Joint work between Collective Voice, the NHS and PHE to improve clinical responses to drug-related deaths

Collective Voice believes that the most significant challenge facing the drug treatment and recovery system today is responding to the health needs of an ageing and increasingly vulnerable population. Moreover, that response must be formed in the context of declining resources and a fragmented delivery landscape.

The increasing fragility of the ageing cohort of heroin users who began their drug use up to 30 years ago has been highlighted by the Office of National Statistics (ONS) and Public Health England (PHE) as the main driver of the recent dramatic rise in drug-related deaths. These deaths, troubling though they are, represent only a fraction of the deaths among service users that Collective Voice members and colleagues in the NHS are witnessing. Given that being in treatment is demonstrated by the evidence to be a protective factor, the rise in deaths among the 40% of heroin users outside the treatment system is likely to be even higher.

As providers of drug treatment services, we have a moral duty to examine and recast our own practice to minimise early deaths. As a campaigning body we have a duty to use our influence to reshape how services are commissioned, resourced and delivered to maximise our positive impact on outcomes.

Collective Voice has therefore come together with NHS providers and PHE to identify a shared agenda that can help minimise deaths. Two broad strands of activity will be undertaken focusing on improving internal clinical practice, and campaigning with others to improve the external environment.

With support from PHE, Collective Voice and NHS drug and alcohol providers will produce a shared Statement of Practice Principles which will:

• Develop and share management information systems able to routinely identify those most at risk of overdose and target resources accordingly.
• Publish a guide to interventions which draws on each organisation’s clinical expertise and experience to delineate practice which minimises risk of overdose. Including access to naloxone.
• Reframe clinical practice with all service users to prioritise their physical and mental health needs, and identify how these will be met.
• Align these interventions with the newly emerging Clinical Guidelines to ensure that good practice to promote recovery does not put patients at risk. Equally we will ensure that concern about drug-related deaths does not create a risk averse clinical culture in which service users’ legitimate ambitions for recovery are thwarted.
• Identify opportunities to target and engage dependent users who are currently outside the treatment system.

Vital though it is to ensure that the practice of drug and alcohol providers is the best it can be, deaths will almost certainly continue to rise unless the NHS significantly improves its response to this population.

Collective Voice will therefore seek to work with allies to influence the wider system in the following ways:

• The current system is fragmented and inefficient. It locates responsibility for commissioning drug and alcohol treatment in the community with Local Authorities, while service users’ physical and mental health needs are met by CCGs, and prison services are separately commissioned by NHS England. The current system needs to be replaced with an integrated system able to ensure continuity of care between prison and community and respond in a timely fashion to the physical and mental health care needs of a challenging population all too often marginalised and underserved by a resistant NHS.
• Challenge disinvestment by Local Authorities, which risks undermining the system’s capacity to deliver the aspirations of the government’s drug strategy and places unsustainable additional burdens on the NHS.
• Promote greater transparency and accountability to ensure central government is sighted on the consequences for national policy of local decisions.

Work to progress the Statement of Practice Principles will run during the first half of 2017, with publication planned for the summer.  Seeking strategic change towards a better integrated system will be a priority for Collective Voice throughout 2017/18.