Czar GazinG
REJUVENATING
THE SECTOR
How do we harness political
support when priorities lie
elsewhere? In the sixth of his series
of articles, former deputy drug czar
Mike Trace sizes up the challenge
T
wenty years ago, the Labour government
positioned substance misuse treatment
as one of its key social policy priorities and
increased central government investment
by more than 400 per cent. These were
the golden days of political support, but
we are now in a period of central government
indifference, linked to significant budget reductions.
When the NTA closed down, I remember Paul Hayes
and Department of Health officials urging the sector
to work hard to convince ministers, local councillors,
and directors of public health of the financial and
policy merits of substance misuse treatment. This was
reasonable advice, as it was clear that we were leaving
a period when policy support and generous budgets
were assured, and our sector would have to compete
with more mainstream concerns, within the context of
a local government financial squeeze.
But it was also a bit of a cop out – the big decisions
that affect the level of focus and investment in the
sector had already been made: the closure of the
cross-government agency set up to act as a custodian;
the end of the central government drug treatment
‘pooled budget’; the incorporation of that money into
a wider local authority public health grant; and the
removal of the ring fence on that grant. The period
since those decisions were made has seen politicians
at local and national level talk widely about the value
of substance misuse treatment, but no serious
attempts to reverse the decline in resources or develop
new or expanded services.
So what ‘big wins’ can the sector offer to policy
makers to rejuvenate the sector? Unfortunately, not all
of the benefits we see from the treatment system can
be translated into political support and increased
budgets.
SUBSTANCE MISUSE TREATMENT REDUCES BLOOD
BORNE INFECTIONS? The fear of drug-related HIV and
hepatitis infections has receded as transmission rates
have declined and treatments have improved. The
cost/benefit analysis of public health prevention
16 | drinkanddrugsnews | June 2019
measures remains positive, but there is no sense of
the crisis that is needed to stimulate policy action.
SUBSTANCE MISUSE TREATMENT REDUCES DRUG-
RELATED DEATHS? The shocking level of drug-related
deaths has also not been enough to trigger a
significant reaction. It seems true that drug users’ lives
are seen as less important – if we had more than
3,000 early deaths per year due to traffic accidents or
knife crime, we would be witnessing national
campaigns and bold new investments. We also have a
problem in claiming treatment can significantly
reduce deaths. Policy makers will ask why the death
rates have gone up throughout the period when the
number of people in treatment expanded massively.
SUBSTANCE MISUSE TREATMENT REDUCES CRIME?
This was the argument that most interested ministers
when I was in government. And the theory was largely
proved correct, with the types of crime most
associated with dependent drug use declining
significantly between 2000 and 2010. Whether it
holds the same potency now – when volume crime
rates are lower, and enforcement priorities are moving
more towards violence reduction and organised crime
– is questionable, but the financial case remains
compelling; treatment reduces offending, which in
turn significantly reduces criminal justice expenditure.
SUBSTANCE MISUSE TREATMENT REDUCES SOCIAL
EXCLUSION? This has in my view always been the
sector’s trump card. Our sector deals with a high
proportion of the most socially marginalised
individuals. They experience, and cause, multiple
problems beyond drug and alcohol dependence. If our
interventions can reduce those problems –
homelessness, family break-up, unemployment, low-
level mental health problems – then it is meeting the
objectives of many central government departments.
Unfortunately, we have not been very good at
demonstrating our impact in these areas – research
has been patchy, and our commissioning data sets do
not provide sufficiently clear results.
SUBSTANCE MISUSE TREATMENT REDUCES HEALTH
SERVICE UTILISATION? This seems plausible, and there
is some research to show reductions in, for example,
A&E presentations, GP appointments, or liver failure.
But we still do not have any comprehensive data on
the impact we have on our clients’ use, and costs of
other NHS services. I would imagine that such
research would demonstrate a strong case for
substance misuse treatment as a cost-effective
prevention measure within NHS strategic plans.
There is a pathway to re-energising political support
for our sector, but I fear that we have not been making
the right arguments, or assembling and presenting the
right evidence. The scramble for resources in a time of
austerity is brutal but inevitable – to protect existing
budgets, or gain support for new developments, the
substance misuse treatment sector needs to offer big
gains in a policy area that the politicians and public
care about.
While our public health achievements are worthy
of celebration, they will never rise to the top of local
authority or NHS priorities. It is more likely that
rejuvenated interest will come from the social
inclusion agenda – helping people to move from
positions of deprivation and dysfunction into work,
stable accommodation, and positive connections with
family and community. And while it is true that the
current national government is not at all focused on
social inclusion, it will not be in power much longer.
Local governments will always see the benefits of
moving people into jobs, and helping them off
homelessness or social service registers. We need to
offer them a clear, and evidence based, vision of what
can be achieved. The long overdue appointment of the
government recovery champion – Dr Edward Day –
presents an opportunity to articulate this vision at the
highest levels. My next article will contain some
suggestions for how he can go about this task.
Mike Trace is CEO of Forward Trust
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