Drugs services: the need for radical action and a population health-based approach

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While Hannah Shead and her colleagues were waiting to take part in a ‘Thank You’ parade at a rainy Devon County Show, a woman came charging up to them, ‘I came to you with my child 24 years ago and you saved my life’, she said. Hannah is from Trevi  – a GSK IMPACT Award-winning charity that established the first residential rehabilitation unit in the UK where women with drug and alcohol problems can remain with their children while in treatment. She describes this as another amazing moment that shows the difference her service makes to people’s lives saying, ’People pop up all over the place!’

Like so many services, drug treatment and recovery have been struggling in recent years with a lack of funding, increasing demand and what Hannah describes as a ‘postcode lottery’ for residential rehabilitation services. The Covid-19 pandemic has also intensified the problems experienced by drug users – many of whom live vulnerable lives. These are just some of the issues this complex area is facing and solutions require co-ordinated action across many sectors including criminal justice, education, employment, housing and health services.

In 2019, drug-related deaths in England and Wales were at their highest since records began more than a quarter of a century ago.

The scale of the problems around illicit drugs demands radical action – in 2019, drug-related deaths in England and Wales were at their highest since records began more than a quarter of a century ago. This is a significant deterioration from the period before 2012/13, when – as one of many contributory factors – England had one of the best records in the world for getting heroin users into treatment.

A radical and comprehensive plan for action by Dame Carol Black has just been published. Her extensive review – commissioned by government in 2019 – brands the current public provision of drugs prevention, treatment and recovery services not fit for purpose. She makes a strong case for significant investment in a ‘health’-based approach (focused on treatment and recovery) as opposed to a ‘criminal justice’-based one (focused on conviction and imprisonment), in which extra money is accompanied by increased accountability and new arrangements for collaborative commissioning in local areas using a budget ringfenced for drugs. These arrangements learn from the model that was in place in England up to 2013 when the National Treatment Agency held local drug-action teams to account for collaborative commissioning plans, and reflect changed commissioning arrangements and a focus on integration in local areas. They also share common elements with arrangements in place in other parts of the UK.

The King’s Fund contributed to Dame Carol’s review by providing an analysis of the strengths and weaknesses of different models of commissioning and accountability for drugs services, drawing on knowledge from other service areas – such as child and adolescent mental health and sexual health services – to inform thinking.

Integrated care systems, place-based partnerships and primary care networks are critical mechanisms for connecting the NHS with services beyond health and care.

Our work on drugs services – like our work about people who sleep rough – is a vivid reminder of how important it is for the NHS to be engaged in the wider population-health agenda. Real integration and a population-health approach are not only about co-ordinating services across primary, community and acute care; or health and social care. This work needs to involve a wider range of public services, reflecting the complexity of people’s lives, and benefits that go beyond immediate health outcomes. For people like Hannah’s patient from 24 years ago, an effective recovery package can not only turn their life around, it will also have a fundamental impact on their child’s life, keeping them out of the care system and improving their life chances. Integrated care systems, place-based partnerships and primary care networks are critical mechanisms for connecting the NHS with services beyond health and care, and should work with partners including local authorities and the criminal justice system to make a radical improvement for this vulnerable population

You can read The King’s Fund’s report to inform Dame Carol Black’s Independent Review of Drugs ‘Improving drug treatment services in England: models for commissioning and accountability’ here.

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