reduction yield from treatment. With some notable local exceptions, very few people
would argue that the system is working on a national level. Health and wellbeing
boards are understandably focused on social care as their overriding priority. Drug
users are not a priority for either LAs or CCGs, and the decline in acquisitive crime
which access to drug treatment has helped bring about has eroded the police’s role
as local champions of treatment.
Commitment to drug treatment varies among directors of public health who lead
on this for local authorities. Public Health England (PHE) has disinvested from its local
presence, limiting not only its ability to promote and share best practice, but also the
local intelligence it previously provided which enabled Home Office and Department
of Health to understand what was really happening on the ground.
From 2018, local control of public health will be further
strengthened as the public health grant is replaced by direct
local authority responsibility for funding from business rates
receipts. Unlike in 2010, drug and alcohol treatment is no
longer part of the protected NHS spend but will have to
compete for resources in the much harsher local government
environment.
Continuing to deliver what has worked and overcoming the
deficits will become increasingly challenging over the next four
years, as the cumulative 20 per cent real terms reduction in the
public health grant, announced in the spending review,
removes the stability of investment that underpinned the
2010 strategy. Investment in drug treatment increased
threefold between 2001 and 2008, since when it has
been broadly flat with a slight decline since 2010,
and a significant shift of existing resources from
drugs towards alcohol since 2013.
There will always be scope for more
efficient use of resources, and the
best commissioners are working
with providers to use innovation
and integration to sustain or even
improve outcomes. However too
often the response is
mechanistic recommissioning
resulting in wasteful churn, or to
demand reductions in contract
price only deliverable through
reductions in the quality of
delivery. The sector needs to
collectively and realistically assess
what can be delivered, and the new drug
strategy provides a timely opportunity to match
ambition with resource.
The ideal 2016 strategy would look very like its
predecessor – the key difference being to identify
how to deliver the joined-up services everyone
has known we need for at least 30 years. Key to
this will be how best to champion an agenda that
is not a natural priority for most of the individuals
and institutions responsible for its funding and
delivery. Collective Voice will work closely with
government to identify workable solutions to this
long-standing problem on behalf of all providers
and in the interests of service users, their families
and their communities.
Paul Hayes leads the Collective Voice project, a group of third sector treatment
providers including Addaction, Blenheim, Cranstoun, CRI, Lifeline Project, Phoenix
Futures, Swanswell and Turning Point
December 2015 |
drinkanddrugsnews
| 15
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DRUG-RELATED DEATHS
Until 2014 drug-related deaths were assumed to be in slow decline.
Reversing the dramatic increases reported over the past two years has to be
a key priority. The underlying causes of the increase are complex and
probably result from the interaction of different factors, particularly the
ageing and increasing vulnerability of the population. The first step must be
to understand the phenomenon and then resource and implement
evidence-based responses.
JOBS AND HOUSES
‘Treatment success has been eroded by the failure to gain stable
accommodation and employment’ (
2010 drug strategy
). The very existence of
Dame Carol Black’s review is testament to the failure of the current strategy to
route people via treatment into long-term employment that will help cement
their recovery. Collective Voice’s contact with Dame Carol and her team give us
confidence that she will provide realistic and deliverable plans to promote
access to employment, which if resourced will offer a new way forward. There
is no such initiative, and therefore no similar optimism, on the housing front.
INTEGRATING PRISON AND COMMUNITY
The ‘seamless transition’ between prison and community sought by the
strategy has not been delivered. Before 2013, prison and community
treatment were commissioned as one system. They are now two separate
systems, with NHS England responsible in prison and local authorities
responsible in the community. The added complexity introduced by the
‘rehabilitation revolution’ has created even more opportunities for vulnerable
prisoners to fall between the cracks on release.
MENTAL HEALTH
Every drug strategy has identified a failure to align mental health and drug
services and none has been able to solve the problem. In essence this is
because the root cause has been the NHS’s consistent failure to invest in
mental health services. The £600m investment in mental health announced
in the spending review provides an opportunity to change this pattern,
which we must seize.
‘LOCALLY LED, LOCALLY OWNED’
Devolving responsibility to localities to enable ‘joined-up local solutions’ to
replace ‘one size fits all top-down targets’ was at the heart of the 2010
strategy’s approach to accountability. Local authorities were allocated
treatment resources previously routed through PCTs in recognition of the
NHS’ historic reluctance to invest in drug and alcohol treatment and the
potential to align drug investment with other LA responsibilities to provide
cost-effective solutions.
The 2016 strategy aims
to overcome failures in:
KEENER
