On 8 February 2019 Professor Dame Carol Black was appointed to lead a major two-part review of drugs policy for the UK Government. The long-awaited final report paints a stark picture of addiction policy, research and treatment in the UK today, and makes a large number of recommendations to turn the situation around.
This report is important; really important. If you work in addiction policy, research or treatment, you need to read this report because there is a good chance that something in the recommendations stands to change your working life. At the centre of this, is the recommendation for increased funding and the creation of a governmental Drugs Unit.
The funding goes up to an extra £552 million (in addition to the £680 million currently spent every year) from the Department of Health and Social Care by year five as well as an extra £15 million from the Department of Work and Pensions for employment support. The Drugs Unit would “coordinate and monitor” cross-departmental work from departments such as the Department of Health and Social Care, the Department for Housing, Communities and Local Government, the Department for Work and Pensions, the Home Office and the Ministry of Justice.
The report also recommends establishing a ‘Centre for Addictions’ to oversee workforce development, a ‘Commissioning Quality Standard’ and a ‘National Outcomes Framework’. These and other structures are, according to the report, needed to address drugs and drug use in England. These centres, frameworks, standards and units have the potential to bring about substantial changes in addiction policy, treatment and research. Did we mention that this report was important?
“In listing everything that needs to be established, rebuilt or trained the size of the task ahead becomes apparent. There is a lot to do.”
Part 1
But first, this latest publication is part 2. Part 1 was published in September 2020 and did not make any recommendations. Its remit was to outline the current situation, and in doing so made for a fairly bleak read. It described underfunded treatment services, increased drug use, and increased harms from drug use. Many of the problems it outlined were the result (according to the report) of reduced funding and local commissioning practices since 2012. As a result of that first report, the government pledged to invest £5 million of additional funding to address county lines drug dealing.
Part 2
So, part 2 was to be full of recommendations, in contrast to part 1 that outlined the current situation. What’s surprising is that this second part seems to be more damming of that situation that part 1 ever was. In the introduction Dame Carol Black summarises this:
“The findings have been disturbing, even shocking. Funding cuts have left treatment and recovery services on their knees. Commissioning has been fragmented, with little accountability for outcomes. And partnerships between local authorities, health, housing, employment support and criminal justice agencies have deteriorated. The workforce is depleted, especially of professionally qualified people, and demoralised. Vital services have been cut back, particularly inpatient detoxification, residential rehabilitation, specialist services for young people, and treatment for cannabis and stimulant users.”
The report is direct throughout “Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences.”. The report repeatedly talks of rebuilding, acknowledging that many services once were, and have been dismantled in the past decade. It talks of “major shortcomings” in probation services. On the situation with the “demoralised” workforce, the report comments that “Leaving peer mentors to do the work of professionals without training or pay is exploitative”. Many of these issues will come as little surprise to people working in the sector; it is, however, encouraging to see them collected and recognised in a report of this importance.
An urgent need for investment and change comes through every paragraph of the report. It feels, at times, shocking the amount of work that needs to be done in order to develop an approach to drugs and drug use that is fit for purpose. In listing everything that needs to be established, rebuilt or changed, the size of the task ahead becomes apparent. There is a lot to do.
It is important to note that this is a report of recommendations on which the government will (or will not) act. Judging by its response to the first report, the government’s response to this second report will come soon. At that point it will be possible to understand what might change, how and when.
Commissioning and the workforce
Two of the many themes in the report are commissioning (so long, 3-year commissioning cycles) and workforce development (did someone mention accreditation?). The recommendations in these areas are substantial and have the potential to bring about vast improvements in treatment for addiction. There are also several welcome mentions of ensuring that research is transferred into practice. Over the coming weeks the SSA web team will dive into the detail of these recommendations, and the government’s response, to better understand the implications for policy, research and treatment.
Recommendations
The report makes 32 recommendations in total. It is worth reading them all and then re-reading them. They include…
- “The government should establish a central Drugs Unit with strong analytical capacity which would develop a National Outcomes Framework and hold departments to account. The sponsoring minister should report annually to Parliament on progress in tackling drug misuse, including publication of relevant data.”
- “We recommend that the government invests, by the end of year 5 of this programme, an additional £552 million in the treatment system through DHSC [Department of Health and Social Care] and an additional £15 million in employment support through DWP [Department for Work and Pensions]. MHCLG [Ministry for Housing, Communities and Local Government] will also need to bid for additional funds for housing support at the next Spending Review.”
- “We recommend that DHSC commission HEE [Health Education England] to devise by the end of 2021 a comprehensive strategy to increase the number of professionally qualified drug treatment staff (psychiatrists and other doctors, psychologists and other therapists, nurses and social workers), and set occupational standards, competency and training requirements for drug workers and peer recovery workers. Government should also fund HEE to cover the costs of training the workforce.”
- “We recommend that local authorities commission a full range of evidence-based harm reduction and treatment services to meet the needs of their local population in line with the new national Commissioning Quality Standard.”
- “We recommend that the government (either HO [Home Office] or DHSC) establish an innovation fund to research which interventions are most effective at changing the behaviour of recreational drug users.”
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