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Our full response to the Dame Carol Black Review, part II

Posted on: 29 July, 2021

Anyone who works in substance misuse, studies substance misuse or believes in social justice, fairness and equality have been holding their breaths, waiting for the publication of part two of the Dame Carol Black review which has been delayed for some months. And the good news is, it has been worth the wait and there is a lot to be celebrated. Dame Carol and her team have clearly listened to the treatment sector, experience of experts and academics, front line workers and those with lived and living experience. It is refreshing to read parts one and two that recognise the impact on vulnerable people, the link to poverty and our deprived communities. In the part one summary, Dame Carol rightly says ‘there is a very tragic human story behind this market analysis’.

For Cranstoun, it is great news. We have been at the forefront of understanding the links between substance misuse, criminal justice, domestic violence and housing and how engagement, work and support with young people can help prevent future harm, crime and cost. Cranstoun’s 50 years was born out of a desire to support the whole person with the opening of a residential community for people in recovery in 1969. The recognition of multiple complex needs has continued with the development of our Criminal Justice and Domestic Violence perpetrator programmes and a foundation of supporting behaviour change.

Unfortunately, we can’t comment on the full list of recommendations within this short overview but Cranstoun are particularly welcoming:

Increased funding
The substance misuse sector has been a victim of drastic cuts over the last ten years. We welcome Dame Carol’s look at the wider sector and link to poverty and deprived areas which have also suffered due to a lack of funding for young people, with youth services in particular having been decimated as has support for employment and housing. These factors are a driver behind problem substance use and must be considered as we build back through increased funding. In particular, the ring-fencing for drug and alcohol in local authorities is welcomed to help increase the reach and service availability for the most vulnerable.

Local outcomes framework and commissioning quality standards
Those in the sector are passionate about increasing quality and standards. Cranstoun have welcomed this recommendation which we believe will drive quality and partnerships. Our key ask is that this must be developed with the sector, as we can help to shape the standards that will best support the most vulnerable in our society. We also want to help shape co-commissioning. Substance use does not sit in isolation, we must work across wider geographical boundaries with the Criminal Justice system, PCCs, health and wider partners. Cranstoun, with expertise across substance use, criminal justice, domestic violence, housing and young people are already working in this way and we are keen to ensure that multi-agency, joined up working continues to be at the forefront of our delivery.

Drugs unit
Supporting people who use drugs means much more than just support for their substance use. We are incredibly pleased to hear of a cross government Drugs Unit, bringing in numerous departments to work collectively to support people within the criminal justice system, with housing, employment and health. Our key ask is that the new Drugs Unit engage with the sector and allow us to help shape this work for the benefit of service users. This will mean working system wide to ensure co-commissioning and collaboration and reducing perverse incentives against specific targets or outcome measures. Cranstoun are building a robust evidence base for the innovative work that is being delivered across England and it is essential that this evidence is used as a foundation for future policy development, investment and collaborative working.

Where are we currently at?
As an organisation, over the next few weeks and months we’ll be looking at our progress against the recommendations to support the wider system response in embedding and delivering DCB’s recommendations. In many areas, I’m pleased to say that Cranstoun are already leading the way and delivering some world class, innovative services.

Intervention and prevention
In the Intervention and Prevention space, the DIVERT™ programme, a pre-arrest drug diversion scheme is being delivered across the West Midlands Police Force Area (7 Local Authorities). It is a community resolution, for people found in possession of any drug and replaces a cannabis warning. Cranstoun’s Drug Diversion (DIVERT™ ) scheme offers police officers an alternative to arrest with access to meaningful interventions aimed at reducing harm, offending and associated drain on the Criminal Justice System. DIVERT™ contributes to a culture change in policing and ensures a health based approach is taken over criminal conviction. Police Officers have welcomed the opportunity to divert individuals to a meaningful intervention through the use of an app that can be accessed on their mobile device so that the referral can take place there and then, on the street. DIVERT™ has also begun to be offered in schools and colleges as an alternative to exclusion for drug possession.

Criminal justice
Unfortunately, substance misuse is a key driver of crime. In the West Midlands, work by the Police and Crime Commissioner on drugs policy found that over 50% of serious acquisitive crime was driven by drugs, the cost in just the West Midlands alone was £1.4bn per year and every 3 days someone died from an overdose. Many of the most vulnerable, and often problematic individuals who use drugs come into contact with the criminal justice system. Many are stuck in the revolving door of the justice system with short term sentences that don’t tackle the root cause of the criminality. Therefore, the Criminal Justice System also provides an ideal engagement point to support individuals and help support them into treatment and away from criminality.

In the West Midlands, the Cranstoun Arrest Referral Service (CARS) was commissioned by the PCC in line with the eight point harm reduction approach to drugs. The new service has learned from the old models of Drug Intervention Programmes and existing joined up working, working across 7 Local Authority areas. The service went live in January 2021, just before COVID-19 impacted the UK. The service has assessed over 2500 individuals, supporting over 1000 individuals into treatment who were not previously engaged and has significantly increased the use of Alcohol Treatment Requirements and Drug Rehabilitation Requirements issued at court that prevent short term custodial sentences.

Recommendations 15 and 16 are very welcomed as the CARS service has supported the development and success of the Community Sentence Treatment Requirements (CSTRs) in the two sites in the West Midlands. The CSTR programme has been strengthened by the CARS service due to the joined up delivery across custody suites and with probation colleagues. The CARS team have also been bolstered by CSTR ‘SPOCs’, the first role of its kind in the country, funded by the Probation Service. These roles are co-located physically in the courts and act as advocates, ensuring that CSTRs are considered in sentencing. Within the first few weeks, the numbers of DRRs and ATRs have already increased. As the roles develop, Cranstoun will be working with partners to share best practice and how to increase performance across the country.

Here at Cranstoun, we also echo the investment required in a trained and supported workforce. As an organisation who achieved gold in the investors in people accreditation, Cranstoun’s strength is our people and their compassion and ambition for everyone we work with across the organisation. The Cranstoun trainee scheme has allowed us to work with people who are driven, motivated and share our values but have never worked in the sector. It has been essential to grow our skilled workforce internally, particularly with the universal investment this year which has proved difficult for all providers to recruit experienced workers. The cuts over the last decade to drug and alcohol treatment has meant less opportunities for those in the sector and less roles available. With the recommendations in Dame Carol Black, particularly funding, the trainee scheme is an essential part of how we will continue to grow and develop experience within the organisation.

We look forward to working with government, the sector, wider partners and those with lived and living experience to implement the recommendations within the Dame Carol Black report. We will be working hard to ensure that best practice and innovation is shared to improve outcomes for some of the most vulnerable people in society.

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