Invest or pay the consequences

Despite a robust evidence base and the best efforts of many skilled and passionate people, the drug and alcohol treatment and recovery system in England and Wales isn’t working as well as it should. 

The realities are stark. Drug deaths are at their highest levels since records began, drug use among young people is up, and it’s becoming clear that a worrying number of people have died of alcohol-related causes during the pandemic.

Years of savage disinvestment from central government have forced hard-pressed local authorities to slash their public health grants. 

But ministers have now been presented with a transformational plan for change. The Government must act to implement it; and local government must be ready to play its part.

“The importance of the review’s timing cannot be overstated

In February 2019, the then Home Secretary, Sajid Javid, appointed Dame Carol Black to conduct an Independent Review of Drugs, which focused first on drugs markets and the toxic combination of violence, poverty and exploitation that underpins both supply and demand. 

It found the current approach in England and Wales to reducing harm to be ineffective – costing £19.3 billion every year, of which less than 4 per cent is invested in drug treatment and prevention despite proven cost-effectiveness across health, prisons, police and emergency services.

Readers will be unsurprised that drug harms were found to be strongly correlated with trauma and deprivation, and to fuel social problems such as homelessness, demands on child social care, unemployment, mental ill health, and crime. 

Councillors will be all too familiar with the challenges this group of constituents face, and the disproportionate demands placed on local services.

But we now have a set of solutions to this immense challenge. The second part of the review, published in July, makes radical recommendations for treatment, recovery and prevention, stating government must “invest in tackling the problem or keep paying for the consequences”. 

It powerfully puts forward the case for renewed national and local political leadership and a significant uplift in protected investment, totalling £1.78 billion over five years. 

Dame Carol also recommended the creation of a new ‘Joint Combating Drugs Unit’ bringing together six key departments; a new long-term drugs strategy published by the end of 2021; and new local outcomes frameworks and commissioning quality standards to be developed “in consultation with the local system”.

Dame Carol’s policy programme is projected to save the lives of more than 3,000 opiate users, bring 95,000 new people into recovery, prevent 2.8 million crimes and save billions of pounds for the public purse. 

This would represent both substantial local wins and contribute hugely to national plans to level up poorer parts of our country.

What next?

The importance of the review’s timing cannot be overstated. Dame Carol has made clear recommendations must not be “cherry picked” and that government must commit to a long-term, whole-system approach. 

While the implementation of some of the 32 recommendations has already begun, the majority require a full government response and are partly or wholly contingent on a robust settlement in the Spending Review.

Public Health Minister Jo Churchill has stated “we can do better, and we should”, with the Black review offering “an opportunity and a time for action”. I agree.

We will know soon enough whether the Government has followed these fine words with the necessary political action.

Collective Voice is a national alliance of drug and alcohol treatment charities, see to find out more. Please visit to find out more about the Black review


Some notable successes

Call for school-based counselling for all