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Paul Hayes
P
aul Hayes was chief executive of the NTA from its inception in 2001
until the agency’s functions were taken over by Public Health England
last year. He now works with a range of voluntary sector organisations
including DISC, the Cyrenians and Family Action and is an honorary
professor at the London School of Hygiene and Tropical Medicine.
Prior to the NTA he’d worked in the probation sector for almost 30 years, and
was chief executive of the South East London Probation Service when he was asked
to put himself forward to be chief executive of the new organisation.
What attracted you to the NTA job?
‘There are two aspects. I’d led on drug and alcohol policy for the Association of
Chief Officers of Probation for a number of years and I was working in Southwark
when the first heroin epidemic hit, so I was acutely aware of the change in the
environment – it was an issue that I was confronted with on a daily basis.
I was given a job developing drug policy for the probation service in London,
and then when I became a chief I was given the national brief, so I’d worked in
drug policy for many years before the NTA was created, and it was put to me that
this might be a good thing for me to do. On a less positive note, the probation
service was being restructured at the time and my job was being abolished, so in
personal terms it wasn’t much of an ask – it was either the NTA or the dole.’
The NTA improved access, cut waiting times, oversaw reductions in
drug-related deaths. How big was the difference it made to treatment
in this country?
‘Immense, absolutely immense – I firmly believe that. If you go back to the Audit
Commission’s 2002 report,
Changing habits
, it describes the treatment system before
the NTA was created. People waiting months, very early drop out, and what you got
was what that particular service believed in – one of the things that report talks
about is inconsistency in treatment and how it’s belief-driven rather than evidence-
driven. But the most important thing really wasn’t the NTA, it was the money.
The Blair government chose to invest an awful lot of money in drug treatment.
Central government spend went up from £50m a year to about £400m – that was the
direct spend, the criminal justice money was on top of that – and the real reason for
the creation of the NTA was that Jack Straw, who was home secretary, basically didn’t
trust Alan Milburn, who was health secretary, to spend the money on drugs if it was
just given to DH. They wanted a new outfit to ride shotgun on it, so they created a
quango jointly owned by DH and the Home Office primarily to oversee the money.
We then decided to take on a best practice, performance management,
commissioning oversight role to achieve that, but that wasn’t set in stone
and it was actually very difficult to achieve, because we cut across a
lot of the pre-existing assumptions about how things
should operate, within both health and
the criminal justice system. We
had to fight quite a
lot of Whitehall battles, battles with the health bureaucracy and the criminal
justice system and local authorities, in order to create that space. But a lot of that
comes back to the money. If you’re dangling cash around you’re given an awful lot
more licence than if you’re not – “we want you to do all this new stuff, by the way
here’s 400m quid to do it”. That makes life a lot easier.
So the performance management stuff was important, the leadership stuff was
important, identifying best practice was important. But without the money, and
the government’s commitment to spend the money – Gordon Brown’s money, Tony
Blair’s leadership – we wouldn’t have got anywhere.’
Do you think Tony Blair’s contribution is something that’s acknowledged?
‘Everybody hates Blair, but I think there may be different views in a different
generation. From my point of view, leaving foreign policy aside and just focusing
on drugs, the drug treatment sector does owe Blair a great debt – the central
direction we got, particularly as a cross-cutting issue. Drugs wasn’t important
enough to any one of the government silos to actually deliver it. It wasn’t
important to DH, which is why Norman Baker’s call for drug policy to go to health
would be a mistake, in my view – it doesn’t kill enough people and it doesn’t make
enough people sick. As far as they’re concerned, drugs is very small beer, and it’s
smaller now because it’s largely been capped off. It’s nowhere near as significant
as tobacco, obesity, alcohol, cancer, dementia – if you’re running the NHS, how
much attention are you going to pay to drugs?
If you’re running the Home Office you’re rather more interested because of the
drugs/crime link, but it’s still not top of your list of priorities – it’s one thing among
many. If you’re interested in welfare dependency then it plays a role, but unless
you’re Iain Duncan Smith it isn’t going to be near the top of your list of priorities
either. So it matters at about the 5 per cent level to about half a dozen different
departments, but not enough to any of them to really give it some oomph. The
only point in our system where cross-cutting issues really come to matter is at the
centre of government – at No.10 – because that’s the only place where they have
to own all these different 5 and 10 per cents that stack up to being a real issue.
So you needed not only the money, but a government that was structured to
drive things from No.10, and that was how Blair did stuff. Obviously all of that –
targets, performance management – became deeply unfashionable, and I think it’s
very interesting that Nick Clegg is now saying he’s taking mental health seriously
because he’s imposing targets on the system. The Lib Dems and the Tories spent
years castigating the previous Labour government for too much focus on targets
and bureaucracy, so I think it’s very interesting that they’re now learning – as most
governments do – that localism and absence of central direction is a great
theoretical prospect in opposition but it’s no way to run a government.’
Overall, what do you think the NTA’s main legacy will be?
You’ve mentioned before that it might well be the National Drug
Treatment Monitoring System (NDTMS).
‘I think it is, and I think it’s important that that’s been retained in Public Health
England, because you need to know what you’re doing, to account for what
you’re spending your money on, how many people you’re treating –
heroin users or ketamine users. The world changes and you
need to keep abreast of that – are you doing as well
November 2014 |
drinkanddrugsnews
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