The delayed drug strategy \u2013 and lack of plan for an alcohol strategy \u2013 is pulling the lifeline from a sector in crisis, hears DDN The new drug strategy is in limbo. Delayed for months without explanation, the questions are mounting against a backdrop of the highest number of drug-related deaths ever recorded. In the new year, the government said \u2018soon\u2019. In February they confirmed \u2018shortly\u2019. On 30 March, Liz McInnes MP asked for a date for the strategy, telling the house: \u2018Local authorities have seen their funding for drug and alcohol treatment slashed by 42 per cent since 2010\u2026 there are more than 1m alcohol-related hospital admissions each year, and alcohol is a contributory factor in more than 200 different health conditions. Let us hope that both a drugs strategy and an alcohol strategy will be forthcoming as a matter of urgency.\u2019 At the end of April, Sarah Wollaston MP asked the parliamentary under-secretary of state at the Home Office, Sarah Newton, when it would be published. She answered: \u2018We are currently developing the new drug strategy, working across government and with key partners. The new strategy will be published in due course.\u2019 With the general election taking place on 8 June, no one is expecting progress anytime soon. Furthermore, there is no hint of an alcohol strategy, apart from in Scotland, despite problematic alcohol use affecting many more people than drugs. At the latest cross-party parliamentary group on drugs, alcohol and justice, Colin Drummond, professor of addiction psychiatry at King\u2019s College London, was invited to speak about alcohol misuse and treatment. He began by outlining the worsening picture on alcohol, stating that \u2018alcohol-related health conditions, including liver disease, have increased and alcohol-related hospital admissions have doubled.\u2019 But his talk went on to explore the deepening crisis for the drug and alcohol sector. \u2018We\u2019ve had a world-class addiction system in the UK, and we\u2019re in danger of losing it. We\u2019re in danger of it not existing in a few years\u2019 time,\u2019 he said. Looking at the recent rise in drug-related deaths (DRDs) he referred to the government\u2019s reaction to a previous epidemic around 2001: \u2018In the 2000s we had a huge investment in treatments, so drug deaths began falling. But they\u2019re now at their highest since records began.\u2019 So what\u2019s going wrong? Why are we failing? \u2018Declining resources for this population\u2019 were an obvious factor, combined with the disastrous effect of constant retendering. Prof Drummond stated that \u2018people with complex needs are not getting the same access to treatment as before\u2019 and went on to say that the \u2018biggest impact of constant retendering is going to be on people with the most complex needs. They\u2019re not attractive people to treat \u2013 they\u2019re costly, with poor outcomes.\u2019 Furthermore, when contracts are tendered, the expectation is that the service will see \u2018twice the number of people with half the amount of money,\u2019 he said. \u2018So they strip staff costs and have fewer qualified staff and more volunteers.\u2019 It was also an extremely expensive process \u2013 \u2018money that could have been spent on treatment instead of lawyers drawing up contracts\u2019. With retendering taking place every three years in local authorities, clients were constantly affected by the changeover process. Add to this the loss of specialists to the field \u2013 \u2018in addiction psychiatry we\u2019ve lost 60 per cent of training places in England\u2019 \u2013 and you have the perfect storm, he said. \u2018It looks like there are plenty of people in treatment, but the people in most need are being denied care. If they\u2019re not being taken care of here, they will pop up elsewhere \u2013 in A&E, GPs\u2019 surgeries and in prison\u2026 there is an artificial separation between health and social care.\u2019 So what needs to change? Prof Drummond suggested immediate recommendations for the incoming government: \u2022 Ring-fence funding that\u2019s going into addiction treatment. \u2018Ring-fencing needs to be safeguarded not further depleted,\u2019 said Prof Drummond. \u2018Cutting these services is a false economy. Local authorities will only see it from their perspective, but it will cost them more money in the long term.\u2019 \u2022 Bring the NHS back into the fold: \u2018We felt it was wrong to put everything in the control of local authorities.\u2019 \u2022 Put a moratorium on retendering. \u2018We see no evidence that it improves services.\u2019 \u2022 Protect specialism and experience, eg addiction psychiatry. \u2018No area should fall over for lack of experience.\u2019 \u2022 Deal with people with complex needs properly. \u2018We need to rebalance the system to do this \u2013 and if we don\u2019t treat them, they cost a lot to the economy.\u2019 \u2022 Back minimum unit pricing (MUP). \u2018It would have huge benefits \u2013 to both moderate drinkers and to people at the severe end of the spectrum.\u2019 \u2022 Increase research capacity. \u2018If we don\u2019t understand the impacts, we won\u2019t learn.\u2019 Discussion between members of the APPG \u2013 which includes MPs, treatment providers, specialist and advisory groups and people representing service user and recovery communities \u2013 reinforced the need for action. \u2018A lot of this isn\u2019t new but political will is lacking,\u2019 said Alex Boyt, who worked for years in service user involvement. \u2018It\u2019s a lose-lose conversation \u2013 people who are not cost-effective are not being treated.\u2019 The \u2018relentless commissioning\u2019 also exacerbated the situation: \u2018Each time clients are lost, old and new providers blame each other.\u2019 Prof Drummond said that \u2018those most affected by cuts have been rehabs\u2019, to which Caroline Cole, interim chief executive at Broadway Lodge, added: \u2018We\u2019ve had to pull back on the numbers of people with complex needs as the local authority can\u2019t pay us what it costs us to treat them.\u2019 The prison population was also being failed. \u2018There\u2019s a massive spike in deaths on release,\u2019 said Prof Drummond. \u2018The window when they come out is vital \u2013 we used to be better at that. There was better throughcare, but the programmes have been dismantled.\u2019 \u2018Work happens inside, but the problem is when they come out,\u2019 said a volunteer at a prison recovery service. \u2018Places are limited \u2013 there\u2019s nowhere to go \u2013 so they go back to old stamping grounds, old habits and back inside. I sat on a drug strategy group at prison and they do their best, but they\u2019re stretched \u2013 and once people are back inside they\u2019re lost again.\u2019 \u2018We see people who are retoxed in prison, put back on methadone, with no link with community services,\u2019 added Sunny Dhadley from the Service User Involvement Team (SUIT) at Wolverhampton. \u2018There seems an inability to have that very basic conversation about economic commonsense,\u2019 said Boyt. \u2018With the election looming, even fewer people are listening than usual. Is there anything we can be doing practically \u2013 other than lamenting \u2013 to make the case?\u2019 \u2018Why doesn\u2019t the treasury see the madness of the way we\u2019re running things? Why aren\u2019t they looking for a rational approach?\u2019 asked one MP. \u2018What we\u2019ve done as a group is to approach all the ministers responsible and given them the evidence,\u2019 said Lord Ramsbotham, the APPG\u2019s chair. \u2018They\u2019ve patted us on the head but not reflected the evidence. The cost of not doing one thing in an area is going to be seen in another \u2013 all exemplified in the lack of a national drug strategy.\u2019 ********** \u2018We need a single government minister for drugs and alcohol\u2019 The Drugs, Alcohol and Justice Cross-Party Parliamentary Group submitted a \u2018charter for change\u2019, calling upon the government to tackle drug and alcohol-related illness and deaths through investment, education, and a commitment to evidence-based practice. Top of the list was the call for a single government minister to be responsible for drug and alcohol policy, accountable to parliament. The minister would be empowered to: \u2022 Focus drug policy on health, mental health and social inclusion, looking particularly at people with multiple needs, such as mental health issues and homelessness. \u2022 Develop a harm reduction strategy to reduce drug and alcohol-related deaths and illness. \u2022 Create a national commissioning ombudsman to ensure transparency and accountability. \u2022 Widen the Care Quality Commission (CQC)\u2019s remit to include all local authority-commissioned drug and alcohol services. \u2022 Ensure competence and accreditation of the workforce by investing in an independent association. \u2022 Commit to reviewing drug policy at national and global levels, building on progress at last year\u2019s United Nations General Assembly Special Session on drugs (UNGASS). The minister\u2019s priorities should include following guidance provided by the Advisory Council on the Misuse of Drugs (ACMD) \u2013 including ensuring comprehensive access to the life-saving drug naloxone across the whole of the UK, and making NICE-approved treatments available to all patients diagnosed with hepatitis C.