Government plans to pilot payment-by-results schemes to treat drug users will create “enormous practical challenges” and could waste public money, experts have warned.
The UK Drug Policy Commission (UKDPC) said the proposed projects for drug users were “the most ambitious and complex” such schemes in Whitehall and “may not deliver the benefits expected”.
“Public funds may be wasted and treatment denied to vulnerable people in need of care” unless the changes are introduced carefully based on evidence, the independent body said.
Changes could also be brought in before their consequences are fully understood, the needs of each addict will vary and the problems will be compounded by the introduction of other radical health service reforms, budget cuts and the introduction of elected police commissioners, it said.
In the Government’s white paper on drugs last December, six pilot schemes were announced which will be used to “incentivise recovery and drive success”, with the amount paid to those providing treatment for drug users dependent upon their success. The pilot schemes, to be set up this year, will cut bureaucracy and create a single system that would redirect funding “away from bureaucratic processing and into the recovery support that individuals need”, the Government said.
But Alan Maynard, professor of health economics at York University and a UKDPC commissioner, warned “the devil will be in the detail”.
“We support the principle of linking funding to the achievement of results,” he said. “But the devil will be in the detail about what results are realistically achievable and measurable and what the unintended consequences might be.”
In considering the outcomes of four different areas – crime, employment, drug use and wellbeing – “there will be enormous practical challenges for those delivering services and for the management of the system”, the UKDPC said.
Prof Maynard went on: “We urge caution in how it’s put into practice and the careful evaluation of the proposed pilot schemes is essential. Recovery from drug problems can be hugely complex, with users often needing services in healthcare, housing, social services, skills training, and employment.
“To get the system right takes a lot of work, and the changes will need to be introduced carefully, using the evidence from the pilots to shape the wider system.”