We welcome the enthusiasm and rigour Dame Black has brought as the Independent Reviewer, and her whole-person approach to treatment and recovery, acknowledging mental health support, housing and routes into employment as vital elements of an effective system, alongside the core of evidence-based pharmacological and psycho-social interventions.
The second part of the Black review is truly a once in a generation opportunity to reform and renew a once world-class system impoverished by a decade of austerity and fragmented by localism. Despite heroic efforts from health and social care services Covid-19 has degraded support for some of the most vulnerable, leaving those with drug and alcohol problems in desperate need of our help. In the face of these impacts and an escalating drug-related death crisis (including worrying spikes during the pandemic) the case for change – and for investment – could not be clearer.
Our workforce is talented and passionate, adept at working with people who feel that the system has forgotten them, that society places little value on their health or happiness. There is a lot of good still to be celebrated; but given the scale of the challenge Collective Voice believes the Review must be published as soon as possible, and that as a field we must be open, honest and willing to change in responding to its recommendations.
We call on Government to prioritise publishing the Independent Review at this critical juncture – and responding to its recommendations when it is published.
What else needs to happen
While the Review will certainly bring fresh direction and impetus, we must recognise that it will not be published in a vacuum. So, while its likely ambitions are to be commended, there are a number of necessary conditions which must be met if those ambitions are not to fail.
- Clear, strengthened leadership across all relevant central government departments befitting the urgency posed by the drug-related deaths crisis, major reforms, and public health emergency to respond to the Review and respond to its recommendations.
- Clarification on the destination of the recovery and treatment policy and leadership function. The location will have a real impact on treatment and therefore the health and happiness of hundreds of thousands of people. The abolition of Public Health England has not come at a good time. And while the establishment of a National Institute of Health Protection is welcome, it is essential the health improvement functions are similarly safeguarded.
- A partnership-based approach between government and the wider field so we can work together to shape a system that delivers to its full potential for the people it serves. Our field contains many thousands of people – from the voluntary sector, the NHS, commissioning backgrounds and in recovery – who can bring decades of relevant expertise to bear. Some have been working on these sticky issues for many years and have seen policy reforms come and go. We have an admirable formal evidence base on the specific treatment intervention; let’s ensure that the accompanying human and corporate knowledge is also put to work by bringing some of those expert voices to support officials designing the new system.
If met, these conditions will provide an effective platform for the implementation of the Review itself, helping to create the necessary political momentum.
Now looking to the Review itself we believe it should:
- Adopt a person-centred understanding of drug dependency built on a broader conception of what constitutes ‘success’, acknowledging the importance of connection and community, and making recommendations on support across employment, mental health, criminal justice and rough sleeping in addition to treatment and recovery.
- Recommend a strengthened policy coordination function at the centre of government, overseeing outcome specification, data capture, and an accountability framework. Whatever form it takes, the locus of coordination should have the necessary levers to intervene in under-performing local areas, and clear balance of interests between stakeholder departments.
- Recommend a major uplift in funding through a ring-fenced settlement to support drug treatment as part of the 2021 Comprehensive Spending Review. We also endorse the Health Foundation’s call for the restoration of the Public Health Grant to 2015 levels as the bare minimum, and maintenance of the grant’s ring-fence.
- Keep commissioning responsibility chiefly at the local government level, but with the added weight of the strengthened centre described above. Better local co-commissioning between substance use and allied areas should be required, driven through effective, high-level strategic local partnerships between Health, the office of the Police and Crime Commissioner, Probation Services and Job Centre Plus.
- Fully address the importance of Tier 4 (in-patient detox and residential rehabilitation) provision, suggesting a specialist central commissioning function, in the manner of Health and Justice services. Tier 4 interventions are underpinned by a strong evidence base for long term recovery and should be an essential part of a healthy system supporting people with addiction, complex health and social support needs. Reductions in budgets have left them uniquely vulnerable due to the spot-purchasing type funding frameworks, eroding pathways from community treatment.
- Offer a compelling vision of how the field can work together to nurture the skills and development of the workforce, to enable it to support the most people in the most effective ways. Many charities have developed extensive in-house training and development programmes and would welcome the chance to work together as a field on a universal set of approaches and standardised training for drug and alcohol practitioners, including as part of the national apprenticeship scheme.
- Address the declines in referral treatment pathways from prison to the community, as well as the decline in community sentences and drug rehabilitation requirements identified in part one of the Review.
It is also essential that the recommendations of the Black Review support and align with the development of the Addictions Strategy later this year.
The likely scope and ambition of the Independent Review is to be applauded. The immediate risk is that some of its recommendations are overlooked at a time of unprecedented challenge and political chaos. Autumn’s Comprehensive Spending Review feels a long way off in a year likely to be dominated by the ongoing Covid-19 rebuild efforts, focus on the economy and the impacts of Brexit.
Collective Voice believes that as a field we must do all we can to keep the flame of the Review burning bright throughout 2021, making the case to political decision-makers for a full response to its recommendations. We stand ready to work with officials, commissioners, providers and those with lived experience to shape a re-invigorated system which can live up to the ambitions of those recommendations.