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
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
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
‘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
but it’s a
December/January 2019 | drinkanddrugsnews | 11