Posted on: 15 June, 2021
Health Services Journal (HSJ), 8.6.21 “Commissioning of addiction services by councils has failed”
The Guardian, 10.6.21 “Addiction treatment harder to get since councils took over, says Tory MP”
Collective Voice was established as a charity ‘’to advance, promote and influence effective care, public involvement and support for people affected by drug and alcohol misuse’’. Since 2015 we have worked – frequently in collaboration – to draw attention to the shocking human impact of significant funding cuts on the availability of treatment and recovery services.
We know things are far from perfect. We are in the middle of an escalating drug related deaths crisis. We are moving (hopefully) into the later stages of a global pandemic. Over the last decade we have faced complex systemic challenge: political responsibility splintered across a number of government departments, insufficient funding, and the necessity of stitching together complex care pathways for highly stigmatized citizens.
In the face of rising deaths, as a sector we have rightly prioritised providing quality services and supporting people to enter treatment. Nothing should deter those we serve from getting support. They should have confidence that treatment services, regardless of who they are provided by, are well regulated and monitored and meet the very highest standards of care.
And finally we have reason to believe the calls made by Collective Voice and many others have been heard. We very much hope that the second part of Dame Carol Black’s Independent Review of Drugs will offer a brighter future vision of accessible, evidence-based and person-centred care for all. It is surely morally incumbent on all of us to do what we can to make this vision a reality. As a field we must focus on the coordination of care and development of effective partnerships with allied services to build the recovery capital of those in our services. Every single person can play an important role in protecting human life and rebuilding human potential.
With significant political will already driving major investment and the possibility of systemic change we are poised to enter an exciting new chapter in the history of treatment and recovery. At this time of opportunity the mechanics of service commissioning must be a secondary consideration to the essential, collaborative work undertaken by charities, NHS Trust and local government across the country. We have historically been frustrated by, and spoken out against, the politicisation of a health care need like addiction and do not believe it is helpful now.
The HSJ article “Commissioning of addiction services by councils has failed” lays the blame for many of the system’s ills at the door of local authorities, rather than the cuts they have experienced. With local government losing almost half of its central funding between 2010/11 and 2017/18, accurate claims regards its inherent ability to commission services are almost impossible to make. It may not be perfect, but on the brink of potential major investment the needs of the people we serve would not be advanced by moving from local government its responsibility for commissioning community drug and alcohol support.
The HSJ article combines analysis of incomplete local authority detox figures with two much broader system-level observations on unarguably worrying trends – decreases in numbers in community treatment and increases in drug related deaths; both clearly complex and multi-factorial – before concluding with a vision of an inferior system delivered largely outside the NHS. We do not find the underpinning logic of the article convincing.
We also don’t recognise the picture painted in the Guardian, which conflates the main focus of the original article (detox) with the entire treatment system. The analysis of spot and block purchasing is confused and lacking context. Scant mention is made of the austerity policies of the government in which HSJ article co-author MP Dan Poulter served as a health minister, which halved the local government financial envelope.
All charities exist to serve the public good and are regulated by both the Charity Commission and, where appropriate, the Care Quality Commission. The voluntary sector has a proud record of delivering high quality, evidence-based drug and alcohol treatment in innovative ways, to often highly marginalised people who have struggled to find support elsewhere. Addiction is not simply a health problem and charities remain highly effective in building recovery capital by providing routes into employment and accommodation, nurturing recovery communities, developing criminal justice pathways and offering support around associated challenges such as poverty and domestic abuse.
Finally, we note that Guardian’s use of the stigmatising term ‘addict’. Along with many others Collective Voice advocates a ‘people first’ approach which foregrounds the human being and does not define them by any particular life challenge. We would be very happy to discuss this with the Guardian further.
Collective Voice will be writing to the Guardian and requestions of the Health Services Journal the chance to publish an article based on the arguments above.