The Home Office's Putting Full Recovery First document has created a hotbed of unrest across the recovery / addictions world with comments from as far afield as Australia. Closer to home, Twitter has been a-flutter with academics, practitioners, and recovery activists who seem predominantly apprehensive, anxious and confused by the departments latest offering.
I'll be exploring some of the issues raised over the coming days through this blog, but in the meantime, here the Substance Misuse Management in General Practice (SMMGP) helpfully provide a brief overview of the document and explore some of the areas of unrest and discussion.
A brief overview: In this document, which appeared on the Home Office website at the end of March, the Inter Ministerial Group (IMG) on drugs sets out to provide a roadmap for a new treatment system based on the overarching principles of wellbeing, citizenship and freedom from dependence. It does this by putting into context the ambition for reforming the system via a ‘purposeful policy programme’ and improved outcomes in a locally led system.
There are some positives to note – it recognises the contribution made by the Substance Misuse Skills Consortium, Recovery Group UK and Drugscope, and the role of these organisations “as key drivers of change” in providing a voice and channel of communication to the IMG.
The document outlines the purpose of Public Health England (PHE) as a ‘recovery orientated body’, with a vision for an integrated substance misuse treatment sector that includes alcohol. It confirms the major transfer of responsibilities to local authorities who will commission treatment services. Broadening the policy scope to include the welfare of families and securing housing and employment for people in treatment, and an integrated system that includes alcohol treatment, is commendable and of course, necessary.
SMMGP comment: The Putting Full Recovery First paper is an important looking document, with an introduction by Lord Henley, Chair of the Inter-ministerial Group on Drugs, and endorsed by Department of Health, DWP, Ministry of Justice, HM Treasury, Department of Education, Cabinet Office, and appears at first impression to be aimed - at least in part - at fulfilling the promises of the ‘Building Recovery in Communities’ programme that was consulted on last year.
We therefore read it with care and anticipation. However, on scrutiny, and disappointingly, it is a confusing document that contains several anomalies, e.g. there are several references to 2010/11 – why publish a (seemingly rushed) document at the end of the business year? It describes PHE almost solely in terms of taking over the functions of the NTA (‘which will be abolished’), when there are more than 60 outcome indicators for PHE of which drug and alcohol treatment is just one.
The frequent use of the phrase ‘full recovery’ in the paper is also confusing and will probably alarm people in treatment who already fear the threat of time-limited sanctions. It isn’t quite clear what is meant by it - whether having full recovery refers to being in treatment plus having a job and a house, or whether it means abstinence is being advocated.
With no clear action points included, it doesn’t quite live up to the promise of providing a roadmap, if anything, it loses its way, and may have the effect of needing to stop and ask again for directions before ending up in a dead end, or causing a pile up.
No one would argue with an ambition to improve people’s lives by having them recover from dependence on drugs (or alcohol) plus having a job and being housed; that is an ambition shared by most of us who work in the field. This document undervalues the recovery gains that have been made in the current system, and sadly writes it off as having been ‘full of …waste’.
Recovery is seldom a single event contained within a set period of time. It is usually incremental, often over many years. It can even be spontaneous. What is almost impossible is to describe it in rigorous terms and attach a value to it upon which payments will be made, once people have achieved it ‘fully’. It would be dangerous if there was a rush to commission services based on the belief that this document sanctions time limited treatment or that the underlying goal is abstinence for all.
We agree that a static treatment system benefits no one, and in recent years there have been encouraging community initiatives and recovery networks gaining ground all over the country, which provide a welcome and important means of support for all. But we know that the evidence for drug treatment as it stands, implemented responsibly, backed by sound clinical governance, and working in partnership with the patient, delivers. It delivers on the prevention of death and disease and crime reduction, whilst improving people’s lives, health and wellbeing, thereby giving them the opportunity of to recover.
During this time of ‘business as unusual’, we will continue to work hard to champion high standards and ensure quality treatment for all. As reflected on our forums and in other communications, we are encouraged by the resolve of the members of SMMGP and others in the field who work to uphold the gains made in treatment in recent years.
The views expressed in this post are those of the SMMGP. If you would like to discuss any of the content with SMMGP please contact Elsa Browne at firstname.lastname@example.org