Monday, 20 May 2013

Can the Work Programme work for all customer groups?

Report of the Work and Pensions Select Committee.

Today’s report (21st 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,
Senior Policy Officer, DrugScope

Thursday, 16 May 2013

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