The end of austerity for addiction services?

For decades, local authorities have held lead responsibility for commissioning services to provide care and recovery for people struggling with drug or alcohol addiction. 

Since 2012, these services have primarily been funded from the public health grant, which has suffered from government cuts through the austerity years. 

Most council services have, therefore, been struggling through a decade of increasing demand and risks, with decreasing resources – estimates range from 20 to 40 per cent cuts since 2012.

Drug and alcohol treatments are a classic ‘cross-cutting’ investment. Effective measures to engage, protect, motivate, and support people struggling with addictions to turn their lives around produce benefits across many sectors – health improvement, crime reduction, improving mental health, and reducing homelessness and unemployment. 

Numerous studies have shown that this is a positive ‘spend to save’ investment that should be planned jointly by local authorities, the NHS, police, probation, and employment services.

In reality, however, commissioners and providers in this sector have been on the defensive in recent times – struggling with reducing budgets while coping with an ageing population of high need, primarily heroin-using clients, who require increasing levels of healthcare and who are dying in greater numbers. 

Meanwhile, new and younger cohorts of people in need – struggling with alcohol problems, cocaine or new synthetic drugs – are not getting sufficient access to support.

There are some signs of light at the end of the tunnel. Central government has appointed Dame Carol Black to review the sector and make recommendations for its regeneration. Her ‘Review of drugs: phase one report’ was an excellent analysis of the challenges and priorities for action. 

The stage 2 report is due out in April, and is likely to call for consistent and ring-fenced rises in funding allocations, allied with much closer policy attention and accountability for delivering outcomes.

“Effective measures produce benefits across many sectors”

New funds are starting to flow for the financial year 2021/22. Allocations have been made to local areas to enhance the drug and alcohol support offered to homeless people, released prisoners and probation clients, and Public Health England is due to announce the details of an £80 million single-year allocation to local authorities, dedicated to improving treatment services. 

These allocations, while welcome and significant, are for one year only, and come with a challenge to council leaders – to show they can spend them wisely on meaningful service enhancements, with outcomes demonstrated more clearly than in the past.

Time is short, therefore, for local authorities to ensure that these single-year allocations are well planned and spent, and deliver real benefits in terms of better health, reduced crime, and increased rates of recovery. 

HM Treasury will be seeking clear signs of re-energised joint commissioning structures at local level, and realistic plans for measuring and reporting on outcomes, when it makes spending review decisions at the end of the year.

My advice to any council leader would be to pull together your local stakeholders to start work urgently on revised strategies that explicitly offer a route to better service coverage and outcomes, ensuring that currently available resources are directed where they are most needed. 

That will give confidence for a more generous spending review outcome for the next three years.

For further information on the Black Review or spending plans, please contact mike.trace@forwardtrust.org.uk. The Forward Trust is a charity that helps people with drug and alcohol dependence. The first part of Dame Carol Black’s independent review of drugs is available on the Government’s website.

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