Mismanaging the war against drugs

Published May 2003

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 and health workers and social workers and voluntary agencies into one big drive against drugs, but earlier this year he realised he just couldn’t stand it any more, so he quit.

In fact, for most of that time he wasn’t supposed to be running the DAT, but his co-ordinator 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 co-ordinators in the area who had gone off sick in the last 12 months because they couldn’t stand it any longer – but he did at least have some help from a new colleague, although he 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 couldn’t stand the waste any more. He had six staff and a budget of £3.5 million a year. He had a potential client group of 25,000 recreational drug users who tumble through the pubs and clubs of central Bristol using cocaine and amphetamine, ecstasy and cannabis; plus a further 12,500 chaotic drug users who buy heroin and crack cocaine from the city’s open drugs market, centered on St Paul’s. He focused on the 4,500 chaotic users who actually 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 any more 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 – all 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.” £3.5 million – and only five NHS detox beds…..

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 skillful 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 whole communities. It is for the sake of that spectacular collection of prizes that the government in 1998 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, 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 now collapse, then that collapse is on the same spectacular scale – a disaster for the whole strategy on crime but a disaster too for blackmarket drug users and for the communities they have wrecked.

The reality is that, after five years of effort and with a budget now topping £400 million a year, despite relentlessly hard work from some 5000 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 tells the story of 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. E|liott’s explanation is simple: “They don’t know very much about drugs, but they do know about management and monitoring and data collection. So that’s what they do.”

In early 2000, the Home Office decided to spend £5 million on Prospects hostels so that drug users leaving prison could have a bed with special treatment – a concrete, practical move. 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 some three years of work, they have consumed hundreds of hours in meetings, spent hundreds of thousand of pounds on plans – but they have not yet provided a single bed for a single drug-using ex-prisoner in Bristol or anywhere else. They say this may happen “as early as 2004” although it will happen 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 central Bristol, homeless and stuffed full of blackmarket 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: re-write 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 official 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 re-written 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 multi-million 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 another five for particularly troubled estates. As users follow the circuit of signposts, their notes follow them and to meet the demands of the performance regime, the notes must have a protocol, so the DAT has had to set up a six-month timetable with milestones for the drafting of new protocols, a consultation period for the service providers, a three-month pilot to test the protocols, a formal review of the pilot phase, followed by implementation of the finalised version. 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 ten 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 targetted 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 and depressing 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 mere 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 all alcohol; some simply cannot face it. Those who remain will have to wait for 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 chidren with them to rehab, but then they changed the accounting rules so that the child’s part of the budget was allocated to the Childrens Directorate who 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 of those 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 make it to 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 £3.5 million, a pool of 4,500 chaotic drug users – a total of only 26 free of drugs. And all the signs on the ground indicate that year, several hundred more men and women joined the ranks of Bristol’s problematic drug users.

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 blackmarket. But this corridor begins with a door which opens onto a blank wall. The prescription of clean heroin which has secured dramatic results in other European countries (see sidebar) 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.

Some 90% of the GPs in the city 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 just 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 under-estimate, that the true figure may be as high as 500,000. They are all stuck in the same corridor of ever-decreasing opportunity for treatment.

Last year, across the entire country DATs spent only £19m on detox (just under 5% of the £390 million 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 they do in Bristol, only 3,800 users will have emerged ready for rehab. Last year nationally, DATs spent only £21 million 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. That is from a population of up to half a million. Since 1998, when the government launched its treatment strategy, the British Crime Survey has recorded “a statistically significant increase in Class A drug use.”

Even if the treatment were available on the ground, the drug-using offenders who are its primary targets would not be reaching it in any numbers. In theory, there are new bridges feeding offenders into the treatment regime – the idea of using the criminal justice system as an outreach network is one of the core ideas of the drugs strategy. The government has spent £106 million to build these bridges. In reality, they carry almost no traffic.

The first and most important bridge is arrest-referral: anybody who is arrested and who has a drug problem is interviewed by an arrest-referral worker who will take their details and offer them an appointment. The problem simply is that, according to the government’s own research, 97% of those who are interviewed fail to make it into effective treatment: nearly half simply reject the approach; of those who accept an appointment, 78% never turn up for it; of those who do turn up, an estimated 45% drop out within a fortnight and an estimated 72% drop out within six months. Home Office researchers found that in 12 months, 48,770 users were screened by arrest-referral workers; only 5,520 subsequently turned up for an appointment; only 1,545 in the whole country in all the 12 months continued to turn up for at least six months. In Bristol last year, they screened 2300 users on arrest; only 177 showed up for their first appointment. The reality is that, after three years of arrest-referral, the Bristol DAT has no evidence that even one user from arrest-referral has completed treatment. But, when the government wanted to tackle street crime last year, it sent down extra money which was ear-marked for the hiring of yet more arrest-referral workers. The Home Office, sensing disaster, has re-organised the arrest-referral workers…. to introduce a new system of monitoring.

The second bridge from criminal justice into treatment is DTTOs – drug treatment and testing orders – which allow courts to order an offender to go for treatment. In February, the probation inspectorate reported that their operation was “extremely uneven” with “an unacceptably low level of achievement” which included drug-test results which were “very disappointing”. Last year, only 6,186 orders were made in the whole country; and there were 5,419 proceedings against users for breaching them. According to one Whitehall source: “Breach is the norm with DTTOs.” In Bristol, courts last year issued only 48 orders and Elliott reckons almost all of them are being breached by offenders who simply do not accept the modicum of treatment which is available and who are willing to take their chances if the court decides to punish them. The government has come up with a remedy: regardless of the failure, Downing Street last year asked the Treasury to fund yet more DTTOs; the Treasury agreed to put up an extra £25 million but only if the probation service agreed to increase their targets by 50%; probation had no chance of hitting the targets, but the Home Office accepted and quietly re-wrote the rules to produce a new, easier DTTO which imposes only minimal requirements on offenders (and which was immediately baptised by drug workers the DTTO-lite).

The Home Office cannot be surprised by the failure of these bridges. They knew very well that both were fragile when they introduced them, because they tested both of them in pilots. Both of them produced alarmingly weak evidence of effectiveness. But the government pushed ahead with arrest-referral because, according to Whitehall sources, it was a way of channeling extra money to the police at a time when the chief constables were rebelling over their budgets. In the case of DTTOs, the early results from the pilots were so bad that Home Office ministers, anxious that they might lose the money they had been promised by the Treasury, simply rolled them out nationally before the final results came through and lied about the pilots. The Department of the Health and the Home Office are now busy blaming each other for the failure of the two schemes. The reality is that they have failed as a route to abstinence, because there is a limit to the number of addicts who will give up their drugs without wanting to; and they have failed as a route to maintenance, because of the lack of well-supported prescription, particularly of heroin.

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 £234 m in 2000/01 to £440 million this year (2003/4). It is not for want of effort on the part of those on the ground, working like hamsters in a wheel. 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 that it is broken down into multiple funding streams, each of which is then subjected to a regime of intense restriction. For years, the Bristol needle exchange has been funded by the local NHS. But, Whitehall accountants decided to impose ‘special measures’ on the new Primary Care Trust because it had inherited debts from the old Avon Health Authority. As a result, the trust announced in February that it could no longer afford the £35,000 for the needle exchange. Drugs workers were horrified.

Richard Elliott, however, could see a solution. There was spare money in another funding stream, the Pooled Treatment Budget, which is the largest single source of DAT funding, provided by the new National Treatment Agency. But they would not let him have it, because their rules forbid their money being switched to projects which are already being funded from elsewhere. Elliott saw another solution. In January, David Blunkett had announced two new funding streams, either of which could afford £35,000. But they wouldn’t let him have any of that either: one stream was reserved for offenders, the other for new schemes. In March, the needle exchange workers were issued with protective redundancy notices, and drug users were warned that the service was on the edge of extinction. The NTA responded by insisting that, as a matter of policy, even if there was no money for it, the exchange must not be closed.

Elliott had only one possible solution: he went to the pub. There, he had a drink with a middle-level civil servant from the regional government and together they came up with a plan. The NTA had so many rules that, even if one rule trapped them, another might set them free. They could ignore the rule which forbade the funding of a project which was already receiving money elsewhere and apply the rule which supported efficiency savings. They would pretend that they were setting up a new needle exchange as a more efficient substitute for an old one. It was not true but it would look all right on paper, and it would release £35,000 from the NTA’s Pooled Treatment Budget. The trouble was that the NTA would know it was not true. It took weeks of discussion, involving nine different local government agencies, new audit trails, new fully-costed service level agreements, the theat of political embarrassment as local MPs and reporters started asking questions, but finally the NTA agreed to blindfold itself with its own red tape.

The most simple things in life are all complicated by the bureaucracy. Some of the Bristol drug agencies last year came up with a plan to buy an old bus to visit the most troubled estates with clean needles and advice. But the money was hidden in different streams: to buy the bus, they needed funds from the Community Against Drugs initiative which required the approval of the city’s Crime and Disorder Reduction Partnership, which involved securing the support of police, city council, health and social services, each of whom had to ensure that the project was consistent with its own priorities and targets; to staff it, they needed funds from the Pooled Treatment Budget which required the approval of the DAT and the NTA, which in turn involved regional government, again all needing to prove on paper that this was consistent with their own performance regimes. Each of the two streams required a partnership bid from the five agencies who wanted to use the bus, all of whom were thus involved in setting up a new Steering Group which had to hold a sequence of meetings to produce the necessary business plans, bids, projections and protocols.

The irony is that the system is self-defeating. In its attempt to secure transparent and accountable funding, it ends up (in the case of the needle exchange) with the bureaucratic equivalent of a bag of old fivers under the table. In order to control outcomes, it ends up up (with the bus) making control itself the outcome. In order to deliver best value, it generates spending for its own sake: consider the case of the Street Crime Initiative.

When the Prime Minister took fright at street robberies last April (2002), 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 (£228.5 million 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 Intiative 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 because he was sidetracked into a series of meetings to decide how they could identify street robbers separately from all the other drug users. (At one point, they considered giving them all red caps so that they would stand out wherever they turned up in the system.)

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 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 co-ordination’ 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 – a small army. 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 succeeded 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 to all this: they gave it a new name (the Drug Management Team) and set up a seminar in May and invited 60 people to come and 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. It took weeks of negotation, but 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 accountants 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 whole deal collapsed in smoke. 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 one 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 succeeded in spending.

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 amongst 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 the ‘drug tsar’, Keith Hellawell, first launched the new national drug strategy in 1998, his team wanted to measure 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 database (which was notoriously inefficient) and simply refused to change anything. Hellawell also asked the Home Office to monitor drug-related crime and handed over a budget of £2 million. The Home Office set up a committee, held a series of inconsequential meetings and just never delivered.

The result is that the treatment strategy, now managed by the new 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 binging 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. As long as the trains leave the station, it really doesn’t matter if they dive straight into the first ditch they come to. The Home Affairs Select Committee and the Association of Chief Police Officers have both made outspoken attacks on 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 examing its roots as though that there 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? And what are they doing with this information, where is the evidence that they are using it to help those on the front line as against merely collecting it for the sake of ministerial soundbites? 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 which no longer score, 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 a year later because it has not been spent. Some of the new money is supposed to provide treatment for those who were 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 £2 million. And all this money is being top-sliced from the treatment budget. In Bristol, Richard Elliott has now been replaced by a new co-ordinator and a temporary manager.

Additional research by Tamsen Courtenay

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