Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by The Alliance (DP085)

1. The Alliance is a unique organization- a registered charity with a remit to help people experiencing substance use problems with independent advocacy, support and advice around issues and challenges they face gaining fair access to appropriate quality evidence based treatment and services. We see the side of drug policy people very rarely talk about—the direct impact of implementation on people experiencing the most challenging health and personal consequences of drug use. We run a helpline and deliver independent advocacy services—these have directly influenced this response. While you will receive many responses from organisations who provide treatment, commission treatment, direct or govern treatment, we would suggest that ours is possibly the only response solely from the perspective of those who use drug treatment services.

2. Let me apologise in advance for the brevity of this submission. Your review, while welcome came with a very short timetable. Like many other small voluntary organisations, our income has more than halved over the last 24 months. Consequently the Alliance has faced some very difficult choices culminating in a programme of cuts and redundancies which have been unavoidable if the organization is to stay afloat. This has left us with only two and a half members of staff (of which I am the “half”—with the remaining two members of staff solely concerned with front line work). This reduction in our resources and staff is ironic as we believe that never has the role of our organization been more critical—in both senses of the word. Whatever the rights and wrongs of our current drug policy it would have been irresponsible for myself or our trustees to prioritise your call for evidence over the very real crisis facing our organisation.

3. However we did not want to let this opportunity pass to reflect the concerns of our constituency and to ask you to please take accounts from those using drug treatment and their representatives when you take oral evidence. As an organisation we would value the opportunity to give oral evidence to the committee.

4. In this letter we are responding to the following terms of reference the inquiry:

The extent to which the Government’s 2010 drug strategy is a ‘fiscally responsible policy with strategies grounded in science, health, security and human rights’ in line with the recent recommendation by the Global Commission on Drug Policy.

The criteria used by the Government to measure the efficacy of its drug policies.

The extent to which public health considerations should play a leading role in developing drugs policy.

The impact of the transfer of functions of the National Treatment Agency for Substance Misuse to Public Health England and how this will affect the provision of treatment.

5. In terms of the impact of drug policy on the people who use our services, it is our understanding that the current government strategy—with its emphasis on delivering a somewhat ill-defined model of recovery—is enabling those who seek to limit access to life preserving, evidenced based treatment on moral grounds, to do so. In many areas fuelled by government tone and approach and pressures on funding and resources, recovery is being defined as abstinence and access to treatment is being rationed and limited. This is contrary to the evidence base on treatment and what we know of addiction. It is damaging the health and wellbeing of some of the most vulnerable people in society. Our evidence for this comes from helpline and advocacy activity and direct reports from our service users which we would be happy to share with you at a later stage of this inquiry with permission from the individuals concerned.

6. We believe that previous and current government approaches to measuring success and efficacy have concentrated on systemic and proxy measures at the expense of enabling services to take account of individual experience. In particular the over emphasis on community safety returns for investment has led to a devaluing of health and quality of life returns and this has had a deleterious effect on some people who are or could be beneficiaries of drug treatment services.

7. It is obvious that the voices of the consumers of drug treatment have a huge role to play in the design and delivery of effective services—and indeed national policy. Through the work of the NTA over the last 10 years there has been greater acknowledgement of this. However the systems which have been built to commission and deliver treatment are largely impermeable to service user influence. They are complex, weighted to deliver national rather than individual outcomes, expensive and cumbersome. A renewed emphasis on meeting locally defined outcomes and person-centred results is to be welcomed. However it is far from clear how this will be achieved. The Alliance has received hugely varying reports on the centrally driven Payment By Results pilots. In some areas—where advocacy and self determination are built into the PBR model—users realize their own outcomes with greater ease. In other areas however we have seen evidence that users are being further marginalized in decisions about their own treatment in the name of outcome focussed delivery. The question is of course who values the results for which we are paying. When the answer is central government, or local commissioners to the exclusion of the people who actually use services, then the experience of consumers can only get worse.

8. The Alliance’s main concern is the health of our users and their well-being and quality of life. In terms of delivering this however, we have observed that public health is by far the most helpful—and the least damaging—of the overarching approaches we have witnessed. The extent to which public health considerations should play a leading role in developing drugs policy is clear and we welcome the transfer of the functions of the NTA to Public Health England. Of greater concern to us currently is the shift in the functioning of CQC and their role in the inspection of treatment services. Despite the excellent work of the NTA in improving treatment consistency, drug treatment is often sadly ill regulated and in the residential sector in particular there is huge variation in the standards and quality of treatment. It is critical we maintain access and quality of drug treatment across England—as the loss of any of our recent gains in consistency will be measured in lives lost.

9. Our most valuable contribution to your work is likely to be in the areas of your inquiry related to healthcare and treatment and we have restricted our comments in this letter to this. However we have contributions to make in other areas—such as enforcement and public health—as they necessarily impact on the people who use our advocacy and advice services. As an organization with a unique perspective, we are also able to take a differently informed view on issues such as Value for Money and overall policy impact. We would very much value the opportunity to contribute further to your inquiry as it progresses.

January 2012

Prepared 8th December 2012