The government needs to invest an additional £552m in the drug treatment system over the next five years through the Department of Health and Social Care (DHSC), says the second part of Professor Dame Carol Black’s Independent review of drugs – one of more than 30 recommendations in the long-awaited document.
An additional £15m in employment support through the Department for Work and Pensions (DWP) is also urgently needed, it says, along with extra funding for housing support through the Ministry of Housing, Communities and Local Government (MHCLG).
Drug dependency issues need to be recognised as ‘a chronic health condition’ like diabetes or hypertension, with the necessary long-term follow-up, it states. While discharge after short-term treatment is currently used as a measure of success this should be stopped as it ignores the fundamental relapsing nature of the condition. Meanwhile, physical, sexual or psychological trauma and mental ill-health need to be fully recognised as ‘the drivers and accompaniment’ of drug issues and classed as co-morbidities rather than separate problems for dual diagnosis, with more done to make sure people don’t ‘fall through the cracks’.
The report into the first part of the review was published eighteen months ago and looked at drug supply and markets (DDN, March 2020, page 4), with the second part focusing on treatment, recovery and prevention. The public provision for these is ‘not fit for purpose, and urgently needs repair,’ says the new document, with the government now facing ‘an unavoidable choice: invest in tackling the problem or keep paying for the consequences.’
A whole-system approach is needed with coordinated action by multiple departments, it stresses, with Dame Black telling a recent Westminster Social Policy Forum event that the government’s response to drug dependency was uncoordinated and ‘not owned by any one department of state’ (DDN, July/August, page 8). The government needs to establish a ‘national drugs unit’, says the report, which would then develop a national outcomes strategy to hold departments to account. DHSC needs to ensure that local authorities spend treatment funding ‘on these services and not on other things’, and introduce a national commissioning quality standard that requires local authorities – as a condition of their funding – to work together with health, housing, employment and criminal justice partners to develop joint needs assessments and publish commissioning plans.
Although departments would obviously have competing priorities they needed to work together to improve treatment, employment, housing support and the way that ‘people with addictions are treated in the criminal justice system’, Dame Black states, with increased funding insufficient on its own. ‘Greater co-ordination and accountability at national level must also flow through to the local level, where responsibility sits for the delivery of drug treatment and wider recovery outcomes.’
Capacity in the system also needs to be ‘significantly’ rebuilt, it says, including ‘recruiting many more professionally qualified staff and trained support workers’, with a recommissioning of depleted inpatient detox and residential rehab services to ensure national coverage. More investment in interventions to help reduce demand was also needed, it adds, while other recommendations include that DWP recruit peer mentors in every Jobcentre Plus area to encourage people with drug issues to access employment support and equip its staff to do more outreach work in the community.
Although the report is calling for significant investment ‘the payoff is handsome’, it says, with £4 saved for every £1 spent ‘from reduced demands on health, prison, law enforcement and emergency services’.
Launching the report on 8 July Dame Black announced to the sector and partners, ‘I hope you feel it’s your review.’ Engaging many stakeholders, including people with a very wide range of lived experience, Dame Black and her team had ‘examined treatment and recovery in detail and found it to be broken and wanting’. Funding had decreased against ‘a backdrop of increasing harm and widening inequalities’, resulting in ‘a great deal of unmet need’.
The conclusion was that ‘whole system change underpinned by additional investment’ would be the only effective option, and this involved strong government leadership supported by effective local partnerships, ‘together with clear accountability’.
‘We can’t do this without investment,’ she emphasised, beginning with £552m invested in treatment over the next five years. ‘It seems a lot but it only takes us back to the levels of 2012.’
Minister for crime and policing Kit Malthouse welcomed the ‘insightful’ report that was ‘filled with evidence and the product of a lot of collaboration’, which included input from recovery champion Dr Ed Day, Prof Keith Humphries, and people with lived experience. ‘It is our moral duty as a government to do something about drug-related deaths,’ he said, and called the Central Drugs Unit a ‘coherent and strategic’ way of linking health, housing and employment with crime prevention. Part one of Dame Black’s report had ‘laid out in horrific detail’ the scale of the drug problem and the prime minister was receptive to the proposed solutions in part two, he said, which would include expanding successful initiatives to dismantle county lines and supply chains and continue partnerships between health, police and social care, such as Project Adder.
Jo Churchill, minister for public health and primary care thanked Dame Black for her ‘commitment to public health’ and said the report championed evidence-led policy and the importance of empathy. The proposed budget, the largest increase in the last 15 years, signified a moment of change, but was necessary because ‘drugs wreck lives’ – of families and everyone around, as well as the person with an addiction.
She welcomed the joined-up approach as ‘addiction doesn’t exist in isolation’ and related to past traumas and complex morbidities. Many people with addiction problems didn’t make it past 40, so ‘intervention needs to be smart and it needs to be early,’ she said. ‘If COVID has taught us anything, it’s that we don’t have to do things the same way,’ she added. ‘The review presents us with an opportunity for action.’
Reactions from the sector
‘Dame Carol is right that we need urgent change,’ said Change Grow Live chief executive Mark Moody. ‘The current situation is intolerable and the people who use our services, the communities they live in, and ultimately the whole country pay the price.’ The government needed to come forward with a new strategy, he said, including new measures of success as recovery was ‘much more than total abstinence’, and it also needed to ‘get commissioning right. We want to see an end to fragmentation of services and short-termism. All the organisations involved must come together to put stable local services in place where they are needed.’
The review represented ‘a potentially defining moment in the course of drug treatment in the UK’, added With You’s executive director for services Jon Murray. ‘At a time when drug-related deaths have reached record levels, its recommendations provide a clear way forward for getting more people the help and support they need, whilst reducing the harm of drugs in our communities. The focus on trauma-informed service delivery is crucial and we are pleased to see recognition of the interconnected nature of problematic drug use and mental health issues.’
While the document could ‘signal a long overdue turning point’ it needed the government to commit to ‘major financial and political investment and a truly collaborative approach to delivery, drawing on the strengths of a wide range of partners’ he added.
The treatment system had long been struggling with the ‘perfect storm’ of rising demand and funding cuts, said Forward Trust CEO Mike Trace. ‘Reducing budgets have resulted in diminishing and inconsistent access to treatment from one local area to another. It means that the experience of individuals, families and children struggling with addiction is too often one of frustration and isolation when they most need help. As we emerge from COVID and make decisions on future health priorities it is vital that addiction treatment, access to recovery, early intervention and support for families and children are firmly on the agenda so that we avoid a continued increase in avoidable deaths from this devastating illness.’
‘There is much to support in this report,’ said Phoenix Futures chief executive, Karen Biggs. ‘We believe this is a once in a generation opportunity to redress the inequality faced by people from all walks of life. In particular to focus on how we can all work together to create genuinely effective, inclusive, connected and caring services and support that lead to sustainable recovery.
‘The report highlights the need for reform and repair of the system can only be solved through coordinated action by multiple departments including the Home Office (HO), Department of Health and Social Care (DHSC), Department for Work and Pensions (DWP), Ministry of Housing, Communities and Local Government (MHCLG) and the Ministry of Justice (MoJ).
‘It will take improved coordination between national and local government departments, the NHS and voluntary sector and many others, including the media and business worlds, to realise this opportunity. This is an opportunity not just for inclusive, effective services but to realise the potential of an inclusive society that works for everyone.’
We welcome the scope and ambition of Dame Carol Black’s Review which represents the best chance to reset and renew our treatment and recovery system in over a decade. Dame Carol has engaged with our field with admirable rigour and heard the many challenges brought about by the profound disinvestment of recent years – as well as the passion, skill and tenacity used to support thousands of people every year into recovery.
The time for political action is now. Following years of disinvestment and a lack of political leadership, we are now experiencing a drug death crisis. We implore the new Health Secretary to urgently respond to the report’s recommendations – to reduce the harms caused by drug use, stem the flow of deaths, and enable thousands more citizens – and their families – to recover.
As a sector, we stand ready to work together with government and wider partners – both local and national – to make the most of this vital opportunity. The hundreds of thousands of people touched by addiction in this country are counting on us all to get this right.
Vivienne Evans, CEO Adfam
Oliver Standing, Director Collective Voice
Chris Lee, Chair English Substance Use Commissioners Group
Danny Hames, Chair NHS Addictions Provider Alliance
Read the full joint statement here
Review of drugs part two: prevention, treatment and recovery at www.gov.uk