Quasi-Privatised Market Model

Overview

Over the period since 1900 a number of approaches have been adopted to manage and provide treatment to problematic users of alcohol in Western Australia (WA). The term ‘treatment’ is used loosely to refer to the broad conceptual approaches for managing problematic users in WA over the period.

However, our contemporary understanding of the term ‘treatment’ is an inaccurate characterisation of punitive practices accepted in the earlier part of the period, even though these were referred to as ‘treatment’ in official accounts of that time.

Quasi-privatised market-oriented model (mid 1990s – present)

The quasi-privatised market-oriented model was adopted in the 1990s and replaced the Alcohol and Drug Authority (ADA) public health model and involved the devolution of responsibility for direct service provision to a dispersed range of residential and non-residential programs operated by non-government organisations (NGOs).

Except for Next Step Specialist Drug and Alcohol Services (Next Step) detoxification hospital in East Perth this quasi-privatised market model supplanted all ADA-operated treatment services by NGO-operated Community Drug Service Teams (CDSTs), which were substantially, if not wholly reliant on public funding through managed contracts.

In summary, over the over course of the period since the mid 1990s, the role of the ADA was transformed through a number of administrative rearrangements, to limit its role to training, funding of services provided by NGOs and oversight of large-scale community based public education programs concerned with alcohol and other drugs, except tobacco control.

In summary, these iterations in the diminution in the role of publicly operated treatment programs and to focus primarily on preventive programs, meant the statutory arrangement that underpinned the ADA remained unchanged for some 40 years, from the original legislation of 1974, until absorption of the Drug and Alcohol Office into the Mental Health Commission in 2015.

In 1 July 1994 reforms of the WA health system were introduced by the Court Liberal Government. These health system focussed reforms also intersected with community concerns about growing levels of illicit drug problems in WA and limited treatment programs, especially in response to growing use of heroin and heroin-related deaths, which had become increasingly evident since the early 1990s.

In 1994 by the Court Liberal government, in response to these community concerns about increased illicit drug problems in WA, established the Task Force on Drug Abuse (TFDA). The TFDA investigated the use of heroin and other illicit drugs and in 1975 recommended the creation of a new administrative structure, separate from the ADA, for managing drug-related problem in WA and the devolution of treatment services to non government organisations (NGOs).

This resulted in the creation of the WA Drug Abuse Strategy Office (WADASO), which operated as a unit within the Premier’s Department and assumed on an interim basis a number of key administrative roles previously performed by the ADA. The WADASO reported directly to the Premier in his capacity as Minister Responsible for Drug Strategy.

By the end of the 1990s the treatment landscape consisted of an almost complete withdrawal of Government as a direct provider of specialist treatment services, with the ADA performing a limited role as the operator of a short term inpatient medical detoxification hospital, Next Specialist Drug and Alcohol Services (Next Step).

Next Step was established in April 1999 as a trading name under the Business Names Act 1962, which rebranded the ADA’s former Central Drug Unit site in East Perth, where it also operated an outpatient service in addition to its short-stay detoxification.

In 1997 the Court Liberal government created the State Health Purchasing Authority (SHPA), which operated as a sub-agency within the Department of Health (DOH), to reflect the separation of purchasing of services from the provision of a wide range of health-related services.

This short-lived reform was referred to as the Funder Owner Purchaser Provider (FOPP) model for funding of health services both inside and outside of the public hospital system. The advent of the SHPA resulted in the transfer of the ADA’s responsibility for purchasing services to the SHPA.

The Drug and Alcohol Office (DAO) was established in July 2002. It assumed administrative responsibility for the ADA, even though the ADA continued as a legal entity; it also managed the ADA’s East Perth based detoxification hospital, Next Step Drug and Alcohol Services.

The July 2002 consolidation also sought to combine within one agency the alcohol prevention and community education/awareness campaigns which were overseen by the Department of Health’s Public Health Division. The Health Promotion Services Branch had developed a number of these campaigns, such as the notable Drinksafe Campaign, launched in March 1988.

The DAO ceased to operate at 30 June 2015 and its functions, as well as those of the ADA, were absorbed by the Mental Health Commission (MHC). At this time the quasi-privatised model of treatment continues to operate since the absorption of the ADA within the MHC.