We welcome the Government's long awaited Drug Strategy but, without significant resources being allocated to deliver the government's commitment, the objectives of the strategy will not be realised. Given drug related deaths at record levels, and the Kings Fund warning of significant cuts in public expenditure, how much of an impact will this strategy realistically make?
The following points are made with this general observation in mind:
The strategy has a large focus on 'building recovery', alongside a clear emphasis on tackling some of the issues posed by intergenerational substance misuse. However, the fact remains that funding has been substantially cut in recent years for young peoples' services across the country. This diminishes hugely the capability of service providers to effectively prevent the younger generation from developing dependencies. It is vital that the government commit to increasing funding for young people's services if it truly wants to address intergenerational substance misuse, as it claims.
The acknowledgement that alcohol and drug dependency require a joined-up approach is positive. However, there is surely a missed opportunity to establish a National Ombudsman for Commissioning: someone needs to champion the ethos and quality standards of the joined-up approach. For example, the five-fold variation between the best and worst performing areas in the UK highlights the importance of providing clear guidelines for Commissioners, and it underlines their current absence. Investing in the specifics of quality standards would help arrest the pattern of provider-mergers and provider-collapses in the sector, such as Lifeline.
The continued focus on the criminalisation of drug addiction marks an unwelcome return to the policies surrounding the failed 'war on drugs'. WDP supports a serious debate within Government about evidence-based approaches, which have shown repeatedly that making substance misuse a criminal justice issue further marginalises and further stigmatises the most vulnerable in society, who are prone to developing a dependence on substances, with all the associated personal, familial, community, and social costs that ensue.
It is proposed that drugs remain illegal because of the analysis showing they are "harmful to human health." Unfortunately, this demonstrates a moralistic approach that also ignores the continued legality of alcohol and cigarettes. Alcohol and tobacco products take a far more lethal and costly toll, and they are both demonstrably excessively harmful and responsible for much wider societal harms. We would encourage the government to put politics to one side in favour of improved treatment, regardless of the status of the drug - socially approved, or not.
It is disappointing to note that the government continues to ignore the benefits provided by safe-injecting rooms, which alongside needle-exchange programmes have been shown to provide a pathway into recovery for individuals that are otherwise difficult to reach, and difficult to engage. Indeed, the strategy is rather narrowly predicated on an arguably simplistic model of recovery, and ignores a much wider need, by missing out the broad spectrum of users who simply want help with their drug use.
The discussions in the strategy around making prison governors responsible for substance misuse commissioning is an interesting approach. The strategy is correct in emphasising the requirement for continuity of care between prison services and community services, however the risk in making governors responsible for commissioning, risks overloading the role of prison governor, and at the same time introduces a misalignment between prison services, and community commissioned services. We would encourage the government to provide clear guidance to prison governors on this topic, and with the requirement to receive significant input from community service providers.
The commitment to a Home Secretary-chaired board, for the strong governance of drug strategy is a robust, positive step, and it is vital that service providers are included on this Board. The consideration and understanding of 'lived' experience is vital at this level, and the contingency of having service providers, who steeped in the culture, will ensure that practical considerations are accurately represented. In addition, the appointment of a National Recovery Champion is further encouraging, but once again the individual appointed to this post should be someone with lived experience in the sector.
The Government's awareness of the link between substance addiction and mental health issues is positive, although their strategy fall short. All too often those struggling with highly complex, individualised needs find it impossible to get the help that they need to begin the process of recovery when these services are separate specialisms. Integrated, dual-diagnosis services are vital in providing these particularly vulnerable individuals with a pathway to recovery.
Developing this theme further, it is imperative that the upcoming national guidance to support local areas in the collaboration across drug, alcohol and mental health services provides clear approaches and opportunities for integration. Given the repeated mentions in the strategy of the statistic that 70% of those in community substance misuse treatment experience mental illness, the lack of clear guidance and strategy on this issue is disappointing, and it undermines the shared aims of these services.
The inclusion of chemsex drugs as a priority in this strategy is welcome. As a subject that is repeatedly in the news, it is vital that the government be seen to deal with this issue in a clear way, as it was with New Psychoactive Substances. However, it remains disappointing that the government has not yet explicitly outlined any plans to increase engagement with LGBTQ communities, which remain hugely underrepresented in substance misuse treatment.
Also vital is the role that employment and secure housing plays in the recovery of those struggling to overcome addictions. The strategy rightly acknowledges this, but does not go far enough. The removal of the stigma surrounding substance misuse and (re)-integrating individuals into their communities is critical in recovery, and the government should take further, clear steps to support this.
The dominant concern, missing from the whole strategy, is investment: the sector requires more funding to effectively treat the vulnerable individuals that make up our client base. WDP remains extremely concerned that, once the ring-fence is removed after April 2019, it is inevitable that funding for drug and alcohol services will substantially decrease.
Continuing strong rhetoric around these issues by government is evidently not enough: funding for services has decreased across the board in the past few years. Local authorities require providers to supply the same services for less funds. This is disguised often by payment-by-results schemes, which are aimed more at saving money than improving service provision. Alternatively, where there is no attempt to disguise, direct cuts are made which damage the whole sector.
Further reduction of funding would have catastrophic effects on all individuals going through recovery, and will put many lives at risk. If the government is seeking to improve the provision of treatment, it is vital that the declining resources available for service providers be reversed to allow effective, safe services to continue to be provided. Failure to invest is a form of investment itself, but the return on such a negative venture does not bear thinking about. The Government has an opportunity to make a substantial contribution to the national wellbeing with this strategy, let's hope it can seize the moment, and follow through with the right investment of materials, to match the investment of some promising ideas.