“Making it stick”: a golden opportunity for the drug and alcohol treatment and recovery system

The second part of the Black Review could be a landmark moment in our field’s history. There are some encouraging signs in the Government’s response. We must now all work together to make it stick.

In February 2019, then Home Secretary Sajid Javid appointed Dame Carol Black to conduct an independent review of drugs. One year later, in the final weeks of a pre-Covid world, its first part was published, focussing on drugs markets and the toxic combination of violence, poverty and exploitation that underpins both supply and demand.

The review’s second part, recently published and aimed squarely at treatment, recovery and prevention, sets out a compelling vision of a flourishing and interconnected system delivering life changing support to some of our most vulnerable citizens. Dame Carol pulls no punches in her call for a “radical reform” of leadership, funding and commissioning – and £1.78 billion new money over five years to boot.

Soon after, the creation of a cross-government drug policy unit was announced, housed at the Home Office. Some will find the location dispiriting, confirmation to them of an unwelcome drugs/crime policy link. Perhaps in an ideal world the more neutral space of the Cabinet Office, with its special status alongside No. 10 and the Treasury at the heart of government, would have hosted the unit.

However, there is good reason to remain relatively sanguine. The Home Office could provide a strong base for driving effective cross-government work on this tricky issue, having historically been an important supporter and protector of evidence-based drug treatment, vocal on an issue departments with more superficially obvious links have remained silent on. Furthermore, though the hosting department may grab the attention, it’ll be the partnership and governance structures, accountability mechanisms and political and bureaucratic buy-in upon which the unit will stand or fall. 

Yesterday’s initial government response marks the next stage in the process of ‘making it stick’. Its headline announcement is the development of a cross-government drug strategy to provide a policy outline for the next phase of government thinking (and, crucially, acting) to support treatment, recovery and prevention. This is a sensible move which should condense the political will behind the recent £80m funding, the Black Review and the creation of the unit into a single coherent narrative (thought it will also focus on enforcement and, in the government’s words, “so-called ‘recreational’ drug use”). As a field we must learn from the 2017 strategy, which saw too many commitments made, many of which were impossible to monitor or ascribe accountability to.

The response also includes a small number of other cost-neutral commitments. A national outcomes framework is promised, which will be used to produce an annual report to Parliament on the strategy’s progress. This adds a welcome layer of accountability and scrutiny, while a local outcomes framework and commissioning quality standard will help deliver at a local level. It is imperative that these structures and strategies are developed in partnership with the field, with service managers, commissioners and those with lived experience all sharing their wisdom with their Whitehall colleagues tasked with shaping relevant models and policies.

There is also a commitment by the Department of Health and Social Care to work with Health Education England to produce a strategy on the future need of the workforce. Detail is scant, but there is little doubt this could be a hugely important piece of work.

Finally, we welcome Dame Carol Black’s ongoing role as an independent advisor, sitting on a delivery board alongside Dr Ed Day and representatives from the six relevant government departments plus the Treasury and No. 10. A chronic lack of accountability has characterised the past decade of treatment and recovery policy. This structure could be an important measure to redress this imbalance and is to be welcomed. Dame Carol’s expertise, rigour, and – importantly – her openness and engagement with the field must be applauded. We have no doubt she will continue to be a powerful advocate for recovery and, in her words, “hold the government’s feet to the fire”.

But while the government’s initial response may have begun to assemble the scaffolding for change, the whole-system renewal Dame Carol has called for still rests on the outcome of the Spending Review. The possibility of a significant, multi-year settlement now hangs tantalisingly in the air, but must be pinned down this autumn if laudable intent is to be translated into tangible deed.

Long-term policy watchers spotting familiar ideas and structures re-emerge may feel cynical, but it seems there can be little doubt that our system could be on the brink of the most significant renewal in a generation. The timing could not be more appropriate. Next week will see the publication of the annual drug-related death statistics which are likely to add terrible news to that contained in recent analysis of alcohol related mortality during the pandemic.

The government says it is “determined to turn the tide on drug related deaths”. If funded, Dame Carol’s programme will prevent over 3,000 opiate overdoses and 2.8 million crimes, and see an extra 95,000 people entering treatment. The time for words alone is long passed, the time to act is now.

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