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Tagged In:  Drugs, Substance Misuse

The Advisory Council on the Misuse of Drugs (ACMD) has issued a hard-hitting warning about the impact of funding cuts and re-procurement on drug misuse treatments.

Its report – entitled “Commissioning impact on drug treatment: the extent to which commissioning structures, the financial environment and wider changes to health and social welfare impact on drug misuse treatment and recovery” reaches a series of conclusions and recommendations.

Decrease in resources

In a letter to Home Office Minister Sarah Newton accompanying the report, ACMD chair Dr Owen Bowden-Jones states: “In brief, the ACMD has concluded that drug and alcohol treatment appears to be facing disproportionate decrease in resources, likely to reduce treatment penetration and the quality of treatment in England.
“This situation is compounded by frequent re-procurement of services that is using vital resources, creating unnecessary ‘churn’ and disruption and resulting in poorer recovery outcomes.”

Challenges to local authority budgets

The ACMD looked at the extent to which commissioning structures, contracting arrangements and the financial environment are impacting on drug misuse treatment and felt the review was needed, given changes in health, social care and the criminal justice system in England; evidence of funding cuts; and concerns over trends in commissioning on drug misuse (and alcohol) treatment outcomes.

It drew on literature on changes in health, social care and criminal justice commissioning; financial data on drug and alcohol misuse treatment; and substance misuse providers and commissioners, professional bodies and treatment providers.

While finding some positives, such as alignment of drug misuse treatment with other local authority and public health-related issues, the document also highlighted the challenges to council budgets.

Instability and disruption

Frequent re-procurement led to a ‘churn in the system’ causing instability, disruption of local system performance and negative impacts on treatment outcomes.

A survey of commissioners found 71% reported a negative impact in the 3 months prior to the start of a contract; 66% reported a negative impact in the 3 months after the start of a contract; 62% up to 6 months after contract start; 44% after a year, with 23% still reporting a negative impact after 2 years.

Providers spoke of funding reductions being greater than official figures; that frequent re-procurement of services was unnecessary and a major drain on resources; short contracts were unhelpful; and commissioners were concerned about the balance of clinical and professional expertise.

Conclusions and recommendations

In its conclusions and recommendations, the ACMD said:

  • Reductions in local funding are the single biggest threat to drug misuse treatment recovery outcomes being achieved in local areas and felt national and local government should give serious consideration to how current levels of investment can be protected;
  • The quality and effectiveness of drug misuse treatment is being compromised by under-resourcing and that national bodies should develop clear standards, setting out benchmarks for service costs and staffing;
  • There is an increasing disconnection between drug misuse treatment and other health structures and that local and national government should consider strengthening links between local health systems and drug misuse treatment;
  • Frequent re-procurement of drug misuse treatment is costly, disruptive and mitigates drug treatment recovery outcomes, and that commissioners should ensure that recommissioning drug misuse treatment services is normally undertaken in cycles of 5-10 years;
  • The current commissioning practice is having a negative impact on clinical research into drug misuse treatment across NHS and third (voluntary) sector providers and that the Government’s new Drug Strategy Implementation Board should address research infrastructure and capacity within the drugs misuse field.

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