Questions the NTA Must Answer

NDTMS figures, given in a 2008 parliamentary question, confirmed that 131,468 people in the last year received methadone or buprenorphine. But only about 2% (about 4,000 patients) are referred to rehab, and there are even fewer psychosocial daycare programmes — which means that 65,000-70,000 patients are unaccounted for. What percentage of the 65,000 are people seeking help forced to wait 12 weeks between an initial appointment and a second one, who are then labelled as being in “12 weeks retention”? An independent audit could perhaps shed light.
The titles of these reports are self-explanatory: Male drug poisoning deaths highest in five years: Health Statistics Quarterly autumn 2008 published by the Office for National Statistics and Drug-Related Deaths in the UK – Annual Report 2008: Increase in the number of Drug-Related Deaths, published by the International Centre for Drug Policy at St George’s University of London. Widespread prescribing was justified as avoiding such results as are listed in these reports; furthermore, 20% involved methadone.
Addiction Today wrote to the NTA saying that “Another success story we would be happy to feature in an article is: What activities, and with what results, did the NTA undertake to implement the actions and recommendations from its own commissioned piece of work on Tier 4 needs, researched by David Best”. We also offered to feature similar research by Ed Day on detoxification provision. NTA communications director Jon Hibbs responded about “the mysterious non-existence of any substantive piece of work from either Ed Day or David Best on the subjects you mention. We can’t publish what we don’t have”.
Addiction Today managed to track down the research, which belongs in the public domain:
Download National needs assessment for Tier 4 drug services (1.07Mb)
Download Tier 4 drug treatment-inpatient provision and needs assessment
Over a dozen rehabs in the UK closed and others made counsellors redundant. Most depend on the state for clients – but it refers only 2% of drug abusers to drug-free treatment, creating a crisis of empty beds and waiting lists of people desperate to fill them.
This is not an issue of harm reduction / abstinence – it is about bad practice versus good practice.
The disproportionately low 2% of referrals also signifiies denial of patient choice. According to researcher Dr David Best, a new phenomenon has arisen: people who want to get off drugs are now afraid to approach agencies because they fear substitute drugs will be pushed onto them instead.
In the hope of raising awareness and working together for solutions, Addiction Today started posing questions to the National Treatment Agency for Substance Misuse in October 2008. Disappointingly – given this charity’s seven years of unswerving support for the NTA – the NTA instead communicated to organisations in the field that “On Addiction Today,… the magazine/website could not be trusted as an impartial source because it misrepresented the NTA’s position on a variety of issues, not least residential rehab… it would be worth checking out the status of AT’s claims about closures with the organisations themselves”.
Not getting through on telephone or website for the defunct organisations is an answer in itself. So here’s a list of closures the NTA arg… Ayurva which was in Farnborough, Thurston House (Hope House clients will move there, with Hope House closing), Pierpoint Women’s Unit (John Grady is clear about this closure), Two Saints in Hampshire, Priory Farm Place, Priory Coach House, Barleywood, Murray Lodge, Bethany Lodge Women & Baby Unit, Phoenix Futures London Residential Service, Phoenix Bexhill, Henderson Therapeutic Community in Sutton.
Also, Adapt’s The Manse closed but was recently taken over for relaunch by Johnny Mack, Isham House has stopped treating addiction patients, Diana Princess of Wales Hospital in Norfolk is in administration, and another treatment organisation is in voluntary liquidation and selling its London and rural premises but does not wish to be named.
Professor David Clarke of Wired has written of “a local commissioner who was telling drugs workers that research showed that residential rehab did not work. Therefore, local commissioners were not going to send people to residential. Very worrying was the fact that the drugs workers believed what he was telling them! No wonder residential centres are struggling to fill their beds, with this disgraceful misinformation”.
The same adjective could be applied to the NTA head-office staff member who unjustifiably told BBC home editor Mark Easton, when researching a programme, that “there is no evidence that rehab works”.
NTA communications director (a new one has been advertised for) Jon Hibbs also posted comments on this website denying empirical research – click here. And NTA board member Peter McDermott stated in The Observer last November that “Residential rehab doesn’t actually work very well” alongside other negative comments.
The NTA has a stated aim of getting people off drugs – but this must surely be mere lip service when millions of pounds in each of its seven years have not been utilised to give its own staff accurate, life-saving information. Incidentally, the NTA was given £8million to spend on staff and over £3million to spend on consultancy, according to its latest annual report.
6. When is £54million not £54million?
When the NTA. recycles a two-year old press release with an unusual juxtaposition of words and figures. Click here for details.
7. Why is the NTA funding an organisation – one of whose directors is a NTA director – without inviting tenders?
This is a more recent question, posed by Peter O’Loughlin of Eden Lodge. “Why is the NTA ‘part funding’ a study commissioned by the UKDPC to examine employers’ attitutdes to recruiting ex-drug users, rather than inviting tenders? Has the Confederation for British Industry or the Small Business Organisations been approached for advice?”.
Minutes from a NTA board meeting show that its senior managers’ salaries, including its CEO’s, are directly linked to outcome targets. So there is a keen interest in the figures being presented to show that targets have been met – but this can act against getting both the right figures and the right kinds of figures. The figures rely on the Top ‘validating’ paper which independent researchers describe as measuring only reliability of crime – ie, consistency of self-report, not validity.
So, clients underreporting drug use and off ending at structured interview, due to stigma and fear of consequences… combined with workers not asking relevant questions… will lead to… targets appearing to have been met. Addiction Research & Theory plans to publish a peer-reviewed paper on this in Spring.
9. If the NTA can do nothing about residential rehab, why is it doing so little about community rehab?
10. Why do NTA figures not differentiate detox and rehab?
Figures are blurred when detoxification and psychosocial treatment are referred to in the same sentence as “abstinence treatment”. The two are very different, with very different goals and outcomes, and perhaps with different types of diagnoses. Expenditure and outcomes relating to each should be given discretely.
11. How many patients are diagnosed with addiction/dependency? How many people are diagnosed as having substance abuse?
Why are we unable to find these two types of patient quantified in the NTA figures? After all, if there is no accurate diagnosis, how can optimal careplans be prepared and implemented?
12. Why are we unable to find numbers of patients with accompanying mental disorders?
13. Where are the figures demonstrating that more chronic, complex clients go to rehab?
This is clarified in NTORS and other empirical research but not in NTA figures.
14. When will the figures showing drug-free clients actually link them with the treatment they receive?
Only then can anyone know what works.
15. How many of those who have “successfully completed treatment” are now in paid employment?
16. Why have drug offences risen?
Why, if the current treatment protocols are “effective”, has violent crime in the Metropolitan Police area for the financial year April-March 2007-8 increased by 22% over 2006-7? Why have drug offences increased by a staggering 73% in the same period?
17. What Dat systems support people in abstinent recovery?
How does NDTMS measure this?
18. If there is a ‘third way,’ what budgets are spent on training, and in what, to sustain recovery paths?
What is the evidence base for this middle way?
19. Does the TOP measurement tool answer these questions? If not, why not?
If Top and NDTMS do not answer these questions, they should be replaced – was Top sent out to tender? Was its review sent to tender? And was it peer reviewed to answer the questions above?
20. Who is accountable – the NTA or Local Authorities, PCTs, Dept of Health?
I was among those who regarded the NTA as responsible for only 2% of people getting into drugfree treatment, particularly as it takes credit for “getting 202,000 people into treatment” in its press releases. However, three of its senior people stated the responsibility belongs to PCT/LA commissioners. “They hold the budgets.”
The NTA annual accounts confirm this: last year, it spent £14,517,000, not one penny on treatment.
However, NTA regional manager Mark Gilman achieves outstanding good practice (in comparison; 7% of patients get the drug-free treatment they seek). Why is his paradigm not replicated nationally?PUBLIC RIGHT TO KNOW
There are many more questions we would like to ask, but 20 is a more realistic target on which to start the new year. Perhaps answers will be forthcoming in 2009, as they were not in 2008.

Dr David Best was formerly research manager for the National Treatment Agency, so was uniquely qualified to debate appropriate treatment with the NTA.


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