Making the case for drug and alcohol services in new times

A blog by Marcus Roberts, Chief Executive of DrugScope

Today DrugScope has launched a new resource called Making the case, as part of our work on behalf of the Recovery Partnership. It's a guide and toolkit to help our members and supporters to make the case for drug and alcohol services at local level - whether that's organising a service visit for elected councillors, marshalling the best evidence to present to local commissioners or working with local media to get positive stories about treatment and recovery out there.  

The days when the political energies of our sector could be focussed mainly on Westminster and Whitehall are gone. The aftermath of the Scottish referendum promises new adventures for devolution and regionalism. This is the latest phase in an emergent politics of 'localism', now de rigeur across the political spectrum (witness, for example, the recent IPPR Condition of Britain report, which is influential within the Labour Party). 

From 2001 to April 2013 substance misuse was the responsibility of a special health authority with a 'ring fenced' budget of around half a billion pounds, topped up by local investment. Both the National Treatment Agency and pooled treatment budget have since been absorbed into 'public health', a migration that has created pressures for both the migrants (pounds and people) and the new host culture (historically inclined to 'prevention' and 'whole populations' - but also with a strong track record of saving and improving lives through 'harm reduction').

The economic and political context for this transition is bracing. The Local Government Association (LGA) calculates that central government funding for councils will fall by 40 per cent over the life time of this parliament (2010-2015). The former LGA chairman, Sir Merrick Cockell, has described 2015-16 as a crunch year, saying 'we expect some councils to be placed in a position where they do not have the money they need to meet their statutory obligations'.

Against this background, an LGA press release on Novel Psychoactive Substances recently expressed concern that 30% of local public health budgets were spent on drug and alcohol services, and hoped for a 'clamp down' on this 'staggering sum'. This shows how our sector might be viewed through the other end of the telescope, and how attractive the budget we have brought into public health is looking to others right now. When Simon Stevens, NHS Chief Executive, declared at Public Health England's Annual Conference that he feared we are 'sleepwalking into the worst public health emergency for at least three decades', he was calling for a radical five year plan to tackle obesity. Priorities are shifting.

Meanwhile recent headlines warn of an NHS funding gap of £2 billion coupled with worries of a 'demographic time bomb' being primed by the ageing population.

The challenges are formidable, but there are positives. DrugScope's State of the Sector 2013 found no evidence of widespread disinvestment in the early months following the changes introduced in April that year. At regional events with our members and other stakeholders the message appeared to be that drug and alcohol services were well-established, with a hard won appreciation of their contribution embedded in local systems and structures ... but also real anxieties about the future.

Last Friday, Public Health England and the Association of Directors of Public Health published a review of the drug and alcohol commissioning intentions of local authorities in 2014-15 and beyond. While the review found ‘little intention to simply disinvest in services’, it reported that over a third of councils were planning to change or reduce funding in the two financial years 2014-15 and 2015-16 (see my blog with Andrew Brown for a summary and analysis).

Our 2014 State of the Sector survey is now 'in the field', with other indications from our members that a significant number of local authorities are investing less in substance misuse services or planning to do so... And recall the LGA's warnings about pressures on local authority budgets coming to a head in 2015-16. The mantra that we hear is 'more for less' and the challenge is to deliver more efficiently without compromising on access or quality. This is a sector with a history of innovation, creativity and resilience and many of our members are actively taking up this challenge… but this is only achievable up to a point.

So how do we ‘make the case’ locally? Let me pick out three key messages.

Firstly, in one of the strongest episodes of the US television series The West Wing, Mrs Landingham is trying to persuade a teenage Jed Bartlett – later to be the US President – to take up the cause of unequal pay for women in the New Hampshire school where his father is the headmaster. Establishing a theme of the Bartlett presidency, he tells her ‘if you want to convince me of something, show me numbers’. Numbers influence decisions. The equation that £1 on drug treatment = £2.50 saved in subsequent costs had an important role in securing the investment that fuelled the expansion of our sector (another example is the major investment in psychological therapies secured by the Layard report on depression, which was, significantly, the work of the Centre for Economic Performance at LSE). We have some good data and research to work with, and some good tools to help us to use it to best effect, including those launched by PHE last week.

Secondly, Gerard Lemos once said to me that ‘the impact of any research study is inversely proportionate to sample size’. By implication, the most influential ‘research’ has a sample of one. The observation was tongue in cheek, but it highlights the importance of human stories in winning hearts and minds. We’ve all been at conferences where the personal testimony of service users has cut through a long day of policy analysis, graphs and statistics. Similarly, getting local officials and representatives along to a service brings home that it is not just an address, a set of interventions, outcome data and a balance sheet, but a building with skilled and dedicated people in it working to make a difference, and a community resource in its own right.

Thirdly, we are one of many sectors facing similar challenges in the current financial environment. The people that we are seeking to influence have headaches of their own: seeking to balance competing demands and priorities, balance the books and manage funding cuts … all with local accountability and scrutiny, and statutory obligations to worry about too. It is important to engage constructively in this environment, look for opportunities for partnership and offer solutions where possible, while giving clear messages about the risks and threats. 

DrugScope has taken a particular interest in developing partnerships with other sectors in a way that has the potential both to cut costs and improve outcomes for service users and their communities. We are doing this, for example, in our work with Clinks, Homeless Link and Mind as part of the Making Every Adult Matter coalition on multiple needs. We are currently working closely with colleagues in mental health, building on the work we did with the Centre for Mental Health on the potential to commission for recovery across substance misuse and mental health. Our sector is also showing how to effectively mobilise the natural resources that are available in local communities – including, of course, the assets and resources of service users, people in recovery and the networks and communities they have created. This is an area where DrugScope has worked closely with the Royal Society of Arts to support their work on user-centred recovery and connected communities.

Looking for solutions in a tight financial environment can spur innovation, but it also creates significant risks. For example, the assets of service users and the dynamism of community networks and initiatives have a critical role to play. It is important, however, to ensure that this contribution is appropriately supported (for example, with funding for development and ensuring that there is support for those taking on roles as ‘recovery champions’ and ‘peer mentors’, an issue my colleague Harry Shapiro took up in the Druglink article ‘Walking the line’). In addition, this augments and cannot replace the contribution of specialist staff with other skills and qualifications. The wider danger is that the pressure of the times fuel an unintended ‘race to the bottom’ and cost cutting compromises quality.

To conclude on a positive note, while ‘stigma’ is an issue and a challenge, the public may be more sympathetic than is often assumed. A DrugScope/ICM poll conducted in 2009 found that nine in ten people agreed that ‘people who have become addicted to drugs need help and support to get their lives back on track’ and over three quarters said that investment in treatment was ‘a sensible use of government money’. One in five had direct or indirect experience of drug addiction (and this figure would be significantly increased if alcohol had been included).

None of this is to underestimate the challenges – a phrase of the Italian socialist Antonio Gramsci seems apt: ‘pessimism of the intellect, optimism of the will’.

I hope you find Making the Case a valuable resource in supporting you to influence local people, opinion formers and decision makers. You can also support us to ‘make the case’ by completing our State of the Sector 2014 survey if you are a service manager, and by joining us as a member if you are not with us already.