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Image © Dame Carol Black

Review of Drugs part two: prevention, treatment and recovery

August 2021

List of Recommendations

Recommendation 1

The government should establish a central Drugs Unit with strong analytical capacity which would develop a National Outcomes Framework and hold departments to account. The sponsoring minister should report annually to Parliament on progress in tackling drug misuse, including publication of relevant data.

Recommendation 2

We recommend that the government invests, by the end of year 5 of this programme, an additional £552 million in the treatment system through DHSC and an additional £15 million in employment support through DWP. MHCLG will also need to bid for additional funds for housing support at the next Spending Review.

Recommendation 3

We recommend that from 2022 to 2023, DHSC require local authorities to spend drug treatment funding, current and additional, on these services and not on other things. Similarly, we recommend that DWP and MHCLG protect any future additional funding provided for employment services and housing support for people dependent on drugs.

Recommendation 4

We recommend that DHSC, DWP and MHCLG make sure that funding for treatment, employment and housing support is distributed fairly on the basis of need.

Recommendation 5

We recommend that DHSC introduce a national Commissioning Quality Standard and require local authorities, as a condition of funding, to work with health, housing and employment support, and criminal justice partners to develop a joint needs assessment and publish a commissioning plan to direct spending from 2022 to 2023. Government should make provision for budgets to be aligned or pooled at local level and each department should use its policy levers to require a strong partnership approach locally.

Recommendation 6

We recommend that DHSC and the Office for Health Promotion review the effect of frequent retendering on quality and cost-effectiveness of substance misuse treatment services.

Recommendation 7

We recommend that DHSC introduce, for 2022 to 2023 and beyond, a Local Outcomes Framework to increase transparency and local authorities’ accountability for their treatment and recovery outcomes. DHSC should consider introducing incentive payments for local authorities to deliver improved outcomes.

Recommendation 8

We recommend that DHSC ensure that the Office for Health Promotion has the capacity and capability to monitor local performance against the Local Outcomes Framework, and report to the new central cross-government Drugs Unit to:

- hold local areas to account for meeting the new Commissioning Quality Standard improve outcomes

- work with the Local Government Association (LGA) to provide a comprehensive improvement support offer for local authorities

Recommendation 9

We recommend that DHSC commission HEE to devise by the end of 2021 a comprehensive strategy to increase the number of professionally qualified drug treatment staff (psychiatrists and other doctors, psychologists and other therapists, nurses and social workers), and set occupational standards, competency and training requirements for drug workers and peer recovery workers. Government should also fund HEE to cover the costs of training the workforce.

Recommendation 10

We recommend that the Academy of Medical Royal Colleges, working with appropriate other bodies, be commissioned to develop a professional body, a Centre for Addictions, for all members of the substance misuse workforce. DHSC should provide seed funding to enable this.

Recommendation 11

We recommend that local authorities commission a full range of evidence-based harm reduction and treatment services to meet the needs of their local population in line with the new national Commissioning Quality Standard.

Recommendation 12

We recommend that DHSC, NHSE and the Office for Health Promotion review by the end of 2021 to 2022 the commissioning and funding mechanisms for high-cost but low- volume services such as inpatient detoxification and residential rehabilitation. DHSC should introduce a regional or sub-regional approach to commissioning these services to ensure national coverage.

Recommendation 13

We recommend that DHSC make increased funding available to specialist substance misuse services for young people to improve the capacity and quality of these services, and also through the national Commissioning Quality Standard ensure that these services are linked with other local services for vulnerable young people and that family interventions are more widely available.

Recommendation 14

We recommend that DHSC and the Office for Health Promotion support local areas to ensure that thriving communities of recovery are linked to every drug treatment system. The government’s Drug Recovery Champion should work with the Office for Health Promotion to develop standards to raise the quality and improve the governance of the recovery sector.

Recommendation 15

We recommend that MoJ, HO and DHSC, with the support of NHSE and the Office for Health Promotion, work together to ensure that the additional funding for drug treatment announced in January 2021 contributes to improved treatment pathways from criminal justice settings. In particular, action should be taken to divert drug users from the criminal justice system into treatment, and maximise the use of Community Sentence Treatment Requirements (CSTRs)

Recommendation 16

We recommend that DHSC and NHSE expand their CSTR programme to 100% of the country by the end of this Parliament. NHSE and HMPPS should work closely with local commissioners of substance misuse treatment to seize the opportunity presented by the recently announced increase in funding for such treatment in 2021 and 2022.

Recommendation 17

We recommend that MoJ, DHSC and NHSE work together to improve by the end of 2021 to 2022 the transparency and accountability of the commissioning and delivery of substance misuse services in prisons, including through publishing how much money is spent each year on these services. HM Prison Service should make sure that enough staff are available to take prisoners to their treatment appointments within the prison.

Recommendation 18

We recommend that MoJ ensure that everyone leaving prison has identification and a bank account and that those who cannot claim benefits online get the opportunity, from the day of release, to access DWP’s telephony service. MoJ and its partners should make sure that prisoners with drug dependence can access and receive drug treatment in the community as soon as possible after release.

Recommendation 19

We recommend that MoJ fund their new health and justice partnership co-ordinator role within the probation service, so that it covers all local probation areas in England, in tandem with the introduction by the NHS of new integrated care systems.

Recommendation 20

We recommend that DWP work with the Office for Health Promotion to roll out IPS to all areas in England within the forthcoming Spending Review period.

Recommendation 21

We recommend that DWP recruit peer mentors (one in each Jobcentre Plus area), to encourage people dependent on drugs to claim all relevant benefits and access employment support, with funding for the posts agreed at the Spending Review.

Recommendation 22

We recommend that DWP augment Jobcentre Plus support by equipping staff to reach out into the community and work more intensively with those with complex needs, including working in drug and alcohol treatment services with people with addictions.

Recommendation 23

We recommend that MHCLG and DHSC work together to gain better understanding of the types and levels of housing-related need among people with a substance misuse problem, with early findings feeding into the next Spending Review.

Recommendation 24

We recommend that DHSC and NHSE develop, publish and implement by the end of 2021 an action plan that improves the provision of mental health treatment to people with drug dependence. This should include consideration of the introduction of contractual requirements or incentives so that NHS mental services target dependent drug users. Consideration should also be given to commissioning substance misuse services to treat some mental health co-morbidities without referring people on to specialist mental health services.

Recommendation 25

Linked to recommendations 9 and 10, we recommend that DHSC commission Health Education England to develop competency and training requirements for all staff working with people with co-existing mental health problems and drug dependence. Resources and standards should be applicable and applied across the mental health and substance misuse workforces.

Recommendation 26

We recommend that DHSC, NHSE and the Office for Health Promotion ensure that opportunities for integrated commissioning of mental health and substance misuse services are explored proactively and articulated as part of the next stages of integrated care system development. This includes ensuring that proposed legislation facilitates integrated commissioning and provision.

Recommendation 27

We recommend that DHSC and NHSE develop, publish and implement by the end of 2021 an action plan for improving the provision of physical healthcare to people with drug dependence, which should be an integral part of local integrated care systems.

Recommendation 28

We recommend that DfE make an assessment of the support available to teachers in rolling out the new Relationship, Health and Sex Education (RSHE) curriculum, and continue to monitor implementation, with a view to more detailed evaluation after 2 years of full curriculum delivery.

Recommendation 29

We recommend that DfE and DCMS, with support from DHSC and the Office for Health Promotion, invest in age-appropriate evidence-based services and support all young people to build resilience and to avoid substance misuse. Local authorities should identify, and provide additional support to, those young people most at risk of being drawn into using illicit substances or involvement in supply.

Recommendation 30

We recommend that the government (either HO or DHSC) establish an innovation fund to research which interventions are most effective at changing the behaviour of recreational drug users.

Recommendation 31

We recommend that DHSC and BEIS encourage more research into what works to combat substance misuse, across supply, prevention, treatment and recovery.

Recommendation 32

We recommend that the government promote greater innovation in research, for example in pharmaceuticals, by offering incentives or rewards to companies or organisations whose developments prove beneficial in practice in the addiction field.

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Related Resources:

1) Review of Drugs - Executive Summary

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