Thursday, 24 November 2011

Hurrah for Balloons

Dr Marcus Roberts, Director of Membership and Policy, DrugScope

I was recently talking to some colleagues about the outbreak of purple balloons on the website of the National Treatment Agency - you may have seen the photographs of people in parks releasing them to symbolise and celebrate recovery.

Some people I talked to responded sceptically. What did balloon launches have to do with the day-to-day realities of delivering drug and alcohol services - particularly during a period of financial austerity? Weren't these images trivialising the challenges that confront our sector at a time of profound change and not a little anxiety?

Well, yes, the recovery walking is going to ring a bit hollow if the balloons are drifting over treatment services that are struggling for survival. Equally, there is a risk that this kind of affirmation and celebration will become narrowly associated with an exclusivist version of recovery - one that celebrates only a narrow range of outcomes, ignores the significance of 'small steps' and leaves much of the day-to-day work that drug and alcohol services do for individuals, families and communities in the shadows.

Allowing for these caveats, I think that the appearance of balloons on the NTA website is a resonant symbol of what is a momentous and positive step for the development of substance misuse services in our country.

For a start, these images look exactly like something you'd find in campaigning materials for 'mainstream' fields of health and social care (such as heart disease or cancer) and that represents a significant shift in perceptions of our sector and service users.

Fear drove the emergence of drug and alcohol services in the 1980s - specifically, the transmission of HIV/AIDS and other blood borne viruses. Fear drove the expansion of drug treatment from the late 1990s - it was all about crime reduction. Both these phases had a profoundly positive impact. As a result of a harm focussed approach, we now have one of the lowest rates of HIV transmission among injecting drug users in the world, and we should never undervalue our sector's contribution to reducing drug-related crime - which disproportionately impacts on some of the most deprived neighbourhoods and communities.

It is an open question how effective positive visions of reintegration and recovery will be in sustaining investment in drug and alcohol services with the devolution of more control to local decision makers in a period of austerity. I can see why arguments around crime reduction and community safety may be more appealing to elected local politicians than a focus on recovery and social reintegration, particularly in a time of austerity (although recent polling by DrugScope and the UK Drug Policy Commission shows a high level of public support for the provision of high quality drug and alcohol services on health and social grounds).

Be this as it may, it is no small thing that politicians are now talking more about recovery and reintegration and less about disease and crime. Perhaps for the first time - beginning under New Labour and continuing under the current government - we are organising our practice and thinking about drug and alcohol treatment increasingly around a concept ('recovery') which is about hope, not fear.

This article first appeared in DrugScope’s Members Briefing. For information about becoming a DrugScope member visit here.

Tuesday, 9 August 2011

Seen but not heard – young people’s treatment issues

In June I spoke on young people’s treatment at the Drugs and Alcohol Today conference. It had been a while since I’d focused on young people’s issues. The new treatment agenda has been built around a vision of recovery that is more relevant to adults (for example, substitute prescribing and abstinence). It is this agenda to which a lot of DrugScope’s own policy work has been responding. I’d not registered some government initiatives, notably the Department for Education’s Positive for Youth programme, including a recently published ‘discussion paper’ on Preventing youth crime and substance misuse. Although, to be fair, it is not exactly prominent on the DfE website and some colleagues in children’s charities were not aware of it either.

In February 2010, we published Young people’s drug and alcohol treatment at the crossroads. Many of its recommendations are still pertinent. For example, we called on government to monitor the impact of funding changes on young people’s services with a focus on local variation; we also made the case for a national policy framework for young adults. But, equally, a lot has changed since then. The Department for Children, Schools and Families is no longer with us (and perceptions are that the Department for Education has a narrower policy focus), Every Child Matters is effectively gone and Public Service Agreements (PSAs) most definitely are. Above all, we are seeing local authority budgets being squeezed to an extent that was not envisaged then, along with a strong emphasis on localism and reducing the involvement of central government.

In December, the London Drug and Alcohol Network (LDAN), part of DrugScope, conducted a survey of young people’s treatment providers. We spoke to 18 London service providers; only three said their current funding situation was safe, and many anticipated substantial cuts. An article in the latest issue of DrugScope’s Druglink magazine shows that this issue has not gone away. Addaction have told DrugScope that some local authorities have imposed funding cuts on their young people’s services of up to 50 per cent.

It’s not all doom and gloom. A lot of the work young people’s services do could fit well with a more public health oriented approach to drug and alcohol issues, when treatment budgets are transferred to the new public health service and local Directors of Public Health. Concerns that the NTA has backed away from young people’s services may partly reflect the fact that much of what those services deliver is not treatment in the normal (or narrow) sense of that word; in financially austere times, it is perhaps understandable that an agency with a strong treatment focus would reconsider that investment. For better or worse, public health has a broader scope. There is also specific provision in the 2010 Drug Strategy for Directors of Public Health and Directors of Children Services to work together, pooling public health and early intervention budgets.

But this is a critical time for the development – indeed survival – of young people’s services. DrugScope will soon be meeting officials in the Department for Education as well as with colleagues at the National Children’s Bureau to ensure that the pressure is maintained. A clear and compelling narrative on young people’s services is currently lacking from government. Nor does there seem to be any mechanism for monitoring what is actually happening to these services on the ground. With the lives of some very vulnerable young people at stake, this cannot simply be a local matter for local people – not least, because with DfE estimates showing that £1 spent on young people’s treatment saves between £5 and £8 in subsequent costs, this is an issue with profound economic and social implications for us all.

Young People’s Drug and Alcohol Treatment at the Crossroads is available at:

Dr Marcus Roberts, Director of Policy and Membership

Tuesday, 5 April 2011

Localism, health and rights

Walking to the tube after a recent meeting on localism and austerity, I found that some of the observations that had been made by the policy experts and practitioners in the group were running around in my head. There was the civil servant who commented wryly that ‘localism’ and ‘austerity’ sort of went together, because Government would be rather less keen to devolve decisions to local authorities in a period of prosperity. A strategic manager from a Drug Action Team observed that drug services had benefited from having a ‘big friend’ from central Government to look out for them in the Bear Pit of local politics, and were afraid that in the ‘new term’ they would ‘get duffed up by the big kids in the playground’. Perhaps most striking of all, a senior civil servant suggested that the critical question in an age of localism was ‘how comfortable we are with failure?’

It seems that even the Secretary of State for Communities and Local Government, Eric Pickles, is finding it a bit of challenge to get ‘comfortable’ with some of localism’s possible consequences. He has recently declared that he is prepared to legislate to stop councils imposing ‘disproportionate’ and ‘unreasonable’ cuts on charities. This was paraphrased by one colleague as ‘localism will deliver the Big Society even if central Government has to compel it to do so’.

It is questionable, of course, how much responsibility local decision makers have for the impact of these cuts. Undoubtedly, individual councils will make better or worse decisions in allocating the resources available to them (and some times ‘political’ decisions), but the constraints within which they are having to make those decisions are tight. As David Brindle, the Guardian’s Public Affairs Editor, has observed, localism is potentially ‘a convenient get out for ministers on some of the most glaringly unfair spending cuts’. In a nutshell, passing the buck (literally) spells passing the buck (metaphorically).

It’s not all about money, of course – important as this is. The provision of local services in the future will depend on how well different local areas adapt to a changing environment, implement and develop new structures and approaches and respond to the challenge of more austere times innovatively. It’s also important to recognise the potential benefits of greater local control and accountability. It was remarked at the localism and austerity meeting that if you speak to local councillors and officials in some of the highest performing areas of the country as judged against the national drug treatment indicators, they often do not have a sense that they are dealing effectively with the drug and alcohol issues that are most visible in their communities and are the priorities for local people.

Ultimately, however, we need to hold on to the awareness that ‘failure’ – wherever the responsibility lies – can have a devastating impact on highly vulnerable individuals, families and neighbourhoods. That is the nub of the moral argument for stepping in to prevent it. There may be many positives to localism, but it is bound to mean that provision for drug and alcohol treatment is much better in some parts of the country than in others (and it could be very bad indeed in some). When he published On Liberty in 1859, the political philosopher John Stuart Mill considered the risks of democratic decision making – particularly to unpopular groups and causes – and concluded that individual rights provided a critical counterbalance to democracy. This observation seems pertinent in the age of localism. No one should ever get at all ‘comfortable’ with service provision (or non-provision) that drops below the same standards of acceptability that would apply to other people experiencing health or mental health problems. We will need to give even more weight and emphasis to notions of right and entitlement to support and treatment, such as those found in the NHS Constitution. Paradoxically, at a time where ‘recovery’ is rightly identified as a key aspiration for drug policy, this means continuing to insist that drug dependency remains a health issue too.

By Dr Marcus Roberts, Director of Policy and Membership

This article first appeared in the DrugScope Members' Briefing. Find out about DrugScope membership here