Putting ‘full’ recovery first…

April 10, 2012 by
Filed under: Recovery 

The Home Office’s Putting Full Recovery First document has created a hotbed of unrest across the recovery / addictions world with comments from as far afield as Australia. Closer to home, Twitter has been a-flutter with academics, practitioners, and recovery activists who seem predominantly apprehensive, anxious and confused by the departments latest offering.

I’ll be exploring some of the issues raised over the coming days through this blog, but in the meantime, here the Substance Misuse Management in General Practice (SMMGP) helpfully provide a brief overview of the document and explore some of the areas of unrest and discussion.

A brief overview: In this document, which appeared on the Home Office website at the end of March, the Inter Ministerial Group (IMG) on drugs sets out to provide a roadmap for a new treatment system based on the overarching principles of wellbeing, citizenship and freedom from dependence. It does this by putting into context the ambition for reforming the system via a ‘purposeful policy programme’ and improved outcomes in a locally led system.

There are some positives to note – it recognises the contribution made by the Substance Misuse Skills Consortium, Recovery Group UK and Drugscope, and the role of these organisations “as key drivers of change” in providing a voice and channel of communication to the IMG.

The document outlines the purpose of Public Health England (PHE) as a ‘recovery orientated body’, with a vision for an integrated substance misuse treatment sector that includes alcohol. It confirms the major transfer of responsibilities to local authorities who will commission treatment services. Broadening the policy scope to include the welfare of families and securing housing and employment for people in treatment, and an integrated system that includes alcohol treatment, is commendable and of course, necessary.

SMMGP comment: The Putting Full Recovery First paper is an important looking document, with an introduction by Lord Henley, Chair of the Inter-ministerial Group on Drugs, and endorsed by Department of Health, DWP, Ministry of Justice, HM Treasury, Department of Education, Cabinet Office, and appears at first impression to be aimed – at least in part – at fulfilling the promises of the ‘Building Recovery in Communities’ programme that was consulted on last year.

We therefore read it with care and anticipation. However, on scrutiny, and disappointingly, it is a confusing document that contains several anomalies, e.g. there are several references to 2010/11 – why publish a (seemingly rushed) document at the end of the business year? It describes PHE almost solely in terms of taking over the functions of the NTA (‘which will be abolished’), when there are more than 60 outcome indicators for PHE of which drug and alcohol treatment is just one.

We therefore read it with care and anticipation. However, on scrutiny, and disappointingly, it is a confusing document that contains several anomalies

The frequent use of the phrase ‘full recovery’ in the paper is also confusing and will probably alarm people in treatment who already fear the threat of time-limited sanctions. It isn’t quite clear what is meant by it – whether having full recovery refers to being in treatment plus having a job and a house, or whether it means abstinence is being advocated.

With no clear action points included, it doesn’t quite live up to the promise of providing a roadmap, if anything, it loses its way, and may have the effect of needing to stop and ask again for directions before ending up in a dead end, or causing a pile up.

No one would argue with an ambition to improve people’s lives by having them recover from dependence on drugs (or alcohol) plus having a job and being housed; that is an ambition shared by most of us who work in the field. This document undervalues the recovery gains that have been made in the current system, and sadly writes it off as having been ‘full of …waste’.

No one would argue with an ambition to improve people’s lives by having them recover from dependence on drugs (or alcohol) plus having a job and being housed; that is an ambition shared by most of us who work in the field

Recovery is seldom a single event contained within a set period of time. It is usually incremental, often over many years. It can even be spontaneous. What is almost impossible is to describe it in rigorous terms and attach a value to it upon which payments will be made, once people have achieved it ‘fully’. It would be dangerous if there was a rush to commission services based on the belief that this document sanctions time limited treatment or that the underlying goal is abstinence for all.

We agree that a static treatment system benefits no one, and in recent years there have been encouraging community initiatives and recovery networks gaining ground all over the country, which provide a welcome and important means of support for all. But we know that the evidence for drug treatment as it stands, implemented responsibly, backed by sound clinical governance, and working in partnership with the patient, delivers. It delivers on the prevention of death and disease and crime reduction, whilst improving people’s lives, health and wellbeing, thereby giving them the opportunity of to recover.

During this time of ‘business as unusual’, we will continue to work hard to champion high standards and ensure quality treatment for all. As reflected on our forums and in other communications, we are encouraged by the resolve of the members of SMMGP and others in the field who work to uphold the gains made in treatment in recent years.

The views expressed in this post are those of the SMMGP. If you would like to discuss any of the content with SMMGP please contact Elsa Browne at elsa.browne@nta-nhs.org.uk



  • Anon

    Please explain why you believe the involvement of the Skills Consortium, Recovery Group UK (whoever they are!) and Drugscope is a positive in this document!

    • Elsa Browne

      Sorry for delay in responding due to being on annual leave. Our comment is related to the acknowledgement by the IMG of the contribution of those organisations (Skills Consortium, Drugscope etc) to policy development in the drugs field. How much consultation on this particular document actually took place, is unclear.

  • Gerry Stimson

    The road map is clear that ‘full recovery’ does not include being prescribed. “Whilst we recognise that substitute prescribing can play a part in the treatment of heroin dependence, both in stabilising drug use and supporting detoxification, it will not be the final outcome paid for in PBR. There may be people in receipt of such prescriptions who have jobs, positive family lives and are no longer taking illegal drugs or committing crime. But it is important to utilise such interventions as a bridge to full recovery, not as an end in itself or indefinite replacement of one dependency with another.” p10 and
    ” We will ensure that open-ended substitute prescribing in the community is only used where absolutely necessary, and only on the basis of a rigorous, multidisciplinary review of a patient‟s ongoing needs and even so with recovery as the eventual goal.”

    Time for all those agencies that went along with the Coalition recovery agenda to speak up against this limited and limiting interpretation of recovery.

  • Sara McGrail

    This document is probably one of the most dangerous expressions of Government Drug Policy I have ever seen. Marking a massive step away from the evidence base on effective treatment, “Putting Full Recovery First” puts political aspiration above individual health and sets out a “vision” that will cause serious damage to our most vulnerable communities and individuals. By setting out its intention to restrict access to effective evidence based treatment the government is sending a signal to providers and commissioners that current practices of involuntary detoxification, service exclusions and rationed and time limited treatment is ok. These approaches cause real distress and hardship to individuals and will present major public health risks to the wider community.

    The involvement of organisations from the drugs field in this new approach marks little more than their desire to please government. The aggressive self interested lobbying of the private residential sector has been a major influence on this document – and the work of the Centre for Social Justice from which much of this “roadmap” is lifted. The approach to implementation outlined in the document is unrealistic and over ambitious given the current state of local structures – and the massive economic and organisational strains on local authorities. The implementation of PBR described in the document will be disastrous unless a significant amount of work and resource is put into skilling up the commissioning sector – which over the past 12 years has become little more than contract management. 

    It is worth noting also that the status of the document is unclear and confusing and that it has inherent contradictions between its language around ambition and implementation