Models of care for treatment of adult drug misusers: Update 2006
The strategy is designed to deliver a more dynamic treatment system by focusing on the service user’s “treatment journey”, together with a focus on individuals’ holistic needs (including housing, education and employment) to maximise the benefits of treatment. The key components of the strategy are:
Improving clients’ journeys through treatment Waiting times. Since April 2006, the expectation will be that service users voluntarily seeking treatment will be able to access treatment within three weeks, with faster access for priority groups. Partnerships will review any wait of six weeks or longer and report to the local partnership and the NTA.
Retention. Retention in structured drug treatment has been built into mainstream health performance management systems. Retention targets are now built into primary care trusts’ local delivery plans (LDPs) and are performance managed by strategic health authorities. The Healthcare Commission ratings of mental health trusts now include retention in treatment for 12 weeks.
Treatment delivery Drug treatment should encourage and maximise the opportunities for service users to achieve improvements in substance misuse, health and social functioning, and reductions in crime and public health risks. A critical factor to success in delivering improvements in clients’ lifestyles is good care planning and frequent review of care plans, with clients as partners in the process. All clients in structured treatment should have an identifiable written care plan, which tracks their progress and is regularly reviewed with them.
Improving treatment completion For clients who wish to be drug-free, treatment systems need to be better configured to create better-planned exits from treatment (including drug-related aftercare and support).
Improvements in community integration Whether clients wish to be maintained in the community on substitute opioid medication or wish to be drug-free, drug treatment systems should be well integrated with other systems of care and social support, to provide opportunities for drug users to receive appropriate housing, social support, education and employment to maximise treatment gains and enable reintegration into local communities.
Improving commissioning The Treatment Effectiveness strategy identifies four critical success factors that are considered important in improving local commissioning partnerships:
Local commissioning partnerships linking plans with relevant
local strategic partnership groups
Better local needs assessments
Development of local workforce strategies
Local commissioners who are competent and enabled to performance manage drug treatment systems with clear routes in, through and out of drug treatment.
Improving service provision Four critical success factors that are considered important in enabling drug treatment services in providing the highest quality drug treatment are:
Ensuring providers have a competent workforce
Ensuring service providers can work with the diverse needs of their service users
Ensuring drug treatment is evidence based and underpinned by good audit or clinical governance mechanisms
Drug treatment services are managed using close to “real- time” data.
For more detail on the NTA’s Treatment Effectiveness strategy, visit the NTA website at www.nta.nhs.uk.
Changes to commissioning
Wider health policy context
Drug treatment commissioning is taking place within the context of wider changes in the health and social care sector, where the emphasis is now on the NHS moving from being a provider-driven service to a commissioning-driven service. Currently, plans are underway to review and reconfigure health bodies such as PCTs, strategic health authorities and foundation trusts.26 The Department of Health intends there to be a faster roll-out of practice-based commissioning (PBC), where primary care practices will be given more responsibility for commissioning healthcare services.27 The intention is that primary care trusts (PCTs) will continue to hold funds, but practices will be responsible for assessing the health needs of local populations and making commissioning decisions on appropriate services to meet those needs. The timetable is set for all changes in the system including reconfiguration of PCTs along local authority boundaries, reconfiguration of strategic health authorities, and universal implementation of PBC, by 2008.
In the longer term, commissioners will also have to be aware of, and be able to respond effectively to, changes to the social care system, as set out in the white paper Our Health, Our Care, Our Say (DH, 2006).28
2.8.2 Drug treatment commissioning partnerships
There have already been changes in the commissioning of drug treatment since 2002 and changes in the priority given to drug treatment in health and criminal justice sectors. Drug treatment has now been prioritised into mainstream health performance management systems. A range of new local strategic