Care Quality Commission
 Printable version
|
 E-mail this to a friend
|
MAJORITY OF LOCAL DRUG TREATMENT NETWORKS SCORE TOP RATINGS IN NATIONAL
But improvements are required in the monitoring and support of patients discharged from detoxification, to minimise overdose risk.
Healthcare watchdogs today (Thursday) rated 87% of the local networks for drug treatment services as "excellent" or "good" in a national review.
A report released today by the Healthcare Commission and the National Treatment Agency (NTA) shows how well local areas are meeting the needs of diverse communities and people who require inpatient or residential drug treatment.
The review covered each of the 149 local drug partnerships in England, where drug treatment is commissioned and managed by representatives from primary care trusts, local authorities, the police and the probation service.
Findings reveal widespread good practice with 15% of local drug partnerships rated as "excellent" and 72% "good" overall. Thirteen percent were rated "fair" and no partnerships had an overall score of "weak".
The review showed the majority of partnerships understood the diverse needs of their local community: 99% carried out needs assessments which addressed diversity issues, 99% met statutory obligations regarding diversity and 91% of services had access to a range of interpretation services. However more work is needed to make sure partnerships maintain this focus on diversity when developing plans for drug treatment, and to consult more broadly with groups not currently accessing treatment.
The NTA estimates that every year about 16,000 people access NHS inpatient detoxification and publicly-funded residential rehabilitation services. The review found that the vast majority of these services provide treatment in safe environments staffed by competent practitioners, with 59% of providers scoring "good" and 34% "excellent" in this area.
Nevertheless the review revealed most partnerships still had scope for improvement, some in key areas:
· There is a significant risk of overdose if a patient returns to drug use after detoxification due to decreased tolerance levels. The review found many partnerships need to do more to minimise these risks: 68% of partnerships did not monitor rates of overdose post-discharge, and around a third (34%) did not ask community-based services to carry out risk assessments for patients who have left detoxification services unexpectedly.
· Twenty eight percent of inpatient services and 41% of residential services were either not reporting data or were reporting incomplete data to the National Drug Treatment Monitoring System (NDTMS). It is a national priority to address this, as local and national strategic planning depends on this information. Without this information it is difficult to know if current provision is adequate, how long people will wait to access services, and rates of completion of treatment programmes.
· There is a commissioning shortfall regarding residential rehabilitation services. Only 44% of local drug partnerships had increased their funding above the rate of inflation for these services over the last five years, despite a significant national increase in budget for drug treatment generally. This area of treatment has not seen the same level of growth, and some partnerships need to address shortfalls in their treatment planning to ensure there is appropriate access to this type of treatment for those who need it.
Anna Walker, the Healthcare Commission’s chief executive, said, "It is excellent to see drug treatment providers are serving their diverse local communities well, and that the quality of treatment is of such a high standard. It is particularly impressive that not one partnership scored ‘weak’ in this review, for the second year running.
"Having said that, it is important to note that partnerships still need to ensure the risk of overdose after discharge is assessed and minimised for every patient, and to make sure that residential rehabilitation treatment is available to all who would benefit from it.
"This is the last in a series of reviews assessing the performance of drug treatment in this country. From the evidence we have collected over three years, it is clear that substance misuse services are performing extremely well. This country is providing top quality treatment to more people with drug problems than ever before, and I hope to see this progress continue."
Paul Hayes, the NTA’s chief executive, said, "The review’s verdict that this country is providing top quality drug treatment is very encouraging.
"As access to drug treatment services has increased over the last few years, the NTA’s priority is to further improve quality. We issued new guidance to partnerships in September 2008 aimed at helping them plan for effective inpatient and residential services, and new government funding was announced in November to boost residential and supported housing placements. It is important that there is a balance of options available so that people can get the treatment most likely to help them overcome their addiction.
"The findings of this report will continue to inform the ongoing improvement of drug treatment services to meet the needs of individuals and the communities they are part of."
Local drug partnerships were asked 40 questions across 11 categories. Each area was then scored on a scale; "weak", "fair", "good" and "excellent". In addition, individual detoxification and rehabilitation services were given their own score.
The watchdogs have made recommendations to partnerships to tackle key deficits highlighted by the review. The NTA is working intensively with the lowest performers, but all partnerships have developed action plans to improve performance. Good progress has already been made.
This is the last of a series of three reviews on substance misuse produced over the last three years. The previous two looked at community prescribing and care planning and commissioning and harm reduction.
The full report and details of the scores for each partnership can be accessed on the website below on Wednesday 28 January. Please use the username and password outlined below:
Username: sm328109
Password: esusims09
For further information contact Emma Reynolds, Senior Press Officer, on 0207 448 9237, or on 07917 232 143 after hours.
Notes to editors:
Key facts and figures from the review
Inpatient detoxification services involve short episodes of treatment, usually in hospital. Residential rehabilitation provides longer programmes of treatment for heavy drug users. NDTMS recorded 11,148 people in inpatient treatment or residential rehabilitation in 2007/8. Although this figure is likely to be higher, given the levels of under-reporting to the database highlighted by this review.
Focusing on the provision and commissioning of inpatient detoxification and residential rehabilitation services, the review found that:
Most partnerships focus on commissioning specialist services for drug users, which leads to better outcomes. Seventy percent of partnershipsm commission all their inpatient detoxification provision from specialist substance misuse units. Partnerships also commission a high volume of their placements from services that performed the best in the review, showing that commissioners focused on providing high quality services when making commissioning decisions.
There were shortfalls in the integration between inpatient and residential services and community-based services, leading to increased risk of overdose following discharge. Thirty four percent of partnerships did not contract community services to carry out risk assessments with service users following unplanned discharge from inpatient detox and residential rehab services. Only 32% of partnerships monitored occurrences of overdose post-discharge, and 58% of partnerships monitored how many service users accessed community based services after discharge. In addition, 23% of inpatient and residential service providers said they did not have a policy specifying that an assessment of risk of overdose be carried out in the event of a service user leaving treatment unexpectedly.
In some areas the commissioning of residential rehabilitation services is not integrated with other drug treatment commissioning. Residential rehabilitation placements have historically been purchased by specialist teams within local authorities rather than by drug partnerships. But current guidance emphasises that local drug partnerships need to integrate the management of the budget for residential services with its main local treatment budget to ensure it is an effective part of the treatment system. Forty nine percent of partnerships did not integrate the budget in this way. Less than half (44%) of local drug partnerships had increased their funding for providing residential services above the rate of inflation in the last five years. This is concerning considering the significant increase in budget for these services.
Looking at how well partnerships met the needs of a diverse population, the review found that:
The majority of partnerships understood the diverse needs of their local community. Ninety-nine percent had carried out a needs assessment to identify the needs of the local population and 92% said they annually reviewed data on service uptake by diverse communities and used it to plan the provision of services. The majority (99%) of the public body members within partnerships fulfilled their statutory duties to develop equality schemes for race, gender and disability.
The majority of partnerships did not focus enough on diversity relating to substance misuse specifically. Despite carrying out excellent needs assessments, many partnerships did not have as effective a focus on diversity in their strategic plans, with 72% scoring "fair" and 4% "weak" in this area. Only 54% of partnerships had undertaken a specific race equality impact assessment of substance misuse services, 19% for race and gender and 18% for race, gender and disability. This is significant as substance misuse affects different communities or groups in different ways.
The majority of partnerships did not consult broadly enough with users not currently accessing treatment. Only 31% consulted with groups not currently accessing services when reviewing and planning. In half of partnerships less than 30% of crack users accessed treatment, indicating that more needs to be done to consult with this group to ensure services are accessible and relevant to them.
The review also assessed individual inpatient detoxification and residential rehabilitation service providers. It found that:
· Eighty eight percent of services had policies on the development of exit plans for service users to ensure effective reintegration back into the community. All inpatient services and nearly all residential services (97%) had procedures for notifying community based care coordinators of unplanned discharge.
· Eighty six percent of inpatient services had prescribing regimes in line with NICE guidelines.
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, which has been achieved. The NTA is now concentrating on the quality agenda, improving services for people in treatment and improving outcomes for those who leave.
