Austerity kills, the breakdown of substance misuse services and the race to the bottom, by Lola Brittain

Last week Mentor UK, a leading voice in drug and alcohol prevention ceased activities after twenty years. Affiliated with the Mentor International Foundation, Mentor UK was a not-for-profit network empowering the prevention of substance misuse. Navigating a complex and problematic field, it has helped thousands of young people, both directly and indirectly and now, it is closing its doors. 

Citing ‘major challenges’ relating to the reduction of funding at both local and national level, Mentor, announced the ‘difficult decision’ on its website earlier last week. 

Mentor’s liquidation represents a tragic loss for prevention, but unfortunately, it speaks to a larger, darker truth. Across the UK substance misuse services are strained to breaking point. With austerity and the removal of ring-fencing, local councils have dealt the substance misuse sector an even small piece of an even smaller pie. 

In a sense, this was to be expected. For financially strained local councils, this ‘non-essential’ service is the perfect target. In comparison to policing, housing and transport, substance misuse services are relatively insignificant to the average voter. And, as a result, funding has decreased, dramatically. 

According to figures relayed by UKAT, funding for drug and alcohol treatment in Islington fell by £3.9 million between 2013 and 2018. Similarly, Camden Council spent £3.3 million less, while Brent Council cut funding by 30%. Unfortunately, this trend is apparent nationwide. 

Consequently, tendering has become competitive. As Matthew Gaskell, Clinical Lead for Addictions with Leeds & York Partnership NHS Foundation Trust, said it has become a “race to the bottom”.

“Specialist NHS Addiction Services and the expertise they encapsulate have been largely squeezed out, and the third sector has mopped up contracts due to its ability to provide more efficient services with slashed budgets. I sit on the NHS Substance Misuse Provider Alliance Board, which consists of all the NHS Trusts who still provide drug treatment and there are not many of us left. Examples of the effect include that by 2020 we expect that all NHS inpatient detox beds will be gone and there are very few of the much-needed psychiatrists and psychologist working in this sector.”

The substance misuse sector has become increasingly bureaucratised and, in this outcome-driven commissioning system, target fulfilment is key.

Mr Gaskell said: “Services tend to be measured on numbers seen and treatment exits, rather than quality measures, or measures which reflect evidence-based practice.”

“What we are left with is an under-resourced, overworked third sector and a service that cannot respond as effectively to the complex needs of its patients. Though organisations across the country do tireless work, they are not adequately trained or supported to treat the increasingly complex population.”  

What’s more, in the face of cuts, competition and complexity, there is little space for treatment providers to expand and innovate. 

Director of Volteface, Paul North noted that “the increasingly complex heroin cohort also results in services having to dedicate shrinking resources to dealing with their needs rather than finding new, treatment-naive cohorts of drug users.”

In its 2017 Drug Strategy, the Government recognised that “effectively funded and commissioned services" are “crucial”, setting out “ambitions” to improve both treatment quality and outcomes for different user groups.

However, in a predictable twist of events, “effectively funded” services did not materialise, instead, further cuts, fewer resources and an ever-widening gap between those in need of treatment and those receiving it.

Evidence of this troubling discrepancy is most prevalent with alcohol. According to the National Drug Treatment Monitoring System (NDTMS), the number of adults in England seeking specialist alcohol misuse services has dropped 17% since 2013/14. And yet, the prevalence of alcohol dependence has remained constant. For the past five years, the number of adults in need of specialist treatment has remained at just over 589,000.

Be it alcohol, opiates or psychoactive substances the story is the same. Cuts do not correspond to an issue in decline they correspond to austerity and cost-effective commissioning. And, unsurprisingly, as budgets have fallen, drug-induced deaths have risen. 

For this, the buck stops with the Government. Problematic drug use is complex and the solution multifaceted, but local devolution is a cop-out. Substance misuse is not a ‘local issue’ it is a national, public health issue that requires attention reflective of its destruction.

To borrow the ignorant idiom, a Labour Government must ‘Just Say No’ to further cuts. Change drug policy, yes. Decriminalise, yes. But, invest and ensure that funding is ring-fenced.

As Nuno Albuquerque, Group Treatment Lead at UK Addiction Treatment (UKAT) said ‘it does not make sense to talk about decriminalising drug use if there isn't an investment from the Government in paying for treatment for the ones that need it’.

With the space to breath, and innovate, with the expertise of the NHS, the oversight of the Department of Health and the rejection of an outcome-driven commissioning system, treatment and the substance misuse sector can be revived, as necessary. 

If not, the problem may outlast the solution. 

This article was written by Lola Brittain, Ambassador for Yorkshire.

N.B. Contributions to the LCDPR blog reflect those of the author and may not necessarily represent those of the campaign as a whole.

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