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drinkanddrugsnews
| December 2013
Policy |
DrugScope conference
www.drinkanddrugsnews.com
Among the
now-familiar talk
of emerging chall-
enges and stretched
resources, delegates at
DrugScope’s recent conference
heard some positive takes on the
new treatment landscape.
ACCENT
there are significant prima facie risks of disinvestment, and adapting to that may
mean further rethinking and reconfiguration.’ The crunch points could well come next
April or the April after, he said, as many contracts would have rolled over into this
financial year and new structures were still bedding in.
‘I’d underestimated how long it would take for some of our systems to
embed,’ echoed director of public health for Barnet and Harrow councils, Dr
Andrew Howe. Although there was an austerity agenda and a now-unprotected
substance misuse budget, he was ‘not hearing about any substantial
disinvestment’, he told delegates. ‘But the challenge to local government is that
the savings are to criminal justice and the NHS rather than them, and
commissioning is fragmented.’
However, local government did fit very well with the aims of the field in that ‘if
it’s about anything, it’s about improving social capital’, he said. ‘I absolutely
recognise that we’re building on enormous success in the substance misuse sector,
particularly around service user involvement – it’s an exemplar of success for other
services – and as a commissioner I’ll be looking for outreach services from our
service providers. I’m hoping that the new system will really help with integration.’
The advent of police and crime commissioners (PCCs) had also created
uncertainty, said deputy PCC for the South Wales Police, Sophie Howe. PCCs
needed to balance budgets and maintain services that local communities cared
about, while working to develop partnerships such as the Drug Interventions
Programme (DIP) – something that combined harm reduction and reducing
reoffending and showed the two could complement each other. ‘But evidence of
effectiveness isn’t enough in the current financial climate,’ she said.
‘The coming years are going to get more difficult,’ CEO of Blenheim CDP John
Jolly told the conference. ‘I’m still mourning the death of the NTA – I think that’s
a huge downside for our sector because we don’t have a body representing us at
national government level.’
The NTA had done some excellent work around service user involvement, said
chief executive of Build on Belief, Tim Sampey. ‘The change to Public Health
England and the tightening of purse strings is a real pity, and re-tendering is awful
– it’s dog eat dog and service users hate it. The buildings change, staff change –
stability is really important for trust and building relationships, and without it the
risk is that people drop out of treatment.’
The recovery agenda was also ‘an awful idea’, he added, and had made service
users panic. ‘When I was using I hated the expression “clean”, and there’s
something about recovery that seems a bit judgemental – whether it’s true or not,
it’s the perception that service users have.’ Nonetheless, mutual aid could well be
the future, he said. ‘I’ve seen some great stuff around mutual aid, and I don’t mean
the 12-step stuff. What we need is community and family and somewhere to belong
– if we can do that we can really help people.’
The ‘elephant in the room’, however, was the underfunding of, and unmet need
for, alcohol services, said John Jolly. ‘There’s been a u-turn on almost everything
in the alcohol strategy, and the resources that are already stretched are going to
become even more stretched, with the risk that alcohol need is going to hugely
reduce our capacity to deliver to other groups.’
There was also the challenge of new drugs, he said, with many users reluctant
to access services and receiving no support. ‘So it’s about how we make our
services relevant to specific groups such as older alcohol users and young
people using new psychoactive substances – you have to give them something
relevant or they won’t come. They need to like what’s on offer and like the people
there.’ In the current commissioning environment, however, there was huge unmet
need and ‘the risk of not being able to meet any of it’.
‘Yes, the funding has changed and there are competing priorities in local
‘W
hatever views people take of the pros and cons of the times
we’re in, what everyone can agree on is we’re charting very
new waters in turbulent seas,’ DrugScope’s policy director
(now newly appointed chief executive) Marcus Roberts told
delegates at the organisation’s
Game on: drug and alcohol
services and the new local players
event.
Localism presented some significant positives and opportunities alongside the
challenges, he said. Although the 2010 drug strategy was still setting a direction
for services, many of the decisions that affected them were now made at local
level, with a loosening of central control and the national drive to focus on crime
reduction gone, ‘or at least fading to grey’. The pooled treatment budget,
however, had been ‘swept into a bigger public health budget with no meaningful
protection, or at least none that anyone can explain or understand’, and there
was now a need to convince local partners who may have previously had no
engagement with the sector.
‘Obviously, it’s also a case of localism plus tight money and further cuts on the
way,’ he said, against a backdrop of the rise of new psychoactive substances and,
‘absolutely critically, the role of alcohol’. But the generic ‘problem drug user’ had
always been something of a cipher, he told the conference, and there was now much
more meaningful work around specific groups like the LGBT community, women
involved in prostitution and older people.
Financially, it was difficult to get a clear grip on what was happening, he said,
although DrugScope research had found more than a third of services reporting a
decrease in funding (including 10 per cent where it was the result of re-
commissioning), 44 per cent reporting a decrease in frontline staff and 63 per cent
an increase in the use of volunteers. More than 40 per cent also said they’d so far
had no engagement with their local health and wellbeing board.
‘Overall the findings have been suggestive, but not seismic, and they do point to
some positives of good adaption and resilience. But it’s worth emphasising that