The 10-year drug strategy: Greater Manchester Combined Authority

Prior to the first COVID-19 lockdown, Greater Manchester conducted an internal review of its drug strategy, positioning itself strategically to act upon reviews by Carol Black and the inception of the 10-year drug strategy. An external review led by subject matter experts was also undertaken prior to the strategy’s implementation. This state of organisational preparedness enabled Greater Manchester to strengthen its approach, resulting in a more seamless implementation of the strategy. Additionally, the establishment of the GM Drug and Alcohol Transformation Board prior to the 10-year drug strategy exemplifies the region's historical focus on forward-thinking approaches to addressing drug-related challenges. 

Greater Manchester benefits from its existing framework of integrated system working, given its status as a group of local authorities, with coterminous NHS, probation and police services already being strongly represented. This collaborative approach is ingrained within the city region's strategy, enabling effective coordination and response to drug-related challenges.

Additionally, the implementation of a drugs early warning system and strong partnerships with the police contribute to the early identification of dangerous drug batches. The region also boasts robust data analysis processes, leveraging national drug treatment monitoring data across its 10 local authority areas to inform future strategy discussions and ensure best practices. Notably, Greater Manchester achieves strong continuity of care rates, with two thirds of individuals released from prison receiving support upon reintegration into the community. This emphasis on continuity of care underscores the region's commitment to providing comprehensive support services for vulnerable populations.

Greater Manchester faces challenges in addressing areas of unmet need, particularly concerning homelessness, worklessness, individuals in the criminal justice system, and children in care. The lack of readily available data on the number of heroin users within these vulnerable groups makes strategic decision-making challenging. Additionally, the 1-year funding cycles pose difficulties in recruitment and retention, as there is no guarantee of stable employment, despite the strategy being a 10-year plan. Moreover, the risk of losing funding if performance targets are not met adds further uncertainty. Local NHS treatment services often outperform in recruitment due to more favourable employment terms in contrast to voluntary sector roles, exacerbating recruitment challenges within the region.

To address the needs of vulnerable populations such as homeless individuals and sex workers, there is a desire to enhance promotion of low-threshold access to treatment models. These models, offering easy access to advice, needles, and methadone, appeal to marginalised groups and can facilitate their engagement in treatment. However, increasing the number of heroin users in treatment requires systemic changes and additional resources.

It's important to recognise that treatment dropout isn't solely due to treatment regimens; lifestyle factors also play a significant role. Understanding these factors can provide insights into how to better support individuals to remain in and complete treatment. Grassroots initiatives like Manchester Action Street Health (MASH), exemplify the importance of developing relationships and providing long-term support to improve treatment outcomes within the community.