Healthcare Watchdogs Call For Consistency In Drug Treatment Throughout Country, England
- Saturday, December 30, 2006, 13:55
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Healthcare watchdogs today called for action to address inconsistent standards of care provided by substance misuse services across England.
These findings were released in a joint national report, which reveals the overall findings of a review carried out by the Healthcare Commission and National Treatment Agency for Substance Misuse (NTA).
Drug misuse affects all aspects of society. The Government estimates drug misuse costs between £10 billion and £18 billion a year and it is clear it affects the life of the individual, the families and the communities they live in.
The review assessed whether local services prescribed drugs safely and planned treatment and coordinated services appropriately. It covered 149 drug action teams (DATs) in England. DATs are partnerships responsible for drug treatment services 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 within those DATs have also been covered within the review.
On the whole, the review showed drug treatment services are getting better and most people in treatment believe services are improving. But it also highlighted several areas of concern where there are variations in the quality of care across England.
Improvements suggested included:
– Strengthen commissioning of prescribing services
Thirty eight percent of local drug partnerships scored “weak†and 37% scored “good†in the commissioning of prescribing services, suggesting practice varies across England. The report found DATs need to ensure they have contracts in place with all service providers and contracts and service level agreements need to include detailed specifications and expectations about service delivery.
– Improve methadone prescribing
Heroin users are often prescribed methadone as part of their treatment. The majority 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. The mean methadone dose nationally was 57mg. Only 30% of services had a mean dose above 60 mg. The review also showed a need to move away from policies that prescribe the same amount for each service user and instead for prescribing to be linked more closely to individual need. In addition, more service users need to be supervised during methadone consumption in the early stages of treatment.
– More consistent use of individual care plans
The review found not enough people who use drug treatment services have a comprehensive assessment of their needs. Forty-eight percent of DATs were ‘weak’ in this area, and 32% rated ‘fair’. In particular, 70% of partnerships scored ‘weak’ for risk assessing. This included 21% of services that had not assessed users on their overdose history and 13% that failed to ask users on their alcohol use. Service user satisfaction is strongly linked to having an up-to-date care plan, but 35% of people in structured services reported they didn’t have a care plan.
– Keep service users in treatment longer
Research has shown that service users are more likely to permanently overcome their drug problems 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.
– Involve service users more
Involving service users in the design and development of their drug treatment is fundamental to ensuring services meet their needs. Thirty-seven percent 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 percent do not have local user forums, 31% do not have access to strategic planning groups for service users and 40% do not offer training or mentoring for service users to enable participation in service planning and monitoring.
Healthcare Commission Chief Executive Anna Walker said; “This report reveals some good news regarding drug treatment services. The number of people receiving specialist treatment for drug problems has increased dramatically in recent years and in general these services are getting better. However the report also reveals variances on the quality of care available across England. It is important that service users get the best treatment wherever they are and that services that have received weaker ratings focus on improving quality.”
Paul Hayes, the NTA’s Chief Executive said: “Drug dependency is concentrated amongst the most vulnerable people living in England and the 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 have enabled the NTA to focus its work on the areas which are failing their populations, to ensure that the worst performing areas match the quality of delivery elsewhereâ€.
The Healthcare Commission and the NTA will be following up this report with two more reviews into this sector. In 2006/2007 a review looking at harm reduction and commissioning will be undertaken and in 2007/2008 a third improvement review will look at diversity and residential services (inpatient and rehabilitation services).
Individual ratings from this initial review were released in September and results from this review fed into the Healthcare Commission’s 2005/2006 annual health check.
www.healthcarecommission.org.uk Healthcare watchdogs today called for action to address inconsistent standards of care provided by substance misuse services across England.
These findings were released in a joint national report, which reveals the overall findings of a review carried out by the Healthcare Commission and National Treatment Agency for Substance Misuse (NTA).
Drug misuse affects all aspects of society. The Government estimates drug misuse costs between £10 billion and £18 billion a year and it is clear it affects the life of the individual, the families and the communities they live in.
The review assessed whether local services prescribed drugs safely and planned treatment and coordinated services appropriately. It covered 149 drug action teams (DATs) in England. DATs are partnerships responsible for drug treatment services 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 within those DATs have also been covered within the review.
On the whole, the review showed drug treatment services are getting better and most people in treatment believe services are improving. But it also highlighted several areas of concern where there are variations in the quality of care across England.
Improvements suggested included:
– Strengthen commissioning of prescribing services
Thirty eight percent of local drug partnerships scored “weak†and 37% scored “good†in the commissioning of prescribing services, suggesting practice varies across England. The report found DATs need to ensure they have contracts in place with all service providers and contracts and service level agreements need to include detailed specifications and expectations about service delivery.
– Improve methadone prescribing
Heroin users are often prescribed methadone as part of their treatment. The majority 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. The mean methadone dose nationally was 57mg. Only 30% of services had a mean dose above 60 mg. The review also showed a need to move away from policies that prescribe the same amount for each service user and instead for prescribing to be linked more closely to individual need. In addition, more service users need to be supervised during methadone consumption in the early stages of treatment.
– More consistent use of individual care plans
The review found not enough people who use drug treatment services have a comprehensive assessment of their needs. Forty-eight percent of DATs were ‘weak’ in this area, and 32% rated ‘fair’. In particular, 70% of partnerships scored ‘weak’ for risk assessing. This included 21% of services that had not assessed users on their overdose history and 13% that failed to ask users on their alcohol use. Service user satisfaction is strongly linked to having an up-to-date care plan, but 35% of people in structured services reported they didn’t have a care plan.
– Keep service users in treatment longer
Research has shown that service users are more likely to permanently overcome their drug problems 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.
– Involve service users more
Involving service users in the design and development of their drug treatment is fundamental to ensuring services meet their needs. Thirty-seven percent 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 percent do not have local user forums, 31% do not have access to strategic planning groups for service users and 40% do not offer training or mentoring for service users to enable participation in service planning and monitoring.
Healthcare Commission Chief Executive Anna Walker said; “This report reveals some good news regarding drug treatment services. The number of people receiving specialist treatment for drug problems has increased dramatically in recent years and in general these services are getting better. However the report also reveals variances on the quality of care available across England. It is important that service users get the best treatment wherever they are and that services that have received weaker ratings focus on improving quality.”
Paul Hayes, the NTA’s Chief Executive said: “Drug dependency is concentrated amongst the most vulnerable people living in England and the 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 have enabled the NTA to focus its work on the areas which are failing their populations, to ensure that the worst performing areas match the quality of delivery elsewhereâ€.
The Healthcare Commission and the NTA will be following up this report with two more reviews into this sector. In 2006/2007 a review looking at harm reduction and commissioning will be undertaken and in 2007/2008 a third improvement review will look at diversity and residential services (inpatient and rehabilitation services).
Individual ratings from this initial review were released in September and results from this review fed into the Healthcare Commission’s 2005/2006 annual health check.
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