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Evidence |
Policy scope
September 2013 |
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in organisations, which coalesce into whole treatment systems. All of these
affect the treatment’s feasibility and impacts – contexts variously of
greatest interest to frontline staff, supervisors and managers,
management committees and commissioners.
Intersecting the contexts down the side are five rows. Choose whether
your interest is harm reduction (drugs only), brief interventions (alcohol
only), cross-cutting treatment issues, medical treatments, psychosocial
therapies, or criminal justice work.
For both drugs and alcohol, the result is a five-by-five grid totalling 25
cells. Within each cell are the major historical and contemporary research
landmarks in that territory, reviews offering a panoramic view, expert
guidance based on this research, and an option to explore beyond these
dozen or so selected documents by searching the Drug and Alcohol
Findings Effectiveness Bank. Each document entry can be clicked on to
access the original document, either directly or via the Effectiveness Bank’s
analysis of the study.
Some cell territories have only rarely and partially been explored, while
others are relatively well mapped. As well as signposting the achievements,
the Matrices expose the gaps in the evidence base. Arrangements are
being made to update the Matrices, probably on an annual basis,
piggybacking on the work
Drug and Alcohol Findings
continues to do to
identify and analyse documents for the Effectiveness Bank.
So what can you do with the Matrices? As a manager, they list the
documents you could advise your new staff to read to help them understand
the basis of addiction treatment, those you could commend to your existing
staff to advance their professional development, as well as giving you
practice-improvement clues from the world’s leading researchers.
They will help practitioners understand the most important foundations
of their work and how to build on them, and help commissioners appreciate
the different ways they can influence effectiveness. Familiarity with these
relatively few documents could be seen as an indicator of an important
dimension of the quality of an organisation and its staff – an appreciation
of the key evidence on which practice has been built and can be improved.
As Audrey Freshman, director of professional development and continuing
education at Adelphi University, said: ‘Wow – this is terrific stuff.’
DDN
Mike Ashton is editor of Drug and Alcohol Findings (http://findings.org.uk),
a national UK collaborative project involving the National Addiction Centre,
DrugScope and Alcohol Concern and supported by Alcohol Research UK and
the J Paul Getty Jr Charitable Trust.
Mike explains the Matrices’ development at Lifeline’s FEAD video bank:
http://bit.ly/16JqzJu
An updated version of the presentation’s slides is available at:
http://bit.ly/17lxiMd. This drills down to one study in one cell of the Alcohol
Matrix – a seminal study from the 1950s that demonstrates that such work still
has considerable current relevance.
POLICY SCOPE
WITH THE NEW COMMISSIONING STRUCTURES
NOW STARTING TO KICK IN AT LOCAL LEVEL
,
what, if anything, do we know about the
impact on drug and alcohol services?
Recent figures from the Department of
Communities and Local Government (DCLG)
suggest that investment in our sector may have
risen slightly this year compared to 2012-13. The
unappetisingly titled
Local authority revenue
expenditure and financing: 2013-14
suggests
that 37 per cent of the local public health
budget is going into drug and alcohol services.
The figures are described, however, as ‘the latest national statistics on
budget estimates’ rather than a record of the actual spend. At least one
unitary authority is recorded as budgeting nothing on substance misuse,
while others record surprisingly large rises. It is also unclear what
significance the government attaches to this analysis. It appeared like a bolt
from the blue without herald or fanfare (although DCLG is required to
‘share’ the findings with PHE which will ‘review’ them on behalf of the
secretary of state for health).
DrugScope has also been dipping into joint health and wellbeing
strategies emerging from health and wellbeing boards. We can report that
some of them have more to say about drugs and/or alcohol than others. It’s
more difficult to know how to interprete this. It is a worry if key strategic
documents are muted or silent on substance misuse. But some local areas
could be developing their strategies to hone in on areas where they want to
innovate or improve (or they could be developing separate strategies for
particular types of service). From this perspective, a lack of reference to
drug and alcohol services could be more a signal of broad satisfaction with
local provision, than a mark of indifference. Again, it’s hard to say.
We can also report that it is messier out there in local authorities than
an organogram derived from national policy might lead one to expect –
although I guess that is what one should expect from ‘localism’.
DrugScope has, for example, been in contact with the London boroughs to
find out how their commissioning structures may be morphing post April
2013. Only three said drug and alcohol commissioning was now located in
public health.
DrugScope is currently developing an ‘observatory’ as part of work with
the Recovery Partnership to monitor what is happening in local areas.
Perhaps the main message from our initial forays is that marshalling and
analysing current resources can feel a bit like a combination of wrestling
jelly and sitting a particularly vexing exam. Still, landmarks and signposts
are beginning to emerge from the fog, and, hopefully, a clearer sense of
what is happening will take shape in the months ahead. The truth is it may
be 2014-15 (or the year after) before all the pieces fall into place and a full
picture of the overall impact takes shape.
The DCLG statistics referred to in this column are at http://bit.ly/15uXGDH
Marcus Roberts is director of policy and membership at DrugScope, the
national membership organisation for the drugs field, www.drugscope.org.uk
What is happening to the
commissioning landscape and how
will it affect us, asks
Marcus Roberts
WHAT’S GOING ON?