Collective Voice has responded to a call for evidence by the Health Select Committee, which is starting an inquiry into the way that public health functions are being delivered after the 2013 reforms which transferred responsibility for commissioning services from the NHS to local authorities.
Our submission starts by providing some context for the committee. We point out that:
- Illegal drug use has been falling, but it remains a significant public health issue with official government estimates suggesting a million people are dependent on illegal drugs, of which almost a third are dependent on heroin and/or crack.
- The rate at which people are dying of drug related deaths has been rising and is now at the highest levels recorded.
- The UK remains the largest market for heroin in Europe.
- There are an estimated 1.6 million adults dependent on alcohol, of which only 6% access treatment.
- Hospital admissions caused by alcohol use run at over 1 million a year, and that problem drinkers visit their GP twice as often as other patients.
- There are significant numbers of people in the treatment system with other complex problems, including homelessness, mental ill-health, and contact with the criminal justice system.
Collective Voice members experience is that the potential for greater integration of services that these reforms promised has yet to be delivered. Where integration has been taking place it has largely been to integrate drug and alcohol services rather than to ensure that the wider needs of people who are being treated have all of their needs met. We raise particular concerns about the integration with mental health services, echoed by Professor Liz Hughes, in today’s Guardian.
Our submission notes the negative consequences of the increased level of re-commissioning that has taken place since 2013 often in our experience linked to reductions in contract value, despite central government trying to incentivise drug treatment outcomes during the same period. We note that the assessment made by the ACMD that currently treatment for heroin users is under threat.
We argue that drug and alcohol treatment has a strong evidence base that it is cost effective, but that the current financial climate means that the promise of the 2013 reforms are unlikely to be met.
In our view the consequence of the decisions to reduce public health funding will feed through into additional costs falling on other aspects of NHS care, the police and our overcrowded prisons. However the real costs will fall on increasingly vulnerable service users, and the poor communities in which they are concentrated.