How government policy in 2020 can nurture recovery, reduce inequalities and save lives

A new strategic vision

The recent Conservative manifesto was light on detail around drug and alcohol treatment, however a subsequent addition was published laying out plans to tackle addiction. This includes two crucial pledges: to introduce a combined addictions strategy and a ‘dedicated monitoring unit at the heart of government’.

We saw at our roadshow events in Halifax and Nottingham how in an era of localism some areas have flourished even in the face of substantial cuts, effectively harnessing the best of both the state-sponsored array of treatment interventions and organic community-driven recovery responses. What, though, of the areas which lack the local passion, expertise, leadership and material resource needed to make this happen?

The issue of resource remains. This month some Collective Voice members have been hit with another round of cuts after absorbing substantial reductions last year. Some areas have lost over 50% of their funding in recent years; a savage reduction in anyone’s eyes.

Previous attempts to deliver treatment and recovery services have hit a ceiling due to siloed approaches. The recent document celebrating ten years (pdf) of the Making Every Adult Matter Coalition puts it best:

‘Criminal justice, substance misuse, homelessness and mental health are terms used to organise public services. These silos do not reflect the human experience of people facing these problems and they cannot, on their own, foster the solutions that help individuals transform their lives.’

Our policy and research discourses are catching up with what those touched by addiction have always known; that only a connected response can work for a problem like addiction which does not reside in any one department of human life but sprawls across them all. Work to support a citizen’s drug problem is almost useless if they have no home, fragile mental health or paralysing trauma.

Whilst it’s welcome to see the issue of problem gambling being pulled into the political mainstream, it’s perplexing to see almost no mention of alcohol in the plans at a time of quiet crisis in alcohol treatment. There is a clear correlation between disinvestment and the diminishing numbers of people getting help; over 16,000 fewer alcohol users were supported this year compared to 2013/14. 82% of people who need specialist help are not getting it, meaning we are supporting less than one in five people whose lives could be turned around with the right help.

The public health emergency posed by an unprecedented rise in drug related deaths shows something isn’t working. There is still substantial stigma in this country against people who use drugs and alcohol, which leaves them politically vulnerable in an age of austerity. Given the increase in deaths and the reductions in funding we must seize every opportunity to bring political attention to this pressing issue. Collective Voice therefore welcomes the prospect of a new strategy, believing:

  1. It should address the public health emergency of drug related deaths by outlining a clear plan to enable local authorities to fund and deliver effective, evidence-based and person-centred support
  2. The government’s response to alcohol must be brought ‘up to speed’, with the strategy outlining how a greater number of alcohol users can be reached
  3. Considering addiction with reference to other domains of multiple disadvantage will enable the strategy to catalyse change in allied areas
  4. The 2017 Drug Strategy made welcome recognition of the fact that addiction (and related domains of multiple disadvantage) is both cause and consequence of poverty and trauma – this bi-directional link should be preserved
  5. The strategy should be driven by an effective inter-departmental approach uniting the Cabinet Office; the Department of Health and Social Care; the Home Office; Ministry of Justice; Department for Education; and Ministry of Housing, Communities and Local Government behind a shared vision
  6. The linking of different forms of addictions must be used as a chance to combat the stigma around drug use

Increasing central control

The central experience of drug and alcohol treatment and recovery services over the past decade has been shaped by two seismic shifts: austerity and localism. Austerity has seen more than a quarter of our funding lost and localism has meant the loss has not been evenly distributed.

It would be wrong to directly link all our challenges with the move of drugs and alcohol to local authority control. However there is an issue over priority. Funding evidence-based and life-saving drug and alcohol services will never be the first thing on the list for local politicians dealing with impossible funding pressures. As a deputy council leader is quoted in a recent report ‘I’ve never had a voter come up to me and say we should spend more money on drug treatment services’.

However a successful central unit will require a careful balancing between the local and the national – and real political power. Its form should be dictated by its function, and its function should be derived from the strategy. So without the strategy it’s hard to trace an outline of the unit in detail but at a minimum:

  1. The monitoring unit should have sufficient powers to encourage local areas into action where appropriate, reducing the local variation in support
  2. The unit must work effectively with Public Health England, with clearly delineated roles and responsibilities
  3. The role of the Cabinet Office must be clarified, with lines of policy ownership made clear between it, the Home Office and the Department of Health and Social Care
  4. Funding must be made available to support the development of the unit to the size it needs to effect real change

Resourcing the work

The proposed removal of the ring-fence around vital public health funds has been postponed by at least a year and will not now happen until 1 April 2021 at the earliest. This is good news, although of course not in itself sufficient to guarantee a high quality treatment system in England.

The government has signalled that public spending will be increase. This is very welcome and could enable the support of a greater number of people. There are over 314,000 people in England who use heroin or crack problematically; and 586,000 with an alcohol problem. Many aren’t currently receiving help. Over half the people starting treatment in 2018/19 were parents. More support means an increase in family stability, fewer children taken into care, fewer blue light call outs, fewer emergency admissions to hospital and fewer people travelling through the criminal justice system.

The Prime Minister has spoken extensively about his commitment to the areas represented by new Conservative MPs. These areas – many of which are ex-industrial – have experienced high levels of drug related deaths and multiple disadvantage. If the government is serious about this commitment then an investment in the health and happiness of our most vulnerable citizens as well as technological or transport infrastructure spending is surely necessary. Therefore we recommend:

  1. The ring-fence around the public health grant is maintained for good
  2. A programme of work is funded in our poorest areas for people experiencing multiple disadvantage which supports their recovery whilst also addressing housing, criminal justice and mental health needs

Helping people will save money across multiple budgets from social care, criminal justice and health. But most importantly let us not forget: every one of these statistics is a human beings with the potential to recover, rediscover meaning and become a healthier and happier citizen.

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