But the strategy was still facing fundamental challenges, including quality of treatment, response to drug dependency within the criminal justice system, and the need for sustained political leadership.

Increasing workforce numbers alone was not enough if services lacked the skilled practitioners needed to deliver effective psychosocial interventions, said Dame Carol. People’ s needs had become more complex, yet treatment was not always sufficiently tailored to individual circumstances. Drug dependency also continued to be stigmatised rather than recognised as a chronic health condition.

She called for a more personalised approach to

treatment, matching it to individual circumstances, the same way that chronic conditions like diabetes are managed. Appropriate housing and access to residential rehabilitation were also an important part of the equation, and she questioned why local authorities were expected to fund long-acting buprenorphine – rather than the NHS funding it as a medicine, as they would for any other health condition.

Difficulties were particularly evident in prisons. Dame Carol’ s 2024 review had identified shortages of appropriately trained staff, burdensome administration, unclear accountability and commissioning arrangements that failed to reflect prisoners’ needs. A subsequent National Audit Office report had highlighted difficulties measuring the cost and effectiveness of prison drug treatment, alongside a real-terms reduction in funding. Prison and community treatment were‘ two sides of the same coin’, she argued. Effective treatment in custody could support people’ s return to the community, while good community provision could help prevent imprisonment in the first place.

Sentencing reform and police-led diversion offered opportunities to reduce

pressure on prisons, with research by the University of Sheffield demonstrating reductions in reoffending. Dame Carol highlighted the scale of the opportunity, noting that annual police custody detentions were around ten times the prison population. However, she warned that diversion must not overwhelm already stretched treatment services – those entering through diversion represented a different cohort from people seeking help independently, and without careful planning and sufficient capacity there was a risk of making services less effective for everyone.

Discussion in the group highlighted how practice often fell short of ambition. Kelly Grehan, policy manager at Revolving Doors, described how people sometimes concealed setbacks in recovery for fear of being recalled to prison. She also highlighted the poor conditions in some accommodation for people leaving custody, with some feeling safer sleeping in a park than staying in a hostel.

Vicky Fobel, programme director of the Better Justice coalition at User Voice, questioned why discussions about early prison release had barely mentioned drug treatment, while Mike Trace argued that

preventing people returning to custody required effective treatment pathways, not simply arrangements for their release.

There were other serious gaps in support outside the criminal justice system. Judith Yates pointed to progress towards hepatitis C elimination through partnership working, but warned of the risks facing people injecting drugs in unsafe environments. Lydia Plant, CEO of Bristol Drugs Project, raised concerns about neglected low-threshold harm reduction services, including needle exchange.

Political leadership and focus were a major concern – tackling drugs had previously been recognised as central to delivering wider government priorities, with ministers given the drugs policy brief. Historic funding cuts had had a significant impact, despite services dealing with a wider range of substances and increasingly complex needs.

APPG chair Grahame Morris emphasised the importance of concrete action rather than another talking shop, with the forthcoming publication of the England and Wales drug death figures offering another opportunity to press the case.‘ Keep banging on doors’, urged Dame Carol, and remain a‘ polite thorn in the flesh’. DDN