A ‘record’ £780m over three years to ‘rebuild the drug treatment system’ has been announced by the government as part of its much-anticipated new drug strategy. While every local authority in England will receive extra money ‘to combat drug and alcohol misuse’ over the next three years, those with the greatest need will receive the funding first, the government says.
The ten-year strategy is intended to ‘tackle the scourge of drugs and prevent crime’ – addressing both supply and demand and creating a ‘world-leading’ treatment system within a decade by improving access and increasing capacity. The 50 local authority areas with the highest needs will be prioritised in order to ensure access to treatment for ‘the poorest and most vulnerable’ – there will also be increased housing support and access to treatment for people sleeping rough, along with more employment support, including a peer mentoring programme. The role of health and justice partnership coordinators – who liaise between prisons, probation and treatment providers – will also be expanded to cover every region in England and Wales, with the aim of boosting joined up working and ensuring consistency in treatment plans.
The success of the strategy will be measured against national and local outcomes frameworks to achieve a series of targets by the end of 2024-25, it says, including ‘a phased expansion to deliver at least 54,500 new high-quality drug and alcohol treatment places – a 19 per cent increase on current numbers’. This would include 21,000 new treatment places for opiate and crack users, and 30,000 new treatment places for non-opiate users, including 5,000 for young people.
As has been predicted, there is a significant focus on drug-related crime in the strategy, with plans to improve treatment for people in the criminal justice system, more testing regimes in prison, more use of Drug Rehabilitation Requirements for people on community sentences, and better support for prisoners to engage with community treatment ahead of their release. However, proposals to take away people’s passports and driving licences for possession offences – widely reported in the press ahead of the document’s launch – are not included in the document itself.
Instead there will be a planned £9m future investment in the ‘Tough Consequences out of court disposals scheme’, the government says, intended to deter people from drug use through a range of potential civil penalties that could include ‘fines, curfews, or in the most exceptional cases, the temporary removal of driving licences or passports’. A white paper to be published next year ‘will consider a series of escalating sanctions’, with crime minister Kit Malthouse telling Sky News that it ‘might involve, we hope, interfering in their lives in a way that brings about behavioural change’. In the meantime, a £300m investment will target supply chains and aim to disrupt gang activities, including the target of dismantling 2,000 county lines operations. With the £780m treatment investment, the total spending on both treatment and drug-related law enforcement will top £3bn over the next three years, the government states.
The government intends to bring about a ‘generational shift’ in terms of demand, it says, with other planned future action including £15m over three years towards rolling out drug testing on arrest through police forces across England and Wales, as well as £5m for an ‘innovation fund to develop a world-leading evidence base to better understand what works in driving changes in attitudes towards drug use’.
‘This is a huge moment which will not only save lives but help level up the country,’ said health and social care secretary Sajid Javid. ‘We’re investing a record amount into treatment services with money to break the cycle of drug use and to support communities by cutting the drug use which drives crime. Treatment services are just one part of the comprehensive strategy which includes helping people back to work, into permanent housing, and cracking down on supply.
The document has been shaped in response to Dame Carol Black’s Independent review on drugs, the government said, with her continuing to monitor and advise on the strategy’s progress. ‘I am delighted that the government is making this very significant investment in drug treatment and recovery services, alongside the funding allocated to tackle drug supply,’ she stated – money that would ‘transform substance misuse services, providing people with high quality treatment and support for recovery. The investment to improve housing support and employment opportunities is just as critical because people need hope, purpose and practical steps to help them achieve a better future. This strategy comes with high expectations and I look forward to advising the central unit and relevant government departments to ensure there is a step change in treatment, recovery and prevention.’
From harm to hope: A 10-year drugs plan to cut crime and save lives at www.gov.uk
RESPONSES FROM THE FIELD…
‘People with drug and alcohol problems should be able to get the right support and treatment when they need it, which this comprehensive strategy sets out to achieve. Councils, which are responsible for public health, share this ambition and want to see vulnerable people being given another chance to find work, rebuild relationships and find safe and secure accommodation. Boosting direct funding for drug treatment and recovery is helpful to meet rising demand, but we also need to see significant investment in the services which help prevent problems before they occur, such as in housing, youth services, mental health and children’s services.
‘As this strategy outlines, investing in drug prevention and treatment now will reap benefits for everyone longer-term, including for the NHS, criminal justice and other public services. This needs to be supported by extra opportunities for users to gain employment, housing, mental health care and help from other agencies.’
‘We very much welcome the government’s plans for the largest ever single increase in investment in treatment and recovery. Drug-related deaths are the highest they’ve been since records began and a decade of austerity has taken its toll on the sector. Properly funded treatment services will be able to reach more people and reduce the harm caused by drugs to individuals, families and communities.’
‘We welcome the major step forward that this strategy signals for the long-term future of drug treatment and harm reduction. We back the strategy’s acknowledgment that addiction must be treated as a chronic health condition. This is a significant breakthrough for drug treatment and a critical first step in removing the stigma that prevents people from walking through the door of treatment services. And we welcome the new investment to rebuild drug treatment and increase capacity by 54,500 high-quality treatment places. But to be successful, the needs of people who use drugs must be prioritised when it is put into practice, and we must ensure that some of the proposed compliance and enforcement measures don’t put people off seeking help. The success of this strategy depends in large part on the people who deliver treatment and recovery services, from psychiatrists to caseworkers and volunteers, so we welcome new funding to attract people to jobs in the sector, to support better training for them, and to keep caseloads manageable.
‘Today is just the start. As Dame Carol Black noted, people who use drugs have been ignored and marginalised for too long by policymakers. We look forward now to working closely with the government and all our partners to put the needs of people who use drugs at the heart of this new approach over the next decade. If we do this, we can bring about genuine change to drug treatment and harm reduction that will benefit us all, in communities up and down the country.’
‘We are encouraged by the financial investment being put into drug treatment; Dame Carol Black’s review rightly states that the ‘payoff is handsome’ with each £1 spent on treatment saving £4 from reduced demand on other services. It is imperative that services are evidence-based and robust, providing a comprehensive range of treatment and care to meet the differing and complex needs of those we support.
‘Dynamic partnerships will be essential if the drugs strategy is to work, and this will require coordinated action within and between government departments and the drug sector.’
‘The government noted in their announcement that the £780m in funding that they have committed will rebuild the sector and that is what we need to do – rebuild. A decade of disinvestment and sporadic funding has decimated drug and alcohol services at a time when demand has increased and the number of people dying has risen by almost 80 per cent. This new strategy will help us get back on our feet but there is a lot of catching up to be done, especially in light of the pandemic which was not factored into the Dame Carol Black review and has caused disproportionate harm to people who use drugs. Despite the much-heralded crime and enforcement elements of yesterday’s announcement, this strategy indicates that the government has begun to recognise that drug use is also a health issue.
‘While this strategy contains few bold new ideas, it does provide the funding, support and commissioning standards that the sector has been requesting for many years. And, most importantly of all, this strategy will save lives, help people to build resilient futures and ensure the most marginalised members of society get the support they need. It is now up to all those working in the sector to use the extra investment to shape and develop service delivery so that we have more impact on more people by expanding the evidence base and the range of services we offer.’
‘Beyond the damaging rhetoric that accompanied the launch the considerable investment in treatment and the acceptance of the Dame Carol Black recommendations in totality are very welcome. The largest ever investment in improving treatment is extremely welcome. This strategy will not reverse the harms of those cuts on the lives of families across the country over the last decade. Nor will it repair the stresses on the working lives of frontline staff across the treatment sector who are the unsung heroes. But looking to the future we should be hopeful that we can now improve the lives of hundreds of thousands of people in need of support and support our workforce to grow, develop their skills and maintain their incredible dedication. We believe the strategy offers the promise we have been campaigning for over the last decade.
‘Strategies are only as strong as their implementation and the culture in which they exist. We have a culture which stigmatises people affected by dependency and addiction leading to daily prejudice and discrimination that limits life opportunities. This strategy references stigma briefly only twice – we know that for the record levels of investment to achieve the desired treatment outcomes we need to address the outdated views of addiction as a moral failing and a purely criminal issue. On this point the tone of the strategy is a missed opportunity.’
‘It’s no coincidence that the government’s own wording is a promise to “rebuild” treatment services and the workforce delivering them. It’s perhaps the closest to an acknowledgment we’ll get that those years of cuts have done immeasurable damage to the drug treatment system. Coping with the daily demand has left services with little time or resource to develop different approaches with diverse communities, although we know from 20 years’ experience that not doing so will perpetuate barriers and inequalities for LGBT people, as well as for other minority groups.
‘It’s vital that investment in treatment services reaches organisations experienced in supporting chemsex users including those with offending histories. Much of this expertise exists outside of traditional treatment providers in small and specialist charities like our own and our LGBT sector partners. We understand the factors that lead to problematic use of chems and are trusted by the communities we work within. As demand for this specialist support grows treatment provision can’t be left to chance, backed by a commissioner or two here and there, or – more likely – left to grant giving trusts to pick up the slack. It must form a core strategic element of a joined-up approach.’
‘The government has accepted the recommendations in the review by Dame Carol Black, including an increase in funding for the addiction treatment sector, housing and employment of £780m across the three years to 2024. Dame Carol recommended a significant new investment in our sector, and a much tighter focus on ensuring the money is spent on services that deliver real results in terms of reducing deaths and drug-related crime, and increasing recovery. The Forward Trust is particularly supportive of this focus on recovery outcomes – we have long said that, even within declining budgets, there has been far too little effort to ensure that every area of the country (and every prison) has a strong recovery community, a treatment system that inspires and supports people to overcome addiction, and a strong family support network. While it is welcome that the new strategy has warm words about this ambition, there is much work to do to make sure the new money achieves this transformation in practice and reverses the declines of the last ten years.
‘On a more critical note, it is depressing to see the strategy launched with a flurry of headlines around the scourge of drug addicts swamping the country with crime and disorder. This is political spin at its worst – you don’t need to condemn and stigmatise millions of people to justify investment in the addiction services. It is good that the government are providing money for us to do this better, but we can do without the stigmatising language. Language that failed to match up to the ambition of the strategy and does little to inspire people that change is imaginable, that their life is worth investing in and recovery is possible.’
‘The strategy rightly recognises that half of people dependent on opiates and crack cocaine are not in treatment, and that drug addiction co-occurs with a range of health inequalities, especially mental health issues, homelessness, and deprivation. Investment in improving the quality and capacity of treatment, as recommended in Dame Carol Black’s independent review, is long overdue following the decade of spending cuts to treatment services. The renewed focus on recovery is both welcome yet ironic given that cuts to funding were originally championed by the incumbent Conservative government, as the Advisory Council on Misuse of Drugs (ACMD) noted in 2017.
‘We are pleased to see naloxone recognised in the strategy as a life-saving and harm-reducing intervention to be offered across the country. Unfortunately, this is only one of many types of tried and tested harm reduction measures that have been implemented by nations more progressive than ours – including heroin assisted treatment, drug consumption rooms (overdose prevention sites/supervised injecting facilities) or medical safe-supply of drugs, including prescribed diamorphine – which are not even mentioned in the new strategy.
‘What is more difficult to spot among the ‘tough on drugs’ fanfare is that there are some positive steps included in the strategy which move us away from the criminalisation of low-level drug possession. Diversion schemes currently operate in a small handful of police forces, and their inception has been police-led, in the absence of government leadership. Diversion schemes are considered de-facto decriminalisation – but they are not described this way in the new drug strategy – which includes plans to double “out-of-court disposal schemes” by the end of 2024/25. It is telling that the expansion of drug diversion was downplayed in the strategy: instead of being celebrated as a step towards avoiding creating criminal records for people, the government’s “tough” rhetoric was reinforced by including the underdeveloped threats to remove people’s passports and driving licenses as possible civil sanctions under diversion schemes (which is to be further elaborated in a white paper in 2022). It is an imbalanced proposition considering that current diversion schemes inform people of the harms of drugs via short drug awareness courses, as opposed to restricting their liberties. The government has made their point: they are still tough on drugs.’