Building for recovery. A DrugScope report for the Drug Sector Partnership.

Recovery is defined in the drug strategy as ‘an individual, person-centred journey, as opposed to an end state, and will mean different things to different people’. This vision is supported within the drug and alcohol sectors as is the Government’s focus on recovery capital, social inclusion and the need for balanced and integrated services. Building from a position of strength There have been considerable advances in developing responses to people with drug and alcohol problems, with much that is valuable to build upon: • There is strong commitment from Government; • There has been a significant expansion in treatment availability and participation and improved outcomes from treatment, in both the community and criminal justice settings; • There is a knowledge base about what works and a robust evidence base for the cost effectiveness of treatment; • There is a high degree of consensus on the way forward; • There is evidence of a significant level of public support for the availability of high quality drug and alcohol services. Building recovery in context The development of recovery orientated services will be shaped and constrained by the policy context. Three factors are of particular significance: • Public spending constraints. For example, local authorities face a 14 per cent ‘cash terms’ reduction in their budgets up to 2014-15 according to the Spending Review 2010; • Localism. In particular the removal of ‘ring fences’, with greater discretion in allocating public health resources for local authorities and other local decision makers, such as Police and Crime Commissioners; • Public policy reform. In particular, the abolition of the National Treatment Agency for Substance Misuse and the absorption of its functions into a new public health body, but also payment by results and reforms - for example – to the welfare system, housing support and criminal justice. Building recovery: the challenges A number of challenges for recovery-orientated treatment are identified in this report: • The risk of disinvestment in drug and alcohol treatment; • The risk that competition on cost could compromise sustainability and investment in capacity building, research and workforce development; • The importance of robust clinical and quality standards where treatment services are commissioned by local authorities outside the NHS; • The importance of workforce development and appropriate support for, and use of, volunteers and peer workers; • Concerns about access to recovery capital, including, for example, appropriate housing given evidence of local disinvestment in housing support and fears of the potential impact of housing benefit reforms; • The importance of supporting Health and Wellbeing Boards and other local structures to bring services together and to ‘join up’ local strategies (for example Health and Wellbeing Strategies and Police and Crime Plans); • The challenge of harnessing the potential benefits of outcome-based commissioning, including Payment by Results, while addressing the risks of ‘gaming’ and perverse incentives, supporting smaller organisations to participate and ensuring that payments are allocated fairly between services; • The need to provide leadership and invest in work to tackle stigma and negative attitudes that can deny people in recovery a second chance, and lock families and communities into cycles of exclusion. Building the foundations for recovery The report calls on central government and local authorities to provide the foundations for recovery. 1. To ensure there is sufficient investment in every local area to provide the tools and resources to deliver recovery-orientated drug and alcohol services. 2. To take urgent steps to ensure there is sufficient specialist provision for young people with drug and alcohol problems, and to make this a key theme for public health and in the Department for Education’s ‘positive for youth’ programme. 3. To prepare Directors of Public Health and other local decision-makers for their new responsibilities for drug and alcohol services, producing guidance and with a key role for the Substance Misuse Skills Consortium. 4. To ensure access to the social capital that is critical for recovery, including giving Public Health England a designated responsibility for co-ordinating recovery. 5. To build on work to address ‘dual diagnosis’ and ‘multiple need’, exploiting the opportunities created by public health and other reforms to ‘join up’ substance misuse and mental health services and implementing the recommendations of the Making Every Adult Matter coalition’s Turning the Tide report. 6. To ensure that systems and structures are developed in ways that recognise and support the role of the voluntary and community sector (VCS) in delivering recovery, including VCS representation on Health and Wellbeing Boards and/ or through local advisory structures for public health. 7. To develop a comprehensive workforce development strategy with the Substance Misuse Skills Consortium. 8. To develop concerted action to address negative attitudes to people in recovery, their families and communities, with, as a first step, Government departments and local authorities making a public commitment to provide training and employment opportunities, review their information and communications activity to promote positive attitudes to people in recovery and develop active policies for inclusion. 9. To build on progress on family support, developing the vision of recovery in a way that includes families affected by a family member’s drug or alcohol misuse 10. To improve provision in the criminal justice system, developing community sentences, diverting non-violent offenders from the prison system and continuing to improve treatment in prisons. \ud Our members are committed to working with Government to address these issues, deliver the ambitions of the 2010 Drug Strategy and work with local partners and colleagues to build recovery-based services that respond to local needs and priorities, while providing high quality and evidence based services to manage the harms associated with problem drug use, to individuals, families and communities