Staff shortages the main obstacle for drive to upgrade drug services

Re-badging old money as new is an old trick that the government
is often accused of performing. But the scepticism that accompanies
so many funding announcements was absent last week when health
secretary John Reid unveiled an extra £219m for drug
treatment.

More than 80 per cent of the money (£179m) will go directly to
drug action teams (DATs) in England. This will be used to double
the spend on treating the 50,000 most severe drug addicts, therapy
for an anticipated 40,000 extra users by 2008 and expanding
treatment for under-18s with drug problems. All of the money will
be spent between 2006 and 2008.

The government also announced an extra £28m in 2006-7 and
£12m in 2007-8 – followed by an extra £40m each year
after that – to expand drug treatment in prisons in England and
Wales. It aims to ensure that by 2008 the estimated 78,000 people
who are either in or go through the prison service each year
receive the treatment they need.

Charity DrugScope hopes the money will rectify the varying quality
of drug treatment programmes. Director of service development Frank
Warburton says: “It’s a significant sum going into drug treatment
in the front line and that has to be welcomed.”

Although the new funding will bring an expansion of services, with
only a small pool of trained drugs workers available it is unclear
where the staff will come from.

Julian Corner, chief executive of mental health and criminal
justice charity Revolving Doors Agency, says the government has to
ensure the workforce is large enough.

Warburton says that although the government is addressing the
training needs of drugs workers, there are still gaps in the
system. “Government agencies are working on qualifications and
training for drug workers but we don’t have a fully fledged system
of recognised qualifications.”

He adds that other issues include the need for a unified system of
quality standards for drug treatment services and an operational
inspection programme.

One problem faced by drug treatment providers is the high dropout
rate of people on rehabilitation programmes. The reasons are both
personal and systematic, from the inability of users to escape
their addiction to services being stretched and inadequate.
Warburton says most dropouts occur in the first couple of days and
that, if treatment services are to improve, this needs to be
tackled. The answer, he feels, lies in ensuring people are referred
to the most appropriate services.

Corner welcomes the money for DATs to spend on treating the 50,000
“most seriously affected drug users” but says it remains to be seen
what the government means by this term and who will be deciding
this.

He is concerned that this money seems to be focused on dealing with
crime rather than preventing people damaging their health – a
Department of Health press statement described the group as
including “many persistent offenders”.

Corner says the current approach of DATs is largely shaped by the
drug intervention programme (previously the criminal justice
interventions programme), which enables them to identify and treat
drug abusing offenders in the criminal justice system.

Enver Solomon, senior policy officer at the Prison Reform Trust,
agrees that there appears to be a “drive” to look at drugs through
the criminal justice system.

But some campaigners feel this part of the new money is not focused
in this direction – Warburton points out that it is not ring-fenced
for just treating offenders.

The 50,000 includes drug users with associated alcohol and mental
health problems. Campaigners have applauded the government’s
recognition that people with complex needs face greater
difficulties accessing treatment or finishing it.

Richard Kramer, director of policy at social care charity Turning
Point, says: “Half of our clients that come to us with a drug
problem also have a mental health problem.”

According to Corner, the government’s recognition is “long
overdue”. He says some drug users with a mental health or alcohol
problem are told they are ineligible for drug treatment; others
start their treatment only to be derailed by their problem.

Drug action teams lack experience outside of drug issues, he adds.
“DATs don’t know about alcohol or mental health. Where is this
[expertise] going to come from? We need to know how the DATs are
going to rise to this challenge.”

Richard Brook, chief executive of mental health charity Mind, says
some people with drug and alcohol or mental health problems do not
access services primarily through DATs and that they still needed
access to “continued and sustained support”. This should be through
mental health and community-based services geared towards
addressing their complex needs.

Kramer says there should be joint commissioning across drugs,
alcohol and mental health services to cater for those whose needs
fall between them. This would help to tackle the refusal of some
mental health teams to offer support until treatment for alcohol or
drugs has been offered.

Corner praises the government’s funding for treatment in prisons as
long as this does not increase the perception of jails as a source
of detox and rehabilitation. Otherwise courts will be tempted to
send offenders with drug problems into custody rather than hand out
community sentences.

Solomon says treatment in prisons should be followed by treatment
in the community to prevent offenders falling back into drug use
after their release. “There needs to be a joining up of services
between prisons and the community so people don’t walk out of
prison and turn back to drugs,” he says.

While the government’s plans have been met with praise, the
shortage of social care workers to implement it and oversee how it
will be spent leaves Reid with a new challenge on his hands.

Spending the money

The slice of drug action teams’ extra £179m to treat the
50,000 most seriously affected drug users in England will be used
to:

• Increase the number of specialist drugs workers to deal with
  the most problematic clients in the community.
• Provide more residential rehabilitation and in-patient detox
  centres.
• Improve the management of cases to adapt treatment to
  individual circumstances.