Initial reflections on the Darzi Report

Blog by our Executive Director, Will Haydock:

Big set piece reports often capture the headlines for a day or two, then fade from view when the next story comes along.  But a report like Lord Darzi’s from last week deserves more attention and influence.

So over the past few days I’ve been thinking about what this report might mean for the treatment and recovery sector. 

Although it paints a somewhat gloomy picture of the situation in the health service, the Darzi report is welcome for the diagnosis of the challenges we face right across health and social care.

The report talks about the pressure created by austerity, the increasing toll of inequalities in the social determinants of health, the surge in multiple long-term conditions, a lack of capital investment, and the importance of ‘the patient voice’ and staff engagement.

These are all issues that have specific resonance in the treatment and recovery sector, and which Collective Voice has raised and worked to address.

We welcome acknowledgement of the importance of the social determinants of health. The report highlights poor quality housing, low income and insecure employment.  We know that these are specific factors that exacerbate harms related to substance use and act as barriers to people in achieving recovery.  This is why working in partnership, both at a national and local level, is crucial to ensure people receive effective support.  The Government should continue to support structures like Combating Drugs Partnerships, and think about budgets and impact monitoring across departments and organisations.  (We talk about this more in our submission to the Treasury consultation on the budget and spending review.)

The report notes the pressures that multiple long-term conditions and specifically mental health needs place on the population’s health and the health service.  We know that co-occurring mental health and substance use has been a longstanding challenge in service delivery.

Government has published guidance on this issue, but it is now seven years old, and there has been little improvement.  We still find that mental health services are not accessible – and sometimes simply do not accept – people who are using substances, which leaves people with inadequate support, and charities and community organisations like ours picking up the pieces.

It also isn’t efficient for the NHS itself.

The government therefore needs to provide leadership and ensure that mental health services are well-funded, accessible and coordinated.

But the solution isn’t just to ask central Government to do more.  We want to be part of the solution.  Our services can help the NHS find its way out of the ‘serious trouble’ it finds itself in.  As the report states, ‘Too many people end up in hospital, because too little is spent in the community.’

Keir Starmer has talked about a preventive approach to healthcare, and that’s exactly what our services offer.  We work with young people and those who are concerned with their substance use escalating, but even where this has developed into dependency, treatment can prevent more serious health and social problems developing.  In fact, we know that people in recovery tend to contribute more to their community than the average member of the public, so these services aren’t simply preventative; you could say they’re progressive – for individuals, families and communities, as people in recovery become ‘better than well’.

The impact of this is seen in practical terms on emergency department attendances, ambulance call-outs and GP appointments.  If people can access the treatment and support they need, it can be transformative.

The report refers to ‘multidisciplinary models of care that bring together primary, community and mental health services’.  Substance misuse services have this approach at their heart – and this has been praised by independent inspections and oversight.

We have also been at the forefront of the use of technology.  With one of the best datasets available across health and social care, and the transformation of services to be available online – accelerated by COVID – we can fairly say we are making good progress in improving the accessibility of our services.

And we are committed to do more on data and technology.  The report talks about using AI to transform care and treatment, and there are certainly opportunities we have been exploring to better monitor risk factors and target support when it is most needed.

But to do this effectively needs support from government in joining up analysis and sharing information so we can more easily provide the joined-up care that is so essential for people with substance use issues.

And at a more fundamental level, talk of AI can seem far off when our prescriptions still have to be written on paper, unlike other areas of healthcare.  Making technology work to improve patient care – and safety – needs government leadership on some of these basic structures and regulations.

This specific challenge with prescriptions is made more acute by the challenges faced by community pharmacies, clearly noted in Lord Darzi’s report.  Pharmacies are currently an integral part of the treatment and recovery system, and the Government must ensure there is consistent, accessible and sustainable coverage across the country.

The report talks about the ‘patient voice’, and this is an area where the treatment and recovery sector has a strong history, with ‘service user involvement’ through forums and commissioning long established, and a growing ecosystem of lived experience recovery organisations.

Nevertheless, this is an area where provider organisations can do more to support people who use drugs and those who use their services.  Collective Voice are keen to work with the College of Lived Experience Recovery Organisations (CLERO) and other groups to support and collaborate with this aspect of the sector.

This focus on people who could actually benefit from support is crucial to remind us to think about the whole context of a person’s life.  We therefore need to ensure that we avoid a narrow focus on health services, and consider the wider determinants of health.  As the Darzi report notes, ‘Being in work is good for wellbeing’ and ‘Having more people in work grows the economy and creates more tax receipts to fund public services.’

That’s why our services have embraced the Individual Placement and Support scheme supported by DWP and DHSC.  An independent evaluation fund that people receiving this support were ‘overwhelmingly positive’ about the programme, but recommended that government should ensure there are ‘adequate resources’ for this.

This resource question runs through the heart of Lord Darzi’s review.  He notes the damage that austerity did to the health service – and we know this hit local authorities and public health budgets even harder; the report itself cites the Health Foundation’s analysis that showed the public health grant was cut by more than a quarter between 2015-16 and this year.

The Darzi report specifically highlights the challenge that lack of capital investment poses.  This is a particular issue in our sector, where specialist services like residential rehabilitation and inpatient detoxification tend to be commissioned on a ‘spot purchasing’ basis.  This can mean that there isn’t the necessary planning and thought about long-term investment in what are specialist facilities – and an essential part of the wider system to support people with issues around alcohol or other drugs.

We recently submitted a response to the HM Treasury consultation on the autumn budget and the forthcoming spending review.  In this, we made five recommendations for future funding for the treatment and recovery sector:

1. Spending plans should make and communicate a long-term commitment to providing treatment for substance use issues in the UK
2. Monitoring of funding and outcomes must be proportionate and appropriate
3. The Government should monitor budgets and impact across departmental boundaries, and support joined-up policymaking and service delivery across departments and organisations at a national and local level
4. Funding mechanisms should support the full range of evidence-based interventions to treat people with substance use issues
5. Funding models and oversight should support innovation in the treatment and recovery sector

But funding is just one part of the picture, and we look forward to seeing the Government’s response to Lord Darzi’s report, and working with our NHS colleagues and wider partners to support and improve the health and wellbeing of people who use substances, their families and communities.

I look forward to continuing these conversations with colleagues as we head to the Labour Party Conference at the end of the week.

After this clear diagnosis of the problem by Lord Darzi, let’s all get to work on the solution.