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.

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?

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

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

Who benefits

Who Benefits? is a broad partnership of charities who want to reframe the terms of the debate about social security. Too often, the portrayal of welfare benefits and benefit claimants in the media and elsewhere is misleading – that benefits are generous, easily obtained, and often a lifestyle choice. We know that that just isn’t the case – work with our members and directly with clients shows only too clearly that people are facing increasing hardship due to a range of factors, including the Work Capability Assessment and the on-going process of welfare reform. Coming from a drug and alcohol perspective, we’re also acutely conscious of the impact of stigma; one of the most insidious and harmful effects of the way that the media talks about social security is to increase the stigma felt by all people who have to rely on benefits to get by.

Who Benefits? aims to provide balance to this largely negative narrative by highlighting the vital role that social security and welfare benefits have in supporting people who would otherwise be at risk – the young, the old, the unwell and those experiencing other forms of disadvantage. Who Benefits? believes that no one should go hungry because they lose their job or become homeless because they get ill, and will give a voice to the millions of people who have been helped and supported through at least one point in their lives by social security benefits.

Who Benefits? is coordinated by The Children’s Society, Crisis, Gingerbread, McMillan Cancer Support and Mind, and supported by dozens of other charities and community groups from a range of sectors, including DrugScope. If you’re interested in supporting or joining the campaign, you can find out how here.

Paul Anders
DrugScope Senior Policy Officer

Turning lives around? Drugs, alcohol and the Offender Rehabilitation Bill

As summer comes to an end and politicians return from recess, the Offender Rehabilitation Bill is about to continue its path through Parliament. The Bill – which was published in May, alongside the Government’s response to the ‘Transforming Rehabilitation’ consultation – is comparatively short, but nevertheless important, and contains a number of provisions that are likely to have an impact on those with drug and alcohol problems in contact with the criminal justice system.

Most significantly, perhaps, the Bill introduces a post-custodial licence period for short-term prisoners (those sentenced to up to 12 months), as well as a period of “additional supervision for the purpose of rehabilitation” in the community for anyone sentenced to up to two years’ custody; the licence period and the new supervision period will, together, last 12 months. So, someone sentenced to six months’ custody – who, under the current regime, would be released after three months in prison, with no supervision – will, under the new legislation, serve three months in custody, three months on licence in the community, followed by nine months of supervision.

The Government has set out clear reasons for these provisions: reoffending rates for those released from short prison sentences are high, and post-release supervision will address this through tailored support to help people ‘turn their lives around’. The lack of support for short-term prisoners has been a concern for DrugScope and others for a long time, and the principle of post-release support is an important one. But there are risks, too: it’s possible that the new licence and supervision periods will mean an increased numbers of breaches. This is a real risk for those with drug and/or alcohol problems, who may lead ‘chaotic’ lives, and find complying with the conditions imposed on them difficult. Apart from the cost attached to this (which the updated impact assessment for the Bill puts at somewhere between £6 million and £42 million annually), there’s also the question of the impact of  additional sanctioning as a result of a breach – which could include a return to prison – on ‘recovery capital’ and the pursuit of ‘rehabilitation’. 

There’s an issue, too, around proportionality of sanctioning, and the implications of the new supervision period for this. Someone given a two-week prison sentence, for instance, will in practice be ‘in the system’ for 53 weeks: one week in prison, followed by one week on licence and 51 weeks of supervision in the community.

The Bill also introduces a ‘drug appointment requirement’, which can be imposed as a licence condition, or during the new supervision period. Under this, you would be required to attend appointments with a view to addressing your “dependency on, or propensity to misuse, a controlled drug”. The requirement has to set out who the individual subject to the condition has to meet with (who must have “the necessary qualifications or experience”), where and when the appointments will take place, and the duration of appointments.

Under the Bill’s provisions, there is no “requirement to submit to treatment”. However, there are unanswered questions about what “treatment” means in this context, and how it may be interpreted in practice. It could, for instance, be interpreted to mean only medical treatment, meaning that some individuals might be required, for example, to participate in some forms of psychosocial interventions; further clarification is needed in this area. There are also potential problems as a result of a lack of specialist provision in some areas: this could result in some people being mandated to attend appointments at services that are not able to meet their particular needs effectively, or, in some cases, where their safety could be compromised – for instance, women who are in intimate relationships that are abusive.

Finally, as some DrugScope members have highlighted, the evidence for the effectiveness of mandating people to attend appointments as a way of ensuring engagement with treatment is mixed – for instance,  the required assessment process in the Drug Interventions Programme (DIP). DIP has been very successful in some respects; the National Audit Office (2010) cites Home Office research that crimes committed by those receiving DIP support and in drug treatment fell by 26% compared to their frequency of offending on entering the programme. However, it’s also significant that of those who were assessed under DIP in 2010-11, only 29% went voluntarily from assessment into treatment, with 6% successfully completing this treatment.

It’s positive to see the Government paying attention to those with drug and alcohol problems in the criminal justice system, and improving resettlement support for short-term prisoners. But there are a number of issues with the approach it is taking, which DrugScope has raised with the Ministry of Justice and will continue to pursue.


Gemma Lousely,
Policy Officer

Only connect

I was recently sent a classic cartoon strip from Scott Adam’s Dilbert series, which documents the indignities and inanities of office life. This strip is set at a meeting where an intern has been invited to introduce himself to new colleagues. ‘I am Asok the intern’, he begins, ‘I report to you. But I also report to Alice on a dotted line. And I report to Carol on a fuzzy thin line. I have a blinking irregular line to Wally, and a wavy brown line to Dilbert’, at which point Alice buries her head in her hands and says ‘please make this stop’.

This strip may strike a chord with DrugScope members who are adapting to a wide range of new structures, which relate to each other in a variety of ways. These include Directors of Public Health, Clinical Commissioning Groups, Health and Wellbeing Boards, Healthwatch (both nationally and through its 152 local centres), Public Health England (nationally and through 15 regional centres), NHS England and elected Police and Crime Commissioners.

There is clear potential in so much simultaneous system change for a proliferation of dotted, fuzzy, blinking, irregular and wavy lines – particularly as different initiatives have been developed by different government departments, and may not always have been exhaustively choreographed.

Take, for example, Public Health England (PHE). At national level, strategic leadership for substance misuse sits with the PHE’s Directorate for Health Improvement and Population Health. But there is no direct line from this directorate to the 15 PHE regional centres (and their substance misuse teams), which are overseen by PHE’s Operations Directorate. The ‘line’ from PHE to local public health budget holders is also of the dotted variety. The recent PHE document ‘Our priorities for 2014-15’ explains that ‘PHE will not performance manage local authorities’, with public health ‘led locally by elected members’. (It was reported at a recent meeting attended by DrugScope that PHE Regional Directors may have autonomy to set their own local priorities independently of PHE nationally – raising intriguing questions, if true, about the scope and force of PHE’s national priorities and strategy within the wider organisation.)

To take another example, DrugScope recently met with the drug and alcohol team within the London Mayor’s Office for Policing and Crime (MOPAC). MOPAC is responsible for discharging the Police and Crime Commissioner role in London, and has identified ‘developing smarter solutions to drug and alcohol crime’ as a strategic priority in the London Police and Crime Plan, but it has limited say in the design and development of treatment services for offenders. The MOPAC team is therefore busy forging connections with decision-makers in the 33 London Boroughs – for example, Health and Wellbeing Boards. They are also working with the PHE London regional team, and thinking about how their work might eventually link up with the Ministry of Justice’s Transforming Rehabilitation reforms.

It was in Howard’s End, that the novelist E M Forster wrote ‘Only connect! That was the whole of her sermon. Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height.’ That might somewhat overstate the benefit for us, but certainly ‘connecting’ will be critical for the future of drug and alcohol services. On a positive note the ‘fuzziness’ and ‘waviness’ of some of the lines could be viewed as a welcome indication of ‘flex’ and fluidity and an opportunity for creative inter-agency work. A lot will then depend on pro-active local work to ‘join the dots’ and ‘build recovery in communities’.

On a practical level, creating robust local forums and getting the right people to attend them is critical (think, for example, of the history of Drug Action Teams). It’s also important that busy people are supported to prioritise the activity that is needed to build relationships and effectively link up with others (for example, at a basic level, in job descriptions and work plans). Organisations like DrugScope have an important role to play in catalysing these processes and supporting members to engage effectively. In the autumn, for example, we are hosting a series of regional events on ‘building recovery’ in this new environment on behalf of the Recovery Partnership, and will be in touch as this – and other related work – develops.

DrugScope is currently monitoring, for the Recovery Partnership, developments for drug and alcohol services in light of the significant changes for the sector and related services. Find out more and tell us about any concerns in your local area at http://www.drugscope.org.uk/partnersandprojects/RecoveryWatch

Marcus Roberts
Director of Policy

The Challenge of Change: Improving services for women involved in prostitution and substance use

DrugScope, with AVA (Against Violence and Abuse), has recently published ‘The Challenge of Change: Improving services for women involved in prostitution and substance use’, the report of a research project that encompassed an evidence review, interviews with women with a history of prostitution and substance use, an online survey of services, and observational site visits. Following a launch event at the House of Lords on 2^nd July, hosted by Baroness Corston, a London-specific launch will be taking place at City Hall on 18^th July, with the Deputy Mayor Victoria Borwick speaking at the event.

As its title indicates, the focus of the ‘Challenge of Change’ project has been on policy and practice to address the drug and alcohol treatment needs of women involved in street-based prostitution. While there are no good estimates of the number of women involved in street prostitution and substance use, the Drug Treatment Outcomes Research Study (2007) found that 10% of women starting drug treatment said they had exchanged sex for money, drugs or something else, indicating that the size of this group is significant. As our research highlighted, women involved in prostitution and substance use experience considerable harms, including mental and physical health problems, sexual health risks, and very low self-esteem. Violence was also a significant issue for most of the women interviewed for the research, from a partner or, more often, from a client or ‘punter’.
 
In spite of this, women involved in prostitution and substance use command little attention within national policies; the 2010 Drug Strategy, for instance, contains no mention of the words ‘prostitution’ or ‘sex work’, or even ‘woman’, ‘women’, or ‘girl’. Where drug and alcohol problems among women or involvement in prostitution are mentioned, guidance is rarely provided on addressing the issues together, despite the mutually reinforcing nature of drug use and prostitution. All of the women interviewed for our study reported working on the streets to obtain money for drugs, and many made it clear that this was the reason that they became involved in prostitution in the first place.

The qualitative interviews, which were conducted by peer researchers, highlighted the barriers to accessing services that this group of women can face. These include personal barriers, such as very low self-esteem, as well as organisational barriers, including service hours of opening and a lack of childcare provision. A key issue for these women is the relationship with their keyworker. For such a vulnerable group, consistency is crucial to aid engagement with services; many women feel the effects of ‘double stigma’ as a result of using drugs and being involved in prostitution, and it takes time to develop the trust necessary to open up. However, several interviewees mentioned that they had experienced frequent changes in keyworker. Interviewees also spoke of feeling ‘judged’ or ‘looked down on’ by staff following disclosure of their involvement in prostitution, and disparities in gender and age were also highlighted as problematic.

The research also identified positive interventions for women involved in prostitution and substance use, including evening opening hours for services, outreach provision and support with childcare arrangements. Women-only provision was identified as crucial, and interviewees also spoke of the importance of support from ‘real’ peers – that is, women with experience of using substances and involvement in prostitution. The research highlighted the tailoring of standard drug and alcohol programmes as an effective approach, and the importance of integrated provision, to address the multiple needs of this group of women, was also clear.   

While there are services that are working to address the specific needs of these women, our research highlighted that the problems they face are not always well catered for. Tailoring of standard programmes remains underdeveloped in substance misuse services, and while all the services we surveyed said they provided access to domestic and sexual violence services, only a minority had these available in-house. Peer support was widely available; however, there was less ready access to women-only peer support. Finally, although many women interviewed for the research spoke about wanting longer-term change in their lives – getting a job, having a nice home, being with their children – in-house support with education, employment and housing was not available in the majority of services we surveyed.

Our report sets out good practice recommendations for services, as well as policy recommendations for decision makers and commissioners, which we believe will improve services for this marginalised, stigmatised and traumatised group of women. The challenge now is to ensure that these recommendations are heard and, of course, implemented.

 

‘The Challenge of Change: Improving services for women involved in prostitution and substance use’ is available here.

Gemma Lousely, Policy Officer

Through my in-tray this month

Rather than focussing on one individual area of policy, it might be useful to look in brief at a number of issues that I have been working on. The sector can be affected not only by decisions relating directly to people with histories of drug and/or alcohol use or services that support them, but also those that have a wider application. This month, there are examples of both – the role of Jobcentre Plus in the reformed welfare system, the evolution of the Government’s Social Justice Strategy, and DrugScope’s monitoring of commissioning and funding arrangements for drug and alcohol services.

Jobcentre Plus

In April, the Work and Pensions Select Committee announced an inquiry into the role of Jobcentre Plus in the reformed welfare system. Whilst most people will be aware of the rise of contracted-out provision (through labour market interventions such as the Flexible New Deal and then the Work Programme) and the increased use of the internet for making and managing claims, the role of Jobcentre Plus is still central to the relationship between the Department of Work and Pensions and the individual.

With Universal Credit due to start national roll-out in October 2013, Jobcentre Plus will have a different and increasingly important role – for example, applying ‘tailored conditionality’ for people entering structured drug or alcohol treatment, negotiating a Claimant Commitment that better reflects an individual’s circumstances, and dealing at first instance with claims for what is currently income-based Employment and Support Allowance, but will in future be part of Universal Credit. On the labour market and job brokerage side, Jobcentre Plus will still be responsible for supporting people towards paid employment prior to any referral to contracted-out provision such as the Work Programme.

In a joint response with Homeless Link, DrugScope submitted evidence concerning current claimant experiences of Jobcentre Plus, as well as outlining some concerns about the future. We need frontline Jobcentre Plus staff who have genuine understanding of the particular needs and barriers of people with histories of substance use, and are able to support people to disclose. We need services that are joined-up and work collaboratively with treatment providers, Work Programme providers and others. We need a conditionality regime that recognises the genuine problems some people have in understanding, remembering and carrying out the expectations placed on them, and when people are ready and able to progress into work, we need to see diverse services that can provide skilled, specialist employment support.

You can read the submission here.

Social Justice Strategy

In March 2012, the Government published “Social Justice: transforming lives”, a strategy that sets out a vision of social justice. Whilst many concepts of social justice have focussed on process and comparative disadvantage, the strategy instead looks at particular groups – families, young people, unemployed people, and disadvantaged adults, and attempts both to articulate the problems, and what the Government is doing to tackle them. Much of the language used in the strategy will be familiar to those in the drug and alcohol sector - prevention and early intervention; recovery and independence, locally designed and delivered solutions; payment by results and multi-agency delivery.

In April 2013, the Government published an updated Social Justice Outcomes Framework along with a one-year review of the strategy, stating more explicitly the indicators to be measured. A number of indicators identified and factors referred to will be of interest to treatment providers – for example the indicators directly concerning people successfully completing drug or alcohol treatment, gaining employment and (where relevant) ceasing offending, but also related subjects such as homelessness, financial exclusion and debt, educational outcomes for young people and health inequalities.

The Centre for Economic and Social Inclusion (Inclusion) has been commissioned by DWP to develop a Social Justice Toolkit that will provide an easy-to-use overview of Social Justice Indicators (based around the themes of families, young people, the importance of work, disadvantaged adults, plus delivering social justice) in all local authorities. The aim is to produce an easy to use tool for local policy makers, commissioners and service providers, to aid understanding of local factors and priorities. DrugScope, along with other agencies including Making Every Adult Matter (MEAM) is working with Inclusion to identify potential data sources with the aim of launching the toolkit in July 2013.

Monitoring

April 2013 saw further changes which will continue to transform the commissioning and funding of drug and alcohol services. Two of the most visible aspects of this are the transfer of public health responsibilities to Local Authorities and the election last year of Police and Crime Commissioners who are significant players in commissioning services that cut across substance use, criminal justice and offending.

These major changes are taking place against a background of further reforms that either relate directly to the sector, or could otherwise have some bearing, for example the folding of the NTA into Public Health England, payment by results, changes planned to offender rehabilitation and welfare reform. Across different policy areas, the continued drive to commission joint services and encourage partnership working is plain.

With so much decision making devolved to local level, DrugScope  - with the Recovery Partnership – is actively trying to understand the national picture. We are currently mapping local decision making and commissioning structures – DATs / DAATs, Directors of Public Health, Health and Wellbeing Boards as well as Police and Crime Commissioners and other stakeholders. We’ll be looking at what priorities they are setting, how they are setting them, and what changes to funding and commissioning occur as a result. Later this year, we’re planning on carrying out a state of the sector – or SOS - survey looking directly at the experience of services and service providers.

However much we can do, nothing counts as much as eyes and ears on the ground. On behalf of the Recovery Partnership, DrugScope has established RecoveryWatch, a system enabling people to let us know of local developments – big or small, positive or negative – to help to inform our work over the coming months.

Whatever your role, your information will be welcome and will be treated with the strictest confidence. You can find out more about RecoveryWatch here.

Paul Anders,

Senior Policy Officer

Can the Work Programme work for all customer groups?

Report of the Work and Pensions Select Committee.

Today’s report (21^st May) “Can the Work Programme work for all customer groups?” will make interesting reading for people in the drug and alcohol sector and beyond. The report reflects many aspects of the submission  DrugScope made jointly with Homeless Link in December 2012, and makes some of the same recommendations we called for. It also gives a degree of prominence to people with histories of drug and / or alcohol use, which has not always been the case when the Work Programme is discussed in Parliament.

Whilst the report addresses a number of issues concerning the Work Programme that are likely to be of general interest, such as performance levels and other aspects of Programme design, there are other parts of the report that speak directly to the concerns of service providers from our sector (particularly those with one of the 35 Work Programme subcontracts the sector holds) and – crucially – clients too.

Having spoken to several providers prior to submitting DrugScope’s written evidence to the Select Committee, several things soon became clear: the commitment of the sector to supporting people towards employment along with disappointment about the ability of the Work Programme to support their efforts in doing this. Whether Work Programme sub-contractors or not, there was a widespread sense that, despite the clear intent to provide a tailored and personalised service, it just wasn’t working for people with histories of drug / alcohol use.

Perhaps of most interest to the sector is the recommendation that the Department for Work and Pensions should use the underspend in the Work Programme to date – caused by lower than expected payments for job outcomes and sustainment –  to fund specialist, pre-Work Programme support to those furthest from the job market, with claimants with severe drug and alcohol issues mentioned. Although the Work Programme funding model may mean that any underspend has to be returned to the Treasury, Mark Hoban, the Minister for Employment, told the Committee that the DWP was negotiating about keeping the current underspend, to use in future years. This is a useful and constructive suggestion that should be given full consideration – many treatment providers from both the voluntary and public sectors offer cost-effective employment services that deliver strong results but constantly struggle for funding. Making use of that experience and drive would a sensible step.

Of similar interest is the recommendation that ‘milestone’ payments should be introduced for those with the most significant barriers to employment. DrugScope’s evidence highlighted the need to balance high aspirations for clients with a realistic appreciation that the journey back into work for our service users can take time and may be indirect. If those furthest from the job market are to receive genuinely tailored, specialist support, the funding needs to be in place to deliver it.

The report also draws attention to the deficiencies of the use of benefit type as a proxy for need, and the contribution to this problem made by a Work Capability Assessment that is still not fit for purpose in determining access to sickness related benefits– many claimants referred in “mainstream” JSA customer groups have significant self-reported disabilities or health problems, which is something the Work Programme payment model can’t reflect. As the Committee finds, the differential payments model is a step in the right direction, but an insufficiently bold one: it recommends a shift to needs-based assessments and more specialist provision, which may make progress in tackling the problem of creaming and parking.

Employer engagement is covered at some length, including the reluctance of firms to hire people who have been long-term unemployed, a factor compounded by the stigma often experienced by jobseekers with histories of drug or alcohol use. Whilst the Committee makes a number of recommendations about this, DrugScope would welcome renewed investment in the intermediate labour market (ILM), for example, social enterprises – something that could help to bridge the gap to employment give people the chance to demonstrate the ability to hold down a job.

Vulnerability is also considered. DrugScope’s own research before submitting evidence suggested that a large number of people using treatment services had had their benefits suspended, or sanctioned. The Committee draws attention to the poor communications received and lack of understanding and awareness of the Programme that may be behind many non-attendances at initial appointments. The Committee recommends that DWP carries out a review of sanctions as a matter of urgency, a call which we would echo. Regulations brought in in October 2012 introduced a much tougher regime, so it is crucial that there is transparency around this and reassurance that sanctions are not being used disproportionately to the detriment of vulnerable claimants.

A further recommendation from DrugScope that the Committee agreed with was the need for stronger minimum service standards. The combination of the “black box” model, an ineffective differential payment system and vague minimum standards means that it’s often difficult to pin providers down to a specific offer. DrugScope welcomes the Committee’s recommendation that a simple, clear minimum entitlement that all providers would have to observe should be developed.

Of interest to any organisation working with people with significant barriers to employment, the first cohort of Work Programme customers are soon to come to the end of their 2 years on the Programme, the Committee rightly expresses concern about post-Work Programme support for claimants. For the reasons outlined above, this may well be where many clients of treatment providers end up, having failed to get or keep a job through the Work Programme. DWP has piloted two different approaches, but it is not yet clear what their plans are – we too would welcome more clarity.

Finally, the report recommends more detailed information about the use of supply chains, expressing concern that specialist organisations are not playing a role (one large provider from the drug and alcohol sector received 5 out of an anticipated 1,000 referrals in its first year), and observes that many charities are effectively subsidising their Work Programme activities from other sources. Providing detailed job outcome and sustainment figures may be a mixed blessing for specialist providers working with those furthest from the job market as almost inevitably, their performance may look unimpressive compared to mainstream organisations working with clients without unusually significant barriers. It could, however, serve to demonstrate the inadequacy of current provision and serve as an incentive to make better use of specialists. This would, over the medium term, be a positive move, but DWP’s recent delaying of prime contractor level performance figures doesn’t bode well for its implementation.

To conclude, the Committee’s report is welcome. It identifies many of the problems for which DrugScope, with the support of our members, has found evidence, and proposes sensible, workable solutions – and hopefully ones that can be implemented before the successor to the Work Programme starts, presumably in mid-2016 or thereabouts. Whilst the elephant in the room is the lack of job opportunities and the intense competition for them, we have to strive continually for improvements in active labour market programmes, and this report makes a welcome contribution to the debate.

If you would like to keep in touch about the Work Programme, or share experiences and comments, please contact  paul.anders@drugscope.org.uk

Paul Anders,

Senior Policy Officer, DrugScope

See DrugScope's work on the Work Programme on our website 

A Public Health Priority?

The reforms to the planning and commissioning of drug and alcohol services that have been the subject of so much speculation finally became the day to day reality for the sector from 1 April. The National Treatment Agency (NTA), which has been such a prominent feature of the drug policy landscape since 2001, closed its doors at the end of March, with its functions absorbed into Public Health England (PHE). The ‘pooled treatment budget’ which has funded the expansion of drug services in England, came to an end, with this funding absorbed into a new public health budget.

So how big an impact will these changes have on service delivery on the ground and what is DrugScope’s role in supporting our members as we enter what feels like a new phase in the politics, planning and delivery of substance misuse services?

PHE published ‘Our priorities for 2013-14’ on 26 April. It includes a commitment to ‘improve recovery rates from drug dependency, recognising this as the core purpose of drug treatment’. There is, however, only one further reference to drug dependency, and two references to alcohol. By contrast, the word ‘local’ makes 48 appearances. The PHE priorities document stresses that ‘improvement in the public’s health has to be led from within communities, rather than directed centrally’ and adds that ‘PHE will not performance manage local authorities’. This sounds like a more ‘hands off’ role than was adopted by the NTA, with PHE largely dependent on its powers of persuasion.

For those imagining that the transfer of NTA functions into PHE might result in business as usual, it is worth noting that around 150 NTA staff have joined an organisation with over 5,000 staff. In addition, the NTA has not been ‘lifted and shifted’ into PHE, but fragmented and split across three separate Directorates. Rosanna O’Connor, formerly the Director of Delivery at the NTA, is now the most senior figure with a specific substance misuse brief in PHE, as Director of Drugs and Alcohol in the Health Improvement and Population Health Directorate. Yet she has no direct management responsibility for the drug and alcohol teams in the 15 regional PHE Centres (formerly NTA regional teams), which sit under a separate Operational Directorate. The National Drug Treatment Monitoring System (NDTMS) and National Alcohol Treatment Monitoring System (NATMS) are housed within PHE’s Knowledge and Intelligence Directorate. How all this will work out in practice remains to be seen.  

What is clear is that Government is serious about ‘localism’ and local authorities will have more discretion about what funding is allocated to substance misuse services and how it is spent. This has prompted real concerns about the risks of disinvestment particularly during a period of financial austerity, with the Spending Review 2010 including a 28 per cent reduction in the local government settlement (once funding for police and fire authorities are excluded) up to 2014-15.

DrugScope – working with our colleagues in the Recovery Partnership – had previously got a reassurance that drug treatment spending would be protected. In June 2012, the Department of Health published an ‘Update on Public Health Funding’ that reported the findings of its Advisory Committee on Resource Allocation (ACRA) that, at least for an interim period, ‘the allocation of the PTB for drugs treatment should continue to follow the approach currently used and praised as effective by the National Audit Office’. However, when the local authority allocations for 2013-14 and 2014-15 were published we struggled to see how any meaningful protections had been incorporated into those budgets.

In March, DrugScope’s Chief Executive, Martin Barnes, wrote to Health Minister Anna Soubry MP to ask whether any protections had in fact been included in the public health budgets and how they would work. The reply from the Minister that we received at the end of April conceded that is was not possible to identify a nominal ‘drugs allocation’ within the budgets announced in January, which places a question mark over the possibility of any meaningful protection. The Minister says that the Department of Health will ‘keep the provision and funding of substance misuse treatment under close review in the first year’. This is welcome, but it also suggests that the Government shares the concerns. It also raises the question of what government would do if there was disinvestment given its commitment to localism.

DrugScope has launched, for the Recovery Partnership, a Recovery Watch initiative and is encouraging members and others to get in contact with us where there is local disinvestment. We are also developing a DrugScope Observatory to monitor local developments and to ‘hold a mirror’ up to national and local government. Later in the year, we are planning a national survey of service providers to assess the impact of the reforms on their work, so watch this space and keep in touch.

Dr Marcus Roberts - DrugScope Director of Policy and Membership

Integrated approaches for women with drug and alcohol problems

I recently joined DrugScope as Policy and Engagement Officer. I have a strong interest in women’s issues, and was therefore particularly pleased that the importance of integrated services for women with drug and alcohol problems is an area that DrugScope has been concerned about for some time.

The LDAN/DrugScope Domestic Violence project, which ran for four years and came to an end in March, worked to encourage collaboration and facilitate partnerships between the domestic violence and substance misuse sectors, given the clear, though complex, links between intimate partner violence and problematic alcohol and/or drug use. Research has, for instance, identified that women who have experienced gender-based violence are 5.5 times more likely to be diagnosed with a substance use problem over their lifetime.[1] 

A 2005 report by the Mayor of London also found that almost two-thirds of the women it surveyed from domestic violence agencies with substance misuse problems reported that they began their problematic substance use following their experiences of domestic violence. All of these women saw a link between their substance misuse and their experiences of domestic violence, with the most common reported being use of substances to dull physical and emotional pain. 

As the final report for the DrugScope/LDAN project – which will shortly be available here –  sets out, national strategies have often failed to address these dual issues, and joined-up approaches have, historically, been lacking in frontline services. We held an end of project event in London on 26th March which also highlighted the continuing limited availability of female-only provision, and the impact that this can have on women using services. Presenting findings from the evidence gathering stage of their ‘Rebuilding shattered lives’ project, Anna Page of St Mungo’s noted that professionals and service users alike have made arguments for both mixed and female-only provision. She highlighted, however, that, according to their analysis, female clients in women-only provision make more positive progress than those in mixed services.[2]

Emerging findings from a forthcoming DrugScope and AVA (Against Violence and Abuse) research report on sex workers’ experiences of drug and alcohol services – to be published in Summer 2013 – also point to a lack of integrated working, in spite of the links between sex work and substance misuse, and particularly use of drugs.[3] This should also be seen in the context of national policies that fail to make the necessary links: the 2010 Drug Strategy, for instance, makes no reference to the words “prostitution”, “woman”, “women” or “girl”.

There is a risk that, as new local commissioning structures come into play, the provision of appropriate services for women will continue to be overlooked. Within local authorities, Directors of Public Health (DsPH) have a broad range of responsibilities, and there are concerns that the needs of the most vulnerable and marginalised groups may go unnoticed. Additionally, from next year, the Community Safety Fund, which Police and Crime Commissioners are responsible for allocating across police force areas, will be rolled into the main policing grant, exacerbating the risk of disinvestment still further.

But the new arrangements also bring fresh opportunities for joined-up, women-specific services. Statutory guidance recently published for Health and Wellbeing Boards, which are responsible for producing the needs assessments and strategies that DsPH will commission on the basis of, specifically sets out the importance of considering “those with complex and multiple needs”. Additionally, the Public Health Outcomes Framework, published by the Department of Health last year, sets out a range of relevant indicators, including on domestic abuse, sexual violence, alcohol and drugs, mental illness, homelessness and reoffending.

At the end of March, the Ministry of Justice also published ‘Strategic objectives for female offenders’, which sets out key priorities in relation to women in contact with the criminal justice system, and announces an independent advisory board to push these forward. After a decidedly slow start on provision for women offenders (particularly disappointing given the lead provided by the Corston report in 2007), these are welcome steps by the Government. Importantly, the new document acknowledges the specific, and often multiple needs of women who offend, and reiterates the importance of services in the community that recognise and address these.

It’s worth noting, too, that the policy focus on multiple needs is being matched by funders’ increasing recognition of the importance of integrated services. Lankelly Chase, for instance, now focuses solely on work that tackles complex needs, and the Big Lottery Fund has recently announced its ‘Fulfilling lives’ programme, which is investing £100 million into services supporting people with multiple and complex needs. It is crucial that, as this agenda moves forward, the multiple and specific needs of women with substance misuse problems are clearly recognised within this, and addressed.

Gemma Lousley, Policy and Engagement Officer.


[1] Rees, S. et al (2011) ‘Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function’, Journal of American Medical Association, 306/5: 513–521.
[2] http://www.ldan.org.uk/powerpoints/DVFinalAnna%20Page%20St%20Mungo.ppt
[3] http://www.ldan.org.uk/powerpoints/DVFinalSex%20workers%20experiences%20of%20drug%20and%20alcohol.ppt

The Future for Safer Future Communities?

In Members’ Briefing of March 2012, we wrote about Safer Future Communities (SFC) – a Home Office funded network of networks aiming to support the voluntary and community sector to engage with the agenda around the new elected Police and Crime Commissioners (PCCs), who from April 2013 will set local priorities around policing and crime prevention, as well as controlling a proportion of the money that has previously flowed into the sector via the Drug Intervention Programme (DIP).

With Clinks as the lead partner supported by strategic partners including DrugScope and a broad stakeholder group, the project has been funded to:

• Provide practical support and advice to organisations that support Home Office objectives in preparation for the arrival of PCCs
• Support the sector as it adjusts to the changing local delivery and commissioning landscape
• Enable VCSE organisations to be in a position to become effective partners with the statutory sector and provide cost effective services, including involvement in co-design and co-delivery of services that meet local needs.

Going from a standing start in much of the country, SFC supported the establishment of a local network in each of the 42 police areas gaining PCCs in the 2012 elections (including London, who had gained a PCC in the form of the Mayor earlier that year), mostly but not exclusively led by local infrastructure organisations. Altogether, around 4,200 voluntary sector organisations have joined local networks.

Unfortunately, in April 2013 the current funding expires, and the outlook is uncertain. That Home Office funding for the project has finished now is disappointing, given the large amount of work that remains to be done in shaping and commissioning services and the phased nature of the PCCs’ assumption of control over budgets (which will not be complete until April 2014). In the context of the priorities above, how successful has SFC been, and what does the future hold?

To turn first to successes, SFC has been a powerful voice for the sector in many local areas, and particularly for smaller organisations who otherwise might struggle to make themselves heard. The very nature of elected PCCs means that as individuals, they value different approaches, want to be responsive to local issues and feel obliged to adhere to their manifesto commitments.

Consequently a one size fits all approach was never going to be effective, and local networks have been pursuing their own lines of engagement with PCCs with varying degrees of success. This work was hampered by the moving of the elections from May to November 2012, which had the effect of compressing the time available for PCCs to create their first Police and Crime Plans and to start managing their budgets.

Turning to the future, some local SFC networks will be funded by their PCC, others are in negotiations with potential funders including PCCs, whilst the national strategic steering group has agreed to continue its work, in all likelihood at an unfunded and consequently a reduced level.

Engaging with PCCs will remain important to many VCS organisations and particularly so for the drug and alcohol sector, given the resources that will go to PCCs’ Community Safety Budgets from DIP and the strong results delivered to date as a result of arrest referral routes.

In addition to community safety, PCCs are expected to be key players in commissioning cross-cutting services that work across different strands of the new environment, including Public Health.  Agencies whose work currently meets crime and community safety objectives, who currently deliver DIP or who believe that they could offer something that would fit with local PCC community safety priorities could still consider contacting their local SFC lead partner to find out what the plans are for the local network.

DrugScope has produced a briefing about PCCs for the sector, and has other resources that might be of interest. They can be found on our website here. You can find more information about Safer Future Communities here, and “Why Invest” from the NTA, a briefing about the impact treatment has on reducing crime and reoffending here.

Paul Anders, Senior Policy Officer, email: paula@drugscope.org.uk

Poverty: the state of being extremely poor?

A recent government consultation has been looking afresh at the issue of child poverty - DrugScope, Adfam and Alcohol Concern submitted a joint response. 

The Labour government elected in 1997 made the reduction of child poverty, which had increased substantially since the late 1970s, a priority area. Some progress had been made but by the mid-2000s that had stalled [1], hampered by stagnant or falling real incomes in some parts of the job market, rising costs and unemployment.

In 2006, the Conservative Party signed up to the then Labour government’s ambitious target of ending child poverty by 2020 [2] and supported the Child Poverty Act 2010 [3], whilst claiming that many of the children who had benefited from Labour’s policies were in households that had only just been lifted above the income  poverty line – “poverty plus a pound”, in the words of Nick Clegg.

The 2010 Act set four criteria for measuring poverty and targets to meet by 2020, primarily relating to relative, persistent and absolute poverty, and material deprivation – broadly the same measures taken across the EU and beyond.

The consultation

One of the drivers of the recent consultation [4] is that a fall in median income from 2008 onwards had appeared to lift some children out of poverty [5] ; they hadn’t become better off financially, the change was due to an average decline in income. This appears central to the matter at hand – relative poverty, as a percentage of median income, has been represented as a moving goalpost, or a cat chasing its own tail [6]. 

To describe it in this way is to misunderstand or misrepresent the difference between the mean and the median. Counterintuitive results, whilst not ideal, do not necessarily represent a sound reason for abandoning measures of relative household income as indicators of child poverty.

The recent consultation proposes a multi-dimensional measure of poverty that could risk burying relative (and absolute) low income under layers of complexity and data about related but largely separate factors and characteristics. The proposed components are:

• Income and material deprivation
• Worklessness
• Unmanageable debt
• Poor housing
• Parental skill level
• Access to quality education
• Family stability
• Parental health

Whilst there is a case to be made for some or all of the above forming part of a measure of childhood disadvantage, there are potential problems – not least that some could confuse cause with effect.

This is particularly so in Dimension 8: Parental Health. Whilst the title of the proposed measure is innocuous enough, the definition of health contained in the consultation appears to extend little beyond (undefined) disability, mental ill health and drug and / or alcohol dependency, the last meriting an individual consultation question.

This is concerning as it risks conflating households in poverty and people with drug or alcohol dependency, despite a paucity of evidence as to the direction of any causal relationship. The prominence given to drugs and alcohol increased when the Secretary of State, Iain Duncan Smith MP, introduced Public Views on Child Poverty [7] in a high profile speech. This research – based on a public opinion survey – suggested that respondents thought that drug or alcohol dependency was more important than income in deciding whether a child was growing up in poverty.

Drug dependency is a serious issue for those affected, but it is potentially a factor for a minority of children in poverty  – in 2003, the Advisory Council on the Misuse of Drugs estimated that up to 350,000 children in the UK were growing up with one or both parents drug dependent, compared to a total number of children in poverty at that time of almost 3,000,000 (in the UK) [8].

For alcohol use, there is additional complexity, with patterns of alcohol use and dependency diverging from drug dependency at different points on the income scale according to a range of factors, not least gender – for example, high-income women are more at risk from dangerous levels of consumption than those on low-incomes.

As the consultation states, it is entirely correct that the final measure chosen should be accepted by the public as a meaningful representation of child poverty, but government should proceed with caution, do everything possible to ensure that policy is grounded in evidence , and avoid the risk of reinforcing stigma.

You can read the consultation response here.

You can find a recent map of child poverty using the measures contained in the Child Poverty Act 2010 here.

Paul Anders, Senior Policy Officer, email: paula@drugscope.org.uk

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1. http://research.dwp.gov.uk/asd/hbai/hbai2010/pdf_files/full_hbai11.pdf
2. http://www.guardian.co.uk/commentisfree/2006/apr/11/comment.politics2
3. http://www.legislation.gov.uk/ukpga/2010/9/contents
4. http://www.official-documents.gov.uk/document/cm84/8483/8483.pdf
5. http://research.dwp.gov.uk/asd/hbai/hbai2010/pdf_files/full_hbai11.pdf page 16.
6. http://www.telegraph.co.uk/news/politics/conservative/7803983/Poverty-is-about-much-more-than-money.html
7.http://statistics.dwp.gov.uk/asd/asd1/adhoc_analysis/2013/public%20_views_on_child_poverty.pdf
8. http://research.dwp.gov.uk/asd/hbai/hbai2010/pdf_files/full_hbai11.pdf