Our Director, Will Haydock, outlines some of the challenges and opportunities in relation to substance use as we approach the Autumn Budget.
Today we have responded to the Government’s consultation on its Autumn Budget. You can read our full submission here, but I thought it would be helpful to summarise our approach more briefly.
Treatment works
We layout a case that will be familiar to most people reading this – that substance use treatment can help the Government deliver on several of its missions: reducing crime and helping relieve pressure on a criminal justice system in crisis; saving lives and helping the NHS; improving children’s life chances; and supporting people into work.
Sometimes when I write these kinds of things I worry that we’re sounding too instrumental, but I suppose this is the Budget so we do need to keep saying that funding substance use treatment is a good investment for Government. And the starting point is always that if we get the support offer right, then we are making lives better for people who use alcohol and other drugs, their families and wider communities, and we can’t do that without winning the argument for investment.
In the submission we also suggest that getting this right is urgent: the National Crime Agency has stated that ‘there has never been a more dangerous time to take drugs’ given the emergence of synthetic drugs, and the statistics on drug-related deaths bear this out. Sadly I expect the statistics released later this week will confirm what is not an uplifting picture.
But there are positives. The last few years have shown that when Government provides leadership and priorities alongside investment, our field can deliver real change. There are now more people in treatment than at any time since 2010, and the continuity of care between prison and community has risen by 20% since 2019 – which is crucial in reducing drug-related deaths, as we know leaving prison is a key risk point for overdose.
The Government must re-state its commitment to reducing harm from drugs
The main part of the submission is what should we actually maintain or do differently. Obviously the starting point is to build on what we’ve achieved since Dame Carol Black’s independent review. Some key elements of success were: the Government made it clear this issue was a priority; they provided investment to achieve specific aims; and they brought together organisations and budgets at a national and local level.
The independent review set out an ambitious five-year programme of investment and delivery that was required to ensure people could have access to the support they need and deserve. Current levels of investment, however, have been frozen at Year 3 levels of this programme, meaning the field has not yet received the funding independently judged to be necessary to re-build support services.
We are therefore calling on the Government to commit to invest according to the original plans in the independent review of drugs. Where the previous Government’s strategy sought to move “From Harm to Hope”, we are calling on the current Government to move from hope to delivery. The Prime Minister has talked about ‘delivery, delivery, delivery’ – and in the field of substance use treatment that means re-starting the work that the Independent Review set out as being so urgent back in 2021.
And this is about more than money. We know that the ‘mood music’ of substance use being important to Government helps focus minds and encourage action across and beyond Government. Without that assurance that (a) Government is committed to this work in the long-term and (b) they have key priorities, delivery can drift and partners can disengage, as we often saw through austerity.
We offer some specific ideas for how – with or without reviving Dame Carol’s five-year plan – services and outcomes can be improved.
Here I’m going to focus on criminal justice, but we cover a range of specific projects in the submission (including a personal bugbear of mine, electronic prescribing), focusing on improving services in prisons, making sure residential treatment is sustainable, and improving access to currently under-served communities, notably women and those from minoritised ethnic backgrounds.
Rebalancing criminal justice investment
But on criminal justice specifically, we suggest that Ministry of Justice (MoJ) budgets should be rebalanced – at no extra cost – to prioritise specialist substance use support alongside prison building and probation supervision.
Current MoJ spending plans to address the prison capacity crisis, with £10bn set aside to build new prisons, appear to continue to focus on a fixed idea of prisons and support. Government estimates suggest the current plan works out at between £500,000 per closed place in 2024-25 prices.[i]
This is a narrow view when there are alternative approaches can be operational much more quickly and at a fraction of the cost: around one tenth of the cost per bedspace created. These include lower security or open prisons that focus on rehabilitation, and drug/alcohol or mental health treatment facilities. These should be included in the capacity plan and invested in accordingly.
More fundamentally, there must also be a re-balancing of prison- and community-based support.
Substance use treatment is not only effective in reducing crime; it is more a more efficient intervention than imprisonment. This is why the Independent Sentencing Review recommended a substantial shift to supporting offenders in the community rather than in prison, stating that “resources could be used more effectively if redirected, in part, to community-based offender management strategies.” Reallocating just a fraction of prison capital funding to substance use treatment would deliver a more effective, efficient response in the community.
And even within current budget plans, there must be a place for specialist substance use support in community supervision of offenders. The Government has announced plans for HM Probation Service to receive up to £700m in additional funding per year by 2028‑29 to meet the additional demand for supervision as more people are seen in the community rather than prison.[ii]
If the Government is to effectively and efficiently reduce offending related to substance use, specialist treatment and recovery services must be at the heart of their plans for community supervision. Probation cannot do this work alone. The evidence – and Government guidance – is clear that there should be specialist staff in place, with strong clinical supervision to ensure a trusted, therapeutic alliance with a clear treatment approach.[iii]
Given the scale of the shift described in the sentencing review and the Government’s plans, the necessary additional support for people whose offending is linked to substance use cannot be provided within current DHSC funding without compromising the support offered to those already in treatment.
We are therefore asking that there is some reflection on the balance of spend between revenue / capital, prison / community, and generic / specialist support.
Leadership and collaboration
We’re hopeful there’s still scope to have these discussions within current spending review allocations, but as I said earlier, there’s more to this.
We need leadership from the Government, regardless of funding, to convey that this is a major concern for them. If we don’t get action on harmful substance use right, then it will have a significant (negative!) impact on a range of the Government’s Missions.
The Government has set out admirable ideas and principles in the 10-year health plan and the response to the Independent Sentencing Review, as well as the Missions more broadly. But these will be hard to achieve without the full engagement of charities, and specifically on substance use. That is why we are ready and willing to help. We look forward to continuing to work closely with Government across different departments and policy areas.
I encourage you to flick through the main submission to see the full range and explanation of what we’re suggesting. It’s easy to use the headings and table of contents to flick through to the sections you’re most interested in. As ever, if you have thoughts or comments then please do get in touch.
[i] https://www.gov.uk/government/publications/10-year-prison-capacity-strategy
[ii] https://www.civilserviceworld.com/professions/article/spending-review-moj-prison-new-places-probation-funding
[iii] See https://www.england.nhs.uk/wp-content/uploads/2024/05/PRN00937-10-year-strategic-plan-for-the-drug-and-alcohol-treatment-and-recovery-workforce-2024-to-2034.pdf
Collective Voice responds to the Government’s consultation on the Autumn Budget
Our Director, Will Haydock, outlines some of the challenges and opportunities in relation to substance use as we approach the Autumn Budget.
Today we have responded to the Government’s consultation on its Autumn Budget. You can read our full submission here, but I thought it would be helpful to summarise our approach more briefly.
Treatment works
We layout a case that will be familiar to most people reading this – that substance use treatment can help the Government deliver on several of its missions: reducing crime and helping relieve pressure on a criminal justice system in crisis; saving lives and helping the NHS; improving children’s life chances; and supporting people into work.
Sometimes when I write these kinds of things I worry that we’re sounding too instrumental, but I suppose this is the Budget so we do need to keep saying that funding substance use treatment is a good investment for Government. And the starting point is always that if we get the support offer right, then we are making lives better for people who use alcohol and other drugs, their families and wider communities, and we can’t do that without winning the argument for investment.
In the submission we also suggest that getting this right is urgent: the National Crime Agency has stated that ‘there has never been a more dangerous time to take drugs’ given the emergence of synthetic drugs, and the statistics on drug-related deaths bear this out. Sadly I expect the statistics released later this week will confirm what is not an uplifting picture.
But there are positives. The last few years have shown that when Government provides leadership and priorities alongside investment, our field can deliver real change. There are now more people in treatment than at any time since 2010, and the continuity of care between prison and community has risen by 20% since 2019 – which is crucial in reducing drug-related deaths, as we know leaving prison is a key risk point for overdose.
The Government must re-state its commitment to reducing harm from drugs
The main part of the submission is what should we actually maintain or do differently. Obviously the starting point is to build on what we’ve achieved since Dame Carol Black’s independent review. Some key elements of success were: the Government made it clear this issue was a priority; they provided investment to achieve specific aims; and they brought together organisations and budgets at a national and local level.
The independent review set out an ambitious five-year programme of investment and delivery that was required to ensure people could have access to the support they need and deserve. Current levels of investment, however, have been frozen at Year 3 levels of this programme, meaning the field has not yet received the funding independently judged to be necessary to re-build support services.
We are therefore calling on the Government to commit to invest according to the original plans in the independent review of drugs. Where the previous Government’s strategy sought to move “From Harm to Hope”, we are calling on the current Government to move from hope to delivery. The Prime Minister has talked about ‘delivery, delivery, delivery’ – and in the field of substance use treatment that means re-starting the work that the Independent Review set out as being so urgent back in 2021.
And this is about more than money. We know that the ‘mood music’ of substance use being important to Government helps focus minds and encourage action across and beyond Government. Without that assurance that (a) Government is committed to this work in the long-term and (b) they have key priorities, delivery can drift and partners can disengage, as we often saw through austerity.
We offer some specific ideas for how – with or without reviving Dame Carol’s five-year plan – services and outcomes can be improved.
Here I’m going to focus on criminal justice, but we cover a range of specific projects in the submission (including a personal bugbear of mine, electronic prescribing), focusing on improving services in prisons, making sure residential treatment is sustainable, and improving access to currently under-served communities, notably women and those from minoritised ethnic backgrounds.
Rebalancing criminal justice investment
But on criminal justice specifically, we suggest that Ministry of Justice (MoJ) budgets should be rebalanced – at no extra cost – to prioritise specialist substance use support alongside prison building and probation supervision.
Current MoJ spending plans to address the prison capacity crisis, with £10bn set aside to build new prisons, appear to continue to focus on a fixed idea of prisons and support. Government estimates suggest the current plan works out at between £500,000 per closed place in 2024-25 prices.[i]
This is a narrow view when there are alternative approaches can be operational much more quickly and at a fraction of the cost: around one tenth of the cost per bedspace created. These include lower security or open prisons that focus on rehabilitation, and drug/alcohol or mental health treatment facilities. These should be included in the capacity plan and invested in accordingly.
More fundamentally, there must also be a re-balancing of prison- and community-based support.
Substance use treatment is not only effective in reducing crime; it is more a more efficient intervention than imprisonment. This is why the Independent Sentencing Review recommended a substantial shift to supporting offenders in the community rather than in prison, stating that “resources could be used more effectively if redirected, in part, to community-based offender management strategies.” Reallocating just a fraction of prison capital funding to substance use treatment would deliver a more effective, efficient response in the community.
And even within current budget plans, there must be a place for specialist substance use support in community supervision of offenders. The Government has announced plans for HM Probation Service to receive up to £700m in additional funding per year by 2028‑29 to meet the additional demand for supervision as more people are seen in the community rather than prison.[ii]
If the Government is to effectively and efficiently reduce offending related to substance use, specialist treatment and recovery services must be at the heart of their plans for community supervision. Probation cannot do this work alone. The evidence – and Government guidance – is clear that there should be specialist staff in place, with strong clinical supervision to ensure a trusted, therapeutic alliance with a clear treatment approach.[iii]
Given the scale of the shift described in the sentencing review and the Government’s plans, the necessary additional support for people whose offending is linked to substance use cannot be provided within current DHSC funding without compromising the support offered to those already in treatment.
We are therefore asking that there is some reflection on the balance of spend between revenue / capital, prison / community, and generic / specialist support.
Leadership and collaboration
We’re hopeful there’s still scope to have these discussions within current spending review allocations, but as I said earlier, there’s more to this.
We need leadership from the Government, regardless of funding, to convey that this is a major concern for them. If we don’t get action on harmful substance use right, then it will have a significant (negative!) impact on a range of the Government’s Missions.
The Government has set out admirable ideas and principles in the 10-year health plan and the response to the Independent Sentencing Review, as well as the Missions more broadly. But these will be hard to achieve without the full engagement of charities, and specifically on substance use. That is why we are ready and willing to help. We look forward to continuing to work closely with Government across different departments and policy areas.
I encourage you to flick through the main submission to see the full range and explanation of what we’re suggesting. It’s easy to use the headings and table of contents to flick through to the sections you’re most interested in. As ever, if you have thoughts or comments then please do get in touch.
[i] https://www.gov.uk/government/publications/10-year-prison-capacity-strategy
[ii] https://www.civilserviceworld.com/professions/article/spending-review-moj-prison-new-places-probation-funding
[iii] See https://www.england.nhs.uk/wp-content/uploads/2024/05/PRN00937-10-year-strategic-plan-for-the-drug-and-alcohol-treatment-and-recovery-workforce-2024-to-2034.pdf
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