A missed opportunity to truly level up our treatment and recovery services

Drug misuse impacts on almost all domains of human life – and cost England £18.7bn in 2017/18. Our drug related deaths figures reveal an appalling picture of human loss and suffering – and cost over £6bn per year. Alcohol harm costs England a staggering £21.5bn per year.

Treatment and recovery offer a powerful response to both the human and economic costs. As well as delivering a powerful human dividend of restored health, happiness and dignity, they reduce costs across a number of areas, with every £1 spent on drug treatment delivering a social return of £4 and every £1 invested in alcohol treatment delivering £3.

But there’s simply not enough resource to deliver a high-quality service for all. England has seen 17% cuts since 2015, with some local areas making reductions of over 40% to treatment budgets. These cuts constitute a false economy by creating costs in other areas of public services. And crucially they have eroded the system’s capacity to innovate, deliver a gold standard of care or develop new support pathways – and come at a time of increasing need.

October saw record annual drug related death statistics – yet again. Covid-19 has highlighted how fragile the support systems around the most marginalised can be, and how easily disrupted. The challenges of Covid-19 (including unemployment) have already impacted on many people’s recovery journeys, increasing support needs.

Today’s Spending Review brings some positive news but leave a number of questions over the longer term sustainability of our treatment system.

£151m of new funding is provided for people sleeping rough or at risk of homelessness due to Covid-19, with substance misuse needs being specifically named. There are two welcome Shared Outcomes Fund pilots: £28m to explore a whole-system approach to drug enforcement and treatment, and confirmation of the previously announced £46m for local multi-agency partnerships to improve the lives of adults facing multiple disadvantage.

However, the public health grant – the main funding stream for local government commissioned treatment – sees no increase despite the manifold challenges of recent months. It is still 22% lower than 2015/16, which is deeply worrying.

Insufficient funding to deliver evidence-based interventions mean some of our most vulnerable citizens will go without life-saving help – and the public purse will accrue unneeded costs when it can least afford to.

The second part of Dame Black’s landmark report will be published in the new year and there is every indication it’ll make ambitious and far-reaching recommendations. This is welcome; but the recommendations will come to naught if two critical conditions are not met.

Firstly, assertive political leadership at national and local levels to maintain momentum and effectively coordinate an agenda which has always fallen awkwardly across multiple departments.

Secondly, an ambitious multi-year settlement in next year’s Comprehensive Spending Review to bring the recommendations to life. All in our field will read Dame Black’s review with great interest – and trust that the government responds to its scope with the seriousness it will surely merit.

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