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retendering. Prof Drummond stated that ‘people with
complex needs are not getting the same access to
treatment as before’ and went on to say that the
‘biggest impact of constant retendering is going to be
on people with the most complex needs. They’re not
attractive people to treat – they’re costly, with poor
outcomes.’
Furthermore, when contracts are tendered, the
expectation is that the service will see ‘twice the
number of people with half the amount of money,’ he
said. ‘So they strip staff costs and have fewer qualified
staff and more volunteers.’ It was also an extremely
expensive process – ‘money that could have been spent
on treatment instead of lawyers drawing up contracts’.
With retendering taking place every three years in
local authorities, clients were constantly affected by
the changeover process.
Add to this the loss of specialists to the field – ‘in
addiction psychiatry we’ve lost 60 per cent of training
places in England’ – and you have the perfect storm,
he said. ‘It looks like there are plenty of people in
treatment, but the people in most need are being
denied care. If they’re not being taken care of here,
they will pop up elsewhere – in A&E, GPs’ surgeries
and in prison… there is an artificial separation
between health and social care.’
So what needs to change? Prof Drummond
suggested immediate recommendations for the
incoming government:
• Ring-fence funding that’s going into addiction
treatment. ‘Ring-fencing needs to be safeguarded
not further depleted,’ said Prof Drummond.
‘Cutting these services is a false economy. Local
authorities will only see it from their perspective,
but it will cost them more money in the long term.’
• Bring the NHS back into the fold: ‘We felt it was
wrong to put everything in the control of local
authorities.’
• Put a moratorium on retendering. ‘We see no
evidence that it improves services.’
• Protect specialism and experience, eg addiction
psychiatry. ‘No area should fall over for lack of
experience.’
• Deal with people with complex needs properly.
‘We need to rebalance the system to do this – and
if we don’t treat them, they cost a lot to the
economy.’
• Back minimum unit pricing (MUP). ‘It would have
huge benefits – to both moderate drinkers and to
people at the severe end of the spectrum.’
• Increase research capacity. ‘If we don’t understand
the impacts, we won’t learn.’
Discussion between members of the APPG – which
includes MPs, treatment providers, specialist and
advisory groups and people representing service
user and recovery communities – reinforced the
need for action.
‘We need a single government
minister for drugs and alcohol’
The Drugs, Alcohol and Justice Cross-Party Parliamentary Group submitted a ‘charter for
change’, calling upon the government to tackle drug and alcohol-related illness and
deaths through investment, education, and a commitment to evidence-based practice.
Top of the list was the call for a single government minister to be responsible for drug
and alcohol policy, accountable to parliament.
The minister would be empowered to:
• Focus drug policy on health, mental health and social inclusion, looking particularly
at people with multiple needs, such as mental health issues and homelessness.
• Develop a harm reduction strategy to reduce drug and alcohol-related deaths and illness.
• Create a national commissioning ombudsman to ensure transparency and
accountability.
• Widen the Care Quality Commission (CQC)’s remit to include all local authority-
commissioned drug and alcohol services.
• Ensure competence and accreditation of the workforce by investing in an
independent association.
• Commit to reviewing drug policy at national and global levels, building on progress
at last year’s United Nations General Assembly Special Session on drugs (UNGASS).
The minister’s priorities should include following guidance provided by the Advisory
Council on the Misuse of Drugs (ACMD) – including ensuring comprehensive access to the
life-saving drug naloxone across the whole of the UK, and making NICE-approved
treatments available to all patients diagnosed with hepatitis C.
‘We’ve had a world-
class addiction system
in the UK, and we’re
in danger of losing it.
We’re in danger of it
not existing...’
‘A lot of this isn’t new but political will is lacking,’
said Alex Boyt, who worked for years in service user
involvement. ‘It’s a lose-lose conversation – people
who are not cost-effective are not being treated.’ The
‘relentless commissioning’ also exacerbated the
situation: ‘Each time clients are lost, old and new
providers blame each other.’
Prof Drummond said that ‘those most affected by
cuts have been rehabs’, to which Caroline Cole, interim
chief executive at Broadway Lodge, added: ‘We’ve had
to pull back on the numbers of people with complex
needs as the local authority can’t pay us what it costs
us to treat them.’
The prison population was also being failed.
‘There’s a massive spike in deaths on release,’ said Prof
Drummond. ‘The window when they come out is vital
– we used to be better at that. There was better
throughcare, but the programmes have been
dismantled.’
‘Work happens inside, but the problem is when
they come out,’ said a volunteer at a prison recovery
service. ‘Places are limited – there’s nowhere to go –
so they go back to old stamping grounds, old habits
and back inside. I sat on a drug strategy group at
prison and they do their best, but they’re stretched –
and once people are back inside they’re lost again.’
‘We see people who are retoxed in prison, put back
on methadone, with no link with community services,’
added Sunny Dhadley from the Service User
Involvement Team (SUIT) at Wolverhampton.
‘There seems an inability to have that very basic
conversation about economic commonsense,’ said
Boyt. ‘With the election looming, even fewer people
are listening than usual. Is there anything we can be
doing practically – other than lamenting – to make
the case?’
‘Why doesn’t the treasury see the madness of the
way we’re running things? Why aren’t they looking for
a rational approach?’ asked one MP.
‘What we’ve done as a group is to approach all the
ministers responsible [see left] and given them the
evidence,’ said Lord Ramsbotham, the APPG’s chair.
‘They’ve patted us on the head but not reflected the
evidence. The cost of not doing one thing in an area is
going to be seen in another – all exemplified in the
lack of a national drug strategy.’ DDN
May 2017 | drinkanddrugsnews | 7