Monday, 10 March 2014

DrugScope launches new briefing on older people’s substance misuse on behalf of the Recovery Partnership

Gemma Lousley, DrugScope’s Policy and Engagement Officer, reports back from the launch event

At the end of February, DrugScope launched It’s about time: Tackling substance misuse in older people, a new briefing published on behalf of the Recovery Partnership. The launch event took place at the Guildhall, in London, with around 50 attendees from substance misuse and older people’s services, as well as commissioners and policy makers.

Several key issues were raised at the event. Marcus Roberts, DrugScope’s Chief Executive, noted that there is a growing awareness of substance misuse as a significant issue for older people, which the report aims to develop. Nevertheless, many of the specialist services visited during the research process for the briefing face funding problems; the majority don’t receive ‘mainstream’ drug and alcohol money, but are supported by independent funders, with fixed-term financing. Sustainable funding needs to be found so that these services can develop their expertise and provision, and to enable them to have a lasting impact.

Following a comprehensive presentation from Dr Sarah Wadd on the scale and nature of substance misuse among older people, Karen Black from Bristol Drugs Project (BDP), which runs the ‘50 Plus Crowd’ – one of the projects featured in the briefing – picked up on the importance of sustainable funding as she highlighted the levels of demand now being placed on the service. She explained that socially-oriented provision, including activities and groups, has played a key role in drawing older people into the service, but noted that many service users now need a higher level of ongoing support, including one-to-one keywork.

She also explained that the outcomes the service works to are not focused on ‘successful completions’ and recovery, but on improved levels of health and wellbeing. In the new ‘public health’ landscape, this should have a particular resonance, and is an opportunity to be built upon with commissioners and decision makers.

Focusing on the loneliness and isolation that some older people experience, which can be an underlying cause of substance misuse, Emma Spragg and Pam Creaven from Age UK noted that there can be a level of acceptance around this among both statutory and voluntary services – a belief that ‘nothing can be done’. While challenging this, they pointed, too, to the particular difficulties of addressing social isolation among older people in the current climate of austerity, when services in the community such as day centres are rapidly disappearing.

Emma and Pam also highlighted that the commissioning of domiciliary care for older people needs to be rethought: if carers are working to fifteen-minute appointments, how will they be able to identify substance misuse issues among those they are working with, and provide support around this?  

Finally, Mike Kelleher from Public Health England (PHE) noted that the report coincides with a number of PHE’s key priorities nationally, including addressing dementia, and reducing preventable deaths and ill health associated with alcohol misuse and smoking. He also highlighted that, while we are now in the era of localism, PHE can support the development of this agenda through national guidance and frameworks, and PHE regional centres have a key role to play in supporting commissioning and so the development of services.

There is a real momentum around this issue at the moment, and DrugScope will be working to ensure that real gains are made. After all, it’s about time.

For more information about the report, please contact Gemma Lousley, Policy and Engagement Officer, at gemmal@drugscope.org.uk


Monday, 17 February 2014

Joining the dots: homelessness, substance use and lessons for future commissioning

At the end of January, Crisis and the Joseph Rowntree Foundation formally launched their Homelessness Monitor England 2013 report. This research, carried out by leading academics in the field of housing and homelessness, looks at the impact of a range of economic and policy developments on homelessness. This includes the post-2007 economic downturn and housing market, the impact of welfare reform and reduced public sector spending, and more generally, other government policies that might have implications, such as the localism agenda.

The research has been funded from 2011 to 2015 and covers (separately) Great Britain, England, Scotland, Wales and, from 2014, Northern Ireland. The research focusses on the numbers rough sleeping, single homeless people, statutory homeless households and the hidden homeless, such as ‘sofa surfers’ and people living in crowded or insecure housing.

While the causal relationships are complex, the connection between substance use and homelessness or housing need is clear. 28% of rough sleepers contacted in London in 2013 had support needs relating to drugs, while 41% had needs relating to alcohol. From the treatment sector’s perspective, in DrugScope’s State of the Sector 2013 research, housing and housing support was identified as the support need most often presented, the most common local gap in provision and also as an area of support where availability appears to have deteriorated over the previous 12 months. As a key component of recovery capital, this may pose some challenges.

Another relevant factor is the removal of the Supporting People (SP) ring fence in 2009. While this has not been without implications for drug and alcohol services and their clients, the impact on homelessness services has been more marked, with some evidence of substantial localised disinvestment. However, while there are similarities, the current position, for community drug and alcohol services at least, is not quite analogous. The funding formerly provided within the Pooled Treatment Budget has been rolled into the broader Public Health Allocations, the latter being ring fenced for public health purposes until at least 2014-15, but there is at least the risk that greater discretion around funding and commissioning could have similar effects on drug and alcohol services.

The last speaker at the Crisis Homelessness Monitor launch was Paul Downie, Deputy Director of Homelessness and Support at the Department for Communities and Local Government, who argued that while financial pressures faced by local authorities are real, outcomes and services can be maintained (or improved) at the same time as making savings through intelligent commissioning, joined-up service design and breaking out of silos.

As one of the four partners in the MEAM Coalition, DrugScope believes that joined-up commissioning and services can improve outcomes for people with multiple needs and also offer value for money. It remains to be seen, however, whether there is sufficient scope to commission intelligently and align and sequence interventions in such a way that outcomes can be protected in the face of such significant pressure on local authority budgets.

One concern is that if breaking out of silos and aligning services was especially easy, more progress would have been made by now – the suggestion itself is not novel. Where there may be grounds for optimism is in the Community Budget concept, which builds on some of the learning from previous initiatives including the previous government’s Total Place. Four areas took part in the Whole-Place Community Budget Pilots from 2012. Last year, the government announced that nine additional areas will receive support via the Public Service Transformation Network to incorporate some of the lessons from the pilots.

Drug and alcohol treatment hasn’t itself been a specific priority for the four pilot areas, which focussed on domestic violence, health and social care, work and skills, the Troubled Families agenda, children and young people, reoffending and making better use of local authority assets. The importance of addressing substance use has, however, been highlighted at almost every step and the Community Budget model suggests at least the potential to positively transform local public service delivery.

The Community Budget model is above all intended to be owned and designed locally.  Its principles broadly include bringing together local government, central government agencies and others with the aim of pooling resources and commissioning coherent and proactive services that are more focussed on long-term outcomes and the individual, rather than on process. Evaluations of the first four pilots have been positive, and the National Audit Office was broadly supportive in its report. The Local Government Association commissioned Ernst and Young to review the potential savings, which they estimated at between £9.4bn and £20.6bn over 5 years.

The Communities and Local Government Committee reported in October 2013 that Community Budgets have the ‘clear potential to facilitate cheaper and more integrated public services. They can also be used to make public services more effective by focusing on the specific needs of local areas and individual service users. However, achieving their full potential will require strong leadership at a local level as well as a commitment from central government to facilitate local partnerships and the flexibilities needed to develop local strategies and solutions to specific local issues’.

With all this, realism is needed. Ultimately, local authorities will need to spend less and commission fewer and / or smaller services.  However, the Community Budget approach does at least give cause for optimism that this can be done - while protecting the interests of the people who use them.

DrugScope provides the London Councils-funded PLUS (pan-London umbrella support) for organisations working around homelessness in London, in partnership with Homeless Link and Shelter. Please contact Paul Anders for information.

Thursday, 2 January 2014

A New Year’s message from Marcus Roberts, DrugScope’s new Chief Executive



'For last year's words belong to last year's language
And next year's words await another voice' T S Eliot

2014 promises to be another big year - for DrugScope, our members, our partners and 'the sector'. A lot of the new bodies and systems will be celebrating their first birthdays in a few months, with an expectation that this could make them more assertive in setting their priorities and allocating their spending from April 2014. Local authorities will face some tough decisions with their budgets subject to further cuts this year. There is also a huge agenda of change for the welfare and criminal justice systems – not least, the Ministry of Justice’s Transforming  Rehabilitation initiative that will potentially have significant implications for offenders with drug and alcohol problems.

We need to redouble our efforts to provide compelling and relevant answers to the question 'Why Invest?' at local level, engaging with non-specialist commissioners and elected officials, and speaking to local concerns and priorities. Fortunately, we've got the data, connections, profile, stories and some good resources too. DrugScope is developing and collecting these resources as part of its work on behalf of the Recovery Partnership.

Nationally, we need to monitor developments and share experiences, to capture good practice and examples of adaption and resilience, while also providing early warning of any threats to drug and alcohol services that could jeopardise the ambition to 'build recovery in communities' that is the centrepiece of the national Drug Strategy. For example, DrugScope will be publishing our 'State of the Sector' report later this month.

The question 'how invest?' is related and just as important - this is partly about the quality of commissioning processes, and the development of things like payment by results, personalisation, strategic recovery champions and Whole Place Community Budgets. But it's also about building on a legacy of evidence based practice, improved clinical governance, and investment in research and training and workforce development in an age of localism and austerity. For example, DrugScope will continue to work with the Substance Misuse Skills Consortium to promote its skills framework and skills hub and through the Federation of Drug and Alcohol Professionals to support professional and practice standards.

DrugScope enters 2014 as a member of the Recovery Partnership with the Skills Consortium and Recovery Group UK. No doubt the idea of 'recovery' will continue to be discussed and contested in 2014. A bit of controversy is no bad thing, it helps to keep ideas alive and prevents them from ossifying into dogma and bureaucratic formulation and application. For DrugScope, the idea of recovery as regaining something lost or taken away has always been the critical one, both in terms of the empowerment of individuals and the fight for social integration and justice - for example, through our work on multiple need and disadvantage as part of the Making Every Adult Matter Coalition or the priority we continue to give to the impacts of welfare reform.

Entering 2014, the task of 'building recovery' can be shaped and informed by a growing body of evidence and experience, including the Strang Report on the role of medications in recovery and the landmark report on recovery published by the Advisory Council on the Misuse of Drugs in December. This is the approach that will guide and inform our work going forward.

The public health agenda provides an historic opportunity to widen and diversify the 'sector's' role in local communities, our influence and reach. Drug and alcohol issues pervade our culture and society - that's why substance misuse services have something to contribute to such a broad range of public health priorities. This is an opportunity to broaden our horizons - for example, in responding to concerns about new psychoactive substances, developing services and interventions for young people and young adults, working with equality and diversity groups (such as the LGBT community, older people and migrants), supporting families and contributing to interventions around domestic violence and child safeguarding and responding to new demands for harm reduction, prevention and early intervention. For example, we will be publishing a briefing on drugs and older people later this month.

There is no doubt about the challenges ahead: the risk of disinvestment is real, and there is a risk that in more challenging times the sector could find itself revisiting some of the polarised debates that were holding it back some years ago.

But I enter 2014 feeling energised and optimistic. Drug and alcohol policy is firmly on the radar at national level. There have been strong hints that a new Health Premium will provide a financial incentive for local authorities to continue to invest in drug and alcohol services. Localism combined with the new public health agenda creates an opportunity to 're-vision' what we are about as a sector and as a broad movement for social change.

In particular, while stigma is a key issue for us, I am heartened that a DrugScope/ICM public opinion poll conducted in 2009 found that nine out of ten people believed drug treatment should be available to anyone with a drug problem who was prepared to address it. Tellingly, one in five said they had direct or indirect experience of 'drug addiction', if we widened that out to include alcohol and other sorts of drug problems then the number would be very much higher. This suggests there is an opportunity to begin a different kind of dialogue with the public than we have had in the past at a time when localism is demanding that we are much more outward facing in our engagement with local communities. DrugScope's media and communications work will continue to reach out to this wider audience and help to create spaces for these discussions.

DrugScope will be doing everything we can to support you, including a strategic review of all our activities in early 2014 to ensure that we are focussing our resources in the best possible way to add value and provide voice, representation and support. Can I end with good wishes for the New Year, particularly to all of our members – and if you’re not a member why not start the year by joining us?

Find out about DrugScope membership and join here


Wednesday, 11 December 2013

Known unknowns and unknown unknowns: minding the gaps in young people’s treatment statistics

The release of the figures on young people's treatment for 2012-13 by Public Health England would seem to show a continuing decline in demand and further improvements in performance. The numbers of young people under 18 accessing treatment fell from a peak of 24,053 in 2008-09 to 20,032 in 2012-13, with Public Health England observing that “this reflects the overall decline in alcohol and drug use by young people over recent years”. That said, it is stressed that alcohol and cannabis continue to cause problems for some young people, while new problems are being created by club drugs and new psychoactive substances. The numbers of young people receiving help with club drugs rose from 2,007 in 2011-12 to 2,834 in 2012-13. Problems with heroin continue to affect only a very small minority: 175 in 2012-13.

The performance of the system is also encouraging. The statistics record an improvement in waiting times, with 99 per cent of young people waiting fewer than three weeks for treatment and an average wait of two days. Around four fifths of young people coming into specialist treatment services left having 'successfully completed' in 2012-13.

The figures are particularly striking in a period when local authorities have been managing cuts to their budgets. Young people's services have historically been more dependent on local funding sources than adult treatment and therefore should be more vulnerable to cuts when local budgets are squeezed.

In addition, there has been less drive and leadership from national government on young people's drug and alcohol services, compared to the strong interest at senior ministerial level in adult treatment and the challenge of 'building recovery in communities'. Indeed there is a general feeling that the Department for Education - in contrast to the former Department for Children, Schools and Families - has stepped back from drug policy. That service provision appears to be holding up in such circumstances is encouraging.

It does, however, raise the question of whether these statistics tell the whole story. When I was at Nacro, the crime reduction charity, we were constantly warning journalists and others of the perils of using statistics on offences recorded by the police as a guide to crime rates (incidentally, police figures are still being used for local crime mapping). For example, when the police improved procedures for reporting and recording racist crime following the Macpherson Report on the murder of Stephen Lawrence, this resulted in an increase in recorded racist crime. This was a good thing, reflecting a greater willingness to report, record and follow up on these offences.

Somewhat similarly, the numbers of young people accessing and being referred to treatment and the availability of treatment are not wholly independent variables - put crudely, you can only refer someone into a treatment service if there is one to refer them to.

Nor is there a direct and unmediated relationship between the overall numbers of young people using drugs and alcohol and the need for specialist treatment, so that a fall in one will necessarily explain a fall in the other.

Only a tiny proportion of under-18s using substances will ever require specialist support and a whole range of other factors tend to come into play where they do - such as experience of trauma and abuse, problems in education, offending, mental health and social exclusion. I'd treat the claim that a fall in the numbers accessing treatment is necessarily explained by overall decline in the much larger numbers who are using drugs and/or alcohol with some caution - which is not, of course, to deny that the decline is relevant and may well be significant too.

Nor, of course, and as Public Health England recognise, do figures on the availability of specialist drug and alcohol services for young people tell the full story about the need for and availability of interventions. Most young people experiencing problems where substance  misuse is a factor are unlikely to ever come into contact with specialist services, but may seek support (or fail to do so) from GPs and other primary care services, mental health services, mainstream children and young people’s service and through other routes.  Less is known about the quality and availability of this support.

I’ve just attended the launch of the Young Mind’s report Same old, about young offenders and mental health, and the problems in accessing services – so it’s also relevant to note that the PHE figures exclude the young people’s secure estate.

All in all, the figures provide grounds for cautious optimism, but it will be important to keep a close eye on interventions for young people during a period of change and transition for local authorities, and with new drug trends too.

The PHE report Substance misuse among young people in England 2012-13 is at  http://www.nta.nhs.uk/uploads/ypstats2012-13commentary[0].pdf

The Young Minds report Same old – the experiences of young offenders with mental health needs is at http://www.youngminds.org.uk/assets/0000/9472/Barrow_Cadbury_Report.pdf

DrugScope’s website for 11-14 year olds – D world - is at  http://www.drugscope-dworld.org.uk/



December’s policy blog was written by DrugScope’s Director of Policy and Membership, Marcus Roberts.

Wednesday, 4 December 2013

The numbers in black and white: facing up to an uncomfortable truth


Editor’s note: in the November/December issue of Druglink, we published an article by Geoff Monaghan who offered a critique of the Release/LSE report on stop and search. Owing to time and space constraints, we were not able to offer the report’s authors a right of reply in that issue. They in turn were concerned at having to wait until the next Druglink in January. Therefore, we decided to publish their reply as a DrugScope blog. 

By Niamh Eastwood and Michael Shiner

Have you ever wondered why people are still complaining about the over-policing of black communities? If you have, Geoff Monaghan’s article in the November / December 2012 edition of Druglink provides some clues.

Geoff, a former detective sergeant in the Metropolitan Police, takes exception to our recent report – The Numbers in Black and White: Ethnic Disparities in the Policing and Prosecution of Drug Offences in England and Wales. The report shows that black people are stopped and searched for drugs at six times the rate of whites, even though they use drugs at a lower rate, and are more likely to be charged when found to be in possession. It also shows that ethnic disparities in drug policing have significant knock-on effects, with black people being taken to court and sentenced for drug offences at a higher rate than white people – often for possession offences. Our analysis is based on official data and the same technique that has been used by the Home Office and latterly the Ministry of Justice for well over a decade. The report has been described by The Voice as a ‘landmark study’[1].

Geoff Monahan is less complimentary, though he begins by acknowledging the legitimacy of our concerns and has ‘no hesitation in accepting the fact that members of black, Asian and minority ethnic (BAME) groups – black suspects in particular – appear to be treated differently from white suspects at a number of points between arrest and conviction.’ He says he knows ‘full well’ that people from such groups are over-represented in stop and search, acknowledging “that some (perhaps many) police officers don’t always conduct their search, arrest and other investigatory powers in strict accordance with the law and codes of practice”.  He also accepts that ‘there are documented cases that confirm ethnic bias in officer decision-making about who to stop and search and/or arrest.’ In a recent report on cannabis policing co-authored by Geoff, our report is cited to support the claim that there are ‘racial tensions’ between police services and people from ethnic minority communities, and that ‘these tensions are linked to the policing of drugs, particularly cannabis’[2]. What, then, is the problem?

Apparently our report’s overall conclusion, that drug law enforcement unfairly focuses on black and Asian communities, ‘is flawed, and so the recommendations are less than sound’. Having accepted the substance of our concerns, Geoff devotes the rest of his article to trying to pick holes in the analysis. His conflicted reaction is illustrative of the defensiveness that has characterised police responses to long-standing evidence of ethnic disparities in stop and search.

The inquiry into matters arising from the death of Stephen Lawrence, particularly the finding of institutional racism, has had a profound affect on the police psyche, but has not prompted the kind of organisational change that many hoped. A key reason for this is that the police service has engaged in an ongoing process of collective denial[3]. The extent to which stop and search is disproportionately targeted at black and minority ethnic communities has remained largely unchanged since the Lawrence inquiry, yet police representatives continue to trot out well-rehearsed arguments that seek to explain the disparities in ways that do not implicate police decision-making. The Lawrence inquiry was dismissive of such arguments, but this has not stopped the police from repeating them. Among the favourite defences are claims that black people are stopped and searched at a higher rate because they offend more and/or are more ‘available’ to the police. The first argument is unsupported by the evidence, and surveys have, as we noted in our report, repeatedly shown that people from black and minority ethnic groups use drugs at a lower rate than whites. With this avenue closed off, Monaghan focuses on the available population argument.

Geoff claims our report contains ‘factual errors’, but fails to identify any. Rather, he challenges the methodology – one that is used by the Government, the police, the Equality and Human Rights Commission and pretty much anyone working on the issue in the academic world. His main objection is that we fail to take account of previous research on the available population, citing that undertaken by MVA and Miller for the Home Office in 2000. A lot is made of the suggestion that the police might not be able to do much about ethnic disparities in stop and search because the composition of the available population is shaped by structural factors, such as unemployment, that are beyond their control.

There is some evidence that black and minority ethnic groups are over-represented among people ‘who use public places where and when stops or searches are carried out’[4], potentially helping to explain why they are stopped and searched at a higher rate than we would expect given their numbers in the general (residential) population. This evidence is limited in several important respects, however. Only two published studies have sought to assess the ethnic composition of the available population in England and Wales and related it to those who are stopped and searched. Taken together they cover a handful of tightly defined localised areas with high rates of stop and search, which means the results cannot be generalised to the country as a whole with any degree of confidence. Leaving aside the methodological difficulties of determining the ethnicity of the available population in what may be busy thoroughfares, these studies were designed to assess the possible role of ethnic bias in street-level decision making. While such decisions are a potentially significant source of bias, they are not the only, or necessarily most important, consideration. The Lawrence inquiry identified ethnic disparities in stop and search as evidence of institutional racism, which recognises that discriminatory outcomes may occur in the absence of individually biased decision-making due to organisational policies and practices.

The emphasis on the ‘available population’ has been described as a ‘smokescreen’ by the Black Police Association[5]. Critics have pointed out that availability does not provide sufficient grounds for a stop-and-search because officers are ordinarily required to have an ‘objective basis’ for suspecting somebody before they proceed. The Equality and Human Rights Commission (2010: 52) has also noted that availability “doesn’t hold up to scrutiny as it is self-fulfilling”[6]  because the make-up of the available population is partly a function of police decisions about where and when to carry out stop and search. Ethnic profiling, in other words, can occur at the level of the neighbourhood as well the individual.

Geoff’s discussion of the available population is highly selective and illustrates the general defensiveness that characterises police responses. Like many police personnel, Geoff treats availability as the final word on disproportionality, with little consideration of the associated caveats and methodological limitations or contrary evidence. According to MVA and Miller, their study ‘did not give a clean bill of health to the police use of stops and searches’[7] , but provided clear examples where people from minority ethnic backgrounds were stopped and searched more often than would have been expected from the available population. MVA and Miller also found evidence that stops and searches were targeted at areas with disproportionate numbers of black and minority ethnic residents, but where local crime rates did not appear to justify such attention. Hence they concluded that their research should not be seen as an ‘excuse’ for the police to turn attention away from the potential role of discrimination.  Most notably, perhaps, MVA and Miller  endorsed the analytical approach we used in our report, recommending that police forces ‘should continue to compile measures of disproportionality based on residential figures’ because ‘these figures remain an important indicator of the actual experience of different ethnic groups within police force areas’, describing ‘the outcomes of stops and searches’[8].

Our research aimed to assess whether the degree to which people from black and minority ethnic communities are subject to drug law enforcement is reasonable given their levels of drug use and the answer to this question is a resounding ‘No – it is not’. We made no claims that ethnic disparities are driven by bias in street-level decision making, though we doubt very much that they can be wholly explained by the available population. Ethnic disparities are greater in relation to stop and search for drugs than other offences, suggesting a degree of targeting, particularly given the relatively low rates of drug use within minority communities. We would also note that the wide ranging discretion afforded to officers; the emphasis on colour blind policing; and difficulties in bringing cases of discrimination to court are crucial in sustaining existing disparities[9].

Geoff rejects the suggestion that cannabis policing is a priority for enforcement and disputes the notion that cannabis warnings have resulted in net widening – something he appears to accept in his co-authored piece on the policing of cannabis[10]. We don’t claim that cannabis has become a formal enforcement priority, but show how the introduction of the cannabis warning scheme alongside targets for offences brought to justice has inadvertently created a perverse incentive structure that rewards officers for going after ‘low hanging fruit’ . The result has been a marked increase in the amount of stop and search targeting drugs, mainly low level cannabis possession, at a time when rates of use have been falling. Cannabis warnings have been issued in their tens of thousands per year, more than doubling the number of criminal justice disposals for drug offences.

The nadir of Monaghan’s argument comes when he suggests arrest rates are low (7 per cent) because ‘all savvy drug users/traffickers need to do is hide their drugs in their underwear, or body orifices’ and the police are unable to detect the substances due to the legal constraints on strip searches and intimate searches. We hope Geoff isn’t advocating widespread invasive searches in order to boost arrest rates for low level drug possession offences. In any event, he is incorrect to state that officers require authorisation from a senior officer to conduct such a search. A strip search can be carried out before arrest if the officer deems it ‘necessary’ and the only safeguard is that the search is carried out in a police station or a designated area out of the public’s view. We have no idea how many such searches are being undertaken as the data is not being centrally collated, despite the humiliating and intrusive nature of the intervention. While few drug searches result in arrest, this is typical of stop and search as a whole, which has an overall arrest rate of around 10 per cent. Even when including cannabis warnings and on the spot fines the hit rate of 18%, which Geoff describes as ‘impressive’, still means that 4 out of 5 people stopped and searched are not found to be in possession of drugs. Such a low yield cannot be simply brushed aside with references to savvy offenders given the ‘alarming’ and ‘disturbing’ lack of professionalism highlighted by the recent HMIC report into the use of stop and search[11].

We welcome the opportunity to respond to Geoff’s concerns, but would rather be having a different conversation. The ethnic disparities we have highlighted are a problem, regardless of what is driving them, particularly given that they cannot be explained by what is known about patterns of offending. These disparities are part of a deeply entrenched pattern of injustice, perpetrated by the state against already marginalised and vulnerable communities in the name of drug control. Geoff says he recognises there is a problem but like so many others steeped in a police oriented worldview he is unwilling to face up to the uncomfortable truth about the fundamental failure of the police to find solutions to a decades’ old injustice.

[1] Elizabeth Pears (2013) ‘Black people have become victims of 'war on drugs’, The Voice, September 1, 2013; http://www.voice-online.co.uk/article/black-people-have-become-victims-war-drugs%E2%80%99
[2] Monaghan G & Bewley-Taylor D (2013), ‘Practical implications of policing alternatives to arrest and
prosecution for minor cannabis offences’, International Drug Policy Consortium, http://www.leahn.org/wp-content/uploads/2013/10/MDLE-report-4-_-Practical-Implications-of-Policing-Tolerated-Cannabis-Markets-1.pdf
[3] Shiner, M. (2010) ‘Post-Lawrence Policing in England and Wales: Guilt, Innocence and the Defence of Organisational Ego’, British Journal of Criminology, 50(5): 935-953.
[4] MVA and Miller, J. (2000) Profiling Populations Available for Stops and Searches, Home Office; page 9.
[5] Metropolitan Police Authority (MPA) (2004), Report of the MPA Scrutiny on MPS Stop and Search Practice, Metropolitan Police Authority.
[6] Equalities and Human Rights Commission (2010) Stop and Think: A Critical Review of the Use of Stop and Search Powers in England and Wales, EHRC; page 52.
[7] Ibid page 87.
[8] Ibid page 88.
[9] See also Alexander, M (2010) The New Jim Crow: Mass Incarceration in the Age of Colorblindness, New Press.
[10] Monaghan G & Bewley-Taylor D (2013), ‘Practical implications of policing alternatives to arrest and
prosecution for minor cannabis offences’, International Drug Policy Consortium, http://www.leahn.org/wp-content/uploads/2013/10/MDLE-report-4-_-Practical-Implications-of-Policing-Tolerated-Cannabis-Markets-1.pdf
[11] Her Majesty’s Inspectorate of Constabulary (2013) Stop and Search Powers: Are the Police Using them Effectively and Fairly?





Tuesday, 26 November 2013

Headspace: Not sorted for E’s or whizz

While the forensic information has yet to be made public, the tragic death of Nick Bonnie at the Warehouse Project in Manchester (28 September) appears to be the latest in a series of deaths linked either to strong ecstasy or the PMA-ecstasy combination. Up until 2011, PMA had only been implicated in two deaths in the previous 18 years. That figure leapt to 20 in 2012, while the BBC File on Four programme (29 October, listen here) claimed that figure had already been exceeded for 2013.

From a public health perspective, why this is happening now is almost beside the point; the question is ‘what more can be done to warn club goers of the dangers of using ecstasy?’ And then you have to throw into the mix the numerous anecdotal reports of serious outcomes for users of some of the new compounds, especially synthetic cannabinoids. There are no official statistics on the prevalence of use of substances like Black Mamba, Annihilation and Exodus Damnation – and nobody should be helping the more scurrilous end of the media, by unduly ramping up concerns. But even if the names are just a marketing ploy to encourage sales, the percussive effects of these drugs are all too real.

We could do worse than reinvigorate some of the harm reduction initiatives from the 1990s, when rave culture was at its height. Not that this was exactly free from controversy. The first materials on safer dancing appeared in Liverpool in 1992 published by the Merseyside Regional Drug Training Unit (now HIT). After hearing about the rising tide of MDMA-related A&E admissions to local hospitals, they produced the ‘Chill Out’ leaflet, setting out what has now become standard information about not getting overheated, staying hydrated and so on.

The tabloid response was swift and brutal, with one paper going so far as to suggest that parents go round to the unit’s offices and chuck the director Pat O’Hare in the River Mersey.  It didn’t take too long for that information to appear in medical articles, in materials from organisations like DrugScope (then ISDD) and Release and, significantly, in government literature. The government also backed the London Safer Dancing Campaign; ISDD launched the London Study Safely Campaign aimed at students and there were other similar initiatives around the country. The more responsible venues began supplying free water, chill out areas and allowing drugs workers onto the premises to offer advice and support. Did people still die from taking drugs? Sadly they did, but few club goers could have said that they had no idea about the possible ways they could reduce potential risks.

It is true that for a decade now, most drug use, be it problematic or recreational has been in decline. And we don’t know how much of a health problem we really have with the new drugs – except there seems to be a lot of them about. But there is sufficient anecdotal evidence coupled with the jump in MDMA-related deaths to warrant a step change in thinking about information provision – not least because, as well as traditional indoor venues, the last decade has seen an explosion in outdoor festivals where drug-related fatalities and casualties have also occurred.

Unfortunately, proactive information underlining risk reduction is looking pretty scarce right now. The government would point to the FRANK website as a reliable source of information – which it is. But, as reported in this issue, a survey of school students in Nottingham showed that while FRANK has high brand recognition, virtually none of the students would use it a source of information. This will sound quite Luddite, but whatever new technology can deliver, I would argue there is still a significant role for shoving a leaflet in somebody’s hand, putting up posters and providing other tangible objects of social marketing.

DrugScope continues to get regular calls from a whole range of professionals looking for just this – and we can’t help, because there are no funds for free print distribution these days. And due to financial cutbacks, government funds for similar communications activities have also dried up.

It is impossible to say if more readily available information would have saved those who have recently died; but it has to be worth making sure people are properly informed. After all, when Leah Betts died in 1995, one of the most widely publicised drug deaths of all time, few of the current casualties would even have been born.

Harry Shapiro

Wednesday, 20 November 2013

The state we’re in

Paul Anders, Senior Policy Officer, DrugScope

Everybody is aware of the pressure that the voluntary and public sector have been under for the last few years. Most areas of public spending have been squeezed to a greater or lesser extent, and some sectors have seen provision and capacity substantially affected. While the drug and alcohol treatment sector has not got off scot-free, the presence of the NTA and the somewhat protected funding structure provided for in the Pooled Treatment Budget (PTB) had sheltered the sector to some extent from the pressures elsewhere.

In April 2013, all that changed. Commissioning responsibilities moved to local authorities accompanied by funding previously indicated for drug and alcohol services, which now forms a substantial part of the local public health allocations. What should be noted here is that while the amount of funding nominally allocated to drug and alcohol services hasn’t gone down, there is (currently) no sign of effective protection or ring-fence for the sector and its clients.

Turning to the Public Health Outcomes Framework, which local authorities will be measured against, we can see that relatively few indicators relate directly to the work of the sector – arguably three out of a total of 66 outcome indicators. While well-prepared providers are already working to demonstrate the way their work supports improvement of other key indicators, there is the risk that local authorities under increasing financial pressure may think that a third of the money delivering a twentieth of the outcomes is not a great deal. Public Health England has a role to play in all of this, although it’s not yet entirely clear what that role may comprise of.

In terms of partnerships with the criminal justice sector, another change has taken place. From April 2013, elected Police and Crime Commissioners (and their staff) have replaced Police Authorities. While they, in effect, take control over their budgets in two stages (in April 2013 itself and then 2014), they will be key players – for example through commissioning Drug Interventions Programme (DIP) successors, or through commissioning outreach or – ultimately – whatever sort of provision they feel would work best locally, which could include none at all, at a time when core police budgets are also under pressure.

Clearly, 2013 could turn out to be a crucial year for the sector –a year zero for two hugely important funding and commissioning reforms. However, it was always unlikely to be a ‘big bang’ year – there are contracts with time remaining, and there was a reasonable assumption that at least some of these new structures would take time to familiarise themselves with their new responsibilities and bed themselves in. However, with around 150 local authorities making decisions about spending on public health, and over 40 Police and Crime Commissioners (PCCs) in charge of community safety and crime reduction, understanding the sector has suddenly become more difficult.

The State of the Sector research, conducted for the Recovery Partnership, is an attempt to address that, and will also provide a useful resource for DrugScope in other activities. The research comprised a large online questionnaire, interviews with services in 9 areas that had been identified as particularly interesting, interviews with a number of chief executives and through Freedom of Information Act requests to every PCC in England and Wales. In London, DrugScope, along with the London Drug and Alcohol Policy Forum, contacted every local authority to learn more about their commissioning structures.

The results so far have, to an extent, been in line with expectations – for the reasons above, it always seemed unlikely that there would have been rapid and significant changes by the end of October 2013 but knowing where the sector has come from will help us to identify the direction of travel more accurately. DrugScope and the Recovery Partnership will be publishing a full State of the Sector report later this year, but produced an interim report for its annual conference in November, focussing on key parts only of the responses to the online questionnaire.

These included:
  • 36% of services reported a decrease in funding, of which around a third was due to losing services as a result of recommissioning.
  •  41% had been through a retendering or recommissioning exercise in the last 12 months, with 64% expecting to in the coming 12 months.
  •  44% reported a decrease in front-line staff numbers, and 63% an increase in the use of volunteers.
  •  43% said they were not engaged with their Health and Wellbeing Board, including no involvement in any Joint Strategic Needs Assessment Consultation.
  • Around 4 in 10 had had involvement with their Police and Crime Commissioner, but only around 1 in 10 was involved via the Police and Crime Plan consultation.
  • 9 out of 10 respondents reported that welfare reform had had a negative impact on their clients.
  • No respondents were receiving funding from Jobcentre Plus’s Flexible Support Fund.
  • Most respondents identified funding and recommissioning as the biggest single challenges facing their own service.
  • The most significant gaps in local provision were (in order) access to housing, partnership / support for clients with complex needs, and education, training and employment opportunities.
The responses to the survey and the interviews carried out with service managers and chief executives paint a nuanced picture of a sector that clearly faces challenges, but is innovating and showing resilience. There are several causes for concern, not least in the external environment, but the outlook is far from bleak – for now.

If you would like to discuss the State of the Sector research, please contact Paul Anders – paul.anders@drugscope.org.uk or 020 7234 9799