July 2012 |
drinkanddrugsnews
| 23
Soapbox |
Alex Boyt
www.drinkanddrugsnews.com
Soapbox
DDN’s monthly column
offering a platform for
a range of diverse views.
DON’T
COUNT ON IT
These days it’s all a numbers
game, says Alex Boyt. But are
they the right numbers?
THE RECOVERY AGENDA SEEMS TO ME TO BE LARGELY RHETORIC,
open to
local interpretation – give some recovery champions some t-shirts, get them singing a few
songs, go on a few walks, train up your workers to think beyond endless treatment, talk
about education and asset-based stuff… you know the sort of thing.
I don’t have much truck with the recovery agenda really. Nothing wrong with groups in
a dispensing clinic chanting ‘come on chaps, you can do it’ but the tricky end of the
agenda is not really about recovery, it’s about abstinence – numbers through the
treatment system, out the other end, and not coming back. You can have all the
ideologically sound commissioners and providers, but don’t get enough people staying
clean and the money will start drying up.
Round my way we lost £600,000 from our pooled treatment budget, largely because
we were a few per cent off our successful completion goals. This was not about improving
recovery in all its nice, broad, inclusive terms, it was about getting people off their scripts.
The message seemed to be ‘you did not deliver the desired outcomes, let’s chop your
funding and see if you can do better’.
Current funding formulas have moved the goal posts again and payment by results (PbR)
is looming ever closer. The recovery focus may improve treatment for some, make it worse
for others, but what it will do is get partnerships scrabbling for new numbers. What are
these numbers, who gets them from where and what have they got to do with care?
What colleagues around the country have been telling me for years is the data largely
stinks. If it was meaningful, you could make a case that the numbers game reflected care,
but I’m less and less convinced of this every time I look at a spreadsheet or sit in a
strategic meeting.
The basic issue is, what drugs are people using? I’ve spoken to service users from
different areas about using on top and they’ve said, almost universally, ‘It’s all self
reporting, most people are using on top but we say we’re not because we don’t want to
get put back on supervised and the worker doesn’t want to look like they’ve fixed us’. The
agency needs to report this and commissioners need to pass it up the line. The data says
this lot are ready for abstinence.
A couple of years ago, planned exit numbers were poor where I worked, so a series of
focused workshops were put together and the stakeholders took action – to find different
ways to code treatment episodes. The idea of changing what happened to the client didn’t
seem to occur to anyone.
A pal of mine works in one of the PbR pilot sites and a problem they encountered was
that when 400 clients were transferred to the new service only 50 of them actually
existed. I’ve worked in areas where new providers are commissioned – invariably clients
disappear in the transfer process and usually the old and new provider blame each other,
but I didn’t know whether to laugh or cry when considerable numbers of clients engaged
were found to have been dead for some while. I’ve known providers who send a client a
text and call it engagement, I know workers who have not seen a client for three months,
suggest to their manager they close the case and are told, ‘keep it open, they may come
back’.
From the top to the bottom I hear depressing tales of a system that collects invalid
data and then allocates resources accordingly, as people seem too tired and scared of
losing money to do anything other than scrabble for more data. A manager at a service
the other day said, ‘We used to be able to provide care for our clients, now we have to get
them in, get them out almost before we get to know them and tell them we don’t really
want them back in the next six months.’
Working for a big urban DAT, we were about to launch a BME user-led project on an old
fashioned frontline – new knickers and condoms for the working girls, hot food to draw in
the treatment-naïve. How did this hit the central targets? Don’t know, the entire
partnership data for the year was declared invalid.
I don’t claim to have a clear national picture, and there are committed people doing
their best, but as we move into the PbR era, as clients have to get better faster, the
pressure to count the wrong things is only going to increase. I get the odd email or card
from service users telling me I make difference – trouble is, I don’t know where on NDTMS
to log this.
Is the recovery focus here to stay? I was at the RCGP conference in Cardiff recently and
someone commented that the trouble with the treatment system is it ‘has no memory’.
Give it ten years and we’ll be back focusing on crime, BBVs and drug-related deaths, and
15 years after that we’ll be back trying to get everyone clean.
Whatever happens, let’s hope we get the hang of counting things.
Alex Boyt currently works for Camden as user involvement coordinator