Models of care for treatment of adult drug misusers: Update 2006
Models of Care for Treatment of Adult Drug Misusers (NTA, 2002)1 – hereafter Models of Care 2002 – set out the national framework for commissioning the treatment of adult drug misusers in England, describing best practice in drug treatment provision. The NTA has carried out two phases of extensive and wide-ranging consultation (in 2004 and 2005) on an update of Models of Care 2002, involving commissioners, service providers, service users and other key stakeholders in the field. The resulting updated document is Models of Care for Treatment of Adult Drug Misusers: Update 2006 (hereafter Models of Care: Update 2006).
This update is intended to build on the framework and concepts in Models of Care 2002 rather than replace them. It requires drug treatment commissioners and providers to have implemented the key tenets previously described in Models of Care 2002, including:
The four-tiered model of commissioning
Local screening and assessment systems
The care planning and co-ordination of care at the heart of
structured drug treatment
The development of integrated care pathways.
This update is written in a similar format to Models of Care: Part 1 (2002), and is intended to fully replace it. Models of Care Part 2: Full reference report (2002), summarises much of the evidence base and is still relevant as a valuable reference source.
Models of Care: Update 2006 also incorporates the new strategy to improve the quality and effectiveness of drug treatment. The Treatment Effectiveness strategy, launched in 2006, has cross- government approval and provides a greater focus on improving clients’ journeys through more effective drug treatment and reintegration into local communities (housing, education and employment). The two main “units for improvement” for improving treatment effectiveness are local commissioning partnerships and the providers of drug treatment.
While the NTA does not have statutory responsibility regarding drug treatment in prisons, the local primary care trusts do have responsibility for commissioning clinical services. The National Offender Management Service (NOMS) has committed to ensure alignment of services and the implementation of relevant key concepts from Models of Care: Update 2006 in prisons.
Models of Care: Update 2006 outlines:
The policy context and rationale for updating Models of Care
The key differences between Models of Care 2002 and Models of Care: Update 2006
The context of improving treatment effectiveness and improving clients’ journeys
A reiteration of the four tiers
Updated information on assessment, care planning and integrated care pathways
Definitions of the full range of treatment interventions in the context of local treatment systems
Draft quality requirements, which are in line with the NHS policy and performance management structures
This update should be viewed in the context of the NHS Improvement Plan: Putting People at the Heart of Public Services (2004)2 and the Department of Health’s (DH) Standards for Better Health (2004).3 Models of Care: Update 2006 supports development “standard D2”, described in Standards for Better Health (2004), which will be used as the basis of Healthcare Commission and NTA Improvement Reviews of drug treatment. Implementing Models of Care: Update 2006 will contribute to the Government’s Public Service Agreement (PSA) target to:
“…increase the participation of problem drug users in drug treatment programmes by 55 per cent by 2004 and by 100 per cent by 2008, and increase year on year the proportion of users successfully sustaining or completing treatment programmes.”
This final version of Models of Care: Update 2006 is accompanied by a suite of documents, including:
A separate report, Treating Drug Misuse Problems: Evidence of Effectiveness (Gossop, 2006),4 reviews the current evidence base. This is not included in detail in Models of Care: Update 2006
Additional linked guidance on care planning – Care Planning Practice Guide (NTA, 2006)5
A summary for service users and carers (due in summer
Separate guidance, Models of Care for Treatment of Adult Alcohol Misusers, is due for publication in 2006 following an extensive consultation period. While there are important differences from this document, the overall framework for commissioning treatment services, the division into four tiers of interventions, the description of levels of assessment that can be used and the focus on effective co-ordination of care through care planning are reiterated and remain consistent for both drug and alcohol treatment service provision. Development of integrated care pathways, high-quality commissioning and service delivery, in response to assessments of need and consideration of evidence for effective interventions, are also consistent between the two documents.