Czar GazinG
HOW DO WE GET
MORE FOR LESS?
As deputy drug czar for the Blair
government, Mike Trace oversaw
the expansion of today’s drug and alcohol
treatment system. In the fourth of his series of
articles, he gives his personal view of the
successes and failures of the past 20 years, and
the challenges the sector now faces.
I
n my last article, I offered to make some
suggestions on how the drug and alcohol
treatment sector can respond to the current
‘perfect storm’ of increasing demand and
reducing resources. In a situation where there
is insufficient political support, at central or
local government, for a big increase in resources for
treatment, we have to find ways of achieving better
outcomes for less funding.
The first thing we need to do is get much better at
focusing the available resources on delivering the
outcomes that matter. This is a challenge to the
commissioning and procurement system. Start by
defining the desired outcomes much more clearly –
the ones that matter to our clients and the community
(and therefore politicians) are reductions in drug-
related deaths, infections and offending; and increases
in purposeful activity, secure accommodation – and
family stability.
Each of these are definable and measurable but, 20
years after we established our national treatment
system, these outcomes are not routinely reported on in
national data systems, few commissioning decisions are
based on evidence of their achievement, and few
providers bother to conduct research on their
achievements against them. I thought we would by
now have developed a clear bank of evidence on the
extent to which local treatment systems achieved these
outcomes and the extent to which individual providers
or models of service deliver the desired results.
Instead we have a very thin outcome evidence
base, which is a real failing after billions of pounds of
investment. This leads to two major problems – it
undermines our ability to demonstrate value for
money to politicians and taxpayers, and it leaves
procurement decisions to be made more on a bidder’s
ability to write good bids or manage good processes,
rather than on their ability to deliver outcomes.
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Secondly, we need to be much better at stimulating
behaviour change among our clients, rather than just
managing the impacts of continuing high-risk
patterns of consumption. Of course, the first
behaviour change is towards safer using and
engagement with services, but we need to move
quickly towards motivating clients to believe they can
make changes in their drug use and wider lifestyle,
then offering them support and practical help to make
those changes.
When people with a history of drug/alcohol
dependence are able to make these changes (what we
all refer to as ‘recovery’), there are massive benefits for
them, their families, and the community. There is also
the benefit that pressure is relieved on the
overstretched system – people in good recovery make
less use of drug/alcohol services, wider health services
and social services. They also cease to be a burden on
the criminal justice and benefit systems.
Next, we have to be brave enough to do less of
something. The demand has increased – from the
diversification of drug problems (no longer just daily
heroin/cocaine use) and the (perfectly sensible)
addition of primary alcohol users to the system. And
the resources are reducing – around 20 per cent in the
last four years, with most informed opinion predicting
that this trend will continue in the next few years.
So, what can we do less of? My focus would be on
reducing the paperwork and bureaucracy involved in
substance misuse case management – these systems
have been built up over many years, and have good
reasons for existing, but it cannot be right that scarce
face-to-face client time is largely taken up with filling
in forms and populating databases. We need to make
the client/worker interaction more human again.
Linked to this, we must lose the obsession with
doing a little bit with everyone and get better at
focusing resources on where we can make a
‘It cannot be right that
scarce face-to-face client
time is largely taken up
with filling in forms and
populating databases.
We need to make the
client/worker interaction
more human again.’
difference. Most services are commissioned on the
basis of engaging with the maximum number of
clients at minimum cost. This inevitably leads to low
intensity provision for most people, when we know
that most of them will need deeper help to tackle the
social and psychological challenges that have brought
them into services. We need to be brave enough to put
less effort into those not willing to engage and more
into those who are open to changing their behaviour.
Finally, we need to reposition the treatment sector
in the machinery of government – with greater health
and social focus, but getting back to the original aim
of convincing politicians that our sector delivers true
cross-sectoral benefits. More about that next month.
Mike Trace is CEO of Forward Trust
April 2019 | drinkanddrugsnews | 15