Home > Recommended changes to Drugs Strategy performance indicators.

Connolly, Johnny and Galvin, Brian and Keane, Martin and Long, Jean and Pike, Brigid (2005) Recommended changes to Drugs Strategy performance indicators. Drugnet Ireland , Issue 15, Autumn 2005 , pp. 3-5.

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The National Drugs Strategy 2001–20081 contains more than 20 Key Performance Indicators (KPIs) across its four pillars and under the co-ordination theme. The KPIs are used to monitor the progress of the Strategy in meeting its objectives. The Mid-term review of the National Drugs Strategy2 outlines progress under each KPI and recommends that a number of KPIs be replaced, amended or discontinued. These changes are outlined below under each of the four pillars and under the co-ordination theme.

Supply reduction

The National Drugs Strategy identified five KPIs to measure progress under the supply reduction pillar. The mid-term review recommends that these be replaced by three new KPIs. The first of these relates to the volume of drugs seized:

·       Volume of drugs seized increased by 50 per cent based on 2000 figures.

There has been an increase in the volume of drugs seized in most drug categories using seizures in 2000 as a base. The volume of heroin seized by An Garda Síochána and Customs and Excise, as reported in the annual Garda reports, remained relatively stable between 2000 and 2003. However, the volume of cannabis resin, cocaine, amphetamine and ecstasy seized increased during the same period.

Although the volume of drugs seized can be a useful indicator of law enforcement activities, a difficulty with using volume as an indicator is that the quantities of drugs seized can vary significantly from year to year, with a few very large seizures in one year distorting the overall picture. The number of separate seizures is generally regarded as a more useful indicator. The second KPI recommended addresses this issue by focusing on the number rather than the volume of seizures:

·       Number of seizures increased by 20 per cent based on 2004 figures.

The mid-term review reports a public perception that drug law enforcement is focused disproportionately on possession rather than on supply prosecutions. Consequently, the third new supply reduction KPI focuses on supply offences:

·       Number of supply detections increased by 20 per cent based on 2004 figures.

Prevention

The National Drugs Strategy set out nine KPIs to measure progress under the prevention pillar. The mid-term review recommends replacing these with four new KPIs, two relating to demand reduction and two to addressing educational disadvantage:

 

·       The 3 Source Capture–Recapture study estimate of opiate misusers, which will be released in 2007, to show a stabilisation in terms of overall numbers and to show a reduction of 5 per cent in the prevalence rate based on 2001 figures (published in 2003).

·       The NACD Drug Prevalence Survey,3 due to be released in 2007, to show a reduction of 5 per cent in the prevalence rate of recent and current use of illicit drugs in the overall population based on the 2002/03 rate.

·       Substance use policies in place in 100 per cent of schools.

·       Early school leaving in local drugs task force (LDTF) areas reduced by 10 per cent based on the 2005/06 rate.

Repeated NACD surveys over time will be very useful for monitoring the impact of the National Drugs Awareness Campaign. The capture–recapture study and the NACD Drug Prevalence Survey have replaced the ESPAD study4 as data sources to assess progress under the prevention pillar in reducing demand for drugs among the target populations. However, these studies have limitations in measuring a reduction or otherwise in drug use among 15–16-year-olds in the school-going population. Though both studies collect data on 15- and 16-year-olds, the sample sizes for each study would need to be much larger to provide robust estimates for each two-year band. Indeed, the research team behind the NACD prevalence study concedes that estimates produced for the total population can be treated more robustly than those for sub-groups of the population, such as different age groups.5 This is because the sample size was calculated to provide a total estimate rather than an estimate for each age band. The studies would also need to ascertain who among the respondents aged 15 and 16 years were attending school. This information was given by the ESPAD study. Half of the 16 actions under the prevention pillar target school-going young people through interventions designed to address educational disadvantage and prevention of substance misuse. The ESPAD survey was designed to obtain data on the school-going population and is carried out every four years. It is therefore, in this case, a more appropriate tool for monitoring progress and making comparisons over time than a general population survey.

The second two new KPIs are closely linked. Both assess progress on actions designed to address educational disadvantage. Consistent monitoring and implementation of substance-use policies in all schools can create a climate where students with substance misuse issues can be supported rather than disciplined. This concern was raised during the consultation process of the mid-term review. An over-emphasis on disciplinary sanctions through suspensions and expulsions can contribute to early school leaving. Also, schools now have a legal obligation to report absences and expulsions to the National Educational Welfare Board, who have been instructed to prioritise schools in local drugs task force areas. Early identification of substance-related absenteeism and expulsions in schools in LDTF areas will lead to early intervention by educational welfare officers, in conjunction with teachers, parents and specialised substance misuse counsellors. This process can support young people in remaining in mainstream education. The mid-term review does not identify the sources of data for this KPI.

Treatment and rehabilitation

The National Drugs Strategy identified seven KPIs to measure progress under the treatment pillar. The mid-term review recommends that these be replaced by four new KPIs. The current KPIs monitor progress in the provision of treatment places, prison-based treatment services, service-user charters and rehabilitation. The number of treatment places for opiate addiction increased from 6,000 by end 2001 to 7,390 places by end March 2005; this KPI has been achieved. According to the mid-term review, a number of services have drafted service-user charters. Although the review recognised that more needs to be done, the prison services have developed an infrastructure for the delivery of methadone treatment and set up a number of drug-free units since 2001. The introduction of counselling services and the development of post-release arrangements for those requiring treatment or harm reduction services will be required in the future; this KPI has been discontinued without explanation.

The KPI on treatment has been revised to reflect the diversity of drug types and the number of drugs used by those seeking treatment, and requires that:

·       100 per cent of problematic drug users will access appropriate treatment within one month after assessment.

 

A set of guidelines has been developed and agreed (although not published) to guide the treatment of problem drug users under 18 years old and the original KPI has been replaced by a new indicator:

·       100 per cent of problematic drug users aged under 18 will access treatment within one month after assessment.

The two KPIs relating to treatment will be measured through the Health Service Executive Addiction Services and the HRB National Drug Treatment Reporting System.

Two indicators pertaining to harm reduction have been introduced:

·       Harm reduction facilities available, including needle exchange where necessary, open during the day, and at evenings and weekends, according to need, in every local health office area;

·       Incidence of HIV in drug users stabilised based on 2004 figures.

The second of these is based on an increased number of HIV cases among drug users in 2004 (see ‘Newly diagnosed HIV infections in Ireland’, Fig. 1, in this issue).

The review recommends that the KPI pertaining to ‘training and employment for treated drug users’ be moved to the new rehabilitation pillar. A working group has been set up to define the scope of rehabilitation and identify the actions to be implemented under the rehabilitation pillar.

Research

The National Drugs Strategy identified two KPIs under the research pillar. The mid-term review recommends that these be replaced by three new KPIs. The first, ‘eliminate all major gaps in drugs research by the end of 2003’, has been reworded to take account of the number of research actions completed to date and has had its time period extended to mid-2008. The second has been split into two KPIs, which are:

 

·         Publish an annual report on the nature and extent of the drug problem in Ireland, drawing on available data; and

·         Publish a report every two years on progress being made in achieving the objectives and aims set out in the Strategy.

Co-ordination

Although not a ‘pillar’, co-ordination is a key theme of the National Drugs Strategy, with its own objective and four KPIs. The objective for co-ordination is ‘to have in place an efficient and effective framework for implementing the National Drugs Strategy’. The associated KPIs have all been achieved.

While not proposing new KPIs for the co-ordination objective, the mid-term review makes two recommendations designed to strengthen high-level co-ordination between the statutory agencies and the multiple service providers and community and voluntary groups in the drugs area. It calls for expanded representation of the community and voluntary sectors, and the inclusion of additional government departments and statutory and other state agencies with responsibilities in the drugs area, on both the Inter-Departmental Group on Drugs (IDG) and the National Drugs Strategy Team (NDST).

Comments by the Steering Group suggest that co-ordination at regional and local levels also continues to be a challenge. For example:

… representatives of the statutory bodies who are members of LDTFs and RDTFs need to be mindful of their role. In particular, they should consult with – and bring relevant information to – their Task Forces regarding developments at both local and national levels within their organisations that impact on progressing actions in the NDS. They also need to ensure that their parent organisations are aware of developments within the Task Forces and how these developments impact on their agencies. (Section 7.8)

However, the perceived difficulties in achieving effective co-ordination at regional and local level, arguably more complex and more challenging than at national level, are not identified in the mid-term review as a ‘key issue’ and are not the subject of a formal recommendation, let alone a new KPI.

Conclusion

The mid-term review recommends significant changes to the number and content of indicators used to measure progress under the National Drugs Strategy. Some of the revised KPIs are in recognition of achievements in certain areas, a response to changing circumstances or an acknowledgement of difficulties with existing indicators. The rationale behind other changes is less clear. The changes in indicators to measure supply reduction and treatment would appear sensible. The linking of school-based substance policy with early school leaving recognises the overlap between these two areas and the wider responsibility of the educational system in prevention work.

The use of population studies to monitor progress of young people still at school under the prevention pillar is problematic. While recognising that further improvements are required in prison treatment services, the KPI relating to prison-based services has been removed without any explanation. The absence of any indicators under the co-ordination theme allows no objective measure for determining progress in this area. It is important that these inconsistencies are recognised if the KPIs are to do what they were designed for, that is, to provide measurable, verifiable and relevant indicators of progress for all aspects of the National Drugs Strategy.

1. Department of Tourism, Sport and Recreation (2005) Building on experience:  National Drugs Strategy 2001–2008. Dublin: Stationery Office.

2. Steering Group for the Mid-term Review of the National Drugs Strategy (2005) Mid-term review of the National Drugs Strategy 2001–2008. Dublin: Department of Community, Rural and Gaeltacht Affairs.

3. National Advisory Committee on Drugs (NACD) and Drug and Alcohol Information and Research Unit (DAIRU) (2005) Drug Use in Ireland & Northern Ireland – first results (revised) from the 2002/2003 Drug Prevalence Survey. Dublin: NACD. (First published October 2003, revised June 2005) www.nacd.ie/publications/prevalence_survey.html

4. Hibell et al. (2004) The ESPAD Report 2003: Alcohol and other drug use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN), Council of Europe, Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs (Pompidou Group).

5. National Advisory Committee on Drugs (NACD) and Drug and Alcohol Information and Research Unit (DAIRU) (2003) Drug use in Ireland and Northern Ireland. First results from the 2002/2003 Drug Prevalence Survey – a summary of the methodology. Dublin: NACD.

Item Type:Article
Issue Title:Issue 15, Autumn 2005
Date:July 2005
Page Range:pp. 3-5
Publisher:Health Research Board
Volume:Issue 15, Autumn 2005
EndNote:View
Accession Number:HRB (Available)
Subjects:MP-MR Policy, planning, economics, work and social services > Policy > Policy on substance use > Supply reduction policy
MM-MO Crime and law > Substance related offence > Drug offence > Illegal drug possession (seizures)
N Communication, information and education > Recommendations or guidelines
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Health services, substance use research
MP-MR Policy, planning, economics, work and social services > Programme planning, implementation, and evaluation
MP-MR Policy, planning, economics, work and social services > Policy > Policy on substance use > Harm reduction policy

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