One way, or another
Let’s make sure we spend on treatment that works.
Of course it makes sense to spend money on what works, and this issue we have powerful arguments for two very different types of treatment. On page 12 Mike Trace sets out evidence from running the first three years of the Island Day Programme. A highly structured 12-step programme, the service based in the London borough of Tower Hamlets – which we covered in DDN when it first opened – has seen steadily rising completion rates from its participants, who are all members of the area’s diverse community. The programme looks at how to control day-to-day influences on behaviour so that clients know they can step out of the door with increasing confidence each day, knowing they are stronger and more supported in every area of their life. The step from addiction to becoming drug free no longer seems such a huge height from which to fall.
Middlegate, the young people’s residential service featured in our cover story, offers a completely different setting – for some very good reasons. Clients are offered a refuge from all detrimental influences in their lives and given the opportunity, with intensive professional support, to untangle their own personal chaos. This relatively expensive infrastructure that threatens Middlegate’s viability is, to the young beneficiaries of treatment, a lifeline to the rest of life – what price should we put on that? And should we let this option disappear in (what we like to think of as) a climate of enhanced choice? Commissioning must always be about value for money, but sometimes this can mean a more intelligent look at long-term investment as well as the evidence of past successes.
Finally, I’d like to welcome Helen Sandwell as our new regular nutrition columnist, beginning this issue. Helen’s written excellent articles for us before and we will now be able to benefit from her expertise on healthy eating in every other issue – read her first column on page 9. It’s certainly needed, as Dr Chris Ford points out in her latest post-it from the surgery.
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