WIREDGOV

Healthcare watchdogs today (Wednesday) are calling for a continued drive to improve drug addiction treatment, to ensure services are delivered consistently across the country.

A report released today by the Healthcare Commission and the National Treatment Agency (NTA), shows results from the second of three annual reviews to assess the performance of substance misuse treatment services.

Focusing specifically on how services are commissioned and harm reduction service provision, the findings reveal the majority of services are performing well within acceptable levels across these categories.

The number of people receiving specialist drug treatment has increased dramatically, with 195,400 in treatment during 2006/07 - up from 85,000 in 1998/99. Estimates for 2007/8 show 210,800 people will receive treatment. This means that more drug users than ever before are getting the treatment they need.

The review showed that there had been considerable improvement in the commissioning and performance management of drug treatment services, resulting in more service users receiving better treatment.

However, there were significant deficits, particularly in the provision of vaccination for hepatitis B and testing and treatment for hepatitis C. As 90% of all hepatitis C diagnoses are associated with injecting drug use, this is a key area of concern.

The review covered 149 ‘local drug partnerships’ in England. Drug treatment is provided by a network of services, commissioned by local partnerships of statutory agencies within a particular locality, rather than being provided by individual organisations. These networks or ‘local drug partnerships’ are aligned to local authority boundaries. They bring together representatives of local organisations involved in the delivery of the drug strategy, including primary care trusts, local authorities, the police and the probation service.

Partnerships were asked 45 questions across 10 criteria. Each area was then scored on a scale; “weak”, “fair”, “good” and “excellent”. Thirty four percent of local drug partnerships had an overall score of “excellent”, 45% were “good” and 21% were “fair”. No partnerships had an overall score of “weak”, however the review revealed the majority of partnerships had deficits in key areas.

The review confirmed widespread good practice in relation to commissioning performance management but also showed that many areas did not have an adequate understanding of local need through systematic assessments. Since the review the Commission and the NTA have issued guidance and supported action plans to address this issue.

Partnerships also made significant progress in relation to care planning and treatment discharge systems, with nearly all (99%) achieving or exceeding 70% of their local target.

A good standard of financial management was found across the sector, with 60% of partnerships achieving the maximum score for this area.

Anna Walker, Chief Executive of the Commission, says: “Substance misuse affects not only the individual concerned but their families, friends, and the communities they live in.

“As the UK has one of the highest recorded drug-related death rates in Europe, it is a clear national priority to minimise the impact of substance misuse.

“It’s very encouraging that thousands more people are now getting the treatment they need, and this review shows there is much to celebrate about the progress that has been made.

“However, it is worrying that the majority of hepatitis C cases are associated with injecting drugs, yet we know access to testing and treatment for the disease is patchy across the country. Similarly, access to clean needles provided by out of hours exchanges varies considerably. These are the areas that need to improve if the health of those who inject drugs is to be tackled effectively, and drug-related deaths reduced.

“Partnerships must now concentrate on driving improvements in the key areas highlighted by the review, in order to provide an equal service to all patients across the country. It is also important that partnerships really understand the needs in their area for these services and provides them accordingly.”

Paul Hayes, the Chief Executive of the National Treatment Agency for substance misuse, said: "Effective commissioning underpins effective drug treatment delivery.
The improvements in commissioning shown by this review are very welcome. However the review also highlights inconsistent practice across the country in key areas of delivery such as testing for and treatment of hepatitis B and C. The NTA will be working with all partnerships to spread best practice more consistently and has agreed action plans for improvement with the poorest performing areas."

Following the results of this review, work has been carried out by the Commission and the NTA with the 25 lowest performing partnerships. Action plans were to developed to improve performance and good progress has already been made implementing this.

The Commission and the NTA will follow up this report with a third and final review into this sector. This will look at diversity and residential services and will complete what has been a comprehensive review of the provision of substance misuse treatment.

The National treatment agency is engaging the sector in a range of initiatives and programmes to address the deficits identified by the review. The joint NTA/Department of Health action plan, Reducing drug-related harm was published in May 2007, and includes a national campaign aiming to tackle these and other harm reduction issues to begin in October this year.

In relation to commissioning the NTA continues to support the work of local areas in relation to treatment planning and needs assessment. 2008 will also see the publication of new guidance initiatives to enhance commissioning practice.


The full report and details of the scores for each partnership can be accessed on the website below from 00:01 on Tuesday 6 May. Please use the username and password outlined below: http://www.healthcarecommission.org.uk/microsites/improvementreviewofsubstancemisuse2006/2007.cfm

Username: subsmisuse0607

Password: hcsubsmisuse316

For further information contact Emma Reynolds, Press Officer, on 0207 448 9237, or on 07917 232 143 after hours.



Notes to editors:

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Information on the NTA


The National Treatment Agency for Substance Misuse (NTA) is a special health authority, created by the Government in 2001 to improve the availability, capacity and effectiveness of treatment for drug misuse in England. The NTA’s purpose is to work with local partnerships and health commissioners to deliver high-quality, effective drug misuse treatment that improves individuals' physical and mental health and wellbeing. In turn, this improves public health, reduces crime and helps make communities safer.

The Government set the NTA a target of doubling the number of people in structured treatment programmes between 1998 and 2008. This has been exceeded two years ahead of schedule. The NTA is now concentrating on the quality agenda, improving services for people in treatment and improving outcomes for those who leave.


Briefing note:

Effective commissioning is key to the delivery of effective drug treatment, ensuring it meets local need and is planned, integrated and strategic.

Key areas of improvement for commissioning include:

· Needs assessment
Over a quarter (26%) of local drug partnerships were rated as “weak” for the quality of their needs assessment. The effective commissioning of a drug treatment system is dependent on having a clear profile of the diversity of local need. When asked whether the partnership carried out or updated a local needs assessment during 2005/06 to inform the commissioning for 2006/07, 21% of partnerships were rated “weak” and 79% “fair” - a poor result considering the impact this will have on the delivery of effective treatment.

· Strategic leadership
The review highlighted deficits in the seniority and frequency of attendance of senior representatives from statutory partners at local drug partnerships’ strategic board meetings. In 15% of local dru partnerships there were board members below assistant director level.

Blood-borne virus (BBV) infections and drug overdoses account for a significant number of drug-related deaths and poor health among drug misusers and particularly drug injectors.

Recent concerns about the rates of BBV infections and overdoses led the Government to launch a new Reducing Harm Action Plan in May 2007. Recorded drug-related deaths due to overdose in the UK are among the highest recorded levels in Europe. Although a steep increase in the 1990s was halted by the implementation of Government targets in 2001, the target to reduce the number of deaths by 20% by 2004 was not met.

The review showed there are key improvements that need to be made in harm reduction:

· Strategic planning for reducing number of deaths
While strategic planning for harm reduction services was generally
good, the scale of both preventable and treatable blood-borne virus
infections and the high rates of overdose deaths, call for additional
action by local drug partnerships. Only 68% of local drug
partnerships had a multi-agency strategic plan for reducing the
number of drug related deaths.

Harm reduction interventions were not provided broadly enough across
the treatment system or sufficiently integrated into it. Just over a
third (37%) of local drug partnerships did not have access to HIV
testing with access to pre and post-test counselling integrated with
their inpatient drug treatment services.

· Testing for hepatitis B and C
Ninety five percent of partnerships reported that less than half of
service users had a recorded test date for hepatitis C. This is a
clear national priority for improvement due to the scale of infection
amongst injecting drug users.

Vaccination for hepatitis B and testing and treatment for hepatitis C
was not provided widely enough via local drug treatment systems.
Ninety five percent of local drug partnerships offered a hepatitis B
vaccination to less than 75% of their service users and 29% did not
have a protocol relating to hepatitis B.

· Out of hours needle exchange
There is a clear deficit nationally in the provision of out-of-hours
needle exchange, with just under half (44%) of local drug
partnerships scoring “weak”. Forty four percent scored “fair” and 12%
scored “good”.



Emma Reynolds
Press Officer
Healthcare Commission
Finsbury Tower
103-105 Bunhill Row
London
EC1Y 8TG

Tel: 020 7448 9237
Email: emma.reynolds@healthcarecommission.org.uk