Fitting into the Future: the future of the Drug Treatment Industry
Our Industry, the drug treatment and policy industry faces an uncertain future.
The state of our industry is not the responsibility of the government or the NTA. The government in the form of the Drug Strategy Unit in the Home Office, (DSU) or the National Treatment Agency (NTA) is not responsible for providing our industry with a vision. The new drugs strategy, Drugs: Protecting families and communities, does not fit within a ten-year vision. The Strategy Action Plan that accompanies the strategy does, however, claim to be the first three-year installment of a ten-year strategy that will bring us up to 2018.
The fact that we are lacking a long-term vision may or may not be seen to be a hindrance. Many organisations are geared extensively towards growth targets that are tracked and refreshed in Annual Performance Plans and sit within Medium Term (3 year) strategies. For most of us, certainly those of us in the Third Sector, our vision is growth and, moreover, growth as measured in the near to medium term.
Those of us who class ourselves as providers are rarely concerned to come together to discuss something as collegiate and long-term as a vision. For us, the source of our funding is the government and that's pretty much all the vision we need thank you. There are very few exceptions to this rule. That is the way we have developed over the course of the past ten years. We devote our best brains and our biggest salaries to competing for new business. This is certainly not to say competition is a bad thing. Health and social care systems where competition is discouraged will probably stagnate, become complacent and tolerate bad practice and poor performance.
Sometimes we claim that the increase in competition has made it impossible for the large Third Sector and Statutory providers to come together and cooperate on issues of common concern, such as the impact of policy upon our beneficiaries and service users. This analysis is another way of placing the responsibility for our lack of vision on the shoulders of somebody else, the Government, the NTA, etc., etc.
There have been occasions when several large organisations have come together to proclaim that ‘Treatment Works’. Treatment may well work, for some, indeed, a majority of our clients. Nevertheless, if one looks at the vision statements of Local Authorities and Primary Care Trusts and other key stakeholders in our local partnerships, one invariably finds something more than self-justifying statements about how good they are. A key part of the purpose behind the development of such long-term visions is to build on strengths and, crucially, to highlight shortcomings.
Without a vision, serious self-criticism is impossible.
It is easy to sneer at long-term exercises in 'visioning', but a serious, integrated approach to tackling deep-rooted inequality and deprivation is, quite frankly, inconceivable without a dedicated, explicit and strongly aspirational long-term plan. So although 'Treatment may Work' and 'Treatment may be Good' it does not in any way excuse us, as an industry, from developing a solid critique of all those things about treatment that don't work and aren't good. If we are unable to do this, and to do it in such a way that the public can see that we are capable of going beyond the narrow short-term interests of our own organisations, then we will not be able to face the public honestly and with conviction. And we will struggle to explain what our vision for the future is. At the moment, we are more than happy to let the NTA take it on the chin for the rest of us. We will not be allowed to get away with this for very much longer.
Without a vision, the already considerable uncertainty that surrounds our future will grow to the point that it will be virtually impossible to analyse our achievements and shortcomings in a way that is balanced and helpful, either for ourselves, or for those who criticise us. A number of clear-sighted critics variously positioned across a spectrum of widely different views and approaches are already far from convinced in our performance as an industry.
There are those who actively campaign for new drug laws who feel that drug treatment providers know full well that many of the harms caused by drugs accrue from a misguided prohibitionist policy and that our responsibility is to be more open and honest about this.
There are those who feel that the first national strategy, with its strongly perceived reliance on the medium term prescribing of methadone was both ineffective and morally wrong.
There are those who wonder why the principal priority of the last National Drug Strategy (1998-2008), with its focus on crime reduction, failed properly to address the health and well being of drug users and their carers.
Some of these criticisms are well made and some aren't. The public isn’t necessarily always as ill-informed as many professionals like to think and the experts aren't always as self-interested as is often claimed.
However, speaking as a Chief Executive of a major national provider, I do not want to manage an organisation with a vision in an industry without one. I do not actually believe that such a situation is possible. I'm not interested in the various unique selling points and claims of various drug treatment providers as long as our lack of vision as an industry is so overwhelmingly apparent.
What are our long term objectives?
Before ever we develop a set of objectives for our industry, we need a vision and before we develop our vision it is important, as any organisation-based planner will tell you, to understand the context. Think context! Ideally that context would be constructed and shared as a result of a discussion. What kind of discussion? A discussion where we can identify that there are a number of different interests and that they aren't all necessarily compatible.
The challenge is, therefore, to have a creative and constructive discussion about the future of our industry. This discussion will help provide the context necessary for developing our vision. It should be an open discussion. We should welcome the contributions of our critical friends, and we should also welcome the contributions of those whose criticisms are not necessarily informed or motivated by friendship. We should open-up.
Self-criticism is hard at the best of times. When our industry is under the critical scrutiny that currently it is, we may feel we need to draw our wagons into a circle. This will not endear us to the public or our critics and, equally importantly, it will not enable us to understand the profound and structural challenges that we face as well as the equally serious but more localised and industry-specific threats that we are already encountering.
We certainly need to be able to declare our own interests. We need to be able to separate out the health and wellbeing of our clients from the safety and strength of our communities and we need not to confuse these separate sets of interests with our own individual financial and career interests as workers and managers in the drug treatment industry.
With a commitment to a long term vision, (one that doesn't set drug users against communities), a readiness to be self-critical and a commitment to understanding the current context in which we are working and planning our future, we will be more ready to think about where we fit into the future.
End of Part One.
# Ian Wardle
# Lifeline UK
# October 15, 2008