17.6.1 Rationale, Objectives and Continuing Relevance
The National Drugs Strategy (NDS) 2009-2016 identifies the HSE as the lead agency in expanding methadone services and reviewing the methadone treatment protocol. The overall strategic objective of the NDS 2009-2016 is to tackle the harm caused to individuals and society by the misuse of drugs through a concerted focus on the five pillars of supply reduction, prevention, treatment, rehabilitation and research.
The high-level objectives of this programme are:
• To create a safer society through the reduction of the supply and availability of drugs for illicit use;
• To minimise problem drug use throughout society;
• To provide appropriate and timely substance treatment and rehabilitation services (including harm reduction services) tailored to individual needs.
The Programme for Government contains a commitment to provide a “renewed impetus to the fight against drugs and to ensuring that the Strategy once again becomes relevant and effective”. It requires every Government Department, Agency or Task Force responsible for implementing elements of the National Addiction Strategy to account to the Minister for their budget annually and to demonstrate progress on achieving targets. The implementation of the NDS is being pursued across various Departments and agencies, and with the community and voluntary sectors.
17.6.2 Programme Funding
Funding for the Drugs Programme is provided for under the HSE Vote and the Department of Health Vote.
HSE Vote
The HSE expenditure in the drugs area is approximately €105m, almost all of which involves current expenditure. A major part of this is focused on drug addiction services, particularly the methadone programme. This includes the cost of clinics, GPs, Consultants, counsellors and pharmacists, as well as the cost of the medicines involved. The HSE also funds a range of drugs projects that are carried out by voluntary and community organisations.
A total of 9,400 people are in receipt of methadone treatment, while the total number in receipt of drug treatment is in the region of 12,500. The demand for drug treatment exceeds supply and waiting lists apply in some areas. One of the issues being explored is the capacity for more people to successfully complete treatment and thus open up treatment to people on waiting lists.
Polydrug use (which is now the norm among problem drug users) and the wider geographical spread of illicit drugs are presenting further challenges in regard to the response of health services.
Department of Health Vote
The majority of the funding of €32.7m is provided to almost 500 community-based drug related projects towards a range of initiatives aimed at counteracting drugs misuse. The funding is allocated by 14 Local and 10 Regional Drugs Task Forces. Funding is also
provided to the National Advisory Committee on Drugs, the research arm of the National Drugs Strategy, and for a number of homeless-related drugs projects.
17.6.4 Programme Effectiveness
The number of people in methadone treatment, which is the only substitute available within this country, has increased year on year. The outturn figures for 2010 indicated that 9,339 people were in methadone treatment. The target for 2011 is 9,000 but the monthly performance reports indicate that the numbers actually treated are in excess of the original target.
17.6.5 Programme Efficiency
Figures on trends are not available. With regard to performance measurement, monthly and quarterly performance indicators are agreed with the HSE for 2011. As part of an assessment of the programme, service delivery and improvements in efficiency, an external review of the Methadone Treatment Protocol was launched in December 2010 which contained 7 main recommendations, each of which has a number of sub-recommendations.
17.6.6 Conclusions
There is a continued need for a National Substance Misuse Strategy as (a) the drugs problem continues to evolve, the range of drugs has increased and problem drug use has spread beyond Dublin to other parts of the country; (b) heroin remains a significant problem, although available information suggests that the use of heroin has stabilised in the Dublin region.
The National Drugs Strategy provides for a review of Drugs Task Forces, including inter alia, a review of their boundaries. The objective is to ensure that maximum benefit is achieved from their activities, that best value is achieved from the financial and staff resources available, and that effort is targeted to maintain progress made and address new and emerging issues. In line with the Strategy, the Department will introduce measures to strengthen the governance and accountability of Drugs Task Forces.
16.3 CONCLUSIONS, SAVINGS AND REFORM
The Social Inclusion programme is focused on dealing with groups that are most at risk of adverse health outcomes due to factors which are often outside the control of the health and social services. The impact of the current economic crisis is not experienced equally by all members of society and there are indications that excluded groups are likely to be especially vulnerable. In particular, financial insecurity can lead to increased levels of homelessness, crisis pregnancy, domestic violence and poorer outcomes for the health status of minority groups such as Travellers.
While levels of funding for these service provision areas have decreased, the need is anticipated to rise. In addition, the reduction in WTEs in supporting services such as Public Health Nursing that have previously been available to these areas is resulting in a further reduction in the overall level of services. While consideration is being given as to how further efficiencies can be made in the programme areas, the savings are likely to be of a modest nature and will be more than offset by increased demand for services.
Key Reforms:
• Efficiency Improvements for Homelessness Programme: Consideration is being given to the introduction of a number of reforms under the Homelessness Programme which may lead to improvements in efficiency. These include:
o Agreed cost models for each type of service;
o Shared services in areas such as front office and recruitment;
o Combined procurement in areas such as insurance, maintenance, and other
utilities;
o Further roll out of a bed management and data analysis system.
• Review of Crisis Pregnancy Programme: The Crisis Pregnancy Programme will undertake a review of the service delivered by a combination of the HSE, charities and other NGOs with the aim of bringing about savings and introducing further efficiencies.
• National Drugs Strategy Governance and Accountability: In line with the National Drugs Strategy, the Department will introduce measures to strengthen the governance and accountability of Drugs Task Forces.