National Outcomes Framework
Last week (8 July 2021) Dame Carol Black published the second part of her independent Review of Drugs, setting out a way forward on drug treatment and recovery for the government. In the opinion of myself and many others, the Review is the most important drugs report of the century so far. I covered Part 1 of the Review in depth and over the next few weeks I’ll be looking at the detail of Part 2 in a series of blog posts, you can find the blog series here. This week’s post looks at Dame Carol’s recommendations for a new central Drugs Unit which hold government departments to account for their work on drugs.
Dame Carol adopts a forthright style in discussing the parlous state of drug treatment in England:
“Funding cuts have left treatment and recovery services on their knees. Commissioning has been fragmented, with little accountability for outcomes. And partnerships between local authorities, health, housing, employment support and criminal justice agencies have deteriorated. The workforce is depleted, especially of professionally qualified people, and demoralised. Vital services have been cut back, particularly inpatient detoxification, residential rehabilitation, specialist services for young people, and treatment for cannabis and stimulant users.”
Describing the situation as “intolerable”, Dame Carol’s review had three main objectives:
- To increase the proportion of people misusing drugs who access treatment and recovery support, including more young people, and earlier interventions for offenders to divert them away from the criminal justice system, particularly prison.
- To ensure that the treatment and recovery package offered is of high quality and includes evidence-based drug treatment, mental and physical health interventions, and employment and housing support.
- To reduce the demand for drugs and prevent problematic drug use, including use by vulnerable and minority groups and by recreational drug users.
To achieve these objectives, she recommends significant changes in four key areas:
- Radical reform of leadership, funding and commissioning.
- Rebuilding of services.
- Increased focus on prevention and early intervention.
- Improvements to research and how science informs policy, commissioning and practice.
Reform of leadership
Dame Carol describes addiction as a chronic condition experienced within the social environment and says that clinical treatment alone is rarely enough. Many people will also need services to help them with family challenges, mental health, housing and employment support. These services must be coordinated at the local level, but now commonly exist in separate silos or are missing altogether. The difficulties experienced at local level are mirrored at national level. Ministers and departments have not worked sufficiently well together in a determined and sustained way.
Dame Carol says that giving the responsibility for drug treatment commissioning to local authority led Health and Wellbeing Boards has not worked:
“The current system of local commissioning is fractured, with different bodies responsible for different services and no real incentive for them to work together. These challenges have exacerbated the impact of cuts in local authority budgets. Because the impact of drug misuse is felt most acutely in the most deprived areas of the country, addressing these problems is central to the government’s ambition for ‘levelling up’.”
A new Central Drugs Unit
Dame Carol argues that an effective government response requires strong and co-ordinated action from multiple departments and says that previous drug strategies have suffered from sporadic cross-government engagement, with attention waxing and waning. She advocates the introduction of a new central Drugs Unit to coordinate and monitor this cross-departmental work and secure commitment and action from multiple secretaries of state.
Dame Carol highlights the importance of this new central unit having adequate analytical capacity. She recommends the development of a new National Outcomes Framework, with data published annually within a report to Parliament so that departments are held individually and collectively to account for progress. The unit should have ready access to senior scientific advice, to ensure that drug policy decisions are informed by the best available research.
Dame Carol’s vision of this National Outcomes Framework is that it should cover all aspects of the illicit use of drugs, including:
- the impact of enforcement action to reduce supply
- measures of drug-related harm and deaths
- drug-related crime
- the number of people (particularly offenders) in treatment
- the number of people with drug dependence accessing mental health services
- measures of progress on housing and employment
She argues that for substance misuse services, measures of service quality and effectiveness, recovery capital and quality of life in the longer term, should be included as well as numerical measures.
Dame Carol says this new unit should be advised by a long-term representative group of external stakeholders, including drug addiction scientists and people with personal experience of drug dependence, to assist the central unit in evaluating the new structures and holding relevant departments to account.
Dame Carol finishes this section of her report by demarcating the responsibilities for different government departments: “The HO should focus on controlling the supply of drugs, drug trafficking, gangs, and drug-related violence, and would continue to lead on legislation. DHSC would focus primarily on harm reduction, treatment and recovery, and DfE would lead on prevention initiatives targeted at young people.”
Next week’s blog post will look in detail at Dame Carol’s recommendation for increasing the level of funding for drug treatment and wider support.
Thanks to Pretty Drug Things for the images in this post. Pretty Drug Things explores different visual aesthetics and marketing techniques used in either promoting or demonising different psychoactive substances in our society.