Drug strategy will fail without new money, say critics
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3460 (Published 17 July 2017) Cite this as: BMJ 2017;358:j3460
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The Drug Strategy 2017 is, in effect, announcing the end for community substance misuse services. The grant from Public Health England (PHE) to Local Authorities (LAs) to commission these services is labelled as being "ring fenced" . However, since there is not a statutory requirement for LAs to provide these services, any ring fencing seems to disappear and funding cuts by up to a third or more seem common and some LAs are considering not providing any local substance misuse services at all.
PHE has no power to direct LAs how to spend the money once it has been handed over. On page 28 of the strategy it states: "We have confirmed the continuation of the ring-fenced Public Health Grant to local authorities until April 2019 which funds drug and alcohol services (treatment and prevention). During this period we will maintain the condition for local authorities to ‘have regard to the need to improve the take up of, and outcomes from, drug and alcohol services’. Our consultation “Self-sufficient local government: 100% business rates retention” set out proposals to fund public health responsibilities beyond this period through retention of locally retained business rates." So it seems the clear implication is that after April 2019, LAs will be expected to fund all substance misuse services themselves with no PHE grant.
How do we think that will turn out given their track record so far? I suggest we lobby hard to make provision of these services a statutory responsibility - and moreover, they should probably be back under the auspices of the NHS instead. Otherwise, anyone with a drug or alcohol problem - or seeking help for a relative of friend, is not going to be able to access any help at all - with all the implications for health, death rates, crime and associated misery that will inevitably follow. Please speak to and lobby anyone you can to help avoid this imminent public health disaster.
Competing interests: No competing interests
Dear Editor,
2017 Drug Strategy – the highs and the lows
The new Drug Strategy 2017 (1) has long been awaited by service providers, health professionals, and researchers alike. It builds on the approach of the 2010 Strategy while recognising the changing drugs’ markets and changing patterns of use of drugs, with a growing proportion of older people misusing drugs. The 2017 Strategy pledges a partnership-based approach ‘to build a safer and healthier society’ and considers how to alter the behaviours and choices of people affected by misuse of drugs. The existing U.K. legislation remains in force, including the recent Psychoactive Substances Act 2016, against a growing international tendency to depart from ‘the war on drugs’. Unsurprisingly, drug consumption rooms or supervised injection facilities do not feature in the new strategy, against the evidence that those measures would reduce drug-related mortality, as addressed by Limb (2).
The 2017 Drug Strategy aims to reduce illicit drug use and increase the rates of recovery from drug dependence. The new Strategy puts further emphasis on reducing demand and aims at actions at both national and local levels to prevent people from starting to use drugs, and to prevent escalation towards more harmful use. It also aims at restricting supply by means of innovative technologies, and pledges to take on a leading role in global action promoting new initiatives in preventing dug harms and sharing good practice regarding, for example, new psychoactive substances (NPS, formerly known as ‘legal highs’).
The above ever growing group of drugs, NPS, is specifically targeted in the 2017 Drug Strategy, which I personally welcome, as our research demonstrates that many of these substances can have an addiction liability of which users are normally unaware. Thus Public Health England (PHE) is developing a NPS intelligence system and collaborating with an NPS clinical network to establish NPS-related harms, and agree clinical responses to those.
As an educator, I also welcome the fact that the new Drug Strategy recognises the importance of helping children and young people to develop confidence, resilience and “risk management skills to resist risky behaviours and recover from set-backs” through Personal, Social, Health and Economic (PSHE) education in schools, in collaboration with the Department of Education. Another positive aspect of the 2017 Drug Strategy is its recognition of the links between substance misuse and mental ill health (e.g. depression) as well as homelessness and personal vulnerability, particularly in women, and contact with the criminal justice system. Improved links with mental health care and a focus on housing and employment are important and necessary for users of drugs to achieve a lasting recovery.
However, and as discussed by Limb, local drug and alcohol services express concerns that the “strategy will fail without new money”(2). They summarise the new strategy with a critical tone as ‘it says much and promises nothing’. Indeed, local services who have suffered cuts in funding expect more explicit promises of sufficient resources to support their work with and for people affected by drug misuse. There is an expectation that the new Drug Strategy Board, chaired by the Home Secretary, should secure the pledge, and this includes funding to implement the aims of the 2017 Drug Strategy. We at Roehampton University deliver knowledge transfer from our research on NPS to Blenheim CDP, a major London-based charity that provides support to drug and alcohol users, their families and carers. John Jolly, Chief Executive of Blenheim, commented on the new Drug Strategy: “I welcome the Drugs Strategy and its renewed focus on reducing drug related deaths, however it will not have an impact unless Local Authorities are provided with adequate and ring-fenced resources to deliver it.’
1. Drug Strategy 2017. https://www.gov.uk/government/publications/drug-strategy-2017
2. Limb M. Drug strategy will fail without new money, say critics. BMJ 2017; 358:j3460
Yours faithfully,
Jolanta Opacka-Juffry, PhD
Competing interests: No competing interests
Re: Drug strategy will fail without new money, say critics
Where is the voice of the Chief Medical Officer and of Public Health England in the running down of public health capacity and capability in England?
Competing interests: No competing interests