C Carlton
16 Nov 2010

This is not the first time that performance based contracting or payment by results, has occurred, it has previously been applied in ‘Improving public addiction treatment through performance contracting: The Delaware experiment’ (McLellan et al, 2008).

However, I would welcome payment-by-results, if the outcomes are seen as beyond that of abstinence, the interventions offered are evidence based, and beyond that of the key performance indicators that services have historically been held account to.

Defining the meaning behind some of the language, particularly a shared concept of what 'recovery' means would be helpful, if it is the outcome to be measured, and also so the public are aware of what they are signing up for.

It is tragic that this is being introduced at a time when it would appear that much of the addiction services have been recommissioned and moved progressively out of clinical services and NHS services in favour of lower costing, voluntary sector services.

A public health approach acknowledges that drug addictions are a 'health problem', yet behaviourally we are systemically doing all that we can to reduce the availability of clinically appropriate, evidence based services.

I would concur with Jack, when he says “after years of evidence based approaches we are simply returning to the dark days of revolving patients and the health consequences will be awful”.

It appears that the UK drug policy, strategy and treatment provision may be systematically working its way out of progressive, ethical, evidence-based, clinically/ therapeutically appropriate approaches to services, which are consistent with human rights, in favour of one size fits all, father knows best, just say no approach, which we know has failed before, and is likely to again.

[Reply]

Carl Cundall
Project Manager
Alcohol Recovery Community
16 Nov 2010

PBR should have been introduced 5 years ago, why should treatment providers get paid regardless of outcomes. Billions were spent forcing people to choose between getting bail or methadone, the emphasis will now be on sustainable and measurable recovery - hallelujah

[Reply]

Jack Muddikins
16 Nov 2010
Response to [Carl Cundall ]

What are you talking about? Treatment providers are all contracted, subject to review and performance monitoring with budgets fixed by numbers in service and retention.

No one was ever forced to choose between bail or methadone, I am not even sure what that means, its nonsense. I hope you know something about alcohol because the drugs world seems to have passed you by.

The government rhetoric of 'recovery' focus is just an easy way of appealing to the smug and self satisfied new abstentionists and the sanctimonious religious 'moral majority' but what it means is less money, less care, poorer health and more needless deaths.

After years of evidence based approaches we are simply returning to the dark days of revolving patients and the health consequences will be awful.

[Reply]