Transcript Colin BRADBURY

Translating Standards into Practice:
The UK approach
Colin Bradbury
Head of Delivery
16th June 2011
Background
 National Treatment Agency for Substance Misuse in England
 Availability, quality and effectiveness of drug (and alcohol)
treatment
 Standards: National Institute for Clinical Excellence (NICE)
and Drug Misuse and Dependence: UK Guidelines on Clinical
Management (the Orange Book)
 Recovery Focus
 Localism: the what, not the how
2/29
Standards into practice (past)
1) Numbers
2) Access
250,000
210,815
200,000
164,768 175,869
125,545
150,000
100,000
10
194,173 200,805
85,000
94,500
99,000
116,000 115,500
8
6
4
50,000
2
0
1998/99 2000/01 2002/03 2004/05 2006/07 2008/09
Adults in treatment
0
2001 2002 2003 2004 2005 2006 2007 2008
Average waiting times (weeks)
3/29
Standards into practice (past)
3) Drop out
4) Leaving free of dependency
20
25000
15
20000
10
15000
5
10000
24656
18274
13717
10208
0
2004/05
2005/06
2006/07
2007/08
% clients not in effective treatment
2008/09
5000
0
2005-06
2006-07
2007-08
2008-09
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Standards into practice (past)
Heroin outcomes
Crack outcomes
52%
37%
31%
12%
3%
29%
abstinent improved
unchanged
deteriorated
abstinent
improved
33%
3%
unchanged
deteriorated
(n=21,075)
5/29
Longer term success
4 year follow-up of
Treatment Leavers
2005/06
(n= 41,475)
NDTMS
Drug Test
54%
CJS:
Prison &
Community
Did not
re-present
46%
6/29
What constitutes successful treatment? (present)
discharge reason and non-representation
rates
unplanned
planned
20
25
30
35
40
45
50
55
60
7/29
Longer term success
Time to representation
14000
12000
10000
8000
6000
4000
2000
0
less than one year
1 to 2 years
2 to 3 years
3 to 4 years
8/29
Challenges for moving to a more recovery
focussed system
 How many?
 Who?
 What can we do to help?
 Jobs and houses
9/29
Some solutions
 Re-presentation data (Drugs Data Warehouse)
 Case mix adjustment
 Patient Placement Criteria
 Payment by Results
10/29