Transcript the Presentation

Ian Wardle
21st February 2011
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For the public who subsidise it
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For the patients who benefit from it
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For the work force that delivers it
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An Ethical framework acknowledging the various
philosophies of care
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A service framework identifying the systemic elements
and their interconnection
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Clinical and practice guidelines
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A data infrastructure measuring various aspects of
performance outcomes
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A regulatory framework of necessary governance and
standards covering systems, services and individuals
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What follows is one person’s view
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It is a partial attempt to frame some of the key
questions that can be asked of the new Mainstreamed
Recovery Strategy
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It contends that the building of the Recovery Oriented
system needs close consultation and discussion so that
we are all clear about the main parts of the new
system and how they fit together and where we are in
the process
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How are the different forms of Recovery Theory
and Practice being taken up, absorbed and then
reinscribed within a new Recovery for the
Mainstream?
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How does ‘transformation’ sit with
‘incrementalism’ in the new mainstream Recovery
Mix?
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Building a united treatment field. How do we
proceed?
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Harm Reduction: A pessimistic anthropology
(Drug Dependence is a chronic relapsing
condition)
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Recovery: An optimistic anthropology
(Getting better is both desirable and
possible)
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Recovery 1:
As a concept crucially linked to abstinence
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Recovery 2:
As a profoundly, personal, qualitative journey
somewhat opaque to measurement
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Recovery 3:
As a process, susceptible to consensual
agreement, friendly to mainstream
interpretation and fit for public endorsement
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Abstinence Based Recovery: (Recovery 1)
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Personalised Recovery: (Recovery 2)
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Mainstream Recovery (Recovery 3)
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What is the desired end point of treatment?
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What are the Workforce Implications?
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What counts as success from the Patients’ Point
of View?
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How can we characterise the different Journeys?
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Abstinent Recovery 1:
Abstinence from all drugs
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Personalised Recovery 2:
Independent living on substantially self defined terms
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Mainstream Recovery 3:
Zero, or near zero dependence on the state in terms
of long term treatment costs and other benefits + no
crime
Recovery 1:
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A ‘balanced’ treatment system focusing upon
the new, ‘back-end’ low-cost, recovery
industries: detox, rehab and supported
housing. (de-complexified; non-statutory,
privately invested.)
Recovery 2:
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A workforce trained in co-production,
functioning in a market-place of demand-led,
user-commissioned, personalised services.
(Multi-disciplinary roots in social care and
complex needs.)
Recovery 3:
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A workforce trained in the new front-end
skills of preparation and engagement. Plus,
critically, the new skills of segmentation
(ppc); outcome measurement (TOP plus) and
Case Closure (Successful Completion)
Recovery 1:
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Abstinence: In Recovery; Membership in
flourishing local, drug free peer community;
abundance of employment, volunteering
opportunities in the new recovery industries
Recovery 2:
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Independent living built on personalised
budgets spent in a choice-rich, market place
of localised services. Recovery defined as a
‘qualitative’ and profoundly personal
experience ‘owned’ entirely by service user
Recovery 3:
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Stable, independent lives with minimum
contact with treatment, little or no
dependence on state benefits. Crime free,
housed and employed with risk free
family/dependent status
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Recovery 1: A peer-led, on-going journey ‘In
Recovery
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Recovery 2: A personalised, co-produced,
‘owned’ journey
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Recovery 3: A journey made with strong
professional support, measurable outcomes
and clear exit routes
The Transformational Elements:
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A new more optimistic anthropology
The therapeutic role of peer communities
Recovery as a personalised, ‘owned’ journey
A system founded on meaningful choice
Better systems of recognition and voice
The strategic acknowledgement of a broader
‘substance-wide’ remit
The Incremental Elements:
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A new priority for the front end of treatment
Recovery outcome measures more directly linked to
clinical practice and case review.
A workforce committed to the new system, its
measurement and the new skills mix.
Assessments that successfully integrate recovery
and harm reduction elements
Completions that register genuine success
Drug treatment has a complexity of purpose.
It is not about one thing.
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Objectives (Personal and Social)
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Constituencies of Interest (Stakeholders)
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Patients (Service Users
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Carers and Families
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We build a unity between patients, workforce and
the public
We meet the challenge of integrating a variety of
recovery approaches and beliefs in a coherent
mainstream strategy
We develop a mature workforce capable of deploying
both the incremental and transformational elements
of the new orientation
We continue to recognise the critical and vulnerable
state of a large proportion of users of our services
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Bric (Building Recovery in the Community). The new
Models of Care will help avoid chaotic commissioning
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The new ‘clinical guidelines’—recalibrating the
treatment system towards a recovery orientation
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New tools of outcome measurement which enrich
rather than ignore clinical judgment
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The new, front-end skills: engagement, assessment,
goal setting, recovery planning and review
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Failure to drive down cost despite efficiency led,
price-based scoring
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Failure to encourage sub-regional and regional
planning
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Failure to properly protect small organisations
and businesses
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Failure to encourage partnerships built beyond
narrow treatment pathways