Ian Wardle21st February 2011

For the public who subsidise it

For the patients who benefit from it

For the work force that delivers it

An Ethical framework acknowledging the various philosophies of care

A service framework identifying the systemic elements and their interconnection

Clinical and practice guidelines

A data infrastructure measuring various aspects of performance outcomes

A regulatory framework of necessary governance and standards covering systems, services and individuals

What follows is one person’s view

It is a partial attempt to frame some of the key questions that can be asked of the new Mainstreamed Recovery Strategy

It contends that the building of the Recovery Oriented system needs close consultation and discussion so that we are all clear about the main parts of the new system and how they fit together and where we are in the process

How are the different forms of Recovery Theory and Practice being taken up, absorbed and then reinscribed within a new Recovery for the Mainstream?

How does ‘transformation’ sit with ‘incrementalism’ in the new mainstream Recovery Mix?

Building a united treatment field. How do we proceed?

Harm Reduction: A pessimistic anthropology(Drug Dependence is a chronic relapsing condition)

Recovery: An optimistic anthropology(Getting better is both desirable and possible)

Recovery 1:As a concept crucially linked to abstinence

Recovery 2:As a profoundly, personal, qualitative journey somewhat opaque to measurement

Recovery 3:As a process, susceptible to consensual agreement, friendly to mainstream interpretation and fit for public endorsement

Abstinence Based Recovery: (Recovery 1)

Personalised Recovery: (Recovery 2)

Mainstream Recovery (Recovery 3)

What is the desired end point of treatment?

What are the Workforce Implications?

What counts as success from the Patients’ Point of View?

How can we characterise the different Journeys?

Abstinent Recovery 1: Abstinence from all drugs

Personalised Recovery 2: Independent living on substantially self defined terms

Mainstream Recovery 3: Zero, or near zero dependence on the state in terms of long term treatment costs and other benefits + no crime

Recovery 1:

A ‘balanced’ treatment system focusing upon the new, ‘back-end’ low-cost, recovery industries: detox, rehab and supported housing. (de-complexified; non-statutory, privately invested.)

Recovery 2:

A workforce trained in co-production, functioning in a market-place of demand-led, user-commissioned, personalised services. (Multi-disciplinary roots in social care and complex needs.)

Recovery 3:

A workforce trained in the new front-end skills of preparation and engagement. Plus, critically, the new skills of segmentation (ppc); outcome measurement (TOP plus) and Case Closure (Successful Completion)

Recovery 1:

Abstinence: In Recovery; Membership in flourishing local, drug free peer community; abundance of employment, volunteering opportunities in the new recovery industries

Recovery 2:

Independent living built on personalised budgets spent in a choice-rich, market place of localised services. Recovery defined as a ‘qualitative’ and profoundly personal experience ‘owned’ entirely by service user

Recovery 3:

Stable, independent lives with minimum contact with treatment, little or no dependence on state benefits. Crime free, housed and employed with risk free family/dependent status

Recovery 1: A peer-led, on-going journey ‘In Recovery

Recovery 2: A personalised, co-produced, ‘owned’ journey

Recovery 3: A journey made with strong professional support, measurable outcomes and clear exit routes

The Transformational Elements:

A new more optimistic anthropology The therapeutic role of peer communities Recovery as a personalised, ‘owned’ journey A system founded on meaningful choice Better systems of recognition and voice The strategic acknowledgement of a broader

‘substance-wide’ remit

The Incremental Elements:

A new priority for the front end of treatment Recovery outcome measures more directly linked to

clinical practice and case review. A workforce committed to the new system, its

measurement and the new skills mix. Assessments that successfully integrate recovery

and harm reduction elements Completions that register genuine success

Drug treatment has a complexity of purpose. It is not about one thing.

Objectives (Personal and Social)

Constituencies of Interest (Stakeholders)

Patients (Service Users

Carers and Families

We build a unity between patients, workforce and the public

We meet the challenge of integrating a variety of recovery approaches and beliefs in a coherent mainstream strategy

We develop a mature workforce capable of deploying both the incremental and transformational elements of the new orientation

We continue to recognise the critical and vulnerable state of a large proportion of users of our services

Bric (Building Recovery in the Community). The new Models of Care will help avoid chaotic commissioning

The new ‘clinical guidelines’—recalibrating the treatment system towards a recovery orientation

New tools of outcome measurement which enrich rather than ignore clinical judgment

The new, front-end skills: engagement, assessment, goal setting, recovery planning and review

Failure to drive down cost despite efficiency led, price-based scoring

Failure to encourage sub-regional and regional planning

Failure to properly protect small organisations and businesses

Failure to encourage partnerships built beyond narrow treatment pathways