The drug strategy had the potential to revitalise the sector, heard January’s meeting of the Drugs, Alcohol and Justice APPG – but now it was time to deliver. DDN reports.
The government’s new drug strategy came after a decade of major disinvestment, an ideological drive towards localism, and a marketisation of the way services are commissioned and funded, Collective Voice director Oliver Standing told the online meeting of the All-Party Parliamentary Group on Drugs, Alcohol and Justice. But there was now a political willingness to ‘spend big bucks – on some areas’, he said. ‘We’ve got the Treasury backing this with some major investment, for which a big hats off to Dame Carol.’ Once again, however, it was crime that had ‘animated the strategy and unlocked the funding.’
Overall the strategy was ‘really good news’, he said, and it was important to separate the policy detail from the political framing that accompanied its publication. ‘Although the phrase “harm reduction” isn’t leaping off every page, one of the three key metrics that the strategy picks out is about reducing harm and deaths.’
The focus on workforce was ‘essential’, he said – and getting that right would be a necessary condition for everything else. ‘I’d also include commissioners in that – it’s become abundantly clear that the commissioning workforce that will enable these things to be funded and commissioned has been absolutely hammered. We need to be clear that investing in those back-office functions is not taking money from the frontline – we need the infrastructure to support the whole system.’ In political terms, the move from PHE to OHID was good news in that ‘it’s relocating our specialist policy function into a government unit that has an explicit mandate to reduce health inequalities’.
While the focus on crime was clearly politically driven, a huge number of people in the criminal justice system had challenges around drug use and ‘absolutely need our help’, he said. It was important to ‘not lose too much sleep’ over the launch’s punitive framing and instead ‘focus on the good stuff’. Talk of middle-class cocaine use might have accounted for much of the media coverage, but ‘if you look at the money there’s about £5m committed to that, and £700m on treatment and recovery’.
The acknowledgement that addiction was a chronic health condition was also ‘really helpful’, said Dr Emily Finch, vice chair of the NHS Addictions Provider Alliance and co-chair of LJWG. ‘That comes, of course, after years of being told that people have to get off methadone in the next three weeks and that drug misuse is a lifestyle problem.’ Although the strategy’s talk about preventing stigma was ‘perhaps not entirely supported by some of the language’ it was ‘good that it’s there,’ she added.
The commitment to improve treatment capacity and quality included metrics for numbers of places, but it was important to avoid ‘bean counting’, she stressed. There was still significant emphasis on performance and accounting, and ‘we need to be careful that doesn’t become more numbers and less actually doing things’ as the sector was already the most performance-managed in the whole of health. ‘It would have been very nice to have more emphasis on local creativity, and ability to develop your own targets.’
Allocation of the new money would involve a menu of interventions that local areas would be able to provide, she said. ‘That sounds good but again there’s a bit of me that says, “Is that going to mean we lose any ability to have individualised, patient-focused treatment, and perhaps a word that’s become completely alien – choice? You get what you’re given in drug and alcohol services, so it would be nice to offer a broader range of treatment.’
The field now had a real chance to come together, said Standing, and it was important that everyone played their role in damping down any potential conflict ‘along the old fault lines of harm reduction and recovery – we’ve clearly got to have both.’ In terms of funding, Dame Black had made recommendations for five years, and the spending review’s lifecycle meant ‘we’ve got the first three years of that – our job now is to deliver this really successfully for the people who need help.’ It was vital to demonstrate that the system was happy to be scrutinised and have accountability, he stressed. ‘If we can do that then we’re likely to get years four and five.’
‘I think it’s very important to understand that the mood in which this money’s been allocated by ministers – and particularly the Treasury – is of support for the sector, but with patience running out for the delivery of outcomes,’ warned Forward CEO Mike Trace. The outcomes framework and accountability systems would need to be ‘really robust’, he stressed, with accountability focussing on issues like ‘have you reduced crime in your area, reduced deaths, eradicated hep C? That’s the sweet spot the Home Office and health are trying to find. But it’s crucially important that we deliver the outcomes the community and the government want. Because if not, it will end in three years.’