new directions for addictions services survey

Much of the progress achieved previously in drug and alcohol treatment has been lost through successive disinvestment in services, competitive tendering, and years of austerity. There is an emerging ‘Quality Gap’ between drug treatments and interventions known to be effective and everyday practice in drug services. There are new patterns of drug use, and increasing availability of drugs on-line. Glaring health inequalities and prospects of a premature death exist for people using drugs and alcohol. Covid-19 has reshaped the ways in which many of us live and work.

The demise of Public Health England leaves open future arrangements for health improvement programmes, and the delivery of both drug and alcohol treatment services. Now is the time to re-think the design, delivery and commissioning of drug and alcohol services, to maximise health and social gain for individuals and to ‘level-up’ communities.

We want to be at the forefront of change. Based on our assessment of where drug and alcohol services are struggling and possible solutions for change, we have identified 12 directives for future commissioning and provision. We have a wonderful opportunity here at this conference with over 500 delegates to ask for your ideas.

For each directive, please rate how important you think it is, with 1 being not important and 5 being very important. Please then provide a few (2 to 3) words or bullet points to expand on your position.

Thank you!

There is a demonstrable investment in evidence based national policies and financial strategies to ensure high quality drug and alcohol treatment services that are safe, effective, caring, responsive, well-led and sustainable.

2. There is a national, coherent and systematic approach to addressing health inequalities and premature deaths experienced by people using drugs and alcohol.

3. Drug and alcohol services work closely together and are integrated with primary, community, emergency, and acute mental and physical health care, with clear pathways between them, so that people in treatment have fair access to health care facilities, and mainstream physical and mental health care are better equipped to address drug and alcohol related problems across clinical settings. There are different approaches to joint working and integration, encompassing ‘one-stop shops’, specialist clinics, and mainstream professionals who have a special interest in drugs and alcohol. What matters is what works locally, and that people get the right help at the time they need it.

4. Commissioners of drug and alcohol services are able to use the national levers and incentives available for collaborative and partnership working, especially with the voluntary sector, across neighbourhood, locality/place, and wider, strategic systems of health and social care.

5. Drug treatment services are equipped to respond to the full range of substance use, including new psychoactive substances, levels of dependency, harmful use (including tobacco use) and states of intoxication. Services are responsive to people using drugs across the age range, personal circumstances and settings. This includes younger and older people, women with children, people in trouble with the law, people from Black, Asian and Minority Ethnic communities, and with other protected characteristics, and people who live in the community or prescribed places of detention. Services offer a full continuum of care and support, and can respond to individuals with multiple and complex needs, who may be harder to reach or initially treatment resistant. This includes multi-agency planning and implementation of individual ‘wrap-around’ supports and the provision of specialist, medically managed in-patient beds.

6. Services are person centred and constructional: they build on personal strengths, family and social networks of support, and community resources, in supporting individuals towards recovery, wellbeing and social inclusion.

7. Commissioners and providers can demonstrate their compliance with a nationally agreed evidence base for effective pharmacological, psycho-social and psychological treatments and interventions for drug and alcohol use.

8. Drug and alcohol services are delivered by sufficient numbers of drug and alcohol practitioners, peer support workers, social workers, therapists, psychiatrists, nurses and clinical psychologists with the requisite values, knowledge and skills. They are trained and qualified using national competency frameworks and standards, and supervised and supported through a robust system of governance, as would be expected in other fields of mental and physical health care.

9. As well as sound managerial arrangements, drug and alcohol services offer clear clinical leadership from Psychiatrists, Nurses and Clinical Psychologists, who can provide clinical expertise, training, supervision and support to staff working often with people with multiple and complex needs.

10. The commissioning of drug and alcohol services draws from local prevalence data and accompanying health harms, especially for new psychoactive substances. These are profiled at the level of neighbourhood, locality/place, and wider strategic systems of care.

11. Whilst overcoming dependency and recovery remains central to the commissioning and provision of drug and alcohol treatment services, harm reduction is also a key element. Services continue to invest in high quality opioid substitution therapy of optimal dosage and duration, and ensure that Naloxone medication to reverse the effects of opioid overdose is available routinely.

12. Performance measures for drug and alcohol services are outcomes oriented and focus on recovery, wellbeing, inclusion and reduction of harm. Outcomes data are routinely available in easy to understand formats, to ensure individual, local and wider public accountabilities.

13. What lessons from handling Covid-19 do you think drug and alcohol services should include in their future design and delivery?

14. What else is really important in the future design and delivery of drug and alcohol services that has not been covered here?