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