Two recent articles (“Commissioning of addiction services by councils has failed”, Health Services Journal (HSJ), 8.6.21 and “Addiction treatment harder to get since councils took over, says Tory MP”, The Guardian, 10.6.21) have made a series of claims about the commissioning and delivery of England’s treatment and recovery services which we respond to below.
Collective Voice was established as a charity “to advance, promote and influence effective care, public involvement and support for people affected by drug and alcohol misuse”. Since 2015 we have worked – frequently in collaboration – to draw attention to the shocking human impact of significant funding cuts on the availability of treatment and recovery services. Over the last decade we have all faced profound structural and operational challenge – political responsibility splintered across a number of government departments, insufficient funding and the need to stitch together ever more complex care pathways for highly stigmatized citizens.
We know things are far from perfect. There are signs of concerning unmet need among young people using drugs. We are in the middle of an escalating drug related deaths crisis. Deaths from alcohol-specific cause have reached record highs.
In the face of rising deaths, as a sector we have rightly prioritised providing quality services and supporting people to enter treatment. Nothing should deter those we serve from getting support. They should have confidence that treatment services, regardless of who they are provided by, are well regulated and monitored and meet the very highest standards of care.
Hope on the horizon
Finally we have reason to believe the calls made by Collective Voice and many others have been heard. We very much hope that the second part of Dame Carol Black’s Independent Review of Drugs will offer a brighter future vision of accessible, evidence-based and person-centred care for all. It is surely morally incumbent on all of us to work together to make this vision a reality. As a field we must focus on the coordination of care needed to build the recovery capital of every person in our services. This will involve effective partnerships between not just treatment providers of all kinds but with primary care, pharmacies, recovery communities and the other domains of multiple disadvantage.
With significant political will already driving major investment and the possibility of systemic change we are poised to enter an exciting new chapter. At this time of opportunity, the mechanics of service commissioning must be a secondary consideration to the essential, collaborative work undertaken by charities, NHS Trusts and local government across the country. We have historically been frustrated by – and spoken out against – the politicisation of a health and social care service like drug and alcohol treatment, and do not believe it is helpful now.
The HSJ article “Commissioning of addiction services by councils has failed” lays the blame for many of the system’s ills at the door of local authorities – rather than the fiscal policies of the government in which co-author Dan Poulter MP served as a health minister, which almost halved the local government financial envelope between 2010/11 and 17/18. Given this context, accurate claims regarding the inherent ability of local government to commission services are almost impossible to make. It remains an ideal place to develop partnership with a wide range of agencies, and Collective Voice would welcome any closer involvement with health partners at a local level enabled by future NHS reform. Local government may not be perfect, but on the brink of potential major investment the needs of the people we serve will not be advanced by the unnecessary disruption of moving from local government its responsibility for commissioning community drug and alcohol support.
The HSJ article combines analysis of incomplete local authority detox figures with two much broader system-level observations on unarguably worrying trends – decreases in numbers in community treatment and increases in drug related deaths. Both of these issues are clearly complex and multi-factorial. From these arguments and observations, a concluding image of an inferior system delivered largely outside the NHS is extrapolated. We do not find the underpinning flow of logic in the article convincing.
Instructive counter-factual cases exist. When drug treatment saw record investment between 2001 and 2013 and a flourishing system commissioned through partnerships, alcohol treatment had quite a different experience as a non-prioritised NHS responsibility. Scotland does not have England’s mixed provision of clinical services but does have the highest levels of drug related deaths in Europe.
We also do not recognise the picture painted in the Guardian, which conflates the main focus of the original article (detox) with the entire treatment system. The analysis of spot and block purchasing is confused and lacking context.
All charities exist to serve the public good and are regulated by both the Charity Commission and, where appropriate, the Care Quality Commission. The voluntary sector has a proud record of delivering high quality, evidence-based drug and alcohol treatment in innovative ways, to support often highly marginalised people who have struggled to find help elsewhere. Dependency is not simply a healthcare problem and charities remain highly effective in building recovery capital by providing routes into employment and accommodation, nurturing recovery communities, developing criminal justice pathways and offering support around associated challenges such as poverty and domestic abuse.
Collective Voice will be writing to the Guardian and requesting of the Health Services Journal the chance to publish an article.