ACMD warns ministers of falling local funding for drug treatment services
Phoenix comments on recent report by Advisory Council on the Misuse of Drugs
ACMD’s recent report 'Commissioning impact on drug treatment' looks at commissioning structures, contracting arrangements and the financial environment and the impact on recovery outcomes for individuals and communities.
We welcome the focus on this area and support the recommendations made to address the issues identified. In particular the report highlights rightly that greater transparency and clearer financial reporting is required so that we all have an understanding about the positive and negative impact of recent change. Local authorities are empowered to make the difficult choices about how to fund services on behalf of their residents, but those decisions and their impact should be explained clearly to the members of the community to whom they are ultimately accountable. In an environment of falling local funding, opaque funding decisions made with little or no public consultation in closed sessions disempower the local community in general, and specifically risk marginalising and discriminating against users of services. As we encourage people in addiction to join and contribute to mainstream society, for the benefit of themselves and the wider community, this lack of clarity and transparency sends the wrong message.
The report also highlights the need for integrated local services. From our perspective as a housing provider and a substance misuse charity, local service fragmentation is a particularly important issue to address. The housing crisis poses a threat to an increasing number of service users as they struggle to engage in community treatment whilst experience unstable and uncertain housing. We would welcome more focus in this area in the future as we know first-hand that provision of recovery orientated housing offers major gains for the treatment system.
Closing gaps between services that risk recovery can be achieved. For example commissioning services with integrated mental health and substance misuse treatment and support is possible and we have had great success in working with mental health and substance misuse commissioners who take a joined-up approach to commissioning. We have created innovative coproductive services that bring together mental health, substance misuse support and a wide range of community based support around the needs of the individual. These are services that empower individuals to engage fully in their communities. This form of commissioning requires consultative commissioners, who understand the needs of their community innately, and welcome service users into the heart of the commissioning process, recognising the value of lived experience and the rights of people who use services to be involved in decision that affect them.
The report is understandably focused on community service commissioning as 98% of people in treatment will use a community treatment services, however the 2% of people who require higher intensity inpatient detox and residential support face additional challenges in accessing funding for services through what can be a complicated process that varies widely by region. There is a lack of focused research in this area and we would be happy to be involved in working with other residential and community providers to look at how commissioning of residential service could be made more effective, efficient and offer a more therapeutic experience for service users and their family and carers.
Finally the report recognises that people who use, or have used, drugs are highly stigmatised. Stigma breeds discrimination so that people in addiction and recovery ‘lose out’ to other service user groups who may be seen as ‘more deserving’. Whilst there are pockets of excellent consultative commissioning practice, in general we continue to see a lack of an independent service user, and ‘affected others’, voice/s and presence in local decision making. As a charity we will continue to amplify the voices of those affected by substance misuse and work with invaluable third-tier umbrella organisations that provided advocacy and insight.