COLLECTIVE VOICE [ a project representing a group of the largest third sector substance misuse service providers ] believes that the most significant challenge facing the drug treatment and recovery system today is responding to the health needs of an ageing and increasingly vulnerable population . Moreover , that response must be formed in the context of declining resources and a fragmented delivery landscape .

The increasing fragility of the ageing cohort of heroin users who began their drug use up to 30 years ago has been highlighted by the Office for National Statistics ( ONS ) and Public Health England ( PHE ) as the main driver of the recent dramatic rise in drug-related deaths . These deaths , troubling though they are , represent only a fraction of the deaths among service users that Collective Voice members and colleagues in the NHS

are witnessing . Given that being in treatment is demonstrated by the evidence to be a protective factor , the rise in deaths among the 40 per cent of heroin users outside the treatment system is likely to be even higher .

As providers of drug treatment services , we have a moral duty to examine and recast our own practice to minimise early deaths . As a campaign ing body we have a duty to use our influence to reshape how services are commissioned , resourced and delivered to maximise our positive impact on outcomes .

Collective Voice has therefore come together with NHS providers and PHE to identify a shared agenda that can help minimise deaths . Two broad strands of activity will be undertaken focusing on improving internal clinical practice , and campaigning with others to improve the external environment .

With support from PHE , Collective Voice and NHS drug and alcohol providers will produce a shared Statement of Practice Principles which will :

Develop and share management information systems able to routinely identify those most at risk of overdose and target resources accordingly .

Publish a guide to interventions , which draws on each organisation ’ s clinical expertise and experience to delineate practice that minimises risk of overdose – including access to naloxone .

Reframe clinical practice with all service users to prioritise their physical and mental health needs , and identify how these will be met .

Align these interventions with the newly emerging Clinical Guidelines to ensure that good practice to promote recovery does not put patients at risk . Equally we will ensure that concern about drug-related deaths does not create a risk-averse clinical culture in which service users ’ legitimate ambitions for recovery are thwarted .

Identify opportunities to target and engage dependent users who are currently outside the treatment system .

Vital though it is to ensure that the practice of drug and alcohol providers is the best it can be , deaths will almost certainly continue to rise unless the NHS significantly improves its response to this population .

Collective Voice will therefore seek to work with allies to influence the wider system in the following ways :

The current system is fragmented and inefficient . It locates responsibility for commissioning drug and alcohol treatment in the community with local authorities , while service users ’ physical and mental health needs are met by CCGs , and prison services are separately commissioned by NHS England . The current system needs to be replaced with an integrated system able to ensure continuity of care between prison and community and respond in a timely fashion to the physical and mental health care needs of a challenging population all too often marginalised and underserved by a resistant NHS .

Challenge disinvestment by local authorities , which risks undermining the system ’ s capacity to deliver the aspirations of the government ’ s drug strategy and places unsustainable additional burdens on the NHS .

Promote greater transparency and accountability to ensure central govern - ment is sighted on the consequences for national policy of local decisions .

Work to progress the Statement of Practice Principles will run during the first half of 2017 , with publication planned for late summer . Seeking strategic change towards a better integrated system will be a priority for Collective Voice throughout 2017 / 18 .