4 weeks in September 2005. However despite this there are still a number of areas where drug treatment service can make improvements.

Emerging conclusions are that drug treatment services need to:

  • Keep service users in treatment longer.
    Drug treatment takes time and research has shown that service users are likely to get a better outcome if they remain in treatment for at least 12 weeks. There have been widespread improvements in this area with 72% of local drug partnerships improving on the 2004/2005 national average for retention and 69% improving on the average for planned discharges*. However, a minority of DATs scored ?weak' on these measures ? 14% had a smaller percentage of service users in treatment for 12 weeks than the 2004/05 average and 11% had fewer planned discharges
  • Improve methadone prescribing.
    Heroin users are often prescribed methadone as part of their treatment. The majority (95%) of services have good policies on methadone prescribing, however some services are still prescribing insufficient doses to maintain users and prevent the use of street drugs. There is a need to move away from standard policies, which prescribe the same amount for each service user and for prescribing to be linked more closely to individual need. In addition, more patients need to be supervised during methadone consumption in the early stages of treatment.
  • Involve service users more.
    It is best practice to involve service users in the design and development of drug treatment services. Thirty-seven per cent of DATs scored ?good' or ?excellent' for supporting user involvement and 7% scored poorly. This suggests that some systems are much better developed than others. Twenty-three per cent do not have local user forums, 31% do not have access to strategic planning groups for service users and 40% do not offer training and/or mentoring for service users to enable participation in service planning and monitoring
  • More consistent use of individual care plans.
    Every service user should have a comprehensive assessment of their needs and a personal care plan outlining the best course of treatment for them. The review found not enough people who use drug treatment services have these, with 48% of DATs being ?weak' in this area, and 32% rated ?fair'. In particular, the level of risk assessment was weak with 70 per cent of partnerships scoring ?weak' when assessing and managing risks for service users
  • Improve commissioning.
    Local drug partnerships, including primary care trusts (PCTs), need to improve their commissioning of drug treatment, including substitute prescribing. Sixty-three per cent of DATs were rated as ?weak' or ?fair' when it came to assessing the detail of their specifications for community prescribing interventions.

The Healthcare Commission and the NTA will also publish a national report detailing the overall findings later in the year.

All of the DATs and trusts reviewed have now received individual reports highlighting their scores and areas for improvement. The Commission and the NTA are working with the minority of organisations with the weakest ratings to develop action plans to improve their performance.

The NTA regional teams in their performance management of DATs will also use the results of the review. DATs will, in turn, use the results to improve their commissioning and performance management of prescribing and care planning and coordination.

This review of substance misuse services is the second of four topics to publish as part of the Healthcare Commission's new improvement reviews. The improvement reviews form part of the Commission's new system for assessing NHS performance, the annual health check.

Anna Walker, the Healthcare Commission's Chief Executive, said:

The number of problem drug users accessing treatment has increased dramatically in recent years, and that is good news. However, we now need to focus on improving quality. It is important that service users get the best treatment wherever they are and that they are encouraged to stay in treatment long enough to stabilise their condition. This review highlights excellent as well as poor practice, allowing the poorer performers to learn from the best.?

Paul Hayes, the NTA's Chief Executive said:

Drug dependency is concentrated amongst the most vulnerable people living in England and most disadvantaged communities. Twice as many people now have access to drug treatment as in 1998 and the experience of most of those in treatment is that the quality of the treatment they receive is improving. Effective drug treatment delivers benefits to individuals, reduces the spread of blood borne viruses, such as HIV and hepatitis within the population at large, and improves the safety of communities by reducing drug related crime.

However this review clearly demonstrates that in some places, local partnerships and health providers are failing to deliver the high quality of care needed to help people turn their lives around.

The findings for this review will ensure the NTA can focus its work on the areas which are failing their populations, to ensure that the worst performing areas match the quality of delivery elsewhere?.

Source: The Healthcare Commission (England, UK).
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