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middle aged. A hard-pressed NHS
struggles to respond to those it
experiences as ‘challenging’, and service
users are easily discouraged by the
bewildering range of NHS signposts and
pathways.
Health and wellbeing boards, created to
knit local authority and NHS services
together, are preoccupied with the massive
challenge of integrating health and social care
and pay scant attention to lower priority issues
such as alcohol and drug treatment. The impact of
this is that a vulnerable population is excluded from
healthcare, resulting in unnecessarily early deaths – in far
greater numbers than the overdose deaths reported in the
drug-related death figures.
A similar chasm has been allowed to develop between prison and
community services. Since 2013 prison drug and alcohol treatment has
been commissioned by NHS England and usually delivered within large
multi-site contracts with generic healthcare providers. Startlingly this means
that neither the Ministry of Justice nor NHS England know how much is spent on
drug and alcohol treatment in custody – however the MOJ’s best estimate
suggests that prison treatment has also experienced a 25 per cent reduction since
they assumed responsibility. Before this, prison and community treatment was
commissioned as one system to facilitate effective transfer between the two
settings. The failure of the current system is illustrated by the fact that only 30
per cent of those assessed as having a continuing need for treatment on release
actually establish contact with a community service.
******* COMPLEXITY *******
The narrowing of local authorities’ ambitions for their specialist treatment
systems is accompanied by continuing decline in the generic services that are
fundamental to recovery. Despite the government’s laudable commitment to
parity of esteem for mental health within the NHS, the secretary of state has
acknowledged that the need to recruit and train enough doctors and nurses will
delay the achievement of this aspiration for many years.
The abject failure of the government’s Transforming Rehabilitation reforms of
the probation service dramatically curtailed the support available to offenders
serving community sentences, and on licence following imprisonment. In
addition, the probation service is now largely absent from local strategic planning
processes in which they used to play a prominent role. While these failings are
largely hidden, what is visible in cities across the country is the dramatic increase
in street homelessness, which has doubled since 2010 and increased 16 per cent
over the past year. This is only one facet of unmet housing need for people with
drug and alcohol problems, but it is currently the most visible manifestation of
the failure of society to meet the needs of its most vulnerable citizens.
******* CRIME *******
The government’s modern crime prevention strategy, launched by then home
secretary Theresa May in 2016, identifies drug treatment as one of society’s most
effective tools to reduce crime. Home Office analysis attributes half the rise in
acquisitive crime at the end of the 20th century to the impact of the heroin
epidemic, and a third of the reduction this century to the improving availability of
treatment from 2001 onwards.
The clear connection between heroin/crack dependence and crime made the
police strong advocates of improved treatment access, and they were extremely
influential players in drug treatment policy between 2001 and 2010. Over the
past decade police interest in drug-related offending and their advocacy of
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40%
17%
Only 17%
of those
who need
treatment
for alcohol
misuse are
getting it
40% of
heroin
users are
NOT in
touch with
services
25% drop
in funding
for
services
25%
30%
Only
30% of
prisoners
with
substance
misuse
issues
contact
services
upon
release
treatment diminished as acquisitive crime continued to fall and priorities shifted
to sexual offences, violence against women and girls, cybercrime, and terrorism.
Very recently there has been some reawakening of police interest in drug
treatment. Traditional crime is beginning to increase; burglary is up by 8 per cent;
theft from vehicles is up by 15 per cent; drug-related gang activity is becoming
more of a concern and appears to be linked to increasing use of firearms. Use of
firearms declined significantly alongside other drug-related offences from 2005
onwards but the most recent crime figures show an increase, including a 20 per
cent increase in the use of handguns. None of these increases can be exclusively
linked to the drug market, but if ready access to a well-funded drug treatment
system helped crime fall between 2000 and 2010 we should not be surprised to
see a reversal of the trend.
espite the scale of these overlapping challenges there are reasons
to be optimistic t hat we can find effective ways to respond. The
drug strategy is a huge step forward in endorsing evidence-based
practice and explicitly recognising the breadth of the responses
needed to succeed. The routine denial of issues such as
disinvestment and fragmentation that characterised official
responses before the publication of the strategy has been replaced with greater
willingness to own the scale of the challenge and seek pragmatic solutions. The
increase in traditional crime creates a rationale for police to renew their advocacy
of treatment, which has significant potential to shape local investment decisions.
Most importantly, the home secretary now chairs a cross-government board to
drive this agenda forward. Her leadership, supported by the objective grassroots
view of a newly appointed recovery champion, and underpinned by the
willingness to hold local authorities to account (via PHE) for their delivery of key
metrics, provides the best opportunity in a decade to address the complexity and
scope of the problems facing service users and their communities.
Paul Hayes is head of Collective Voice
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February 2018 | drinkanddrugsnews | 7