Dame Black has spoken loud and clear. How policy makers respond will be crucial, says Oliver Standing.
At the recent Glasgow drugs summit Dame Carol Black shared a number of truths many readers will be sadly all too familiar with. Drug problems spring up in areas of poverty and social exclusion; successful treatment and recovery is contingent on effective, coordinated support around housing, mental health and criminal justice; and when people leave prison they often miss out on the vital support they need. She also reminded delegates that our world-class treatment and recovery has been eroded and fragmented by austerity and localism.
Some commentators may look at the Glasgow summits and conclude that no concrete political outputs were agreed. At a time when drug-related deaths and other visible manifestations of extreme inequality such as rough sleeping are on the rise this is understandable, as is the perception that ongoing increases in drug-related deaths constitute a serious failure of public policy and/or political leadership. We must harness the sense of outrage and urgency that many of us feel to bring about change.
Positive developments
So, in that spirit, I want to point to some more positive policy developments that may help build the necessary momentum to make that change happen. Though the last Conservative manifesto was light on detail around drug and alcohol treatment, a subsequent addendum was published laying out plans to tackle addiction. This included two crucial pledges – to introduce a combined addictions strategy and a ‘dedicated monitoring unit at the heart of government’. Collective Voice welcomes both commitments.
The addictions strategy should address the public health emergency of drug-related deaths by outlining a clear plan to enable local authorities to fund and deliver effective, evidence-based and person-centred support. The 2017 strategy was not gripped firmly enough by government to bring about transformational change. This strategy should be driven by an effective inter-departmental approach, united behind a shared vision.
The monitoring unit could bring some welcome political attention to a field that has been fundamentally shaped in the past decade by the twin challenges of austerity and localism. Austerity has seen more than a quarter of our funding lost and localism has meant that loss has not been evenly distributed.
Challenges
It would be wrong to directly link all our challenges with the move of drugs and alcohol to local authority control. But there is an unquestionable issue over priority. Funding evidence-based and life-saving drug and alcohol services will never be the first thing on the list for local politicians dealing with substantial funding pressures.
However, a successful central unit will require a careful balancing between the local and the national. The unit should have sufficient powers to encourage local areas into action where appropriate, reducing the local variation in support and working effectively with Public Health England with clearly delineated roles and responsibilities. Most importantly, the development of the unit must be supported by sufficient new funding and political investment to ensure its long-term potency.
While more money is not the answer to all of our questions it is a good response to a great many, as the unprecedented scale of the cuts has forced local authorities to make very difficult decisions. Increases in public spending could enable the support of a greater number of people. There are over 314,000 people in England who use heroin or crack problematically, and 586,000 with an alcohol problem. Many aren’t currently receiving help. More support means an increase in family stability, fewer children taken into care, fewer blue light call outs, fewer emergency admissions to hospital and fewer people caught up in the criminal justice system.
The prime minister has spoken extensively about his commitment to the areas represented by new Conservative MPs. These areas – many of which are ex-industrial – have experienced high levels of drug-related deaths and multiple disadvantage. If the government is serious about this commitment then an investment in the health and happiness of our most vulnerable citizens, as well as technological or transport infrastructure spending, is surely necessary.
The proposed removal of the ring-fence around vital public health funds has been postponed by at least a year and will not now happen until April 2021 at the earliest. This is good news, although of course not in itself sufficient to guarantee a high-quality treatment and recovery system in England. Therefore we recommend that the ring-fence around the public health grant is maintained for good and that the lost public health funding at local government level is restored.
New policy developments can help make the case for joined-up and connected services. Previous attempts to deliver treatment and recovery services have hit a ceiling due to siloed approaches. Our policy and research discourses are catching up with what those touched by addiction have always known – that only a connected response can work for a problem that does not reside in any one department of human life but sprawls across them all. Work to support a citizen’s drug problem is almost useless if they have no home, fragile mental health or paralysing trauma.
Considering addiction with reference to other domains of multiple disadvantage will enable the strategy to catalyse change in allied areas. The 2017 strategy made welcome recognition of the fact that addiction is both cause and consequence of poverty and trauma – we were pleased to see £46m in the recent budget for a programme of coordinated work on multiple need, and we also hope that the second part of Dame Black’s review will make the case for effective partnership work, something the voluntary sector has always been good at.
The new strategy and monitoring unit should also refocus political attention on alcohol treatment. Whilst it’s welcome to see the issue of problem gambling being pulled into the political mainstream, it’s perplexing to see almost no mention of alcohol at a time of quiet crisis in alcohol treatment. There is a clear correlation between disinvestment and the diminishing numbers of people getting help – over 16,000 fewer alcohol users were supported this year compared to 2013-14, while 82 per cent of people who need specialist help are not getting it.
The government’s response to alcohol must be brought ‘up to speed’, with the strategy outlining how a greater number of alcohol users – and their children – can be reached and supported. The fact that stigma can force people to the margins and prevent them getting life-saving help should be recognised.
The linking of different forms of addictions in the new strategy must be used as a chance to combat the stigma around drug use. The second part of the Carol Black review also provides a valuable chance to acknowledge the negative role stigma can play in stopping people getting help – supporting recovery can be a powerful way of addressing wider health and social inequalities.
My final message to government would be: we know what works. We are equipped with a range of interventions from opioid substitute therapy to motivational interviewing, from needle exchange to residential rehab, which can be drawn upon by skilled workers to meet the needs of their clients at the exactly the right time.
If the field is provided with sufficient resource and appropriate structures we can unleash the transformative power of treatment and recovery to change lives, reunite families, support communities – and save the state money while we’re at it.