Drug and alcohol services

Category: 2getherI’ve been looking at the performance of drug and alcohol services, using the limited public data available. The 2gether NHS trust provides drug and alcohol services in Herefordshire but not in its home county of Gloucestershire, where they are provided by the charity Turning Point after 2gether lost the contract (for reasons that are unclear).

Some statistical reports are available from the National Drug Treatment Monitoring System (NDTMS), part of Public Health England. The reports seem only to be available in a funky online reporting tool that doesn’t let you compare each region to the national picture in any easy way.

Because NDTMS makes national comparisons hard, I gave up and didn’t try to make national comparisons from their data. I suppose this is exactly what NDTMS intended when it imposed its funky online reporting tool on us all.

I gave in, however, to the temptation to compare Herefordshire with Gloucestershire.

Drug treatment

Outcomes for adult drug treatment are defined as part of the Public Health Outcomes Framework (PHOF), as part of the Health Improvement domain, in the form of two indicators:

2.15i  Successful completion of drug treatment — opiate users
2.15ii  Successful completion of drug treatment — non-opiate users

A notice appears (at the time of writing) on the PHOF website:

“Due to technical difficulties, the release of the indicators in the February update of PHOF was delayed by approximately 1 hour 10 minutes; Public Health England apologises for any inconvenience this may have caused.”

This is hilarious because the data for the drug treatment indicators dates from 2012. An additional delay of 1 hour 10 minutes must have been extremely inconvenient for many people!

Fortunately, NDTMS provides more recent data. The latest figures there are for January 2014:

Opiate Non-opiate
Herefordshire 6.1% 24.0%
Gloucestershire 7.2% 26.3%
England average 7.8% 40.6%

In comparison with PHOF’s 2012 data all these results for both Herefordshire and Gloucestershire would have been red-flagged as significantly worse than average compared with England as a whole. In absolute terms, success rates are pretty dismal at best.

Alcohol treatment

Outcomes for alcohol treatment seem to be a grey area. I can’t find relevant indicators in the outcomes frameworks, and I can’t find outcomes data in the NDTMS reports.

The Health and Social Care Information Centre, however, provides data on emergency admissions for alcohol related liver disease, an indicator known as CCG 1.8. This can be used to calculate a home-made prevalence statistic (admissions per 100,000 of the adult population in the year October 2012 – September 2013):

admissions prevalence
Herefordshire 40 27.5
Gloucestershire 71 14.6
England 10,863 24.8

This suggests a much less significant problem in Gloucestershire – little more than half the prevalence of Herefordshire when estimated in this way.

NDTMS only provides activity data without telling us the outcomes, and there’s no national summary either. Taking discharges per month as a measure of activity, averaged over the ten months to January 2014, and then calculating the rate of discharges per 100,000 of the adult population, the levels of activity can be judged relative to the home-made prevalence statistic above:

discharges rate relative
Herefordshire 17 11.6 42%
Gloucestershire 41 8.3 57%
England ? ? ?

This indicates somewhat more treatment activity in Herefordshire relative to the size of the population, but somewhat less relative to the prevalence of alcohol-related disease.

Transparency

A glaringly obvious feature of NDTMS is the amount of locked data unavailable to the public. A glaringly obvious feature of PHOF is the amount of data that’s too old to be worthwhile. Alcohol treatment, in particular, seems to lack even agreed outcomes indicators. Lack of transparency in these areas can only be impeding progress towards tackling the problems.

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About Rod

Chairman of the Gloucestershire charity Suicide Crisis, Vice Chair of Relate Gloucestershire & Swindon, and an enthusiast for public involvement in the NHS.
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