Right for the people

MarcusWhen do specialist drug and alcohol services play a part in the wider public health agenda, asks Marcus Roberts.

In the last couple of days I’ve been involved in two ‘summits’ organised by DrugScope on behalf of the Recovery Partnership: one on older people’s experience of drug and alcohol problems; the other the latest in a series of regional summits on ‘building recovery in communities’ that we hosted in Leeds for the Yorkshire and Humber region.

Three big (and related) policy themes emerged as common ground across these two events – the relationship between ‘recovery’ and ‘public health’, the distinction between ‘services’ and ‘interventions’ and the challenge of ‘keeping it real’ on disinvestment and balancing an appreciation of the financial constraints on commissioners (notably local authorities) with a robust defence of investment in our sector.

The older people summit focused on two distinct groups – an ageing population in existing drug and alcohol services, and a larger group of people in later life who may be using drugs (including prescription or over-the-counter drugs) or (much more commonly) alcohol in harmful ways, often as a way of ‘self medicating’ to cope with experiences associated with aging such as bereavement, loneliness and isolation.

I don’t need to spell out the significance of the distinction between ‘recovery’ and ‘public health’ in this context. What was less obvious to me is that the wider public health agenda for older people looks like it is more about ‘interventions’ than specialist ‘services’. We heard from some great projects working with this age group which clearly have an important role to play, such as DASL’s Silver Lining project in the London boroughs of Bexley and Greenwich. But there is also a big agenda of work to equip and support generic and older people’s services to deal confidently with drug and alcohol issues – for example, GPs, mental health services and residential care programmes.

The wider significance of this point was brought home at the Regional Summit in Leeds where one of our speakers observed that public health naturally thinks and works with ‘interventions’ rather than ‘services’ as such. This raises the question of when, why and to what extent specialist drug and alcohol services are best suited to deliver the interventions that are part of the wider public health agenda now emerging on drugs and alcohol.

This links to the broader issues about funding. The point was also made at Leeds that with local commissioners facing swingeing cuts they would be ‘laughed out of the room’ if they sought increases in investment in drug and alcohol services in the coming years, with the implication that it is not easy arguing for sustaining current levels of investment in local authorities facing budget cuts of 30, 40 or 50 per cent. Even allowing for a lot of creativity and collaboration this raises the obvious question of how this circle can be squared without either reducing access or cutting cost and quality.

Marcus Roberts is director of policy and membership at DrugScope, the national membership organisation for the drugs field, www.drugscope.org.uk

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