On borrowed time

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The delayed drug strategy – and lack of plan for an alcohol strategy – is pulling the lifeline from a sector in crisis, hears DDN

The new drug strategy is in limbo. Delayed for months without explanation, the questions are mounting against a backdrop of the highest number of drug-related deaths ever recorded. In the new year, the government said ‘soon’. In February they confirmed ‘shortly’.

On 30 March, Liz McInnes MP asked for a date for the strategy, telling the house: ‘Local authorities have seen their funding for drug and alcohol treatment slashed by 42 per cent since 2010… there are more than 1m alcohol-related hospital admissions each year, and alcohol is a contributory factor in more than 200 different health conditions. Let us hope that both a drugs strategy and an alcohol strategy will be forthcoming as a matter of urgency.’

At the end of April, Sarah Wollaston MP asked the parliamentary under-secretary of state at the Home Office, Sarah Newton, when it would be published. She answered: ‘We are currently developing the new drug strategy, working across government and with key partners. The new strategy will be published in due course.’ With the general election taking place on 8 June, no one is expecting progress anytime soon.

Furthermore, there is no hint of an alcohol strategy, apart from in Scotland, despite problematic alcohol use affecting many more people than drugs.

At the latest cross-party parliamentary group on drugs, alcohol and justice, Colin Drummond, professor of addiction psychiatry at King’s College London, was invited to speak about alcohol misuse and treatment.

He began by outlining the worsening picture on alcohol, stating that ‘alcohol-related health conditions, including liver disease, have increased and alcohol-related hospital admissions have doubled.’ But his talk went on to explore the deepening crisis for the drug and alcohol sector.

‘We’ve had a world-class addiction system in the UK, and we’re in danger of losing it. We’re in danger of it not existing in a few years’ time,’ he said. Looking at the recent rise in drug-related deaths (DRDs) he referred to the government’s reaction to a previous epidemic around 2001: ‘In the 2000s we had a huge investment in treatments, so drug deaths began falling. But they’re now at their highest since records began.’

So what’s going wrong? Why are we failing? ‘Declining resources for this population’ were an obvious factor, combined with the disastrous effect of constant retendering. Prof Drummond stated that ‘people with complex needs are not getting the same access to treatment as before’ and went on to say that the ‘biggest impact of constant retendering is going to be on people with the most complex needs. They’re not attractive people to treat – they’re costly, with poor outcomes.’

Furthermore, when contracts are tendered, the expectation is that the service will see ‘twice the number of people with half the amount of money,’ he said. ‘So they strip staff costs and have fewer qualified staff and more volunteers.’ It was also an extremely expensive process – ‘money that could have been spent on treatment instead of lawyers drawing up contracts’.

With retendering taking place every three years in local authorities, clients were constantly affected by the changeover process.

Add to this the loss of specialists to the field – ‘in addiction psychiatry we’ve lost 60 per cent of training places in England’ – and you have the perfect storm, he said. ‘It looks like there are plenty of people in treatment, but the people in most need are being denied care. If they’re not being taken care of here, they will pop up elsewhere – in A&E, GPs’ surgeries and in prison… there is an artificial separation between health and social care.’

So what needs to change? Prof Drummond suggested immediate recommendations for the incoming government:

Ring-fence funding that’s going into addiction treatment. ‘Ring-fencing needs to be safeguarded not further depleted,’ said Prof Drummond. ‘Cutting these services is a false economy. Local authorities will only see it from their perspective, but it will cost them more money in the long term.’

Bring the NHS back into the fold: ‘We felt it was wrong to put everything in the control of local authorities.’

Put a moratorium on retendering. ‘We see no evidence that it improves services.’

Protect specialism and experience, eg addiction psychiatry. ‘No area should fall over for lack of experience.’

Deal with people with complex needs properly. ‘We need to rebalance the system to do this – and if we don’t treat them, they cost a lot to the economy.’

Back minimum unit pricing (MUP). ‘It would have huge benefits – to both moderate drinkers and to people at the severe end of the spectrum.’

Increase research capacity. ‘If we don’t understand the impacts, we won’t learn.’

Discussion between members of the APPG – which includes MPs, treatment providers, specialist and advisory groups and people representing service user and recovery communities – reinforced the need for action.

‘A lot of this isn’t new but political will is lacking,’ said Alex Boyt, who worked for years in service user involvement. ‘It’s a lose-lose conversation – people who are not cost-effective are not being treated.’ The ‘relentless commissioning’ also exacerbated the situation: ‘Each time clients are lost, old and new providers blame each other.’

Prof Drummond said that ‘those most affected by cuts have been rehabs’, to which Caroline Cole, interim chief executive at Broadway Lodge, added: ‘We’ve had to pull back on the numbers of people with complex needs as the local authority can’t pay us what it costs us to treat them.’

The prison population was also being failed. ‘There’s a massive spike in deaths on release,’ said Prof Drummond. ‘The window when they come out is vital – we used to be better at that. There was better throughcare, but the programmes have been dismantled.’

‘Work happens inside, but the problem is when they come out,’ said a volunteer at a prison recovery service. ‘Places are limited – there’s nowhere to go – so they go back to old stamping grounds, old habits and back inside. I sat on a drug strategy group at prison and they do their best, but they’re stretched – and once people are back inside they’re lost again.’

‘We see people who are retoxed in prison, put back on methadone, with no link with community services,’ added Sunny Dhadley from the Service User Involvement Team (SUIT) at Wolverhampton.

‘There seems an inability to have that very basic conversation about economic commonsense,’ said Boyt. ‘With the election looming, even fewer people are listening than usual. Is there anything we can be doing practically – other than lamenting – to make the case?’

‘Why doesn’t the treasury see the madness of the way we’re running things? Why aren’t they looking for a rational approach?’ asked one MP.

‘What we’ve done as a group is to approach all the ministers responsible [see below] and given them the evidence,’ said Lord Ramsbotham, the APPG’s chair. ‘They’ve patted us on the head but not reflected the evidence. The cost of not doing one thing in an area is going to be seen in another – all exemplified in the lack of a national drug strategy.’

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‘We need a single government minister for drugs and alcohol’

The Drugs, Alcohol and Justice Cross-Party Parliamentary Group submitted a ‘charter for change’, calling upon the government to tackle drug and alcohol-related illness and deaths through investment, education, and a commitment to evidence-based practice.

Top of the list was the call for a single government minister to be responsible for drug and alcohol policy, accountable to parliament.

The minister would be empowered to:

• Focus drug policy on health, mental health and social inclusion, looking particularly at people with multiple needs, such as mental health issues and homelessness.

• Develop a harm reduction strategy to reduce drug and alcohol-related deaths and illness.

• Create a national commissioning ombudsman to ensure transparency and accountability.

• Widen the Care Quality Commission (CQC)’s remit to include all local authority-commissioned drug and alcohol services.

• Ensure competence and accreditation of the workforce by investing in an independent association.

• Commit to reviewing drug policy at national and global levels, building on progress at last year’s United Nations General Assembly Special Session on drugs (UNGASS).

The minister’s priorities should include following guidance provided by the Advisory Council on the Misuse of Drugs (ACMD) – including ensuring comprehensive access to the life-saving drug naloxone across the whole of the UK, and making NICE-approved treatments available to all patients diagnosed with hepatitis C.