At Blenheim CDP we welcome the clear policy shift to a recovery agenda in the 2010 Drug Strategy, its focus on reducing drug use and dependency and its increased focus on community reintegration and service user led provision. We are concerned, however, that the combined impact of public sector re-organisation will result in a lack of sustainable investment in drug and alcohol services, undermining the recovery agenda and the Governments Drug Strategy with a negative impact on vulnerable individuals, families and communities.
In February 2012 the Recovery Partnership, in a letter supported by Blenheim CDP and all the key provider organisations in the substance misuse sector, wrote to Andrew Lansley, Secretary of State for Health, and Theresa May, Home Secretary, setting out the risk of disinvestment.
It is clear that the abolition of the NTA, the transfer of an estimated £1 billion of drug and alcohol funding into Public Health England, and removal of the specific ‘ring-fence’ around the ‘pooled drug treatment budget’, will result in significant disinvestment in substance misuse services unless action is taken now to prevent this. The current plan is that Local Authorities will initially continue to be funded for achieving current pooled treatment budget targets but there is serious doubt about the future of funding for drug and alcohol services and there is are particular concerns about the disinvestment of expenditure from local NHS and Local Authority budgets which have historically been invested in drug and alcohol services.
This concern is driven by the fact that Local Authorities will be able to spend as they wish in meeting a large number of significant and largely underfunded public health responsibilities. There is a particular challenge in ensuring the provision for people affected by drug and alcohol problems is given sufficient priority at local level when there will be so many competing demands on public health funding, given the levels of stigma they (and their families) can experience. In November 2011, at a Drugscope conference, a number of Directors of Public Health clearly indicated they would be seeking to divert current drugs treatment funding to other public health priorities.
This challenge is not helped by the limited reference to drug and alcohol services in the Government’s ‘Healthy Lives, Healthy People’ (HLHP) consultation documents, and in the wider public discussion of health reform. Despite the fact that drug and alcohol treatment and other services will represent a quarter of the national and up to half of the local public health spend, the White Paper contained only a handful of references to drugs and alcohol.
Paul Hayes, NTA CEO, has expressed serious concerns about the threat to drug and alcohol service provision resulting from local disinvestment. There are seriously concerns about the potential for local areas to disinvest in alcohol provision and the NTA have written to local areas in London for example expressing concern about the under reporting of spending on alcohol services.
Young people’s drug and alcohol treatment is particularly dependent on local investment. There has been substantial disinvestment in young people’s services since the 2010 Spending Review and this trend was confirmed in research by the UK Drug Policy Commission in 2011/12.
The removal of the ring fencing of the Drug Intervention Programme money along with the transfer of a third of the money to an elected official responsible for crime and policing at a time of dramatic cuts in police funding raises the significant threat of disinvestment in DIP services to fund other initiatives more attractive to the electorate, or simply to fund existing core policing activity.
This change is also likely to lead to a geographical redistribution of the money as the remaining two-thirds of the money will now be allocated via drug allocation to local authorities using a different formula for distribution. So in terms of DIP money the Police may choose to disinvest it in drug and alcohol services and the remaining current ring fenced money will come down to Local Authorities via a generic allocation for drug services which they can choose to disinvest in DIP services or indeed drug misuse services in general if they choose.
It is unclear what requirement (if any) it is envisaged there will be for Public Health England to provide services such as needle exchange, screening and testing for blood borne viruses, vaccination and treatment for hepatitis and other health problems associated with the use and administration of drugs, or what alternative arrangements are proposed for these vital services. Indeed, even within the realm of Public Health, the reorganisation seems at risk of being something of a fiasco. Professor John Ashton, Joint Director of Public Health, NHS Cumbria and Cumbria County Council is brilliant in his condemnation.
It is unclear what role and/or responsibilities are envisaged for GP Consortia in the provision of harm reduction services and drug and alcohol treatment more generally. There is serious concerns that Clinical Commissioning Groups in many areas seem ill prepared to take on their new responsibilities, generally, and particularly around the needs of those with serious drug and alcohol dependency.
The Health and Wellbeing Boards in many areas will not have progressed sufficiently to enable them to effectively manage their public health responsibilities by April 2013.
It is unclear who will monitor standards, quality and investment in drugs and alcohol services in line with the Drugs Strategy following the demise of the NTA.