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problems and will ensure that those who misuse drugs but are not charged are also helped to engage in treatment.

Since 31 March 2006, Restriction on Bail has been “switched on” in all local justice areas across England. This means that any adult who appears before a court in England after testing positive for a specified class A drug, in connection with the offence for which they are charged, could be eligible for Restriction on Bail if they reside in England. The restriction on bail provision provides an opportunity to engage drug-misusing defendants with treatment, by restricting access to court bail if they refuse a drug assessment and any follow-up treatment proposed.

The above provisions only apply to those aged 18 or over. Offenders will be faced with the choice of complying with what is required of them or face criminal sanctions. The expectation is that the majority of people will comply with the requirements rather than risk prosecution.

2.5.3 Prison drug treatment

Prisons have a high concentration of problematic drug misusers present in one place at any one time. There is an annual throughflow of approximately 130,000 offenders and an average of 84,500 drug-misusing prisoners may be in custody during the course of a year – with around 49,000 present at any one time.

The drug treatment service framework is a core element of the prison drug strategy and consists of clinical services, CARATs and drug treatment programmes (rehabilitation programmes and therapeutic communities). The range of drug interventions is designed to meet the needs of prisoners with low, moderate and severe drug misuse problems.

Clinical services for drug users in prison are described in Prison Service Order 3550 (HMPS, 2000).20 Guidance on the commissioning and delivery enhanced clinical services, covering a

range of Tier 3 prescribing interventions consistent with the

existing Department of Health clinical guidelines (Drug Misuse and Dependence – Guidelines on Clinical Management (1999)21) is to be published in 2006 by the Department of Health.22 This guidance document will also represent part of a framework for the joining together of clinical and CARAT teams in prison under an integrated drug treatment system (see section 3.4).


Variation in the quality and effectiveness of drug treatment

There is a wide variation in the quality of drug treatment provision, which can be seen in differences in the abilities of services to retain clients. Analysis of treatment surveillance data (NTA/NDEC 2004)23 showed that clients attending one service in the north- west of England were seven times more likely to drop out of treatment than clients in a similar service in the same region.


Models of care for treatment of adult drug misusers: Update 2006

The Audit Commission report Drug Misuse 20048 noted that clients are often unsure about the goals of their treatment and are not fully involved as active partners in treatment, for example through lack of involvement in their care plans.

There is a wide variation in the quality of practice across the drug treatment field. Forthcoming audit and research findings, from the NTA and the NTA and Healthcare Commission Improvement Reviews, will illustrate a wide variation in prescribing practice, care planning, supervised consumption and needle exchange practice. One of the intentions of Models of Care: Update 2006 is to promote more consistently high-quality and effective treatment practice.

A comprehensive review of counselling, assessment, referral, advice and throughcare services (CARATs) undertaken between 2003 and 200524 mirrored the above findings. The consultation process of the review found variations in the quality of CARATs delivery working practices across the prison estate. As a result, a CARAT practice manual has been developed which provides workers with minimum agreed and accepted operational guidelines for all component elements of the service.

The NTA has been working in collaboration with the Healthcare Commission to develop a series of Improvement Reviews for substance misuse treatment. These annual reviews will be used to facilitate improvements in key aspects of drug treatment services. The review process started in autumn 2005, focusing on care planning and community prescribing interventions in 2005/06. In 2006/07, it will focus on commissioning and harm reduction.


Improvements required in treatment effectiveness

Given the variable effectiveness of drug treatment services, this update places a greater focus on the need to improve the effectiveness of drug treatment systems. This includes improving interventions to reduce the risk of blood-borne virus (BBV) infection and the risk of overdose. It also focuses on the need to improve engagement and retention in drug treatment, the effectiveness of drug treatment delivery, and the reintegration into communities of those completing treatment or being maintained in treatment.

2.7.1 Treatment Effectiveness strategy

This update is also set in the context of the NTA’s Treatment Effectiveness strategy, which identifies some of the critical success factors to improving drug treatment and bases a delivery

plan for 2005–08 on them.25 main groups:

The success factors fall into two

  • Improving clients’ journeys through treatment

  • Improving local drug treatment systems.

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