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Britian losing drug war { May 22 2003 } Original Source Link: (May no longer be active)
http://www.guardian.co.uk/drugs/Story/0,2763,961014,00.htmlhttp://www.guardian.co.uk/drugs/Story/0,2763,961014,00.html
Special investigation
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How Britain is losing the drugs war
Today, the Guardian launches the biggest investigation of the criminal justice system ever conducted by a British newspaper. Beginning a series which will run throughout the year, Nick Davies looks at the government's attempt to deal with the most prolific of offenders - the drug users who commit an estimated 7.5 million crimes a year.
Thursday May 22, 2003
The Guardian
Richard Elliott couldn't stand it any more. For nearly two years, he had been acting as the government's drugs envoy in Bristol, running the city's drugs action team, handling millions of pounds a year, linking together police, health and social workers and voluntary agencies into one big drive against drugs, but earlier this year he realised he couldn't stand it any more, so he quit.
In fact, for most of that time he wasn't supposed to be running the drugs action team (DAT), but his coordinator had quit a year earlier because she couldn't stand it any more either and so Elliott, who was supposed to be the commissioning manager, had taken on her job as well.
He didn't want to do that; he knew of at least four other DAT coordinators in the area who had gone off sick in the previous 12 months. He did at least have some help but his new colleague was soon working so hard that he started getting chest pains and, when he carried on regardless, his left arm started tingling and going purple until finally he couldn't stand it any more and went off sick. Then he quit too.
Elliott could no longer bear the waste. He had six staff and a budget of £3.5m a year. He had a potential client group of 25,000 recreational users of cocaine and amphetamine, ecstasy and cannabis; plus a further 12,500 chaotic drug users who buy heroin and crack cocaine on the city's open drugs market, centred on St Paul's. He focused on the 4,500 chaotic users who live in Bristol but at the end of all his work and all that public money, the total number of NHS detox beds which he was able to provide to help any of those users was five, one of which was reserved for those with mental illness.
Even more than that, what Elliott really couldn't stand was the bureaucracy - the 44 different funding streams, each one with its own detailed guidance and micro targets from the centre, each one with its own demand for a detailed business plan and quarterly reports back to the centre; the endless service agreements he had to sign with every local provider with their own micro targets and a demand for quarterly reports back to him so that he could collate them and pass them back to the centre; the new annual drugs availability report to the centre; the annual treatment plan to the centre over 68 pages and nine planning grids with 82 objectives (that's what Elliott's colleague was working on when his arm went purple); the funding announced too late for planning and then handed over too late to be spent and finally spent for spending's sake to prevent it being reclaimed by the centre; the staff hired and trained and then suddenly sacked when funding or targets were switched by the centre, (or just quitting because they couldn't stand it any more). He reckoned he and his staff spent only 40% of their time organising services for drug users - the rest of their time was consumed by producing paper plans and paper reports for Whitehall.
Elliott wrote a resignation memo for a colleague with the heading "Ravings of a burned-out mind". He described the culture of control in Whitehall, their "monitoring fetish" and their short-term thinking, and he wrote: "Monitoring has become almost religious in its status, as has centralised control ... The demand for quick hits and early wins is driven by a central desire analogous to the instant gratification demands made by drug users themselves ... The criminal gangs that control the market are laughing all the way to the bank and beyond, as we tie ourselves in knots with good practice guidelines and monitoring. It's like trying to fight with one hand tied behind your back, a boxing glove on the other and strict instructions not to punch."
When the government declares its intention to attack the causes of crime, it signals its intelligence - its understanding that it cannot control crime simply by using the ancient and inefficient levers of conventional criminal justice. When it goes on to identify those causes, it can see through the endless confusion two huge social turbines generating criminality. One of them is the boom in child poverty during the Thatcher years with all of the profound and intricate damage which that inflicted physically and emotionally, socially and spiritually, and the government can see that, to undo that damage, it will need to invest several generations of intense and skilful political effort. It may decide (as it has) that it is worth doing, but it takes that route knowing that it will be long and uncertain.
But the second great engine of crime is different - the war against drugs. That is finite and tangible, with drug users blamed for 7.5 million offences a year, up to 90% of all property crime in some areas. And any government can see that, by taking finite and tangible steps on drugs, it can score a real impact on crime and disorder and, what is more, it can save lives and restore communities.
In 1998 the government launched a national campaign of treatment, creating a network of 149 drug action teams, reinforced since the autumn of 2001 by a new national treatment agency (NTA), fuelled by the belief that by promoting treatment alongside law enforcement it could finally generate success where criminal justice alone had failed. But if the drug action teams collapse, then that collapse is on the same spectacular scale - a disaster for the whole strategy on crime but a disaster too for black market drug users and for the communities they have wrecked.
The reality is that, after five years of effort and with a budget now topping £400m a year, despite relentlessly hard work from some 5,000 dedicated people on the ground, there is an alarming shortage of effective treatment and no sign of a reduction in demand for drugs.
Richard Elliott describes an organisation which is being managed to death, where centralised direction has mutated into systematic suffocation.
The government says the DATs must do the work; so the DATs must prove they are working; and very quickly the proving becomes their work.
Elliott's explanation is simple: "They don't know very much about drugs, but they do know about management and monitoring and data collec tion. So that's what they do."
In early 2000, the Home Office decided to spend £5m on Prospects hostels so that drug users leaving prison could have a bed with special treatment. Since then, the Home Office's Prison Service have a) chosen five pilots areas, including Bristol, b) set up a new team to manage the project, c) gone through a rigorous tendering process to select providers, d) produced a detailed specification for the hostel regime, e) transferred "ownership" of the project to the national probation directorate who set up a new team to manage it who, f) converted the regime into a set of operating manuals and g) held numerous meetings with DATs to monitor progress, and h) asked DATs to develop "a methodology for site search and selection", and i) to set up local planning teams to draft, consult on and agree referral protocols, after which, j) they set up local project boards and k) this February they held a press launch. But there was nothing to launch.
After three years of work, they have consumed hundreds of hours in meetings, spent hundreds of thousand of pounds but have not yet provided a single bed for a single drug-using ex-prisoner in Bristol or anywhere else. They say it may happen "as early as 2004" although only in the five pilot areas which will then be subject to a three-year evaluation.
Just before Christmas last year, a 20-year-old prisoner named Sean Wildman, who had been sent to Exeter prison with a drug problem, died on the streets of Bristol, homeless and stuffed full of black market heroin.
Over and over again, Elliott found that a problem was confronted not with a solution but with a bureaucratic process. Problem: there are not enough detox beds. Solution: pay for some more. What the DAT had to do: rewrite the service level agreements with local providers; increase their targets by 10%; conduct an audit to measure the gap between the detox they had and the detox they needed; cut the funds to meet an NHS efficiency target. Outcome: no change yet.
Problem: there are not enough rehab places. Solution: pay for some more. What the DAT had to do: audit and review existing rehab places; join a regional review of rehab places; hand over £5,000 from their treatment budget, along with all the other local DATs, to fund a new regional offical to take over central purchasing of rehab; set up an inquiry into the need for special rehab places for black, Asian and women users - and, of course, all this had to be recorded on planning grids, most of which then had to be rewritten to improve its performance score. Outcome: no change yet.
Problem: users come out of rehab with nowhere to live. Solution: find them somewhere to live. What the DAT was required to do: conduct a review of residential treatment services in Bristol; set up a special integrated care pathways group to liaise between agencies; develop a new protocol between treatment and housing; set up a waiting times group to monitor waiting times and the implementation of the protocol. Outcome: no change yet.
The result on the ground is that the government has created a multimillion- pound collection of signposts. There are 15 different agencies in Bristol swapping referrals, making assessments and providing leaflets. There is a specialist agency for black people and another for Asians and five for particularly troubled estates.
There is no shortage of information for drug users. There is masses of advice and support. There is anger management and debt management and counselling, both group and individual. There is aromatherapy and acupuncture and careers advice and nutritional advice. This could help new users or old users who have given up. But where on this tragic roundabout is the treatment which is going to transform the life of a career criminal who has spent the last 10 years on heroin?
The answer is that down on the ground floor of the vast edifice of drug treatment, there is a small door which occasionally opens to allow a handful of users to proceed down a corridor of smaller and smaller doors. The first door is marked "detox" and, in Bristol, it leads to a room which has five beds in it, from the National Health Service. A simple detox takes a fortnight, so on the face of it, each of these beds can handle 26 patients a year, a total of 130. In reality, however, one of the beds is always reserved for drug users who are mentally ill; the other four beds may sometimes be used as an emergency overflow for mentally ill patients who are drug free; and any of the beds can be used for more than two weeks if the user has extra problems (Aids, hepatitis, other addictions). In reality, in a year, they expect to admit only 96 drug users.
A little further down the corridor, are two even smaller doors. One leads to the Salvation Army who keep five more detox beds which are purchased by the DAT, potentially serving a further 130 drug users. But one of these is reserved for alcoholics. And the other four are reserved only for those who are "vulnerable and entrenched rough sleepers". Those who can get through this door tend to have more problems than the NHS users and occupy each bed for longer and so, in a year, they expect to admit only 80 drug users.
The second small door leads to "home detox", where the user is visited by a nurse and given medication to help. Eighty users a year can squeeze through here.
So, from the 4,500 chaotic users with Bristol addresses who are targeted by the DAT, only 256 will have access to detox. And the doors beyond this are smaller still. Detox is not magic; it can be very hard, and some of the detox beds nationally are in grim mental health wards. With the NHS and Salvation Army beds, at least 40% will fail to complete their detox. With home detox, 60% are expected to fail. On that basis, of the 256 who start, no more than 138 will stay the course and be ready for rehab. But the fact that they are ready does not mean they will reach the end of the corridor.
The two main rehab houses in Bristol require total abstinence, not only from illegal drugs but also from prescribed drugs, like anti-depressants, and also from alcohol; some simply cannot face it. Those who remain will have to wait up to 20 weeks for a place; some will give up and go back to their drug. Those who persist must be assessed and means-tested by community care ; some will fail to meet the criteria. Some of those who survive will be mothers with children. Until last year, they could take their children with them to rehab, but then they changed the accounting rules so that the child's part of the budget was allocated to the children's directorate which refused to pay, which means some mothers cannot take the place they have been offered.
Last year, the Bristol DAT finally placed only 55 of its detoxed drug users in rehab. Sixteen dropped out before their course was completed. Twenty-nine completed the course and, at the time of writing, nine were still there. For this maximum of 38 drug users who complete rehab, one more narrow door remains. Will they remain drug free? This last door leads nowhere. They may get support from their family or from Narcotics Anonymous but, so far as the state is concerned, there is effectively no more help. Past experience suggests that within six months, 45% will be back on their drug. On that basis, only 21 of these users will reach the end of the corridor of narrowing doors.
Using DAT funds, Bristol social services will send some of their clients down the same corridor, perhaps a further 40. If they fall by the way at the same rate as the others, five of them may reach the end. A year's work, a budget of £3.5m, a pool of 4,500 chaotic drug users - a total of only 26 free of drugs.
There is one other treatment corridor which leads not to abstinence but to "maintenance" - a prescription designed to provide users with clean drugs in order to keep them away from the crime and ill-health of the black market. But this corridor begins with a door which opens on to a blank wall. The prescription of clean heroin which has secured dramatic results in other European countries is simply not available in Bristol. There is not one single heroin prescription in the city. The same is true of most communities in Britain. The only other door on the corridor leads to the prescription of methadone. And here, Bristol has a success story.
Ninety per cent of the city's GPs are willing to prescribe oral methadone - far more than in most communities. More than 1,000 users in the city have prescriptions which may keep them safe from the black market. The difficulty is that these are the problematic users who need help to stop them going back to the black market and to sort out their lives, but the tight control of funds from the centre means there are only eight key workers at the Bristol Drugs Project, so only 200 of them receive real help. The others sit at home getting bored and watching television. "Methadone and Neighbours," Elliott calls it. It is a recipe for returning to drugs.
The disaster in Bristol is merely part of a disaster across the country. Nobody knows how many chaotic drug users there are in Britain. The Home Office claims there are "more than 250,000". There are specialist academics and drug workers who will tell you that that is a gross underestimate, that the true figure may be as high as 500,000.
Last year, across the entire country DATs spent only £19m on detox (just under 5% of the £390m available). The NTA says an average detox costs between £3,000 and £4,500. Taking the lower figure, that means they paid for a maximum of 6,333 detoxes. If they fail nationally at the same 40% rate as in Bristol, only 3,800 users will have emerged ready for rehab. Last year nationally, DATs spent £21m on rehab places, slightly less than the previous year. At an average cost, according to the NTA, of £6,000, that pays for only 3,500 of those users to go on to rehab. If they fail at the same rate as the Bristol users, only 2,415 will complete the course and only 1,328 will emerge drug-free. Since 1998, when the government launched its treatment strategy, the British Crime Survey has recorded "a statistically significant increase in class A drug use".
This is the story of a fiasco at the heart of the criminal justice system. This is not for want of money; the national treatment budget has risen from £234m in 2000/01 to £440m this year (2003/4). It is not for want of effort by those on the ground. And it is certainly not for want of political will; this is where the government will win or lose the electoral battle on crime.
The problem is twofold. First, the whole treatment project is built on a foundation which is distorted by the ideology of prohibition, with the result that the most effective forms of treatment remain strictly rationed. The second part of the problem is the running theme which colours every aspect of contemporary criminal justice in Britain - that the project is being grossly mismanaged from the centre. The government is so determined to control every aspect of the delivery of policy that the control itself becomes the object of the project, disrupting and obstructing, delaying and destroying.
Over and over again since the mid 1980s, governments have (commendably) sworn allegiance to the fight against Aids among drug users. On the ground, what that means is needle exchanges, which allow injectors to swap their dirty works for clean ones. Bristol was one of the first cities to act on this. In 1987, they set up an exchange which now protects the health of a thousand drug injectors. This costs only £35,000 a year. It is supported by every official statement on drugs policy. Earlier this year, the Bristol Drugs Project which runs the exchange was told that its funds were being cut. And the reason for that was not because there was no money, but because the money was trapped in the bureaucracy.
The underlying problem is that Whitehall now refuses simply to hand over a budget. They insist it is broken down into multiple funding streams, each of which is subjected to a regime of intense restriction.
In April last year, when the prime minister took fright at street robberies, he called a series of summit meetings in Downing Street. They generated a high-profile attack on muggers, which involved every interested government department. Money came pouring down through the bureaucracy (£228.5m of it.) A considerable chunk of this was reserved for the DATs. In Bristol, Richard Elliott suddenly found himself last July with an offer of £600,000. This was every manager's dream - but, as usual, the money was attached to rules. Elliott would have liked to spend it on more detox or needle exchange or prescription, but that was not allowed: the money had to be spent on convicted street crime offenders, it had to set up new initiatives, and they must deliver treatment within 24 hours. Furthermore, he must spend £400,000 on staff and running costs and £200,000 on capital. And he must do this before the end of the financial year, only nine months away.
It was not at all clear to Elliott how on earth he was to invent a new scheme which could be linked clearly and solely to street crime. Nor was it clear how Whitehall could possibly know that this would involve the required division of capital and revenue, nor how this new scheme could absorb £600,000 in only nine months without any sign of further funding once the nine months was over.
Finally, Elliott could not begin to see how he was going to navigate this unknown scheme through the bureaucracy without crashing into the obstacle course of policies and priorities which restrained the activities of all the agencies whose help he needed.
The immediate effect of the prime minister's energy was to derail Elliott's plans for a new day-care programme. He had spent three months negotiating a deal with other agencies, securing their money by fitting his plan into all of their performance targets and monitoring requirements. The contract was about to be signed when the street crime initiative was announced: two of the agencies immediately pulled their money off the table to "await fresh guidance"; and Elliott was unable to renegotiate with them as he was sidetracked into a series of meetings to decide how they could identify street robbers separately from all the other drug users.
To spend his £400,000 on revenue, Elliott needed a labour-intensive scheme. He decided to set up an intensive supervision and drugs management unit (ISDMU) which would guide street criminals from police and prison and courts up a fast stream for treatment. Elliott knew only too well that there was just about no treatment at the end of the stream, but the scheme worked on paper because it matched national requirements for "care coordination" and "integrated care pathways", as specified by the models of care for the treatment of substance misuse under the terms of the national service framework. Whitehall was happy. But Elliott wasn't. The money was now not going to come through until October, leaving only six months to spend it: to use £400,000 on wages in that time, he was going to have to hire 32 people. He begged and pleaded and wheedled and wrote business plans and finally persuaded the bureaucrats to let him roll over some of the money to the next financial year - but only if he could "demonstrate a need". That meant he had to have his staff in place by April. But when they advertised for new probation officers to run the scheme, not one person replied; there is a national shortage of skilled drug workers. By April, they had suc ceeded in recruiting only one manager and a couple of resettlement workers.
So that was the ISDMU. Unnecessary. Wrongly staffed. Yet more signposts. None of them leading anywhere. Funded with £400,000 which might or might not survive the end of the financial year. All of it likely to be junked if they couldn't find a future funding stream when the street crime initiative dried up. The bureaucrats had the answer: they gave it a new name (the drug management team) and set up a seminar in May and invited 60 people to review its specification.
In the meantime, Elliott was trying to spend his £200,000 capital. He decided to buy an empty building from the local probation service to house the ISDMU. Probation had a better idea. Their budget for helping drug users leaving prison was being cut, so they offered to supply the building for free if Elliott would let them take over the scheme. After weeks of negotiation, they struck the deal. Elliott went off and spent his money on a new refuge for prostitutes who had committed street crimes - at which point the ac countants at the national probation directorate came up with a new policy which required local probation to pay rent to use their own buildings. The empty building would now cost them £56,000 a year. Probation didn't have it, so the deal collapsed. Elliott eventually parked the ISDMU in part of another probation building and spent more weeks negotiating a deal to bring in arrest referral workers to help to pay the rent there. He also set up a monitoring system to provide weekly reports to Whitehall on the ISDMU's progress. To this day, not a single drug user has received treatment through the ISDMU. And even though there is a crying need for more treatment in Bristol, Elliott expects Whitehall to claw back any of the £600,000 which he has not spent .
Elliott knew his work was being swallowed by a monster. By virtue of their endless monitoring, Whitehall knew that the same thing was happening across the country. But the outside world knew next to nothing about it. Like a sci-fi alien, the bureaucracy mutated and reproduced itself in the shape of an effective organisation. Simply, in among all the numbers that it collects so obsessively, it has chosen to measure its performance with a number which is fundamentally misleading. This is a result not so much of conspiracy as of sheer Whitehall bloody-mindedness.
When the "drugs tsar", Keith Hellawell, first launched the new national drug strategy in 1998, his team wanted to mea sure the performance of its treatment wing in three ways: the number of users engaging in treatment; the number who emerged with a successful outcome; the number of drug-related offences. But Hellawell set targets for the whole strategy which were widely regarded as extravagantly optimistic, with the result that officials at the Department of Health and the Home Office, who were going to have to deliver the results, went into a collective sulk.
Hellawell's team wanted the Department of Health's regional drugs database to monitor treatment outcomes, but officials saw this as a challenge to the existing notoriously inefficient database and refused to change anything. Hellawell also asked the Home Office to monitor drug-related crime and handed over a budget of £2m. The Home Office set up a committee, held a series of inconsequential meetings but never delivered.
The result is that the treatment strategy, now managed by the NTA, measures its success simply by counting those "participating in treatment". This is a problem because Whitehall officials say the counting is "haphazard and inaccurate". Some say it is just phoney. Worse, it includes "soft" treatment like counselling which was never covered by the original research on effective treatment; this encourages DATs to divert users away from expensive, scarce treatment like detox or prescription, so they hit their performance targets without providing the treatment which is really needed by the problematic users. Worst of all, the counting take no account of outcomes. In Bristol last year, for example, Richard Elliott's DAT successfully hit its target, 1,969 users "participated" in treatment. But what happened to them next? They may now be clean and law-abiding, or they may be bingeing on drugs and running a criminal empire; they may be dead. That's not being counted in the target.
The NTA is pledged to have 200,000 drug users "participating in treatment" by 2008. The home affairs select committee and the Association of Chief Police Officers have both attacked the policy but still at the NTA, they count them in, but they do not count them out. As far as the government is concerned, Bristol last year delivered 1,969 success stories.
The defence for this regime is that the elected government has a right to impose its mandate and a need to drive agencies and individuals who drag their feet. That must be right. And in the late 1990s, there was alarming evidence that prisons, probation services and health authorities were pilfering their drugs funds for other services. The new NTA effectively confiscated their drug budgets to ensure they were properly spent (and at one point last year, NTA officials were drafting instructions for DATs to defend themselves against a concerted campaign by probation to grab back their lost money).
The tragedy is that the government could secure its interests with one annual financial audit and a regular qualitative inspection. Instead, it keeps pulling up its delicate plant and examining its roots as though that were not killing it. Why would a civil servant know more about drugs treatment than a drugs worker? Why would anybody in Whitehall know more about what Bristol needs than the people on the ground? In criminal justice, the drugs programme is the core of the core. The truth is as bad as this: this government's entire strategy on crime is heading for failure because of its behaviour over drugs.
In January this year, David Blunkett announced a new funding structure: new streams, new rules, most of them redirecting old money, all of them primarily devoted to offenders to the exclusion of other drug users. All the agencies on the ground are working on a new round of plans and protocols to fit the new rules, cancelling old schemes, generating new protocols and agreements and audit trails. They say the money may come through by October, leaving only six months to spend a year's cash.
Cynics say it's deliberate: Whitehall can announce big money and then claw half of it back because it has not been spent. Some of the new money is supposed to provide treatment for those jailed under the street crimes initiative, but the first of those came out of prison in May with not a cent's worth of new treatment available.
But the bureaucracy is doing well. In the last six months, the NTA has decided to recruit two new directors, one new office manager, nine new regional deputy managers, five and a half new staff for the quality directorate and two new staff for the communications department at a total annual cost of £700,000 (plus £300,000 more for office space). In the interests of perfecting their monitoring, the NTA has just agreed to set up its own inspectorate with five more new civil servants, with a development budget of £100,000 and an annual running cost of £250,000. In the interests of collecting data, it's also rolling out a new electronic monitoring system to collect information from all DATs and all providers, with the "key benefit", according to NTA minutes, that it will help them to show they are hitting their numerical targets. This is so complex that the Bristol Drugs Project, for example, has had to assign half a member of staff for an entire year to collect the information, while regional offices and some DATs are having to hire full-time staff to handle it. That is costing £2m. This money is being top-sliced from the treatment budget. In Bristol, Richard Elliott has now been replaced by a new coordinator and a temporary manager.
Additional research: Tamsen Courtenay
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