Paul Hayes is determinedly upbeat in the aftermath of Brexit
The country currently has no government, no prime minister, no opposition, no friends, and may soon disintegrate – and that’s ignoring the football!
As we pass through the most profound political crisis since the war, what are the implications for the alcohol and drug treatment sector?
Even in a situation of maximum uncertainty, two assumptions seem reasonably robust: there will be less money and declining political interest. The referendum offered two visions of the economy post Brexit – lower growth leading to lower tax revenues feeding through into lower public expenditure, or a Britain unleashed as a dynamic low tax, low spend, low regulation economy. Neither of these suggests imminent decisions to devote extra resources to marginalised ‘undeserving’ populations.
Just as significant, the amount of national political interest in our sector is likely to shrivel. For the foreseeable future Westminster and Whitehall will be obsessed with the mechanics of Brexit. The chances of political time and energy being focused on addressing alcohol and drug treatment are negligible.
Tactically this may have some short-term value. There has been a lingering threat to evidence-based treatment since 2010; the absence of political interest may therefore be helpful in preventing renewed ideological attacks. But solving the underlying causes of dependence which are rooted in inequality, or addressing the structural deficits in the system – access to mental health services, jobs, houses; the disconnect between prison and community services; drug-related deaths – would require consistent, committed political leadership over many years. This is not going to happen.
So where does this leave us? In a much better place than most of us think. This sector has a unique talent for pessimism, which is at odds with its strong track record of helping achieve positive change in complicated lives. So the first thing we need to do is reflect on our strengths and attributes.
England has a world-class treatment system delivering rapid access to evidence-based interventions for a higher proportion of our population who need it than almost any equivalent country. This has yielded major reductions in heroin and crack addiction, very low levels of HIV infection, and declining drug-related crime.
Despite static funding between 2008 – 13 and reductions of around 25 per cent since, investment in drug and alcohol treatment has still doubled since 2001.
We have a wealth of intelligent skilled and committed frontline staff. Over the past decade, the ability of middle managers and senior leaders to understand the environment in which they operate, motivate staff to deliver, and provide a clear sense of direction, has improved significantly.
The sector has learned how to draw on the knowledge and experience of service users to enrich the quality of delivery. This is now deeply embedded and is key to current and future success.
There are key allies in Whitehall. The Home Office continues to see treatment as one of its most effective interventions to reduce crime. The chief medical officers of the UK and NICE are stout defenders of current evidence-based practice. NHS leaders understand the role of alcohol and drug treatment in diverting long-term cost pressures from their hard-pressed services.
So how do we begin to deploy these resources? Assuming there is no direct ideological challenge to the evidence underpinning our success, the biggest threat comes from a series of local decisions to de-prioritise and disinvest by local authorities and their partners. These will impact negatively on a population becoming more vulnerable as it ages and also suffering from the cumulative consequences of austerity.
This presents twin challenges to the sector. Firstly we have to find a new narrative, as persuasive to local authorities as previous harm reduction and crime led narratives have been to central government. This needs to be a shared endeavour across the sector, service users and our allies in Whitehall.
Secondly we need to challenge ourselves to become ever more innovative to protect and improve outcomes in a climate of reducing budgets. Experience suggests that this is more likely to be achieved by a workforce that is optimistic, motivated and well led then it is by managers and staff who are consistently reminded of how powerless they are as they struggle in the face of ‘the cuts’. However if working smarter is genuinely to be more than rhetoric, we also need to learn as a sector what genuinely can’t be achieved and to walk away from contracts that are offered at a price that cannot sustain outcomes.
Collective Voice is keen to work with the wider sector to fashion this new narrative and gain better understanding between all parties, but particularly commissioners and providers, of the scope for innovation and the point at which cash savings in one part of the system create greater cost pressures elsewhere. Our series of events in September for service users, NHS and third sector providers, commissioners, and young people’s services – which will include officials from the Home Office, Department of Health, PHE and local government – will look at how we can best protect what has already been achieved and respond to the new challenges we face.
Paul Hayes is head of the Collective Voice project, www.collectivevoice.org.uk