Campaigners worry that review could undermine treatment progress

Regional offices of the National Treatment Agency look set to be transferred to revamped strategic health authorities. But Gordon Carson finds that the structural changes may have a detrimental effect on future success

Significant progress has been made in drug treatment since the government published its drugs strategy in 1998 and, particularly, since the establishment of the National Treatment Agency for Substance Misuse (NTA) in 2001.

The NTA, a Department of Health arm’s-length body set up because the NHS was not giving enough priority to drug treatment, is on track to meet key targets.

For example, the number of drug misusers receiving specialist treatment rose by 89 per cent from 1998-9 (85,000) to 2004-5 (160,450), not far short of the target to double the number from 1998 to 2008.

The government also says performance management of drug treatment in the NHS has improved since it was included in primary care trusts’ star ratings in 2004.

But campaigners are concerned that a government review of the NTA could threaten this progress, while there are fears that the ring-fence for drug treatment funding could be removed (Agency review may hit treatment plans, 27 April).

The review is likely to lead to a change of focus for the NTA, with plans to transfer its nine regional offices, which monitor the effectiveness of treatment and the use of funds by local drug action teams, to strategic health authorities by 2009.

Under NHS reforms, the number of SHAs will fall from 28 to 10, meaning they will be coterminous in most cases with regional government offices, which are responsible for joining up policies in the regions.

By transferring responsibility to SHAs, NTA regional offices will be brought closer to mainstream health services while maintaining current advantages of coterminosity with regional government offices. And it will leave the NTA’s national office to concentrate on strategy, quality assurance, guidance, and policy.

But Deborah Cameron, chief executive of charity Addaction, says the transfer of control could lead to a loss of momentum for drug treatment because SHAs have “a plethora of other priorities to deal with”.

Dr Brian Iddon MP, chair of the all-party parliamentary drugs misuse group, warns that SHAs are “always under pressure for cash”. But he says one positive result of the transfer could be a shift in viewing drug treatment from a criminal justice issue to a health issue.

The criminal justice agenda has undoubtedly been key to improving drug services. Treatment for offenders is one of the NTA’s nine priorities, and breaking the link between drug misuse and crime is a key aim of the drugs strategy.

As a result, Iddon says non-offenders who want to give up drugs are “often second in the queue to people who have gone through the judicial system”.

There have also been claims that some drug misusers are deliberately committing crimes because they believe this will make it easier to access treatment services, although Iddon says there is not enough evidence to suggest this is a major issue.

DrugScope chief executive Martin Barnes says the NTA has attempted to raise the profile of drugs misuse as a health issue. But he says criminal justice will continue to be the main driver, in light of targets under the drug interventions programme, which aims to divert drug-misusing adult offenders from crime into treatment, to increase the number of people gaining access to services through the criminal justice system.

“That’s the political price we’ve paid to get the investment,” he says.

Iddon and Barnes say it is essential that drug treatment funding continues to be ring-fenced, but there are concerns this could be removed.

Iddon also says there is still room for improvement in providing counselling and in weaning people off the heroin substitute methadone.

“There’s not enough counselling and it’s too easy to put people on the green slime and just forget about them,” he adds.