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

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 

Wednesday, 25 June 2014

Voices from the Frontline: does your organisation support people with multiple needs?

We need the help of the drug and alcohol sector in shaping an important programme of work around people with multiple needs, and helping us to understand the impact of welfare reform and commissioning changes on this group. 

If your organisation works with clients who, as well as drug and alcohol problems, also experience problems such as homelessness, mental health and involvement with the criminal justice system, please spend 10-15 minutes completing our survey. Please note that the survey will close on 11 July. 

Voices from the Frontline 

"We want to have some control over our next steps. We want choices" 

Over the next two years the Making Every Adult Matter (MEAM) coalition will be delivering Voices from the Frontline, a project to bring the voices of people with multiple needs and those who support them to the heart of the policy debate. The group of service users this project will seek to represent are those: 

  • Experiencing several problems at the same time such as mental ill health, homelessness, drug and alcohol misuse, offending and family breakdown;
  • With ineffective contact with services; and 
  • Living chaotic lives.

Membership survey 

To start the project, the coalition partners, DrugScope, Mind, Clinks and Homeless Link, are surveying our member organisations to try and understand how two policy areas, access to services (commissioning changes) and access to benefits (welfare reform), are impacting on those with the most complex needs. 

We chose these two topics because they came up time and again in the sector surveys carried out by the MEAM coalition partners. For example, in the research we did for DrugScope’s State of the Sector report, one complex needs service manager told us: 

"I know of people who have been repeatedly cut off from benefits in the
 middle of serious physical and mental health problems and treatments, 
whose cases have gone to court or tribunal repeatedly, and repeated 
judgements in court say that they should not have been cut off.” 

This survey is our first step in building a picture of how these important changes to services and support are seen by people with multiple needs and by those working with them most closely. The findings will inform our work over the next two years, which will help policy makers nationally and locally shape policy both in the run up to the general election and beyond. 

What to do next 

If your organisation works with multiple needs clients, this is your opportunity to help us understand the situation in the areas you work in. Please spend 10-15 minutes helping us by completing the survey. The survey will close on 11 July. 

If you have any questions about the survey, or would like to find out more about the project, contact Sam Thomas (, who is managing Voices from the Frontline.

Monday, 23 June 2014

A threat to us all: tackling organised crime a priority for Home Secretary

On the 11 June the Home Secretary gave a speech about organised crime and illicit finance, as you might expect drugs played an important part in her analysis of the problems that society faces as a result of the activities of these sorts of criminals.

As you’ll see she’s keen to portray organised crime as something that affects us all:

Most people don’t think of themselves as being a victim of organised crime, but the chances are that everyone in this room has been affected by organised crime in one form or another. Maybe you were caught up in their activities. Maybe your house was burgled by somebody addicted to drugs shipped here by a criminal gang. Maybe your emails were hacked. Maybe your insurance premiums are inflated because of organised scams. Maybe your taxes are higher because of fraud. Whatever your precise experience or experiences, the chances are that organised crime has affected all of us here today. 

She also suggested that it poses an existential threat to national security.

The threat from serious and organised crime is very significant and it is forever changing. Whether it is online or offline, overseas or at home, whether we are talking about drugs, stolen goods or trafficked people, organised crime amounts to a serious threat to our national security.

Her analysis of how those in organised crime create or use hollowed out states to create a alternative power structures (including justice, housing and jobs) is similar to that set out by Nils Gillman in his interesting lecture on deviant globalisation that you can hear here.

While decrying their value system May recognises that there is innovation in the ways that people involved in organised crime attempt to subvert the control systems that are in place.

Niche skills are bought to order – last year, for example, a drugs trafficking network brazenly hired cyber criminals to alter cargo manifests in an attempt to smuggle their goods in containers.

Her view of how this leaks into the legitimate market seemed to focus on individual corruption or exploitation rather than suggesting that there is systemic collusion between business and this huge illicit market.  But she announced there will be a cross-government anti-corruption plan in the next few weeks, which may take things further, meanwhile the approach she set out sees partnership rather than regulation being the way to reduce the threat of organised crime’s involvement in the financial sector.  She said that she’d recently met with chief executives from the financial services sector and there was going to be a Financial Sector Forum set up to share information on the “criminal finance and cyber threats we face”.

More broadly than the anti-corruption plan the Home Secretary also talked about the new Serious Crime Bill that was announced in the Queen’s Speech, and how this would close some loopholes in recovering the proceeds and assets of crime, and the wider strategy that the government have been pursuing in relation to serious and organised crime.

The take home messages for me were:

  • Her analysis of the problems posed by organised crime – that it affects us all, that organised crime can supplant the state if we don’t take care, and that there is innovation that needs to be countered – seems strong.
  • While drugs made up an important theme in her speech there’s no sense that I had that May is interested in really doing anything different to change drug policy other than to have a much stronger central control over serious crime enforcement responses.
  • She sees the financial sector as an important partner in addressing serious crime but recognises that corruption is an important tool that organised crime uses to enable it to operate.

Andrew Brown
Director of Policy, Influence and Engagement

Wednesday, 21 May 2014

Prevention: time to look at the bigger picture?

DrugScope’s new Director of Policy, Influence and Engagement, Andrew Brown, writes his inaugural blog for us on a subject close to his heart…

I’m now in my third week at DrugScope and I’ve already learnt a huge amount about the work we’re doing and how it connects to other, wider agendas. 

For example, I’ve been hugely impressed by the high quality of the work that we and our colleagues in the MEAM coalition have been doing to improve outcomes for some of the most vulnerable and troubled adults in our communities.  We will shortly take that further through the Voices from the Frontline project which will be – as the name suggests – trying to make sure that the views of service users and those who are working with them are part of policy consideration at national and local levels.

But for this, my first blog for DrugScope, I want to concentrate on an area that has been at the centre of my professional life for the last decade; how do we improve the quality of drug and alcohol prevention for young people through our school system.

Like my fellow members of the European Society for Prevention Research I’m conscious that while school-based prevention can be effective, it often hasn’t been and we have to be conscious that some approaches have been shown to do more harm than good.

As the Education Select Committee start their investigation into Personal, Social, Health and Economic (PSHE) education in schools, there’s an opportunity to reiterate the need for our health education to take account of where evidence is leading us, and to improve the experience that young people get.

My view is that much as in recovery, there’s an increasing recognition that we should be looking to the wider lives of young people and address substance use as part of the complexity of their lives.  That’s why I welcome the recent editorial in the BMJ pointing out that it isn’t a zero sum game when it comes to health education and wider academic attainment.

And interestingly a number of approaches that seem very promising look at the deeper roots that lead to young people developing problems and work from there.  One programme, which is widely acknowledged as having strong evidence, is the Good Behaviour Game, a strategy for teachers to use in primary schools; developed in the US and which will be the subject of the first UK randomised control trial next year.

I have great hopes for the programme, but we know that it takes a long time for evidence to accumulate and for programmes to become adopted in mainstream practice.  In the meantime, there is clear guidance that every school and teacher can take which will improve the quality of the experience of pupils.

I hope that many DrugScope members and supporters will join us in calling on the Education Select Committee to add their voice to the earlier recommendation by the Home Affairs committee, and to those of young people going to school now, that PSHE should be an statutory part of the school curriculum.

The deadline for doing so is 12:30 on 6 June.

Tuesday, 22 April 2014

If the cap fits…

Senior Policy Officer Paul Anders takes a closer look at the welfare cap and what it means in practice.

The Government’s 2014 Budget introduced a new social security or welfare cap as part of efforts to reduce a social security budget that the Government regularly describes as having got out of control. This has received significant media coverage and I thought it might be worthwhile looking at the consequences of the new cap and how it sits in relation to two other recently introduced caps.

The first of these affected Local Housing Allowance (LHA).  It is part of a number of measures designed to bring down the overall cost of LHA, including uprating LHA amounts by the consumer price index measure of inflation (with a fixed increase of 1% this year and next), moving to the 30th percentile from the median and introducing an absolute limit of 4 bedrooms regardless of household size and composition. A further change was extending the shared accommodation rate to those aged up to 35, with some exceptions – some of which may apply to people in treatment, if they have, for example, lived in some types of residential services for 3 months or longer.

The second cap to be introduced was the overall benefit cap. This limits claimant household income to the ostensible median wage for comparable working households - £500 per week for couples and single parents with children, and £350 per week for single people without children living with them. The extent to which claimant households are affected by either of these caps depends on a range of variables, but they will primarily tend to apply to larger households and those living in expensive areas such as London and the South East – almost half of the 38,665 households capped to the end of January 2014 were in London.

The 2014 budget introduced a different kind of cap – instead of being targeted at individuals or households to address instances of extremely large claims, the welfare cap is meant to act as a limit to most spending on social security. The cap has been set according to Office of Budget Responsibility (OBR) projections, starting at £119.5bn in 2015-16 and rising to £126.7bn in 2018-19, with a +2% margin. This is out of total social security spending of around £200bn (and total government spending of £720bn, by way of context), this discrepancy being the result of some types of benefit being excluded from the cap:

Attendance Allowance, bereavement benefits, Carer’s Allowance, Christmas Bonus, Disability Living Allowance, Employment and Support Allowance, Financial Assistance Scheme, HB (except HB for JSA claimants), Incapacity Benefit, Income Support, industrial injuries benefits, In Work Credit, Maternity Allowance, Pension Credit, Personal Independence Payment, Return to Work Credit, Severe Disablement Allowance, Social Fund – Cold Weather Payments, Statutory Adoption Pay, Statutory Maternity and Paternity Pay, Universal Credit (except for jobseekers), Winter Fuel Payments, Personal Tax Credits, Child Benefit, Tax-Free Childcare

Jobseeker’s Allowance and HB for JSA claimants, Universal Credit for claimants subject to full conditionality and on zero income (i.e. most people currently on JSA), State Pension (basic and additional), transfers (e.g. TV licences for over-75s), benefits paid from DEL (e.g. Funeral Expense Payments, Sure Start Maternity Grants and New Enterprise Allowance)

There was a Commons vote on the cap which attracted cross-party support. The reason? The Government claimed that ‘cyclical’ benefits like Jobseeker’s Allowance (JSA) and housing support for unemployed people had been excluded, meaning that the cap wouldn’t impact on individuals or households affected by a future economic downturn. This resulted in the cross-party support, even though it’s not strictly true: Tax Credits and housing benefit for working claimants are directly influenced by the economy and job market, as is the number of Employment and Support Allowance (ESA) claimants. The same goes for their counterparts under Universal Credit.

What does the cap mean in practice?

It’s important to reassure clients that the cap doesn’t mean that there’s any new limit on individual benefits. Should the OBR indicate that the cap is likely to be breached, the government has to table a motion in the House of Commons:

·         Proposing to increase the cap; or
·         Explaining why spending above the cap is necessary; or
·         Proposing changes to bring spending back beneath the cap.

It’s not clear yet what would happen in the event of the government losing the vote, but we do know that there’s nothing to say that any cuts to bring spending back under the cap would have to come from the particular benefit(s) that have been responsible for breaching it in the first place. It wouldn’t necessarily follow that further increases in the cost of housing support for people in employment (a not unlikely scenario – most new Housing Benefit claims in 2010 and 2011 were made by people in employment) would result in further LHA/HB reductions, although any shortfall would need to come from one or more of the benefits subject to the cap.

Out of control?
A final word about the claim that spending on benefits has got out of control. Given the number of households who are entitled to some sort of social security and changes to the system over time, it’s arguably possible to find figures that support almost any position.

What is pretty clear is that as a percentage of Gross Domestic Product (GDP), spending on benefits (including pensions) has increased. Much of that increase is due to positive reasons (increased life expectancy and sick or disabled people living longer, more active lives than was the case a few decades ago), but there are more negative reasons too. Spending on Housing Benefit for unemployed and employed people has increased, to an extent as a consequence of a reduced stock of social housing and long-term structural problems in the UK housing market, and the cost of Tax Credits and Housing Benefit for employed households reflects a tendency towards low wage employment.

Turning to benefits at an individual level on the other hand, the values of most main benefits have tended to decline compared to average earnings, whether under Conservative, Labour or coalition governments. ESA has declined from around 15.5% of average earnings in in 1995 to around 13% in 2008, before recovering to about 14.5% in 2012. By the same measure, JSA has declined from around 23% in the early 1970s to around 12% in 2012, or, to put it another way, while JSA has almost kept pace with the Retail Price Index measure of inflation, if it had kept pace with average earnings, it would now be worth around £145 instead of £72.40.

Also at an individual level, the Council of Europe’s European Committee of Social Rights suggested in a 2013 report that some individual types of benefits in the UK were too low, although it should be noted that all of the 37 countries reported on were also found to be in breach of European Social Charter requirements, and some to a greater extent. Returning to the macro level, Ha-Joon Chang, a professor of economics at the University of Cambridge, argued in a recent Guardian article that compared to the UK’s OECD peer group, spending on social security as a percentage of GDP is unexceptional. Data from Eurostat suggest that compared to western European peers, welfare spending in the UK may be somewhat lower than the norm. (Incidentally, Eurostat data also suggest that UK spending on employment support and labour market policy interventions is also rather low, even while we have a comparatively demanding conditionality regime – although that is a blog for another day).

It’s complicated

Whether or not the welfare bill is out of control or unaffordable and what the likely impact of spending on social security may be is a question for politicians and other policy makers, as well as macro and behavioural economists. There is evidence that while what we spend on welfare has increased by some measures, it remains unexceptional compared to other countries, and that at an individual claimant level, benefits do not appear particularly generous.

That may seem like fudging the issue, but the reality is, social security is complex, and it’s worth bearing that in mind when sweeping statements are made.

The draft Child Poverty Strategy 2014 – 17: share your views with DrugScope

Last month, the Government published its draft Child Poverty Strategy 2014-17.  Here, Senior Policy Officer Paul Anders sets the scene – and invites your feedback to DrugScope’s response.

Child poverty concerns drug and/or alcohol treatment providers for a number of reasons. Many services work with families affected by substance use, with local authorities as part of Troubled Families provision, or work directly with young people themselves. Most services will be aware of the sustained harm a deprived childhood can often cause and will have an interest in mitigating it.

The current measures of child poverty are contained in the Child Poverty Act 2010:
  • Relative income: household income less than 60 per cent of current median income;
  • Combined low income and material deprivation: children who experience material deprivation and live in households with incomes less than 70 per cent of current median income;
  •  Absolute income: household income less than 60 per cent of 2010/11 median income adjusted for prices; and,
  • Persistent poverty: household income less than 60 per cent of current median income for at least three out of the previous four years.

In November 2012 the Government launched a consultation on additional or alternative ways to measure child poverty. They proposed a new ‘multidimensional’ measure which could potentially include a range of other factors, such as worklessness, poor housing, parental skill and parental drug and/or alcohol use. The rationale included the need to learn more about ‘what it means to grow up experiencing deep disadvantage’ and the need to think more about the causes and routes out of poverty.

We were concerned that the proposals appeared to conflate or at least misrepresent the complex relationships between cause, effect and correlation.  In particular, they appeared to draw a connection between parental drug and alcohol use and child poverty – ignoring the lack of evidence as to the direction of any causal relationship between poverty and substance use.  Instead, government communications emphasised a small public opinion poll conducted on behalf of the Department for Work and Pensions, suggesting that respondents thought that drug or alcohol dependency was more important than income in deciding whether a child was growing up in poverty. 

A further concern was that claiming such a link between parental drug and/or alcohol use and child poverty risked further stigmatising parents with histories of substance use and, for that matter, households living in poverty more generally. Any solution to child poverty will require socially inclusive policies focused on reintegration.  If drug and alcohol use is disproportionally (and potentially incorrectly) emphasised as a causal factor of child poverty, the public, services, employers and other stakeholders are even less likely to be receptive to the reintegration of people with experience of substance use.

Given our shared concerns, Adfam, Alcohol Concern and DrugScope submitted a joint response to the consultation; I blogged about it at the time. The idea of a multidimensional measure – or indeed a series of them – was in many respects very appealing, but we felt that anything that blurred the current focus on income and material deprivation risked not so much moving the goalposts as burying them.

In March 2014, the Government published its draft Child Poverty Strategy, including a summary of responses to the 2012 consultation. There was support for a multidimensional measure, but as was the case with DrugScope and partners, most respondents emphasised the overriding role that income and material deprivation must have in any definition of poverty. For the time being, the measures in the Child Poverty Act 2010 apply.

About the draft Child Poverty Strategy 2014-17

The draft Strategy contains proposals to reduce child poverty grouped under the following headings:

·         Supporting families into work and increasing their earnings;
·         Improving living standards; and
·         Preventing poor children becoming poor adults through raising their educational attainment.

Under these headings, many of the individual proposals are things already in place, like the Work Programme (including the two drug and alcohol pilots, which are to be continued), the Troubled Families initiative and drug/alcohol payment by results pilots, or on the slipway, like Universal Credit (including ‘tailored conditionality’) and free school meals.

The proposals also include ‘investing in drug and alcohol treatment’, although this appears to reflect only the process of localism and public health reform that started in April 2013, the draft Strategy stating that local authorities will have ‘more freedoms and funding to local areas to enable those who know their communities best to decide which services to offer’.

DrugScope/LDAN will, jointly with Adfam, be submitting a response to the draft Child Poverty Strategy. If you would like to feed in to this, you can do so by taking a short survey here: .

Alternatively, please get in touch with Paul Anders at