State of the Sector 2014 — 15
The first State of the Sector report was published early in 2014 and provided a snapshot of the drug and alcohol treatment sector as it entered into new and uncharted territories. 2013 had seen some of the biggest system changes for over a decade. These included the abolition of the National Treatment Agency and the transfer of its functions to Public Health England, the absorption of a ‘ring fenced’ drug treatment budget into the wider public health funding pot and increased discretion for new local decision makers and bodies (including Directors of Public Health, Health and Wellbeing Boards and Police and Crime Commissioners) to decide how much they spend and on what.
The drug and alcohol treatment sector benefits from some exceptionally good data about its clients, outcomes and impact – notably the National Drug Treatment Monitoring System (NDTMS), and, more recently, an equivalent for alcohol (NATMS). Our annual survey has a different purpose: to provide a ‘health check’ of the sector itself during a period of change and upheaval, and to ‘hold a mirror up’ to local and national government on the impact of reforms. It is an attempt to paint a picture of a changing landscape by capturing the experiences of those directly involved in managing and providing services in our communities.
Last year we found many signs of innovation, resilience and adaptation. There were also anxieties about the ability to sustain the necessary investment to deliver the ambitions of the Drug Strategy, particularly as reductions in local government funding were requiring councillors and their officials to take difficult decisions about priorities. How will services for an often marginalised and stigmatised group fare in this environment?
We found no evidence of deep and widespread disinvestment at this early point, although 35 per cent of respondents reported a decrease in funding, and there were other grounds for concern. These included increased caseloads, a reduction in front-line staff and difficulties in accessing ‘recovery capital’ in some local areas (in particular, housing and housing support, mental health services, support for complex needs and employment). A subsequent study of commissioners by Public Health England found that at least a third of local authorities were expecting to reduce funding for drug and alcohol services in the years 2014-15 and 2015-16, with considerable uncertainty beyond that.
In the period that we asked people to consider for this State of the Sector report - September 2013 to September 2014 – the impact of earlier reforms has continued to work through, but with no new policy changes of the sort that we saw between 2010 and 2013 (although we are seeing big public service changes, notably the Transforming Rehabilitation reforms of probation and offender management).
Reductions in funding for local councils have also continued in this period, and are ultimately expected to lead to a reduction in overall funding of around 25% by 2015-16.
The theme of innovation and resilience comes through again in State of the Sector 2014, but so does a clear message that service managers are experiencing or anticipating significant reductions in funding. It is in the nature of localism that this will vary between local areas. And the trends we picked up last year continue to be in evidence, with over half of respondents reporting reductions in front line staffing, for example, and many reporting challenges – particularly – in accessing housing and housing support, mental health services and support for dual diagnosis and complex needs. Also in evidence again is the impact of the constant cycle and churn of local commissioning and recommissioning, with over half of services responding to the survey saying that they’d been through a tendering or contract renegotiation process in this period.
This remains a time of opportunity, challenge, uncertainty and risk for drug and alcohol services – and it is important that policy and decision makers maintain a ‘clear line of sight’ through to what is actually happening on the ground. State of the Sector provides a voice for nearly 200 services. But it is also important that reliable and timely data on local spending is publicly available, and we would welcome clarity, for example, on how Public Health England will be following up on last year’s review of commissioning intentions going forward. This is particularly important with the introduction of a ‘health premium’, along with new grant conditions, to protect drug and alcohol investment. These services work with some of the most marginalised and vulnerable individuals, families and communities. The impact that they have on people’s lives, and the wider economic and social benefits they bring, have been clearly demonstrated over many years. It is vital to sustain the investment to ‘build recovery’ in every local community.