The belated final evaluation of the drug and alcohol PbR recovery pilots found they were expensive, delayed treatment entry & had fewer treatment completions.
Some reported that PbR created opportunities for increased creativity and flexibility in the way in which services were designed and delivered. PbR had also encouraged a greater emphasis on monitoring and reviewing the progress of those in treatment. However the emphasis on measuring progress solely in terms of the PbR outcomes was both extremely costly and time-consuming but also had the potential to alter and
In my view, implementing rapid sanctions alone is unlikely to promote reduced drug use or offending. Desistance and recovery rarely involve a simple, linear path to success. If every relapse is met with 5 days in custody, it is hard to envisage how offenders will achieve the long term stability and abstinence required to build a personally fulfilling and law-abiding lifestyle.
Measuring drug recovery is problematic, to say the least. Recovery from drug dependence is, like desistance from crime, rarely a linear process and typically includes lapse and relapse over many years. Different people choose different recovery goals: some people remain abstinent from all substances for life; others continue to use occasionally; or replace drug dependence with a reliance on alcohol.
Complexity is almost always the enemy of effective PbR because it inevitably results in unintended consequences. Concern about possible unintended consequences results in worries about gaming the system which, equally inevitably, results in additional measures being taken to address these concerns which involves further complexity which…, well, you get the picture. In this post, I want to make the case for simple, robust measures to assess how effective PbR schemes are in meeting their outcomes.
Most payment by results pilot schemes are targeted at entrenched social problems. These problems – troubled families, long term unemployment, re-offending and drug dependency – are complex by nature. They require a coordinated response which addresses a wide range of issues. PbR funded interventions are a natural commissioning approach to tackle complex problems. However, PbR schemes quickly run into trouble when the outcomes themselves become complex.
00000In this latest in a series of short video interviews on payment by results, Nicola Singleton from the UK Drug Policy Commission gives her views on PbR and drug recovery. Nicola was involved in the co-design stage of the PbR drug recovery pilots and thinks that PbR has potential but questions whether it is the right vehicle for the long term, personalised outcomes that characterise recovery from drug dependency. You can keep up with UKDPC’s …
00000Not everything that counts can be counted… The first challenge of payment by results schemes is to set the right outcomes. The second is to set the right method of measuring those outcomes. Sometimes measurement is not too difficult – if a PbR scheme is about prevention re-offending, then the Police National Computer can be used to record reconvictions. Of course, the PNC doesn’t count every offence, only those when the offender is caught and …
00000Measuring recovery The biggest challenge of the drug recovery payment by results pilots has been agreeing a simple but robust measurement system to report on whether new approaches to drug treatment are successful in helping problem drug users stay clean and lead constructive and fulfilling lifestyles. There was an extensive public consultation about what these outcome metrics should be and, even though they have recently been updated, it’s far from clear whether they will work in …