By stewartb

We know the rate of drug-related deaths in Scotland is very high relative to other places in the UK and Europe. Opposition politicians in Holyrood, UK government ministers, the BBC and other mainstream media sources frequently amplify what are undoubtedly serious matters.

Acknowledgement by the same sources of any slowing in the drug-related mortality rate in Scotland is less forthcoming. Comment by politicians and media sources about the long term and still rising trend in drug deaths in England and Wales is rare. Comment on the marked and persistent contrast in the rate of drug deaths between English regions is similarly rare. It is hard to deny that drugs issues have become politicised in Scotland to a degree that is unrecognisable elsewhere in the UK. It is the overt politicisation that motivates this blog post.

We know that policies regarding illegal drugs – beyond the domain of public health – are reserved to Westminster. So in the context of sustained negative criticism of the Scottish Government with its constrained powers, it seems wholly appropriate to comment upon a new report into the Westminster government’s actions on illegal drugs. It is especially pertinent as the report comes from the authoritative National Audit Office (NAO). A too good to miss opportunity to ‘learn’ from what a government with unrestrained powers has achieved?

Source: National Audit Office (20 October 2023) Reducing the harm from illegal drugs. https://www.nao.org.uk/wp-content/uploads/2023/10/reducing-the-harm-from-illegal-drugs.pdf

Context

The NAO report provides some context for the situation in England and Wales (with my emphasis):

Para 1.4:  ‘… the number of deaths from drug misuse in England has been increasing since 2012. … Between 2011 and 2021, the number of deaths increased by 80% to 2,846, the highest since records began.’

Para 1.5: ‘In the past decade, the Department of Health & Social Care (DHSC) funding for substance misuse treatment and, more broadly, public health funding, has fallen. Annual spending on adult drug and alcohol treatment decreased by 40% (£340 million) in real terms between 2014-15 and 2021-22. Of the 150 unitary authorities in England, 140 have reduced funding for substance misuse treatment during this period. Forty-two of these areas saw a fall of 50% or more.’

Para 1.6 ‘.. in 2021-22, in 98 out of 150 unitary authorities in England, 48% or more of the people who used opiates and/or crack cocaine were not in treatment.’

Assessment of recent actions

The NAO acknowledges that the Westminster government’s 2021 drug strategy – ‘From harm to hope’ – committed additional funding and has led to new local partnerships. However, two years on from the initial implementation of the strategy, the NAO reports:

• ‘some local service providers told us the strategy reinforces – rather than helps to address – the stigma attached to people who use drugs, and questioned whether it struck the right balance between dealing with people who use drugs through the criminal justice system versus directing them to treatment services’.

• ‘The 2021 strategy focuses on the same core themes as the 2010 and 2017 strategies …. Departments have used nearly all of the new funding to continue or expand existing projects or, in the treatment sector, reverse some of the declines in funding seen over the last decade.’

• The strategy aims to reduce the demand for drugs, but government does not yet have the evidence to know how to do so. …. In May 2022, the Advisory Council on the Misuse of Drugs concluded that the UK did not have a functioning drug prevention system and that significant investment was needed to rebuild prevention infrastructure and co-ordinate support services.’

• ‘the cross-government Joint Combating Drugs Unit (JCDU) established to co-ordinate and oversee the development and implementation of the strategy has not yet assessed how it can work more effectively with central and local government partners to understand the impact of projects and judge what changes are needed to achieve the strategy’s 10-year aims’

• ‘The new local partnerships are improving collaboration but are at different levels of maturity and the JCDU does not yet understand how this is impacting the provision of local services. … Progress since has varied, with only 30% of partnerships completing a local delivery plan by the JCDU’s deadline of December 2022, and there are wide variations in the bodies involved.’

• ‘Progress implementing the strategy is mixed. …. not all of the 2022-23 funding allocation was used. Departments underspent by £22 million (15%) across the treatment and recovery workstream and by £8 million (64%) on the reducing demand workstream. The DHSC’s delays in finalising the allocation of the public health grant in 2022-23 and 2023-24 have also made it more difficult for local authorities to commission new services and recruit staff.’

• In April 2023, the JCDU, working with departments, recognised the risks, rating four of the five strategy ambitions for the treatment and recovery workstream as ‘amber’’ or ‘red’.

No quick solution

The NAO also notes:

• ‘It is too early to conclude whether the 2021 strategy will reduce the harm from illegal drugs. It will take time for new funding and interventions to address a complex set of issues, and many of the indicators used to measure progress lag behind activity.’

• ‘Tackling the harm from illegal drugs represents a significant long-term challenge. Local authorities have welcomed the new funding provided for 2022-23 to 2024-25 but cautioned that a long-term response is needed to replace lost services and support people with complex needs.’

• ‘The lack of certainty after 2025 restricts the ability of local authorities to recruit and plan strategically, with some already asking service providers to plan to reduce services beyond 2025 in the face of uncertain funding.’

• ‘there are staff shortages in the treatment and recovery sector, with shortfalls of medical professionals such as clinical psychologists and psychiatrists. It will take time to rebuild the capacity and expertise needed to achieve benefits, such as reducing caseloads, and provide tailored, expert support.’

• ‘People with complex needs come into contact with a range of services, which cut across departmental responsibilities, including those connected with mental health, homelessness, employment, accommodation and justice. These services need to provide integrated support to minimise the risks of gaps and overlaps and provide the necessary support to vulnerable people and their families.’

• ‘the JCDU does not yet know how strategy funding is affecting outcome targets, such as reducing drug use, and establishing this will be difficult. Given the complexity of the issues, it will be challenging to determine a causal link between strategy initiatives and changes in outcome indicators such as the level of drug use, crime, and drug-related deaths.’

End notes

For a blog post aimed at a readership in Scotland, it’s noteworthy to have a report from a public sector audit body that acknowledges complexity, that recognises that time is needed to achieve substantial results, and also recognises explicitly the challenge for government in establishing causal links between its strategy initiatives and outcomes.

Notwithstanding these elements of the NAO’s formal assessment still includes damning criticisms. The report offers lots of scope for the construction of soundbites and headlines by opposition politicians, the BBC or other news media organisations to be aimed at the responsible government. You will know the type of things I mean – the type of findings that would be exploited if this was a report from Audit Scotland!

Has anyone spotted coverage of this NAO report by the BBC? Anyone come across a Labour spokesperson’s ‘outraged’ remarks?