|Love Money?, photo by Flickr user Rob Jewitt|
A JSNA is an assessment of the current and likely future health and social care needs of a local area. They are often lengthy documents and the information from them is used to develop a Joint Health and Wellbeing Strategy (JHWS), which forms the basis of health and care commissioning in local areas. However, these vary hugely from one authority to another.
There has been lots of talk about changes to funding for drug and alcohol treatment in recent years, but relatively little hard evidence. Although the Department for Communities and Local Government produces actual and projected spend on a range of services twice a year, these figures do not really provide sufficient detail for analysis. Last month, DrugScope’s State of the Sector 2014-15 revealed a net average reduction of 16.5%, but that was at a service level, which tells us very little about how local systems are being resourced.
This project is an attempt to shed some light on what’s really happening in terms of funding. It consists of two components. The first is a scan of all 150 or so JHWSs in England, to try to ascertain the inclusion and/or prioritisation of drugs and alcohol. As there’s no standard template – or length – of JHWS, this has involved scanning of each strategy and then assigning the prioritisation given to one of three values for each of adult alcohol interventions, adult drugs interventions and young people’s substance misuse interventions. We should acknowledge that the assignment of prioritisation is inherently subjective – many areas have not marked drugs and/or alcohol explicitly as a priority, but do make a number of references to the issue, for instance referring to substance misuse in the context of the whole population, specialist interventions, the night time economy or a mixture of the three. We’ll consider carefully how best to report these findings.
Secondly, in order to understand the changes in funding allocations, we are obtaining detailed financial and supporting information about the allocation of funding to specific elements of substance misuse treatment. Through Freedom of Information Act requests made to all commissioning local authorities, the plan is to compile a picture of the changes in funding allocations over the years 2013/14, 2014/15 and 2015/16.
Of the strategies I have looked at so far, it is noticeable how much they vary - not only in style, size and approach, but also in tone. While some are single page documents listing the Council’s priorities for the coming months or years, others give in depth accounts of issues affecting the local area and discuss ways to overcome problems. The need to address substance misuse is recognised in most JHWSs, though approaches vary.
While there is an emphasis on service provision in some cases, the integration of drug and alcohol services was also observed, either as an amalgamation of the two services, or as integration into wider health areas such as mental health. Understanding alcohol consumption as a population-level concern was common to many strategies. Consequently, these tended to focus on prevention strategies or educational programmes more than on the provision of specialist treatment.
The same applies (although possibly not to the same extent) to the inclusion of drug misuse in assessments and strategies. Health and Wellbeing Boards are clearly trying to find the right balance between prevention and education and specialist treatment. There are a few strategies that address both acute and “lifestyle” drug and alcohol issues. Further investigation would be required to see if strategies’ priorities and content correlate with the known drug and alcohol issues in an area or region. Public bodies have 20 working days to respond to FOI requests we have submitted. As we’ve started out by making requests to a small number of authorities, to ensure that we get the question right, we’ve had limited responses so far. The ones we’ve received, though, suggest that the question will elicit the information we – and stakeholders in specialist treatment – need.
The report will be published later in the year. In the meantime, I will be providing occasional updates via this blog. If anyone would like any additional information, please contact me by email at firstname.lastname@example.org.