Drink and Drugs News DDN December 2018 | Page 11

Comment Parliamentary GrouP CZAR GAZING As deputy drug czar for the Blair government, Mike Trace oversaw the expansion of today’s drug and alcohol treatment system. In the first of a new series, he gives his personal view of the successes and failures of the past 20 years, and the challenges the sector now faces. 1. The golden years IT IS HARD TO IMAGINE THESE DAYS, but from 1997 into the early 2000s, we had a government that saw drug policy as a top-level priority, that accepted the argument that treatment was the most cost-effective response and was willing to spend money on a nationwide system aimed at reducing the crime, health and social problems associated with problem drug use. I had the privilege of working for the wonderful Mo Mowlam at that time, a period where we increased spending on drug treatment from around £200m to over £800m per year (it reached over £1bn by 2005). We sent this money to local drug action teams (DATs) with pretty tight guidelines on the range of services to commission, and set up the National Treatment Agency (NTA), to oversee spending and delivery. With the benefit of hindsight, there are many things we could have done better, but the basic intention was sound – to offer a national system of care and treatment to marginalised people struggling with drug problems, with the aim of reducing drug-related crime, deaths and infections. We also hoped that this policy would help some of the most marginalised and stigmatised people in society to turn their lives around. We wanted local partnerships to develop drug treatment systems (replacing a patchwork of unconnected services), consisting of a ‘menu’ of services that delivered four functions – supportive outreach and immediate care to encourage users in to contact with services; consistent case management and one-to-one advice; substitute prescribing for those dependent on heroin; and a range of options to motivate and facilitate recovery. We also developed specific procedures to channel users into treatment from the criminal justice system (arrest referral, drug treatment and testing orders, prison programmes). The vision was of a well-funded national framework of health and social support to a marginalised and stigmatised group, to help them stay alive and healthy, and make positive changes to often harsh lives. We know that, in the last ten years, the national political commitment to this strategy has dissipated, the NTA has closed down, the responsibility for sustaining it has been passed to local authorities, and the amount of funding available has gone down by at least a quarter. In this series, I want to ask the big questions - how much of our original vision has survived, did it achieve its objectives, how well has the sector managed the downturn to protect what matters, and how can we tackle the challenges we face now? Mike Trace is CEO of Forward Trust www.drinkanddrugsnews.com HAvINGtHevIsIoN Good commissioning goes beyond purchasing, hears DDN A ROBUST DISCUSSION ON COMMISSIONING was the focus of the year’s final meeting of the Drugs, Alcohol and Justice Cross-Party Parliamentary Group. ‘The focus has been on austerity and shrinking funding, but the demand for our services has certainly not decreased,’ said WDP chair Yasmin Batliwala, who gave a provider’s perspective. Doing more with less meant that providers had to be innovative and ‘think outside the box’. In turn, commissioners ‘must give providers the best chance of success’ by addressing inconsistency and subjectivity in tenders, she said. Commissioning varied enormously from area to area, and a commissioning ombudsman (as proposed in the recent Charter for Change) would help to encourage standardisation, including minimum-term contracts, and ‘eliminate questionable decision-making’. All too frequently immediate cost savings were not taking into account longer-term investment, such as provision for youth services and healthy-living interventions. ‘Since the NTA went, we assumed more wellbeing would be added to contracts, but this hasn’t been the case,’ she said. Mark Gilman had worked in the sector for 35 years before setting up the Expert Faculty of Commissioning with colleagues, as ‘we were concerned we were losing the memory of commissioning and wanted to keep a repository of expert knowledge’. The faculty already works with around half of local authorities that commission drug services and aims to promote best practice. ‘Too often commissioning falls to purchasing, but it’s a design job,’ he said. ‘It’s about having the vision to say, “What’s the problem, who’s in pain, and what should we do about it?”’ The most important thing was to get those who were not in treatment into treatment – ‘and you get this if you give them a free opioid. Until sanity breaks in the war on drugs, give them OST… they want to get, as quickly as possible, a drug that keeps them alive.’ The rise in polydrug use and the increase in drug-related deaths intensified the need for commissioners to understand this. Anthony Bullock, drug and alcohol commissioner from Staffordshire, had been working with the faculty to share good practice. Among his recommendations were to make sure the narrative was much clearer: ‘There are so many nuances to addiction and recovery – what is it we want to achieve?’ Alongside this, we needed to shift the mindset ‘from funding to investing’ and ‘be able to demonstrate the value of what we do’. Treatment meant different things to different people and it was important to recognise that different elements were needed, including peer support. ‘Our job as commissioners is to collaborate and coordinate,’ he said. ‘We need to support services to work together and have support around them.’ In the discussion that followed, Pete Burkinshaw, PHE’s alcohol and drug treatment and recovery lead, commented that it was important not to generalise in associating bad practice with all commissioning, and that we needed to be ‘careful, nuanced and precise.’ DDN ‘Too often commissioning falls to purchasing, but it’s a design job.’ December/January 2019 | drinkanddrugsnews | 11