England has a new drugs strategy – what now lies ahead?

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The new drugs strategy for England shows the government is serious about righting the wrong of nearly a decade of disinvestment and political neglect. £533 million has been committed over the next three years to community treatment and recovery services, with additional funding for prisons.

As a society we now have a serious chance to transform our national treatment system and turn the tragic tide of rising deaths. But it won’t be simple.

Like many fields of health and social care, England’s drug and alcohol treatment system has changed over the years, shaped by both shifting health policy and fiscal constraints. The past decade saw central government move commissioning responsibility to the local level while cutting local government funding in real terms with a 37 per cent reduction under austerity measures. That period also saw a 60 per cent increase in drug-related deaths, leaving thousands of family members and friends to deal with a bereavement unlikely to be ever recognised by society.

Dame Carol Black’s government-commissioned independent review pulled no punches in diagnosing a system in distress and called for ‘radical reform’ of the leadership, funding and commissioning of services – and a £1.78 billion investment to fund services and rebuild the workforce.

The strategy accepts all of Dame Carol’s most important recommendations and – crucially – HM Treasury has agreed a major settlement, unleashing more than £700 million over three years...

The government responded first by establishing, in July 2021, the Joint Combatting Drugs Unit to focus cross-government policy development and then in December 2021 with the publication of a full, cross-government drug strategy. The strategy accepts all of Dame Carol’s most important recommendations and – crucially – HM Treasury has agreed a major settlement, unleashing more than £700 million over three years, with the lion’s share devoted to treatment and recovery.

There is much to be encouraged by. The treatment and recovery section of the strategy is rigorous and balanced, pointing sensibly to an overarching metric of ‘reducing drug-related deaths and harms’. It is absolutely right to put forward ‘the full range of evidence-based interventions’ as an appropriate whole-system aim. Multiple issues that have bedevilled the system for many years are acknowledged, such as the lack of join up between drug and alcohol services and mental health and homelessness support, or improving continuity between custody and community.

But none of this is easy. It is now apparent that the famine years have seriously eroded the most important element of the system: the people who make the magic happen. The stock of people needed to commission and deliver high-quality services has been depleted. In a fight fought on multiple fronts there is an urgent need to do four things simultaneously: replenish local government commissioning capacity; improve training pathways for professional roles, such as addiction psychiatrists, psychologists and nurses; develop the current workforce to minimise further loss of staff; and recruit a new cadre of entry-level practitioners.

To meet these challenges the government will commission Health Education England to develop a comprehensive strategy for those working in drug treatment services. This will bring welcome heft, though with a clock ticking the main challenge is probably one of timing.

Elsewhere the strategy rightfully recognises the importance of weaving lived experience through the tapestry of our living systems. The drug and alcohol field is very rich in lived experience-led initiatives, with family support groups, recovery communities, informal networks of activist drug users and routes into employment for peer mentors and recovery champions all playing their part. Dame Carol has recognised that authentic, ‘contagious’ recovery must play a key role alongside evidence-based health interventions. With people with lived experience self-organising through projects such as the College of Lived Experience Recovery Organisations (CLERO), the strategy and funding now provide an opportunity to develop new ways of working. Local government commissioners can now focus on weaving recovery communities and peer-led services though the fabric of the local support networks. Some areas such as Lancashire (Red Rose Recovery and The Well), Halifax (The Basement Project) and Nottingham (BAC-IN) are already blessed with brilliant projects; in other areas commissioners may need to plant seeds that will flourish over the coming decade.

...the strategy acknowledges that deep-seated stigma remains a barrier to engaging and supporting people who feel like society has given up on them.

Finally, the strategy acknowledges that deep-seated stigma remains a barrier to engaging and supporting people who feel like society has given up on them. Stigma harms both people with drug and alcohol problems and their family members, prevents them asking for help and worsens the help that is provided. But recognising it is only the first step. Positive language that foregrounds the person, rather than the issue they struggle with, is an important step in combatting stigma, with much room for improvement in both media and policy discussion. It is also essential we move to an understanding of addiction as rooted in poverty, trauma and social exclusion to enable a sophisticated and compassionate response. There are welcome initiatives already under way in the drug and alcohol field such as ‘Stigma Kills’ by the NHS Addictions Providers Alliance.

After many tough years the strategy provides a meaningful framework for change – and the accompanying settlement provides the energy to make that change possible. Treatment providers, commissioners, officials and those with lived experience now have a responsibility to work pragmatically together to implement the strategy – primarily of course to deliver life-changing support to people with drug and alcohol problems, but also to demonstrate an effective use of public funds and increase the likelihood of continued investment. Hundreds of thousands of people are counting on us all to get this right.

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