In a keynote speech for the NHS APA Virtual Conference 2020, Dr Ed Day addressed the importance of building a partnership between professionals and people with lived experience in overcoming addiction.
Dr Day has worked as an NHS Consultant in the field of addictions in the West Midlands for 20 years and, in May 2019, was appointed National Recovery Champion by the Home Office. In this role he advises Dame Carol Black in her ongoing review of drug treatment services.
In his speech for the NHS APA Virtual Conference 2020, Dr Day reflected on the last 20 years, how treatment systems have developed, and that they may be enhanced in the drug treatment review.
He noted that the addictions evidence base that has been developed over the last 20 years is better compared to anything else in the world, and that treatment outcomes are comparable with or better than other countries. “It is something we can be proud of in the UK. We really can congratulate ourselves on some of the excellent work which has done that.”
Dr Day emphasised the complexities of addictions: “It really is a disease of the social environment, and the context it develops in cannot be ignored. We know that once you start developing problems, be them substances or behavioural addictions, they lead to a range of psychological and physical problems.”
“We know that with adequate support this is a thriving and potentially self-sustaining system that works synergistically with the professional services. It’s really important to see that both services can have a role at any point in this journey.”
By shifting the paradigm to a chronic care model, Dr Day believes it can be managed better while giving people power to enhance their lives. “Addiction falls squarely into this chronic care model. Recovery is a long process and is very hard to achieve. It requires a much more sustained effort than sometimes we may have been able to deliver.”
The steady and relentless reduction in budgets in the last decade is fundamental to current struggles. He said: “Cuts and changes in policy have meant considerable variability in the commissioning process particularly in England, so we really have a postcode lottery happening in front of our eyes. I see a massive exodus of skills from the field as budgets are cut and a destruction of the training pathways to develop a skilled workforce.”
Speaking of the future, however, Dr Day is more optimistic that we are about to see a paradigm shift. “This problem, as part of the review, may be taken more seriously, proper investment may come, and we may have the opportunity to make real changes to our treatment systems.
“This is where the recovery orientated system of care comes in. We have a balance of professional and peer led services with experience. Without the two working together, my argument is that neither works effectively.
“Once people are attracted to treatment, we need to engage them and retain them in treatment, and we have to be delivering the best quality interventions to bring about behaviour change and to sustain that behaviour change. Lived experience is so important in the addictions field and this passion that people in recovery bring builds a self-sustaining system.
"We need to work out the best way of delivering, commissioning and overseeing the system and this is one of the key things that the Dame Carol Black review will consider. I am optimistic of the future; watch this space.”
“We know that with adequate support this is a thriving and potentially self-sustaining system that works synergistically with the professional services. It’s really important to see that both services can have a role at any point in this journey.”
The uncoupling of the NHS from the addictions services has meant that it is difficult to link with mental health teams and acute hospitals: “This is a real issue as we go forward and we can’t let it continue. We have to return Clinical Services and to the level of funding to what it was in the past. We must invest properly in the delivery of psychosocial interventions and in staff training and supervisions. We need to think of strategies to re-integrate with the NHS to ensure that we get maximum value for money from primary care and acute services.
“And the Live Experience Recovery Organisations need to be given greater respect with specialist funding ring-fenced. At the same time, they need to develop quality standards and there needs to be investment in staff training and a description of what the roles at this side of the system would involve.”
Dr Day concluded: “I would like to see the development of physical Recovery Community Centres that empower and invest in the local recovery community. We need to work out the best way of delivering, commissioning and overseeing the system and this is one of the key things that the Dame Carol Black review will consider. I am optimistic of the future; watch this space.”