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The group of NHS providers , NHSSMPA , is looking at new ways to make sure service users stay connected with essential skilled healthcare
‘ isn ’ t what it is used to be ’ goes the quote , but are drug and alcohol services what they used to be ? Well no . Historically , before the formation of the National Treatment Agency ( NTA ), some areas saw two year plus waiting lists for opiate substitution therapy ( OST ), and investment in alcohol services was severely lacking .
While there had since been improvements in these areas , the combination of commissioning by local authorities , the global financial crash and ongoing austerity has conspired to result in devastating disinvestment in our services .
Disinvestment and retendering cycles have resulted in changes in the skill mix of services , with fewer nurses , doctors and psychologists ( those registered with professional bodies ) in teams , and an over-reliance on staff without professional registration or specialist training , and volunteers . There has been a significant loss of knowledge , practice and skills along the way , as provider organisations design services that try to manage the reduction in budgets while still meeting need .
The need for high calibre clinical skills and expertise were recently highlighted by two eminent leaders in the field – professors Colin Drummond and Sir John Strang in the Mental Health Times and BMJ respectively . Professor Drummond stated :
‘ Without proper care there are serious risks including epileptic fits and hallucinations , brain damage , suicide and risk of overdose . Yet many services do not have doctors or nurses with sufficient specialist training and competence to provide safe care .’
This highlights that registered staff and doctors have been in steady decline , but also that many of those recruited lack the relevant training , supervision and support to ensure high quality provision for complex service users . These experts do exist , but more and more they are in a lead role rather than ‘ on the ground ’, which can affect their contribution locally . There are only so many hours in a week .
A reduction in budgets means cash-strapped services are able only to work the purest interpretation of the service specification , compounding the effect of smaller budgets with a loss of social capital from providers .
As a sector we have been eager to seek solutions , usually through collaborative partnerships across health and social care . The significant decline in registered staff , including nurses , social workers , clinical psychologists and doctors means it is harder to achieve improvements even when the willingness has been there . Being able to speak the language of those that you wish to collaborate with has its advantages and enables effective partnership to prosper far more easily . The loss of these posts ( and the assurance of the NHS badge ) has negatively affected partnerships , most notably with health colleagues .
The continued reduction in professionally registered staff in treatment services is diluting the skills and professionalism required to address the needs of our service users . A recent CQC publication reports on serious concerns uncovered in many of the independent detoxification clinics across the country . Furthermore , the reduction in registered staff and the number of NHS providers jeopardises the overall standard of care and the ability to forge meaningful ventures to enhance care pathways . In short , the loss of these providers , practice and skills means some drug and alcohol services are relying on limited clinical expertise , to the detriment of care .
Public Health England ( PHE ) recently commissioned three publications highlighting the importance of the roles of nurses , addiction specialist doctors and psychologists within the drug and alcohol sector ( available at www . gov . uk ). They are a call to commissioners and providers that these skills and professional contributions are core and essential , and that their loss is having an impact on the overall provision of care as well as putting service users at risk .
As a group of NHS providers , NHSSMPA hopes to contribute to changing this . The following examples show innovations by NHS services where good practice has been implemented to improve the wellbeing of our service users . They also illustrate
20 | drinkanddrugsnews | March 2018 www . drinkanddrugsnews . com