It is the responsibility of the National Treatment Agency for Substance Misuse (NTA) to improve the quality, availability, accessibility and effectiveness of drug treatment in England. To ensure effective delivery of drug treatment services, the Models of Care document was developed to provide guidance on the optimal models of care for drug treatment services (DH 2002). The NTA will deliver three key quality improvement elements: clear quality standards, effective local delivery and strong monitoring mechanisms. They will also ensure that services address the needs of currently underrepresented client groups such as women, Black and minority ethnic communities (BME) and under 18s.

Services for drug users can be grouped into four broad bands of tiers as follows:

• Tier 1: Non-substance misuse specific services requiring interface with drug and alcohol treatment;
• Tier 2: Open access drug and alcohol treatment services;
• Tier 3: Structured community-based drug treatment services; and
• Tier 4: Residential services for drug and alcohol misusers (DH 2002).

The Department of Health has published Models of Care (DH 2002), which is the national framework for commissioning drug use treatment services for adults in England. The document provides the framework required to achieve equality, parity and consistency in drug treatment across England and to develop an integrated system of needs-led services. It has been developed to allow for the delivery of higher quality and more effective and cost effective services that are closely informed by research evidence. It reflects professional consensus and up to date research evidence of ‘what works best’.

Models of Care provides guidance to support the development and commissioning of:

• A four-tiered treatment framework (i.e. treatment interventions/programmes defined by different levels of intensity and structure);
• Integrated care pathways;
• Levels of assessment within a tiered system; and
• The co-ordination of drug treatment and effective management of care across specialist services and general health, social and other care.

Models of Care also reviews research evidence relating to:

• The main drug treatment modalities;
• Issues pertaining to special groups (Black and minority ethnic populations, women, alcohol and drug misuse); and
• Cross-cutting issues such as blood-borne viruses, overdose prevention and mental health co-morbidity).

The implementation of the Models of Care (DH 2002) framework and guidance is currently taking place. Substance users in each Drug (and Alcohol) Action Team (D(A)AT) area should have access to a treatment system across the 4 tiers of treatment. The implementation of this will be monitored through the DAT treatment plan. These are:

• Generic health and social care services that are responsive to the needs of drug users (e.g. primary care, A&E departments);
• Open access specialist services (e.g. needle exchanges);
• Structured community based specialist drug treatment services (e.g. specialist prescribing services); and
• Access to residential and in-patient specialist drug treatment (e.g. residential rehabilitation).

A strategy for the implementation of the framework provided by Models of Care has also been developed by the Department of Health. D(A)ATs are expected to demonstrate that they have developed the framework at local level in line with the implementation timeframe (from January 2003 to March 2004). This involves D(A)ATs undertaking the following:

• Assign responsibility for Models of Care implementation to a local implementation group (group and membership to be decided at local levels) (January 2003);
• Identify priorities for service development (January 2003);
• Review of services against evidence base (October 2003);
• Publication of an agreed referral, screening and assessment system (November 2003); and
• Publication of care pathways and care co-ordination arrangements (March 2004).

References
DH (Department of Health) (2002). Models of care for substance misuse treatment: promoting quality, efficiency and effectiveness in drug misuse treatment services. Full report for consultation. Department of Health. London.