Our Director, Will Haydock, talks about our response to a recent Parliamentary Committee inquiry.
Collective Voice has just submitted to the Justice Committee’s inquiry on drug use in prisons. You can read our full response here, but I thought it would be helpful to summarise our thinking a bit in a blog post.
Perhaps the most revealing question in the call for evidence was ‘Overall, what progress has been made to date on implementation of the Government’s 10-year From Harm to Hope drug strategy in relation to tackling drugs in prisons?’
The answer is surely ‘not enough’. There are still too many drug-related deaths in prison and not enough people accessing support.
In some ways, the reason for this is reasonably straightforward. When the previous government published From Harm to Hope, it described it as the ‘formal, substantive response to the Independent Reviews of Drugs led by Dame Carol Black and accepts all of her key recommendations’ – but those reviews specifically excluded treatment in prisons.
Dame Carol recommended specific changes in funding and governance for community-based treatment, and the implementation of this has delivered results.
As part of the previous government’s drugs strategy, there was significant investment in substance use treatment and clearly stated ambitions (a) to increase the number of people accessing treatment in the community and (b) to improve the proportion of people with a substance use need identified in prison who go on to access support in the community on release (‘continuity of care’). Both elements had headline metrics in the drugs strategy National Outcomes Framework.
This results are clear. More people are in treatment in the community than at any point since 2009-10, and progress is being made at an impressive rate, with 2023-24 seeing the largest rise in adults in treatment since 2008-09. Similarly, the continuity of care rate has improved dramatically from 33% in 2019 to over 54% today.
By contrast, the commitments made in From Harm to Hope in relation to prison-based treatment were more limited, and as a result there has been less progress. Just two of the Government’s commitments in the strategy referred to prison: restricting supply and continuity of care.
Neither of these focus on delivering substance use treatment in prison, and where there has been progress on continuity of care this has been driven to a considerable extent by investment and oversight on the other side of the prison gates, in the community treatment and recovery system.
While there has been a steady increase in the number of people accessing support in prison in the last three years, numbers remain well below pre-COVID figures. The prison data series starts in 2015-16, and the 2023-24 figures were down 17% from that high starting point. In the community, the comparison is an 8% increase.
There are well-known issues with the supply and use of new synthetic drugs in prisons, and there’s a feeling that current models and resources for treatment aren’t enough to engage the full range of people who might benefit from support.
Again, this directly contrasts with community settings. There, it’s people using alcohol or drugs other than opiates who have seen the biggest increases in engagement in treatment in the community, demonstrating that where there is investment and focus, services can provide an attractive offer for a wide range of people who need support.
In 2021, Dame Carol wrote that provision for substance use treatment and recovery in the community ‘urgently needs repair’. The same description could perhaps be applied to the prison setting today.
The Government already has a diagnosis of the problem from an unpublished report Dame Carol has conducted looking at treatment in prisons, and we also have the evidence of what has worked to turn around a similar situation in the community.
We therefore recommended to the committee that there should be new, dedicated investment for substance use treatment in prison, and a clear strategic focus on this issue from all relevant departments and agencies.
The current arrangement of sub-contracting substance use treatment and recovery services as just one element of a general healthcare contract should also be changed. This narrowly positions substance use treatment as a healthcare service under the remit of the NHS, which is at odds with both the type of work being done and the outcomes it delivers.
Substance use issues are shaped by wider factors including prior trauma, mental health, and social and economic issues such as employment and housing, and effective treatment must therefore take a similarly broad approach, using psychosocial interventions and linking to broader work and meaningful activity. This is particularly important in prison, where mental health issues are much more common than amongst the general population.
Treatment and recovery services also deliver outcomes that stretch beyond health, reducing reoffending and reducing the illicit market for drugs in prisons.
The risk in the current arrangement is that healthcare commissioners and providers, with many other areas of concern, may not give substance use issues the specific attention and resource they need, and they are unlikely to prioritise the wider outcomes that could be delivered. (The relevant outcomes aren’t included as key performance indicators in the national framework, for example.)
Conversely, prison staff and senior management – for whom those outcomes are potentially invaluable – are not directly involved in service design and contract management, so are less involved in driving these key outcomes and making essential links to wider supportive work.
Partnership structures in the community – including links into prison – have been central to driving improvements in outcomes, mirroring joined-up leadership within central Government. Comparable structures and processes involving all the relevant partners are not in place locally to oversee and drive improvement in prison treatment.
We therefore recommended that substance use treatment in prison is directly commissioned as a dedicated service, and overseen by a partnership of stakeholders with a specific focus on wellbeing and social functioning including reducing reoffending.
If we are to deliver real change in prison-based treatment, we need to look beyond From Harm to Hope, which was fundamentally limited in scope.
Dame Carol’s more recent internal review of prison drug treatment could be the basis for a cross-government approach to improving support in prison for people who use alcohol and other drugs. We look forward to working with the Government and the full range of stakeholders to ensure that people can access the support they need.
Collective Voice responds to Justice Committee inquiry into drugs in prisons
Our Director, Will Haydock, talks about our response to a recent Parliamentary Committee inquiry.
Collective Voice has just submitted to the Justice Committee’s inquiry on drug use in prisons. You can read our full response here, but I thought it would be helpful to summarise our thinking a bit in a blog post.
Perhaps the most revealing question in the call for evidence was ‘Overall, what progress has been made to date on implementation of the Government’s 10-year From Harm to Hope drug strategy in relation to tackling drugs in prisons?’
The answer is surely ‘not enough’. There are still too many drug-related deaths in prison and not enough people accessing support.
In some ways, the reason for this is reasonably straightforward. When the previous government published From Harm to Hope, it described it as the ‘formal, substantive response to the Independent Reviews of Drugs led by Dame Carol Black and accepts all of her key recommendations’ – but those reviews specifically excluded treatment in prisons.
Dame Carol recommended specific changes in funding and governance for community-based treatment, and the implementation of this has delivered results.
As part of the previous government’s drugs strategy, there was significant investment in substance use treatment and clearly stated ambitions (a) to increase the number of people accessing treatment in the community and (b) to improve the proportion of people with a substance use need identified in prison who go on to access support in the community on release (‘continuity of care’). Both elements had headline metrics in the drugs strategy National Outcomes Framework.
This results are clear. More people are in treatment in the community than at any point since 2009-10, and progress is being made at an impressive rate, with 2023-24 seeing the largest rise in adults in treatment since 2008-09. Similarly, the continuity of care rate has improved dramatically from 33% in 2019 to over 54% today.
By contrast, the commitments made in From Harm to Hope in relation to prison-based treatment were more limited, and as a result there has been less progress. Just two of the Government’s commitments in the strategy referred to prison: restricting supply and continuity of care.
Neither of these focus on delivering substance use treatment in prison, and where there has been progress on continuity of care this has been driven to a considerable extent by investment and oversight on the other side of the prison gates, in the community treatment and recovery system.
While there has been a steady increase in the number of people accessing support in prison in the last three years, numbers remain well below pre-COVID figures. The prison data series starts in 2015-16, and the 2023-24 figures were down 17% from that high starting point. In the community, the comparison is an 8% increase.
There are well-known issues with the supply and use of new synthetic drugs in prisons, and there’s a feeling that current models and resources for treatment aren’t enough to engage the full range of people who might benefit from support.
Again, this directly contrasts with community settings. There, it’s people using alcohol or drugs other than opiates who have seen the biggest increases in engagement in treatment in the community, demonstrating that where there is investment and focus, services can provide an attractive offer for a wide range of people who need support.
In 2021, Dame Carol wrote that provision for substance use treatment and recovery in the community ‘urgently needs repair’. The same description could perhaps be applied to the prison setting today.
The Government already has a diagnosis of the problem from an unpublished report Dame Carol has conducted looking at treatment in prisons, and we also have the evidence of what has worked to turn around a similar situation in the community.
We therefore recommended to the committee that there should be new, dedicated investment for substance use treatment in prison, and a clear strategic focus on this issue from all relevant departments and agencies.
The current arrangement of sub-contracting substance use treatment and recovery services as just one element of a general healthcare contract should also be changed. This narrowly positions substance use treatment as a healthcare service under the remit of the NHS, which is at odds with both the type of work being done and the outcomes it delivers.
Substance use issues are shaped by wider factors including prior trauma, mental health, and social and economic issues such as employment and housing, and effective treatment must therefore take a similarly broad approach, using psychosocial interventions and linking to broader work and meaningful activity. This is particularly important in prison, where mental health issues are much more common than amongst the general population.
Treatment and recovery services also deliver outcomes that stretch beyond health, reducing reoffending and reducing the illicit market for drugs in prisons.
The risk in the current arrangement is that healthcare commissioners and providers, with many other areas of concern, may not give substance use issues the specific attention and resource they need, and they are unlikely to prioritise the wider outcomes that could be delivered. (The relevant outcomes aren’t included as key performance indicators in the national framework, for example.)
Conversely, prison staff and senior management – for whom those outcomes are potentially invaluable – are not directly involved in service design and contract management, so are less involved in driving these key outcomes and making essential links to wider supportive work.
Partnership structures in the community – including links into prison – have been central to driving improvements in outcomes, mirroring joined-up leadership within central Government. Comparable structures and processes involving all the relevant partners are not in place locally to oversee and drive improvement in prison treatment.
We therefore recommended that substance use treatment in prison is directly commissioned as a dedicated service, and overseen by a partnership of stakeholders with a specific focus on wellbeing and social functioning including reducing reoffending.
If we are to deliver real change in prison-based treatment, we need to look beyond From Harm to Hope, which was fundamentally limited in scope.
Dame Carol’s more recent internal review of prison drug treatment could be the basis for a cross-government approach to improving support in prison for people who use alcohol and other drugs. We look forward to working with the Government and the full range of stakeholders to ensure that people can access the support they need.
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