Tuesday, 3 July 2012

Still Barking Up the Wrong Tree

So it's official. Justice Secretary Ken Clarke has told the House of Commons Home Affairs Committee that 'the UK is plainly losing the war on drugs'. 

"We've engaged in a war against drugs for 30 years. We're plainly losing it. We have not achieved very much progress. The same problems come round and round but I do not despair. We keep trying every method we can to get on top of one of the worst social problems in the country and the single biggest cause of crime."

The best he could offer the committee was that "there was better co-ordination between government departments".

So since when do intelligent people just carry on doing the same thing, when clearly as Ken confirms "nothing seems to be working". If he was a probation client and displayed such obvious cognitive deficits, we'd put him on an Enhanced Thinking Skills course. You'd think that the time had come to consider other options, a different approach perhaps, but not at all. What the government is actually doing is carrying on with the same failed policies and just 'reshuffling the deckchairs' by paying drug treatment providers differently.

As I have discussed previously, the government is convinced that introducing Payment by Results to whole swathes of public service provision will miraculously deliver better value for money by encouraging better outcomes. In April this year this new miracle accountancy device was rolled out in eight areas who bid to be guinea pigs under the grandly titled Payment by Results for Recovery Pilot Programme. From the initial twelve applications,  Bracknell, Enfield, Kent, Lincolnshire, Oxfordshire, Stockport, Wakefield and Wigan were selected, not to do anything substantially different, just carry on with failed policies like community methadone prescribing. This initiative follows on from the previous one entitled Drugs System Change Pilot Programme that involved lots of accountancy changes, but kept delivering the same failed treatments.

Confident in the knowledge that the war is being lost, I nevertheless forced myself to read some of the impenetrable crap that the new PbR industry has spawned and in the process provided  lots of jobs for bean counters. This is typical from Enfield:-

 In 2009 the DAAT  was keen to develop a revised commissioning framework to
embrace the wider Personalisation Agenda and Department of Health’s World Class 
Commissioning Vision. This included tendering for a new contract  that required
applicants to submit proposals for a mixed outcome and activity service level 
agreement against a capped annual contractual value of £1.35M. Tender applicants 
were also tasked with driving up performance against previous activity levels to
ensure that the DAAT Partnership was able to evidence value for money. The tender 
applicants had to submit two separate weekly unit costs: one for people in treatment
in receipt of prescribing services; the other for those in treatment but who were not 
receiving prescribing services. The new contract was awarded to a third  sector 
provider and came into effect on 1sJanuary 2010, running for 5 years. The DAAT, 
therefore, has obtained set weekly tariffs with the prime provider for processing
individual community treatment budgets.

Reading this stuff you could be fooled into believing that it might represent a policy that could lead to better services for alcohol and drug dependent people. Instead we all know it will just lead to cynical creative accounting on an industrial scale. What's needed of course is a change in policy, away from methadone or abstinence for everyone, to a real personalised agenda that includes heroin prescribing and residential treatment. Just imagine what a difference it would make if a heroin addict could be assured of regular, quality assured, free doses in a safe environment and without the risk of contaminated needles or the imperative to go out stealing. It would reduce crime at a stroke and make our job a damn sight easier.      


  1. Same old, "we will do something" about this, instead of going to doctors who deal with it in reality and may have solutions, lets carry on in the same old way . Slightly off topic, but a major drugs firm had a record settlement made against it for pushing drugs on children for "treatment" against all medical and regulatory advice, but I don't see any directors going to prison.

  2. Anonymous John4 July 2012 at 09:45

    "We keep trying every method we can". Untrue, as they haven't tried decrininaling it.

  3. This is not a field of work I really wish to engage in and so I could be reasonably critized for not putting my money where my mouth is; but - I do know that vast amounts of money are supporting all too many drug intervention schemes to pump massive amounts of methadone into our communities. There is no financial incentive to reduce, withhold scripts, if the client is still actively using Class A drugs or to be really radical/effective and promote and support coming off drugs altogether! That is what happens when contracts ; are given to the cheapest bidder!

    1. There is a current resurgence in the notion of encouraging drug-free lifestyles and by using methods well known to Alcoholics Anonymous members. My problem is that it's being put forward as the ONLY way of dealing with drug addiction - in reality there is no definitive solution - people need to be offered a range of options - methadone reduction; total abstinence or legal prescribing.