A moral imperative

One year on, an alliance of 13 NHS trusts is gaining momentum in addressing the failings of the sector and developing more effective pathways to care, as Danny Hames explains.

The NHS Substance Misuse Providers Alliance (NHSSMPA) has been in existence for just over a year. NHSSMPA is a collaboration of 13 NHS trusts, all of which provide substance misuse services in the community and prisons. While NHS provision has changed in the last few years and just over a quarter all community substance misuse treatment systems are NHS, we continue to provide inpatient detoxification facilities nationwide and work in numerous prisons. Celebrating 70 years of the NHS, and in this time working with those affected by drugs and alcohol, means it is in our DNA.

Our aims are to work more closely as NHS providers, and with our colleagues in the third sector, to improve outcomes for service users through sharing and de­vel­op­ing practice and to offer policy makers engage­ment with the NHS substance misuse community.

What unites NHSSMPA is a belief that people deserve high quality services which can improve their lives. For us, this means a competent and qualified workforce where volunteers complement but are not relied upon; interventions that are evidence based and individualised; that we are effective partners and contributors to a local health and social care economy; and that we protect the safety of our service users while walking alongside them to provide the best chance of recovery.

Age-specific mortality rates for deaths relating to drug misuse, registered 1993 to 2016, England and Wales

The impact of the abstinence vs harm reduction debates of the last few years, leading directly and indirectly to some some individuals being pushed through treatment systems too quickly, has been over-simplified and dangerous. Thankfully, NHSSMPA believes the new drug strategy and the presentations accompanying this have underlined a change in tone. For us as NHS providers, harm reduction has always and continues to be a priority.

There is (quite rightly) a very prominent debate regarding the reduction in funding for substance misuse services, and of course NHSSMPA strongly believes that services should be adequately funded. However, we should not let this mask the fact that recently doubt has been cast upon the governance and quality of the sector.

The emphasis on ensuring we are competent and thoughtful guardians of funding, and that this properly benefits service users, has never been more important. Local authorities are experiencing significant challenges to their budgets and there are numerous patient groups deserving of funding. So there is a strong moral imperative to use the monies we receive effectively, most importantly because:

1. We are seeing the highest levels of drug-related deaths since records began. In 2016 this numbered 2,593 deaths associated with drug misuse.

2. Recovery rates are dropping for opiate users. In 2011­-12 treatment completion was 8.59 per cent; year to end November 2017 it was 6.7 per cent (NDTMS). This is all despite a narrative underpinning many procurement exercises that service redesign will mean improved performance.

3. The CQC’s recent review of non NHS residential was shocking – 63 per cent of services were assessed as not meeting the regulation on ‘safe care and treatment’ (CQC).

4. The unfortunate demise of Lifeline, a charity with an income of £53m, demonstrated poor organisational governance and left more than 5,300 potential creditors, including other charities.

NHSSMPA is highly committed to advocating for appropriate funding, but we must not ignore that there have been very significant indications that the sector needs to improve its governance and outcomes for patients. NHSSMPA organisations have a public service and moral duty to achieve this. Over the coming years NHS providers will make our contribution and commit our expertise, because justifying the effectiveness and quality of what we offer has never been more necessary.

Danny Hames is chair of the NHS Substance Misuse Providers Alliance

If you are a NHS trust and would like to find out more about NHSSMPA please contact candie.lincoln@sssft.nhs.uk