Cover story
The
hearT
of The
MaTTer
Can we meet six basic
challenges to repair a
fragmented treatment
system, asks Paul Hayes
rexit continues to dominate mainstream debate. But far more
important to most people, particularly the poor, the marginalised, and
the ‘left behind’ is the cumulative impact of years of austerity and the
continuing failure of the economy to grow.
The prime minister’s promise to overcome the ‘burning injustices’
which blight so many lives, seems distant. The reality of sluggish
growth, falling wages, and slow but steady degradation of the services on which
the poor and vulnerable rely, provide the context in which drug and alcohol
treatment providers work and our service users live.
Below are six of the key challenges facing the drug and alcohol treatment
system during 2018. As the government recognised in last year’s drug strategy,
truly effective interventions depend on their cumulative impact. People need
adequate access to physical and mental health treatment, a realistic prospect of a
job, a safe place to live, and enough income for food and clothing.
Since the financial crash of 2008, the cumulative impact of squeezed budgets
and changes in policy have placed strains on service users’ capacity to survive and
recover, which treatment providers cannot address in isolation – no matter how
brilliantly they implement the drug strategy or how assiduously they abide by the
clinical guidelines.
B
******* ALCOHOL *******
Only one person in six who needs alcohol treatment is able to access it. Alcohol
harm is concentrated in our poorest communities, with 30 per cent of all alcohol
consumed by 4 per cent of the population. The health damage, the societal
consequences and the costs to the NHS are well understood. Despite this, the
government has thus far resisted publishing an alcohol strategy identifying how
it will reduce the overall harm of alcohol use and in particular how it will close
the gap between the growing need for treatment and shrinking capacity. There is
growing political pressure for the government to be more active in social policy,
and an alcohol strategy would be the ideal place to begin.
6 | drinkanddrugsnews | February 2018
******* DRUG-RELATED DEATHS *******
The Local Government Association, PHE, and the ACMD have all identified
treatment for England’s heroin-using population as the key to reducing drug-
related deaths. Being ‘in treatment’ is a protective factor: deaths are significantly
lower within the 60 per cent in contact with services than the 40 per cent who
are not. Every local authority commissioner and provider should be striving to
understand why people do not access services and find the most effective way to
reach them. However, with providers extended to the limit to meet the needs of
the 60 per cent, resourcing will be fundamental to success.
******* DISINVESTMENT *******
In 2012/13, total spend on drug and alcohol treatment in the community and
prison was more than £1bn. It is now around £750m. Local authorities are
increasingly focusing their commissioning