CZAR GAZING – A hopeful sign

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Concluding his theme of how to rejuvenate the sector, Mike Trace sees opportunity in the appointment of the recovery champion.

Read it in DDN Magazine 

Mike Trace is CEO of Forward Trust

Central government has been happy to allow the drug/alcohol treatment sector to drift and suffer cuts over the last six years. But the appointment of a government recovery champion, Dr Ed Day, gives some hope that a coherent national strategy can re-emerge. The role has no salary and no budget, but Dr Day will report directly to ministers so has the opportunity to articulate a strong case for rejuvenating the sector.

 

Of course ministers currently have a life span of one to three months, but we have to hope that a stable government emerges in the autumn – one with the bandwidth to think seriously about social justice and social inclusion.

By that time the recovery champion should be prepared with a concise set of data and arguments that will persuade the government to re-invest in treatment for drug and alcohol problems, and to ensure that investment is properly targeted. Here are a few ideas of what his advice should include:

Remind the government why this sector is important

Substance misuse care and treatment is one of the strongest social inclusion weapons the government has in its armoury. Hundreds of thousands of the most marginalised people in our society – struggling with homelessness, worklessness and alienation, and unwilling to engage in mainstream services – decide to make contact with drug/alcohol services, presenting an opportunity to improve their physical and mental health, and start a journey towards recovery and reintegration.

When this works, the government reaps rewards in terms of reduced crime, improved public health, reduced homelessness, reduced benefit dependency, and improved family and community relationships. There is also the added bonus of undermining the power and reach of illegal drug markets.

Provide the data to back up arguments

I know from experience that treasury officials need to see credible calculations of benefit before the purse strings are opened. Numbers in contact with treatment, and numbers leaving treatment and not returning, will not cut it. Neither, I am afraid, will a reduction in the risk of drug-related deaths, as long as the total number continues to increase. We have to show that our efforts deliver real outcomes for government and communities.

One of the biggest failings of the NTA, and my office before it, was not to have put in place longitudinal research that showed the sector’s impact on crime, health, employment and family/accommodation. We do have a number of small-scale studies that show positive results – Dr Day needs to compile these into the best current evidence base, and make arrangements for much more meaningful evaluations in the coming years.

Give them a clear description of what recovery looks like

The sector can continue debating its definition of recovery – does it require abstinence, can you be ‘in recovery’ and still drink or smoke problematically – but government needs a clear ‘mission’ to buy into. The UKDPC definition works best for me: voluntarily-sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society.

But government needs to have a way of recording when someone can be considered to be ‘in recovery’. We can’t run client surveys to answer this question, nor can we define it in terms of the nature of their contact with services. For me, if someone is not committing crime, is in positive contact with family/significant others, and is engaged in work, study, or other positive activity, then this is a pretty good proxy measure of recovery.

Bring back the pooled budget

Everybody agrees that the behaviour change that can result from drug/alcohol treatment has benefits for many government departments, but since the demise of the pooled budget, the funding burden is falling on the NHS and local authorities, while other departments such as the Home Office, DWP, and justice, are taking a back seat. (This is happening right now with the redesign of probation, where the Ministry of Justice is simultaneously saying that drug/alcohol treatment is essential to its objectives, but that local authorities must pay for it.)

The drug treatment pooled budget that was in place from 1999 to 2012 balanced this shared interest and responsibility and gave all departments an interest in contributing to shared costs and shared outcomes, at a level that no department would shoulder on its own. We need to get back to that system – with all departments contributing to programmes and pathways that deliver personal development and recovery.

A new crop of ministers needs a new vision for drug/ alcohol treatment and recovery – it lies in a positive investment in the potential of people who, for most of their lives, have been neglected, abused, stigmatised and punished. If we are to take social inclusion seriously, providing support to recovery and reinte­gration for these people is one of the most humane and cost-effective policies a government can take.

1 COMMENT

  1. I would agree with the general gist of Mike’s commentary. However, none of it will work if delivery is left in the hands of local decision makers. A national programme is required (we know it works – sort of) to provide a common framework in which those local decision makers can operate. Too much fracturing exists currently and that also needs to change.
    A common framework can ensure consistent development and delivery of treatment, interventions and recovery. It would focus the attention and energy of the 150+ local authorities who currently have to balance competing priorities, by offering a cogent reason why dealing with substance use is a significant factor in delivering population wide improvements. Housing and homelessness, community safety, benefits, hospital admissions and care, general population health, prison health, mental and physical co-morbidities – the list goes on of those issues impacted by substance use. Hopefully, the new Tzar will start the discussion to bring this back. Otherwise we are doomed to at least stand where we currently are.

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