Thursday, 11 September 2014

10 things about alcohol and other drugs you may have missed

These slides are a way of capturing some of the interesting information about alcohol and other drugs that I come across in my reading.

As you'll see the ones below include data on drug related deaths in England and Wales, local government spending on substance misuse services, mental and behavioural problems for adult prisoners, prisoners testing positive for drugs, the use of custodial sentences for drugs offences in England and Wales

It should be clear where I've sourced the information from (but if not and you'd like to know then do get in touch)

It is also worth saying that if there are any errors in the presentation they are almost certainly mine rather than the original authors.



Earlier slide packs are available here.

Monday, 8 September 2014

The Unusual Suspects

Photo by Flickr user Rick Payette
Last week I took part in a session at the Unusual Suspects Festival, an event which brought together individuals and organisations that are delivering social change with the aim of exploring how collaboration and social innovation can work in sync to help address some of society’s most pressing challenges.  A group of us from the Making Every Adult Matter (MEAM) coalition looked at the issues of collaboration that have been thrown up by working together on multiple and complex needs. 

MEAM is a coalition of the membership bodies for service organisations across homelessness (Homeless Link), drugs (DrugScope), mental health (Mind), and criminal justice (Clinks) which came together in 2009 to improve practice and policy for those with multiple and complex needs and who struggle to stay engaged with services.

Without running through all of the contributions that were made at our session – I’ve collected together the Tweets that I and others sent out if you’re interested and the slides we presented are below – there were a number of themes that came up across the presentations.



Collaboration is messy and trust is key
We talked about how frustrating collaboration can be and that sometimes it may feel that it would be easier if we did things by ourselves; but that doing so would mean that we’re less likely to achieve all that we could.  We explored how within MEAM we have learnt to accept that collaboration can be a messy business, but that this mirrors the complexities of the issues we’re trying to address, and leads to better outcomes.

It is through developing trust in each other and a deeper understanding of each other’s expertise that we have achieved outcomes that are truly shared.  And remembering and exploring the focus of the MEAM coalition has been an important loadstone for the work we’ve done together.

Being able to have open conversations, both with partners and with our funders, has also been critical to deepening the relationships. We know that sometimes MEAM will be at the front of some of the partner’s work and at other times it may not be a priority, but that this doesn’t mean that we’re not equal partners.  We know that sometimes we aren’t as visible on issues as we would be if we were to speak as individual organisations, but we believe that we are stronger by standing together.

We also know that trust is important in the direct work that the MEAM coalition has facilitated. Those working to support individuals with multiple needs in local areas explained how building towards mutually agreed outcomes and at a pace set by individual beneficiaries seems to have borne more fruit than working in silos. We heard about one case where small steps towards a trusting relationship with a client started with buying a bike lock and ended with the client engaging with drug treatment and taking steps towards recovery.

Resources are at the heart of getting it right
Across MEAM there has never been a desire to build the coalition as a separate organisation, and that has determined how resources have been allocated.

Most of the posts that are focused on delivering our shared MEAM agenda are ‘embedded’ in the organisations that make up the coalition – so my colleague Sam, who is managing the Voices from the Frontline project, sits at the desk next to me, but works with a team that sits in Homeless Link, Clinks and Mind.

But we also reflected that having a small ‘core’ MEAM team that focusses solely on how to progress the coalition’s aims has been at the heart of the progress we’ve made.

Similarly, in the direct work that localities have undertaken using the MEAM Approach, bringing shared resources to bear on the issues that service users have identified as their priority has been crucial.

Give it away
At a period of time where many organisations (including DrugScope) are thinking about how we create new forms of income MEAM is taking a slightly different tack.

MEAM has chosen to ‘give away’ the approach that we’ve developed to working with people with multiple and complex needs – providing information and advice via the MEAM Approach website.

It isn’t that MEAM partners don’t want to be paid for what we do but our view has been that it is more important to share with others how we’ve worked and to see if that leads to new contacts and subsequently new opportunities that are mutually beneficial to us and to people with multiple needs.

Anyone can see the detail of how we’ve worked and this has helped (we think) develop a sense that with patience and a person-centred approach, things do turn round for the people we’ve been trying to support.

So where next?
We concluded by reflecting that we need to make sure that we’re listening to and reflecting on the stories and priorities of the people who find themselves with multiple needs.  Thinking we know all of those stories and that we’ve nothing left to learn would be a terrible mistake.

My sense of the discussion we had at the festival was that the partners involved in MEAM retain a strong commitment to the aims that brought us together in the first place.  We see both the continuing failures in society to reduce the most extreme harms that this group suffer and the potential to make a step-change, should our and others’ efforts in this area bear fruit.


Wednesday, 3 September 2014

Sharp rise in drug deaths is a cause for concern

Last year the Office for National Statistics consulted on making savings by stopping the analysis they do on drug related deaths.  Fortunately that consultation concluded that this was a “high impact output with widespread support” and as a result we have this year’s report, which shows that the recent trend of falling numbers of people dying as a result of drug use was sharply reversed in 2013.

Deaths that were attributed to illegal drug use rose by 20% in 2013 to 1,957 contributing to the overall number of drug deaths (both legal and illegal) which at 2,995 are the highest levels since 2001.

Over half of all drug related deaths involved an opiate, and for men in their 30s this rose to two in three (68%).  The most commonly recorded opiates were heroin and/or morphine which were seen in 765 deaths a 32% increase from 2012.  They also record 429 deaths where methadone was detected.

The ONS suggest that the end of the ‘heroin drought’ which has seen rising purity of street heroin may explain the increase in the number of deaths associated with the drug.

But there are a number of other drugs where 2013 is the year with the highest number of deaths since records were started.  These include:

  • Amphetamines including ecstasy (120), 
  • New Psychoactive Substances (60), 
  • benzodiazepines (342), and 
  • tramadol (220)

Also worth noting is that while alcohol deaths are recorded separately, in 30% of the cases in this report there was a mention of alcohol or long term conditions associated with alcohol abuse, in addition to drugs, in the coroners’ reports.

Men in their 30s, followed by those in their 40s, had the highest mortality rates as a result of drug use. And the ONS point out that:
The male mortality rates in these two age groups were significantly higher than the rates in all other age groups, and much higher than females of any age.
However, in a background note, they do point out that nearly 1 in 7 deaths among people in their 20s and 30s were drug related.

Marcus Roberts, DrugScope’s Chief Executive, in our response to these figures says:
DrugScope has grave concerns over the significant increase in the number of drug-related deaths registered in England and Wales last year.  The figures mark a reversal of the recent downward trend and appear to show the sharpest increase since the early 1990s.  Of course, this is about more than just numbers; each death represents a tragedy for the individual concerned, their family and friends.
In 2012, the Advisory Council on the Misuse of Drugs (ACMD) reported to the Home Secretary that naloxone saves lives and ‘fits with other measures to promote recovery’, concluding that the drug should be made more widely available.  While the government (in 2014)  accepted this recommendation, the current date for implementation is still a year away, in October 2015.

In our media release, we call on the Home Office and Department of Health to reconsider that timetable, “so that this life-saving medication can be used sooner, to prevent more people from dying.”

Thursday, 28 August 2014

Your chance to have your say about the State of the Sector

In late 2013, DrugScope carried out the first State of the Sector study on behalf of the Recovery Partnership. Focussing primarily on partnership working, non-treatment related activity, support needs, the impact of recommissioning and, where relevant any funding changes, the resulting report attracted significant interest from policy makers and key stakeholders.

For example, Marcus Roberts, DrugScope’s chief executive, presented the findings to the Inter-ministerial Group on Drugs. Public Health England took a steer from the report in setting their 2014-15 work plan focussing on employment and housing, and the report was picked up by the media, including in a column by Owen Jones in the Independent.

This year, State of the Sector is back, with the survey being launched in a couple of weeks. Whereas in 2013 we limited the scope to adult community and residential services, in 2014 we’re also looking to hear from young people’s services and prison services.

To help us design questionnaires that will hopefully give us a deep understanding of the current issues for the sector, and how it is addressing them, we’ve consulted widely. We’ve spoken to government departments, executive agencies like Public Health England, and – crucially – agencies and service managers with significant experience of providing and managing the types of services we’re keen to hear from.

In addition to the online surveys, learning more – and being able to say more – about the experience of services is crucial, which is why this year, we’ll be carrying out a number of short interviews with service managers from across the country - something that gave real depth to our understanding of the quantitative results of the survey when we did it last year. We’ll also be interviewing three chief executives, as we did last year, to help us present the strategic picture alongside local experience.

How to take part
We’ll be launching three questionnaires in September – one each for adult community and residential, prison services and young people’s services. As we are interested in developing a deep understanding of the circumstances services are facing and how they’re adapting to them, the questionnaires are quite substantial and in places ask for detailed information. To assist you in completing the survey, you might find it useful to have the following to hand:
-              The number of clients accessing your service;
-              Their support needs
-              Details of any changes to your funding and the length of your contract;
-              Any other services you work in partnership with, and
-              To what extent your clients are able to access other specialist services.

One of the reasons last year’s report was so influential was because of the numbers taking part. This year we’re aiming for more participants again.

Confidentiality
We’re conscious that some of the information we’re asking for is potentially sensitive, and that some opinions might be contentious. We take confidentiality extremely seriously: all responses will be kept anonymous, and when we include direct quotes in the final report, we’ll take care to ensure that no potentially identifying information is included – in fact, once a quote has been identified for inclusion, that’s the only editing we do. We hope that services will be reassured by this and will be frank in their responses.

We’ll email members, subscribers and other contacts as the surveys go live, or you can check our website and Facebook page. If you would like more information, please contact Paul Anders – paul.anders@drugscope.org.uk . If you would like to read last year’s report, please follow this link: http://www.drugscope.org.uk/POLICY+TOPICS/StateoftheSector2013

Friday, 15 August 2014

Rise in benefits sanctions: an incentive or a punishment?

New figures from the Department of Work and Pensions out this week show a sharp increase in the number of people being sanctioned – that is, having their benefits temporarily withdrawn.  (Thanks to my colleague Paul Anders for drawing my attention to them).

The most dramatic increase is among those claiming Employment Support Allowance (ESA), which supports people who are unable to work, or need support to work, due to illness or disability. Sanctions are applied (as I'll explain in more detail) where someone has failed to comply with the requirements that come with claiming their benefit.

How much has sanctioning increased?


The figures are stark: in the first quarter of 2013, 3,574 people on ESA were sanctioned; the figure for Q1 of 2014 is 15,955. That’s an increase of 346% – and understandably, this dramatic surge has drawn critical comment from Crisis and others.

The sanctions regime for ESA was significantly toughened in December 2012, meaning claimants could lose more of their allowance for less flexible – and potentially longer – periods of time. Since then, the number of people being sanctioned has steadily increased:

Before we jump to any conclusions, the first thing to look at is the number of claimants. Can the increase be accounted for by greater numbers of people claiming ESA?

The ESA caseload in February 2013 was about 1.6 million. It’s been increasing steadily since the benefit was introduced in late 2008, and in February of this year hit the 2 million mark:


However, that's only an increase of 31% over the year - clearly nowhere near enough to account for the rise in sanctioning during the same time.

So, why are more people being sanctioned?


Everyone claiming ESA is assessed for their ability to work. (This is generally done through Work Capability Assessments, which have come in for criticism, not least from our partner Mind, who are campaigning for them to be improved.) If you’re assessed as being in the “work-related activity” group – DWP jargon meaning you’re able to take steps towards future employment – you’re required to do two things: attend interviews with a Work Programme adviser, and “participate in work-related activity”.

Looking at the data, the proportion of sanctions that are applied for failing to attend an interview is falling, while that for not participating in work-related activity is rising. Usually, the latter will mean failure to meet a “jobseeker’s direction” – a request that might include attending a training course or updating a CV (it’s worth noting that no-one on ESA is required to apply or interview for a job).

So, we know that more people are failing to meet the conditions laid down, beyond the basic requirement to attend an interview. What we don’t know, however, is whether the directions being given are appropriate considering claimants’ health and personal circumstances. If they're not, the increase in sanctions could reflect a failure to recognise the needs of claimants.

Should we be worried?


A recent survey of service providers we carried out jointly with Mind, Homeless Link and Clinks showed that sanctions were of overwhelming concern to organisations working with people experiencing multiple needs – for example, those with combined substance misuse and mental health problems. Combine that with evidence from our partner Homeless Link that sanctions are affecting many vulnerable people – particularly those with mental health and learning difficulties – and we need to ask hard questions about why so many more are being applied.

Over the coming months, Voices from the Frontline – the project I’m running – will be helping service users and professionals to discuss their experience of the benefits system. It’ll be interesting to see what this tells us about the requirements attached to ESA, and whether they’re changing in a way that explains the rise in sanctions.

Few dispute that an effective welfare system needs to incentivise people to move closer to the job market, but it's worth remembering that ESA is designed to help people who will need support (and sometimes quite intensive support) to do that. Given the scale of the increases we're seeing, sanctions for ESA are starting to look less like an incentive and more like a punishment.

Sam Thomas is the programme manager for Voices from the Frontline, a new project to bring the voices of people with multiple needs and those who support them to the heart of the policy debate. He works with a team based across the Making Every Adult Matter coalition (Clinks, DrugScope, Homeless Link and Mind).

You can follow him on Twitter at @iamsamthomas.

Wednesday, 30 July 2014

Survey reveals impact of welfare and commissioning reforms on people with multiple needs

DrugScope – together with its partners in the Making Every Adult Matter coalition, Clinks, Homeless Link and Mind – is running a two-year project called Voices from the Frontline. It starts with a theory and a conviction. 

The theory is that people experiencing multiple needs and exclusions – those who have a combination of problems including mental health, substance misuse, homelessness and offending – may be disproportionately affected by reforms to welfare and the commissioning of public services. 

To test this, over the last month we surveyed members of the MEAM coalition partners. Over 140 organisations participated, between them representing as many as 70,000 individuals. The results provide strong evidence that people with multiple needs are losing out from recent reforms. However, they can only give us a partial picture of what’s happening. 

This brings me to the conviction. If we want to understand the problems that people with multiple needs are facing, we need to involve them in that discussion. That also goes for the practitioners who support them, who can help us link local circumstances with the national picture. Voices from the Frontline aims to make this happen and this data is helping map out the territory. 

So, what did we find – and what does it suggest should be on the agenda? 

Welfare reforms are having an overwhelmingly negative effect on people with multiple needs.


This doesn’t come as much of a surprise – there’s plenty of evidence that welfare reforms have hit the most vulnerable hardest – but our data provides useful detail. We asked services to assess how many of their clients with multiple needs are affected by various changes to the welfare system:



Clearly, of all the reforms to welfare, strengthening of sanctions has had the biggest impact on people with multiple needs. Since 2012, heavier penalties have been placed on those claiming Jobseeker’s Allowance (JSA) and Employment Support Allowance (ESA) (which supports people unable to work due to illness or disability). Four out of five services reported that more than half of their clients with multiple needs had been affected by the new regime. This reinforces evidence from Homeless Link that sanctions are having a serious affect on people with complex problems. Changes to Work Capability Assessments – which determine eligibility for ESA – are also having a widespread impact.

Alongside this, cuts to legal aid and advice are heavily affecting people with multiple needs. Breaking this down by sector, services working on criminal justice and homelessness issues reported more of their clients with multiple needs being affected. It may be that reduced access to legal support complicates difficulties caused by other reforms – for instance, appeals against benefits decisions – and this is something we want to look at more closely.

Changes to commissioning structures are having a mixed and uncertain impact.


We also asked services to assess the effect that various changes to commissioning – the processes through which they access public funding – were having on multiple needs clients. The clearest finding was that the end of ring-fenced funding for Supporting People is having an overwhelmingly negative impact on people with multiple needs:



Supporting People is a national programme of funding for housing-related support, aimed at helping people live independently. Since 2012, local authorities have been able to spend this allocation as they wish, and many have opted to cut services that had previously been funded from it. These decisions – taken against the advice of the then Housing Minister Grant Shapps – are clearly disadvantaging people with multiple needs.

In general, though, commissioning changes present a mixed picture. For instance, services were guardedly positive about the introduction of Police and Crime Commissioners and Health and Wellbeing Boards. On other reforms yet to take hold – Transforming Rehabilitation, for example, which is reforming the management and rehabilitation of offenders – they reserved judgment. And when asked about the cumulative impact of all the recent reforms, their responses were negative, but not overwhelmingly so:



What does this all add up to?


This ambivalence about the impact of the (often very complex) changes to commissioning structures highlights a wider truth about these results. Although we should be concerned about the impact of individual reforms, it’s more important to understand how they interact. People with multiple needs present a challenge for policymakers, because their problems tend to cut across different services, making them particularly vulnerable to the combined effects of reform.

We’ll be publishing a full report on the survey results next month – and over the next year, we’ll use these findings as the basis of discussions with service users and practitioners across the country. We’re confident that their insights can help policymakers to design systems that improve and don’t disadvantage, the people who need them most.

Sam Thomas is the programme manager for Voices from the Frontline, leading a joint team across Clinks, DrugScope, Homeless Link and Mind. If you’re interested in being part of this work, or would like to find out more, email samt@drugscope.org.uk.

Friday, 27 June 2014

Devolved commissioning of victim and witness support services: an opportunity for substance misuse services?

Safer Future Communities Consultant Julia Mlambo, based at the London Voluntary Service Council (LSVC), gives us an insight into the way Ministry of Justice commissioning of victim and witness services is changing – and what that might mean for substance misuse services.

Historically the Ministry of Justice (MoJ) commissioned a range of victims and witness support services, nationally. However, from  April  to September 2014, the MoJ will be devolving funding to Police and Crime Commissioners (PCCs) to enable them to commission services more responsive to local victims’ and witnesses’ needs.

After October 2014, the MoJ will still retain a small national specialist commissioning portfolio.  However, most of the services previously funded by the MoJ have been told that their funding will only be in place until the end of September. After that, it will be up to local PCCs to decide whether they want to continue to support them.

As well as devolving the commissioning of services, the MoJ has said that it will increase the amount of funding available to procure services, to encourage PCCs to commission innovative interventions. These new resources are likely to mean more opportunities for criminal justice related providers, including substance misuses services.

It is worth being aware of some of the key legislative and policy drivers that will affect the commissioning of victims and witness services over the next few years. Some of these are laid out below:

MoJ Victims' Service Commissioning Framework (May 2013) – Sets out principles to underpin the commissioning of Victims Services, setting out the 8 category of need. These are areas in which service providers should aim to support people to achieve improvements in their lives post victimisation. Categories include ‘mental and physical health, drugs and alcohol, finance and benefits etc. 

The EU Directive on Minimum Standards on the Rights, Support and Protection of Victims of Crime (2012) - The directive sets out victims’ rights, outlines what support should be available to victims and promotes the use of restorative justice interventions. 

Changes in the commissioning of health related justice services - responsibility for the commissioning services such as health care in police custody suites, sexual assault referral services (SARCs) will be transferred from the Police Service to NHS.  In light of these changes, in some areas, there are plans to retender these to improve costs and quality.

If your organisation offers innovative substance misuse interventions in the criminal justice field, you may find you have access to new funding opportunities.  Now is the time to contact your local PCC to see what their future commissioning intentions are.

Thanks to Julia Mlambo, Safer Future Communities Consultant, London Voluntary Service Council (LSVC) for this blog.  If you have any questions or would like any further information, please contact Julia at Julia@lvsc.org.uk