In a follow-up to our recent three-part commissioning series, Tony Margetts looks at commissioning drug and alcohol services from a criminal justice perspective.
Britain has long used criminal law and criminal justice agencies as a key part of its response to drug use. While alcohol and tobacco have been regulated and licensed, other drugs fall under the venerable Misuse of Dugs Act 1971 or the more recent Psychoactive Substances Act 2016.
While this approach has been the subject of much debate – with critics suggesting a more tolerant and health-based approach may serve the nation better – this article looks at the response of criminal justice agencies to the national drug strategy, and the challenge of commissioning in a complex and fragmented landscape.
Dame Carol Black said in her first report, ‘More than a third [of the 82,000+ people in prison] are there due to crimes relating to drug use (mostly acquisitive crime). These prisoners tend to serve very short sentences, have limited time in prison treatment and poor hand-offs back into the community. They are highly likely to re-offend.’ This finding influenced much in the 2021 drug strategy and this article considers the implications of this.
These agencies, with overlapping but not identical interests, will be commissioning in a complex landscape. The government, in its guidance to local partners, has asked areas to set up Combatting Drugs Partnerships to coordinate a local response to the national drug strategy.
These are mostly working on a local authority level and are chaired by directors of public health, making the involvement of prisons – which operate across local authority areas – challenging. The partnerships will also have to implement the ‘three strikes’ response to drug testing currently being contemplated by the Home Office as part of the controversial Swift, certain, tough white paper.
The last ten years have seen a considerable loss of experienced staff from prison and probation services, and both drug and alcohol knowledge and commissioning experience has been lost. Clinks, in a series of reports on the work of the voluntary sector within criminal justice, has highlighted the inflexibilities of Ministry of Justice (MoJ) as a partner. The services are also working under considerable staffing pressures, making the day job hard enough.
So, what are the priorities for commissioning in the criminal justice system? Here are a few suggestions:
Improving the knowledge levels around drug and alcohol treatment within the staff of criminal justice services so that they can contribute to joint commissioning appropriately. This means both a better knowledge of the evidence base for drug treatment and better commissioning skills. One of the objectives of criminal justice services is reducing re-offending and this requires good, accessible treatment services.
Improving the preventative and diversionary offer within the criminal justice system for people whose offending is related to drug use. This is an area that has been a focus for some police, fire and crime commissioners (PFCCs), including the West Midlands, but should be developed further and linked to the liaison and diversion services.
BARRIERS TO TREATMENT
Working not just to increase the numbers in treatment but also looking at the barriers to treatment for people with multiple problems. This is a key part of the Project ADDER pilots but needs to be a concern among all commissioners. Many of the people with drug and alcohol problems within criminal justice services are not in treatment.
Better joint working between the staff of criminal justice agencies and treatment providers – informing sentencing recommendations and appropriate enforcement of community sentences and licences for released prisoners
CONTINUITY OF CARE
Ensuring continuity of care between prison and the community and drug treatment, informing the supervision and enforcement of prison license conditions. At present there appears to be a prison/probation pathway relating to post release license and another between prison healthcare and community services with limited joint working to support prisoners after their release. This is a key role for the newly created health and justice partnership coordinators within the Probation Service.
Tony Margetts is a drug and alcohol treatment commissioning consultant
The criminal justice system is a broad term – key commissioners are:
HM PRISON AND PROBATION SERVICE (HMPPS)
Part-privatised in 2014, The National Probation Service is now part of the civil service and sits with prisons in HM Prison and Probation Service (HMPPS). Drug treatment was the subject of a ‘disappointing’ thematic inspection in 2021 which included a raft of recommendations for the new model probation service. The probation service is working to improve the offer for drug and alcohol-related offending, including the commissioning of drug and rehabilitation services and increasing the use of community sentences requiring treatment for drug and alcohol problems.
The National Probation Service also commissions services, including some for offenders with drug and alcohol problems, and works with a number of third sector organisations who are also providers of local authority and prison commissioned services and who are represented by an umbrella organisation, Clinks.
The prison service has a strategy from 2019 which will need an update to bring it in line with the 2021 drug strategy. The direction of this can be judged from a white paper prepared under Dominic Raab in 2021 – now back at the MoJ – which looked at increasing the use of testing, making treatment, including abstinence-based treatment available to prisoners, and expanding ‘incentivised substance-free living units’, which sound like a sort of rehab unit in prison.
POLICE AND PFCCS
PFCCs have considerable discretion in what – if any – drug and alcohol services they commission, with approaches ranging from the recently discontinued heroin assisted treatment in Middlesbrough to calls to reschedule cannabis as a class A drug.
LOCAL AUTHORITY PUBLIC HEALTH COMMISSIONERS
Commissioners are responsible for commissioning community drug and alcohol treatment services, including the treatment elements of drug rehabilitation orders and alcohol treatment requirements, which are imposed by courts and can be breached by failing to comply with treatment. Some areas are piloting government schemes to address the needs of people with multiple problems, particularly Project ADDER, which looks at improving access to treatment for offenders and Changing Futures, which looks at people with multiple problems including offending, homelessness, mental health, and domestic abuse.
Often overlooked as a commissioner of drug treatment, NHS England is responsible for healthcare in prisons, including drug and alcohol treatment and liaison and diversion services designed to assess the health and social care needs of people arrested by the police. It also commissions the Reconnect service, which is currently being rolled out nationally and which is designed to improve continuity of care between prison and community drug treatment services.