As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the first of a new series, he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces. Read it in DDN Magazine.
The golden years
It is hard to imagine these days, but from 1997 into the early 2000s, we had a government that saw drug policy as a top-level priority, that accepted the argument that treatment was the most cost-effective response and was willing to spend money on a nationwide system aimed at reducing the crime, health and social problems associated with problem drug use.
I had the privilege of working for the wonderful Mo Mowlam at that time, a period where we increased spending on drug treatment from around £200m to over £800m per year (it reached over £1bn by 2005). We sent this money to local drug action teams (DATs) with pretty tight guidelines on the range of services to commission, and set up the National Treatment Agency (NTA), to oversee spending and delivery.
With the benefit of hindsight, there are many things we could have done better, but the basic intention was sound – to offer a national system of care and treatment to marginalised people struggling with drug problems, with the aim of reducing drug-related crime, deaths and infections. We also hoped that this policy would help some of the most marginalised and stigmatised people in society to turn their lives around.
We wanted local partnerships to develop drug treatment systems (replacing a patchwork of unconnected services), consisting of a ‘menu’ of services that delivered four functions – supportive outreach and immediate care to encourage users in to contact with services; consistent case management and one-to-one advice; substitute prescribing for those dependent on heroin; and a range of options to motivate and facilitate recovery. We also developed specific procedures to channel users into treatment from the criminal justice system (arrest referral, drug treatment and testing orders, prison programmes).
The vision was of a well-funded national framework of health and social support to a marginalised and stigmatised group, to help them stay alive and healthy, and make positive changes to often harsh lives.
We know that, in the last ten years, the national political commitment to this strategy has dissipated, the NTA has closed down, the responsibility for sustaining it has been passed to local authorities, and the amount of funding available has gone down by at least a quarter.
In this series, I want to ask the big questions – how much of our original vision has survived, did it achieve its objectives, how well has the sector managed the downturn to protect what matters, and how can we tackle the challenges we face now?