Both DrugScope and UKDPC have welcomed the high level outcomes specified in the 2010 Drug Strategy, and support a focus on outcomes in the commissioning and delivery of drug services. We note that there are different ways of developing ‘payment by results’ (including the activity-based tariffs that have been introduced in the NHS since 2003 and the ‘social bond’ approach at HMP Peterborough) and alternative ways to incentivise a focus on recovery outcomes.
Developing PbR for drug recovery in a way that incentivises outcomes for treatment and recovery creates significant practical challenges for those managing the system and delivering services. The challenge of moving to a new system in the pilot areas is compounded by the fact that the introduction of Drug Recovery PbR would overlap (for example) with radical health service reforms, a new system for prison commissioning, the introduction of elected police commissioners and restricted budgets for local councils. In particular, there is a need to properly integrate a number of different PbR initiatives that will be dealing with overlapping client groups, including Drug Recovery PbR, the Work Programme, PbR for alcohol problems within the NHS and PbR in the criminal justice system.
The draft outcomes document suggests that limited progress has been made towards a robust and detailed framework that can: incentivise effective delivery of the recovery outcomes in the 2010 Drug Strategy; ensure sufficient consistency to enable meaningful evaluation of the programme; provide a viable business model for service providers (particularly from the voluntary and community sector); and avoid the ‘perverse incentives’ that can exclude people from accessing the support they need for recovery or leave them ‘parked’ within services.