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Coalition Conundrum (PDF) POLITICS COALITION CONUNDRUM for the Advisory Council on the Misuse As we await the new drug strategy, opinion of Drugs to be replaced by an ‘advisory council on addiction’. is split on how the spending cuts, the Rumours circulated soon after the election that Iain Duncan Smith, in his coalition government and its ‘Big Society’ new role as Secretary of State for Work and Pensions, was lobbying for his will make their mark on future policy. department to have a role in drug policy, specifically drug treatment.A llegedly, Martin Barnes picks through the evidence there was at least one ‘difficult’ meeting with the Home Secretary, Theresa May. Although the Home Office continues to “I feel extremely strongly on this subject and politicians suggest it is one of the have lead responsibility for the strategy, and desperately want to see a reduction of Prime Minister’s top personal priorities. it is significant that the DWP is tasked drug use and better paths to enable people There are limitations in trying to read with leading on ‘recovery’. Yet it is unclear to get out of it. If one takes a slightly the government’s aims and intentions what policy levers the department will progressive or, as I would like to think of through the prism of what the respective have, as the responsibility, and budgets, it, thoughtful view, one can be accused of coalition parties said before the election. for aspects such as housing, education being soft. I reject that utterly.” Funding priorities, party politics and (as and skills and family support sit David Cameron MP, 2002 Harold Macmillan observed) ‘events’ will elsewhere in government. inevitably have influence – but however To add to the complexity, the Minister “These are quite remarkable days… recent cynical or sceptical we may feel about of State at the Cabinet Office, Oliver political events have been so extraordinary politics in general, in many policy areas Letwin, has been leading a cross- and unpredictable” there is a commitment within government departmental review of commissioning Kenneth Clark, Secretary of State for to thinking and working differently. and developing a system of payment by Justice, June 2010 Before the election much of the results for drug treatment. Oliver Letwin Conservative Party’s thinking on drug is described as a one of David Cameron’s During the election campaign drug policy was articulated by the Centre ‘closest allies’. policy did not get much of a mention, for Social Justice and Iain Duncan The Coalition: our programme for with few specific commitments in the Smith. The Centre’s ‘Addictions’ report, government, published in May, featured a party manifestos. More than six months published in 2007, although never number of commitments relevant to drug on from the formation of the coalition formally adopted as Conservative Party policy, including temporary bans on new government, what do we know so far policy, was highly critical of Labour’s about it’s approach to drug policy? approach to drug policy, describing it as Some pieces of the jigsaw are in a ‘costly investment in failure’. Although place, but despite publication of the methadone had a ‘useful and positive role drug strategy consultation document in the treatment of addiction’, methadone in August, and much support in the prescribing was said to perpetuate sector for the broad aims and themes ‘addiction and dependency [and] has it contained, there remains a lot of been promoted while rehabilitation uncertainty. treatment has been marginalised.’ It is difficult, if not impossible, to ‘Abstinence’, the report concluded, separate anxieties about the new drug ‘is the most effective form of treatment, strategy, due to be published in December, and the only appropriate one for many from the concerns about the impact addictions’. In January this year, Iain of the Spending Review and spending Duncan Smith said that a ‘fatalistic and cuts. On the detail, the situation within undignified strategy of maintenance government is complex and policy not recovery, fuels…ongoing failure’. He discussion still ‘fluid’. However, perhaps called for a quadrupling of residential the most surprising thing is just how rehab places, the replacement of the much of a priority drug policy is being National Treatment Agency (NTA) by given across government. Senior officials a new Addictions Recovery Board and 6 | DRUGLINK NOVEMBER/DECEMBER 2010 ‘legal highs’ and exploring alternative The drug strategy consultation There is recognition within forms of secure, treatment based document does not mention methadone. government that a more ambitious accommodation for mentally ill and It recognises the need for a joint approach to treatment and recovery drugs offenders. There was no mention of approach (‘where appropriate’) to drugs needs to be adequately funded. There a new drug strategy. and alcohol and preventing and reducing will be a ring-fence for public health but In light of the commitment to reduce substance misuse ‘of whatever type’; we do not know if the ring-fence for drug the number of ‘quangos’ it was perhaps it promises a strong commitment to treatment will be retained. not surprising that the NTA is to be supporting recovery and reintegration: Considerable effort is going into abolished and its functions transferred ‘the end result should be the focus, developing a system of payment by to the new Public Health Service. After rather than the means’. The document results – the Conservative Party’s the announcement, the NTA business mentions ‘abstinence’ but acknowledges intention to move away from ‘process- plan was published. In trying to reflect that while a ‘drug free lifestyle is the based’ funding to an ‘outcomes’ or the political zeitgeist (before publication ultimate aim’ ‘reducing harm is an ‘impact’ based approach was flagged of the drug strategy consultation) it important component of treatment’. before the election and will be applied nonetheless sent hares running on the Speaking at DrugScope’s conference in across criminal justice, health and social issue of methadone prescribing. November, the NTA’s chief executive care. But expectations that new forms of Under the heading ‘Championing Paul Hayes provided welcome assurance, funding and commissioning will generate abstinence-focused treatment’ it states describing harm reduction services as cost-savings are as yet unproven. that new guidance for treatment in “the bedrock of what we do”. He added: Then there is the importance and prisons has introduced ‘strict time- “Our challenge is adding recovery, not added complication of the commitment limits to end the practice of open-ended subtracting harm reduction.” to ‘localism’: a radical devolution of substitute prescribing in prisons’ and power and financial autonomy to local that this principle ‘will be extended into THE MOST SURPRISING government. The government has swept community settings’. Although there is a aside Public Sector Agreement (PSA) more accurate description of the guidance THING IS JUST HOW targets, Comprehensive Area Agreements later in the document, the reference to MUCH OF A PRIORITY have been abolished and the Spending ‘strict time limits’ caused alarm among Review ‘gives councils unprecedented many treatment providers and service DRUG POLICY IS freedoms and flexibilities and far more users. The 2009 business plan made BEING GIVEN ACROSS control over their budgets’. Revenue explicit mention of ‘harm reduction’ and grants to local authorities will be reduced ‘needle exchange’, words which now GOVERNMENT. by 26 per cent. The essential components appear to be absent. for recovery – housing, training, family A goal of avoiding open-ended Concern about the truncated six-week support and so on – are reliant on locally prescribing is not the same as, and consultation process and the lack of delivered and funded services. should not be confused with, the setting detail in the document underlines A key message in DrugScope’s of ‘strict time limits’. The wording was a need for the government to more response to the drug strategy unhelpful and detracted from other fully articulate its approach to drug consultation is the need to build on what relevant statements, for example: the policy, and particularly treatment. has been achieved. Our report on drug ‘approach’ taken in prisons ‘needs to There is evidence (for example via treatment in 2009, Drug treatment at the be undertaken with the full support of DrugScope’s FundingWatch network) of crossroads, highlighted that while there clinicians if it is to be successful’; an commissioners, local partnerships and were disagreements and differences in expert group (chaired by Professor John service providers pre-empting what they approach in the sector, there was at the Strang) would be tasked with developing think a ‘rebalanced’ treatment system same time wide consensus on the need new clinical protocols and any change will look like – questions are being asked for a balanced approach to treatment and would be ‘underpinned by the latest about funding for substitute prescribing, on the way forward. evidence and best practice’. ‘recovery’ is seen by some as meaning This has been further evidence by the abstinence, morale in many needle support for the Drug Sector Partnership’s exchange services is low. drug treatment consensus statement The new strategy is expected to (www.drugsectorpartnership.org.uk). Our be shorter, less detailed and less report warned: ‘Solid achievements could ‘prescriptive’ than previous strategies. be lost, if respect for clinical judgment
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