Nacro's response to Breaking the Cycle Green Paper

Breaking the Cycle: Nacro’s response | 14The payment-by-results systems in operation elsewhere in the NHS have been appliedto surgical procedures such as hip replacements where we understand it is relativelystraightforward to apply a ‘price-for-the-job’ mechanism. This is far less simple in the worldof recovery from substance misuse where so many variables come into play. Against thisbackground there are a number of issues which need to be considered, and solutions for manyof these are not well advanced in the criminal justice system:• The notion of personalisation, building on evidence which suggests that the more serviceusers are involved in setting their own targets and outcomes, the more successfulthe intervention. This is challenging but needs to be built into relevant commissioningarrangements nonetheless.• Sufficient timeframes for recovery need to be applied and this may include rewarding thenon-linear nature of progress, thus requiring the right balance between payment for activityagainst payment for outcomes.• Deciding whether outcomes should be measured at the individual or cohort level, given thepotential for variation in progress between individuals.• Ensuring the right reliable tools are in place to measure progress for different offendercohorts, and that these can track progress over the long term and build a body ofknowledge about which interventions work with which offenders in which circumstances.• Organising implementation to get the balance right between piloting new arrangements andthe need to move to scale as quickly as possible.• Incentivising cross-sector collaboration, but getting the balance right between consistencyof good practice with local variation.• Shifting the culture and focus on skill building away from maintenance and activity andtowards hard outcomes, without alienating the client base and increasing levels of attrition.• The need for reliable trials and independent evaluation which test new approaches anddemonstrate what works.Q13 How best can we support those in the community with a drug-dependentneed, using a graduated approach to the level of residential support,including a specific approach for women?With regard to the provision of drug treatment in the community, the proposals are sensible.The aim of providing a range of treatment interventions that vary in intensity depending onneed is one that Nacro supports. Nacro has been calling for more involvement in partnershipswhich move offenders through specialist drug treatment with ‘move-on’ interventions, such aslearning and skills advice and guidance, employment training, housing, money managementskills and support with family and other relationships. For women offenders, services should begender specific and embedded within the existing women’s community project network. TheDiverting Women from Custody programme should be continued and models of service deliverybased on women’s specific needs must be applied to drug treatment.