NHS SMPA response to the Drug Strategy 2017

The NHS Substance Misuse Providers Alliance welcomes the publication by the Home Office of the Drug Strategy 2017.

From our perspective, this provides a balanced roadmap for the future which we can either be embraced in spirit of co-production or alternatively critiqued to the extent where a desire for the perfect gets in the way of the good.

Our approach will be to make a success of the strategy, embrace the elements we deem positive and constructively work to address the areas where further development is required. We welcome the strong focus on the importance of partnership working that is present throughout the document. This is particularly the case where the strategy stresses the importance of working with colleagues in mental health, employment, the criminal justice system and housing. These are not necessarily new ambitions and relationships do already exist in many areas but from our perspective they often do not function operationally or have become ineffective. As NHS providers we are used to working in partnership and look forward to reinforcing these relationships.

The emphasis and focus on a number of vulnerable groups is important. However we particularly welcome the emphasis on the increasing relevance of physical and mental health issues and how these factors can compound an already complex picture with regard to the vulnerabilities of the ageing, traditional service user population. As service users get older drug and alcohol treatment services need to ensure they have an appropriate, knowledgeable workforce that is able to intervene appropriately and navigate the range of services someone encountering long term conditions will encounter. Drug and alcohol treatment should not be seen as a “niche”. Increasingly it is important that the sector steps up as a full and engaged partner in health and social care whom understands it’s responsibility to not only to individual, but positively influencing population health. 

We are pleased to see the strategy acknowledging the changing profile of substance use in the country and of the broad spread of issues now encountered, for example Addiction to Medicines, CSE, Chem sex, IPEds, the place of the internet and the global nature of both the issues and solutions associated with substance use. Of particularly note is the focus on substances such as synthetic cannabinoids and the renewed commitment to address these issues. The Alliance will continue to make its contribution to this and many of the debates included in the strategy.

We are aware that this is a Drug Strategy, but also note the inclusion of alcohol in many places and would welcome the merging of the two in future years, particularly as that is the expectation at a commissioning, prevention and treatment level.

We note that the Strategy emphasises successfully addressing substance with the goal of complete abstinence. Whilst an ambition of supporting individuals to become free from dependence must unify all treatment providers, it is important to guard against a simplistic or narrow interpretation of this. The most fatal interpretation being a lack of acknowledgment and value placed on the reduction of substance related harm. This is particularly pertinent when considering the very troubling rise in Drug Related Deaths. We wholeheartedly support a sophisticated, ongoing and energetic effort to reverse this trend. 

We note that the Strategy talks about extended and a diversification on information collection and analysis. Whilst we value the availability of high quality information, and deem this essential, particularly in measuring joint outcomes with partners in employment, mental health, housing and the criminal justice system we would caution against any increased administrative and reporting burdens. 

This is particularly important when we see drug and alcohol treatment budgets consistently reducing across the country. Providers are doing their utmost to innovate, target their resources and mitigate the impact on the person who receives treatment. The success of this varies and is heavily influenced by how the budget cut applied. It is important that we are mindful of this scenario with regards to any development or initiative, and the potential impact on front line resources. The Strategy does not particularly discuss the role of commissioners in local areas and the central function and accountability they should have for ensuring the successful commissioning and management of treatment systems. We would welcome a stronger overview of commissioning functions, processes and decisions along with more support and resources to support them in this function. 

A move towards stronger governance, , as described in the Strategy, with the establishment of the Drug Strategy Board and the appointment of a National Recovery Champion is broadly welcomed by the Alliance. Senior Ministerial control is a powerful statement that will aid the provision of stability and direction for the sector. As a representative forum of service providers we would assert that this board needs to include the voice of providers from both the NHS and Voluntary Sector to support its effectiveness and relevance. This will ultimately benefit our service users but we also would hope provide stronger assurance into local decision making. We note that this function remains within the Home Office, but are encouraged at the commitment to a cross- cutting strategic view recognising the multi-faceted nature of these issues. We are particularly encouraged by the emphasis on moving mental health and substance misuse closer together.

Broadly we feel the new Strategy, along with the newly published updated clinical guidelines, provides an excellent road map for the development of the sector over the coming years. As with any roadmap there are some paths that will need to be trodden more, and ones that have not even been mapped yet. The test of the success of this strategy is not now though, but when we reflect on this when a new strategy has been released and we ask ourselves did we as government departments, local commissioners, elected members and service providers step up for those we ultimately serve, why this sector exists – the individuals, families and communities blighted by drugs; I hope the honest answer will be yes.

Danny Hames

Chair of the NHS Substance Misuse Providers Alliance