“A man may take to drink because he feels himself to be a failure and then fail all the more completely because he drinks. It is rather the same thing that is happening to the English language. It becomes ugly and inaccurate because our thoughts are foolish, but the slovenliness of our language makes it easier for us to have foolish thoughts.” George Orwell, Politics and the English Language, 1946

It is rather the same thing too that is happening to the National Treatment Agency for Substance Misuse. Last week, like Orwell’s drunken man, their CEO, Paul Hayes, began to dig his grave. His effort on the BBC’s Today programme to justify the unjustifiable and to deny the undeniable - why only 3.6% of the 200,000 going through his treatment system  are cured each year - was described by Melanie Reid the next day as ‘jobs worth personified, complacent and patronising’.[1] However the NTA’s new ‘guidance’, released last week, for commissioning ‘Tier 4 Services’ – residential or quasi residential rehabilitation and detox to you and me – took the NTA’s brand of foolishness to even new heights.[2]

Rehab of course is the best approach to getting people drug free – a fundamental truth but one which has escaped the NTA from its inception.[3] So under their watch rehab has been staggering towards its demise. Last week Addiction Today reported that twelve centres have closed this year alone, with the loss of a uniquely skilled workforce. 

So would the stated intention of the new guidance “to address problems commonly reported in accessing and facilitating access to (Tier 4) services” be lived up to? Would the prayers of addicts like Andrew (a heroin user since he was 17, on methadone for the last ten years and driven to despair:  “I’ve asked for rehab on 5 separate occasions” he said, “and on five separate occasions it just got put to one side”), interviewed on Today before Hayes, be answered? 

Sadly not.  As an exercise in circumlocution and distancing the NTA from the reality of a disappearing ‘Tier 4’- from its responsibility for presiding over the demise of the rehabs - this document takes the biscuit. Soon, should even the most creative and ‘out on a limb’ treatment commissioner want to, he will have no where to send his despairing ‘user’.  But then on a determined refusal to respond to the rehab crisis the NTA has something of a ‘previous’ and certainly a history.

Two years ago Paul Hayes’s response to evidence presented to him of dangerously low rehab occupancy levels and redundancies was:

“It is difficult for us to act until we know whether we are dealing with a new crisis or a recurrence of the problem we have been living with for years”

Really?  But 1,200 beds were lying empty. That was half of the anyway far too few 2,400 total beds. Who was to act if not the NTA?  Surely it was up to them with their billions of pooled treatment budget to correct the deficit in residential funding caused by the withdrawal of community care funds through (which in 1992 some 20% of identified addicts got treatment).  Who else but the NTA, established for the purpose, should take the lead interest in building rehab up and protecting it from recurring funding problems?

Of all this, and in face of predicted closures actually happening in front of the NTA’s nose, there is no mention in the new document at all.  Reading  it you would be forgiven for believing that the failure to get the current desired 10% of clients into rehab lies with commissioners, commissioning, partnerships and local relationships[4]; that it is  not a result of the treatment structure – a bureaucratised monster of the NTA’s own making that produces more paper than actual care; that it is not the consequence of the NTA’s perverse treatment targets and built in disincentives; that it is not a function of funding; and  nothing to do with the decision not to push the £54.9 million finally allocated to ‘Tier 4’ for 2007/8 to 2008/9 directly into existing rehab support.[5]

Of weasel words, of an obscuring of the truth and false argument the document is replete.

For example:

“Tier 4 service provision have not uniformly benefited from the improvement in capacity and quality experienced by community-based treatments since the launch of the first national Drug Strategy in 1998,”

Have they not?  Why? Because services are not actors (in the case of Tier 4, non existent ones) in this drama which such spurious logic turns them into, as though they had minds of their own. It goes on:

“In fact, the lack of effective Tier 4 commissioning processes and structures in some areas has resulted in impeded growth and a failure to guarantee income streams”….

Here a blatant reversal of cause and effect serves the very useful purpose for the NTA of laying blame elsewhere and distancing those responsible (in case you forget – who else but the NTA?)  for those very income streams.

However they do want us to know they do mean well and they do understand:

…..“Improving Tier 4 provision is a key part of the National Treatment Agency’s (NTA) Treatment Effectiveness strategy. Tier 4 service provision can provide effective responses to drug misuse in treating people whose use has been long and heavy, and people with complex needs, and they can enable drug users to move towards long-term abstinence when and where appropriate. Inpatient service provision can also assess and stabilise chaotic clients and certain Tier 4 service provisions may also have an important role to play in diverting individuals away from long-term substance misusing careers by intervening early”

How reassuring that such abstractions can work.

This mixture of vagueness and sheer incompetence makes the writers of this guidance, who we are all paying for, appear indifferent as to whether the words mean anything or not.  Just as Orwell noted, each time a topic is raised the concrete disappears into the abstract and the only turns of speech used are those that are hackneyed. Whether simply foolish or complacently mendacious it is difficult to tell. They are equally damaging.

As guidance for those purchasing treatment for the likes of Andrew it stinks. Despite an impressive group to advise, the NTA has produced what they excel in - a Kafka-esque elevation of best practice jargon and bureaucratise masking a lack of commitment to getting clients drug free. In page upon page of soul destroying advice it does not once tell the poor commissioner how to pay for the last rehab beds should he be lucky enough to find them.

As a programme for action it is as empty as the beds in the closed down rehabs.