Collective Voice responds to the 10-year health plan

Positive principles, but health is about more than the NHS: Collective Voice offers a cautious welcome to the Government’s 10-year health plan

 Collective Voice welcomes the ideas and principles outlined in the Government’s 10-year health plan but suggests there is still too great a focus on the NHS itself, when charities and other community organisations often can – and already do – deliver impact more effectively, efficiently and equitably.

We call on the Government to clarify the role of charities in delivering this plan, specifically in relation to supporting people facing issues with alcohol and other drugs.  This must include ringfenced funding with a clear, long-term commitment to substance use treatment alongside a specific alcohol strategy, with dedicated funding, clear priorities, outcome metrics and cross-departmental governance.

Executive Director Will Haydock released the following statement:

To substantially improve lives and ease the pressure on the health system and other public services, we must address harm related to use of alcohol and other drugs.[i]

Fortunately, we know what to do.  The evidence is clear that substance use treatment helps people turn their lives around and delivers a good return on investment for public services and communities.[ii]

Charities are at the heart of this work employing over 80% of today’s treatment provider workforce.[iii]  Our sponsor organisations together help over 200,000 people every year by prescribing medication, delivering psychological interventions, and offering peer-led and wider recovery support, including services for young people and families.  This is an essential part of our health and care system.

Unfortunately, there is no mention of this kind of support in the Government’s plan.  Charities are barely mentioned, and drugs and addiction are effectively absent.  The only real reference to alcohol is a commitment to improve labelling which, while necessary, will do little to narrow health inequalities and support the most vulnerable.

This is a mistake.  Charities are uniquely placed to deliver services for some of the most vulnerable people in our society, offering flexibility and innovation, working across professional and organisational boundaries to respond to multiple complex needs and system-wide challenges.

Let charities help

The value of a 10-year plan is to set a vision – to have clarity of objectives and a map of how we’re going to get there.  But substance use treatment services are still operating with no clarity on policy or funding plans from this Government.  Without that clarity, it’s hard to develop and sustain the partnerships and innovation that the 10-year plan envisages, and we end up losing valuable staff who want greater clarity and security.

We call on the Government to clarify the role of charities and substance use treatment specifically in delivering the ambitions of their plan. This must include ringfenced funding for substance use treatment, with a clear, long-term commitment to this work and a specific alcohol strategy, with dedicated funding, clear priorities, outcome metrics and cross-departmental governance.

When charities are trusted to deliver, the evidence shows we are successful.  We have already delivered dramatic progress in response to Dame Carol Black’s 2021 review of drug treatment.  Over 327,000 people have been engaged in treatment for their issues with alcohol or other drugs in the last 12 months, meaning more people are in treatment in the community than at any point since 2009-10.^[iv]  Moreover, progress is being made at an impressive rate, with 2023-24 seeing the largest rise in adults in treatment since 2008-09.^[v]

The Government must maintain their support for this work, and can learn from this example and apply it to other elements of health and social care.

We look forward to working closely with the Government to implement what are admirable ideas and principles.  These will be hard to achieve without the full engagement of charities, but we are ready and willing to help.

Will added the following comments on specific elements of the plan:

From hospital to community

The Government’s emphasis on community-based support is welcome.  However, where the plan talks about a ‘Neighbourhood Health Service’ to be provided through ‘a devolved and diverse NHS’, we should really be thinking ‘a devolved and diverse health system’  that goes far beyond the NHS itself, given that it’s so often charities and community groups that will be best placed to reach all parts of communities and deliver real impact.

From analogue to digital

Charities are at the forefront of taking a digital approach and supporting people in a range of ways, from online chat and virtual consultations and support to the development of an AI bot to help equip people who use drugs with knowledge to make decisions around their use.^[vi]

However, the Government and NHS must do more to enable digital tools and innovation in our field.  While AI and new technology can be eye-catching, we must make the most of 20^th-century technology that is already available.  Substance use treatment services are still required to write most prescriptions on paper, which creates unnecessary work for valuable staff, and is a less convenient – and less safe – process for clients.  We need the Department of Health and Social Care to provide leadership on this and prioritise implementing simple changes that could save huge amounts and make thousands of people safer.

From sickness to prevention

We welcome a focus on prevention.  If we can stop people developing serious issues with alcohol or other drugs, this saves everyone heartbreak, as well as benefiting the public purse.  But there must be a nuanced approach to prevention, which doesn’t always have to mean big, population-wide interventions.  In fact, targeting interventions and campaigns is crucial to address health inequalities, and that can include specialist support.

Notes:

[i] In 2023-2024 alone, there were 280,747 estimated admissions where the main reason for admission to hospital was attributable to alcohol. That figure rises to 1,018,986 if we add in secondary diagnoses related to alcohol.  Shockingly, there were 3,618 deaths related to drug poisoning registered across England and Wales in 2022. Data taken from  https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data and https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2023registrations

[ii] The official estimates in 2018 suggested that substance use treatment provided £2.4bn benefits, with £4 return on every £1 invested in drug treatment totalling £21 over 10 years, and £3 return on alcohol treatment totalling £26 over 10 years. See https://www.gov.uk/government/publications/alcohol-and-drug-prevention-treatment-and-recovery-why-invest/alcohol-and-drug-prevention-treatment-and-recovery-why-invest

[iii] See https://www.hee.nhs.uk/our-work/mental-health/drug-alcohol-treatment-recovery-workforce-programme/workforce-census

[iv] See https://www.ndtms.net/ViewIt/Adult

[v] See https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024/adult-substance-misuse-treatment-statistics-2023-to-2024-report#:~:text=Trends%20in%20treatment%20numbers&text=The%20number%20of%20adults%20entering,up%20to%202021%20to%202022.

[vi] A wide range of Collective Voice members use online chat to offer support to clients.  See, for example, https://www.wearewithyou.org.uk/find-support/talk-to-a-trained-recovery-worker; https://www.changegrowlive.org/webchat; https://www.forwardtrust.org.uk/find-support/reach-out-online-chat/.  Cranstoun have recently launched an AI tool DrugBot: https://cranstoun.org/news/ai-meets-harm-reduction-drugbot-launches-across-the-uk/