The 10-year drug strategy: Peterborough City and Cambridgeshire County Councils

The collaborative efforts between Peterborough and Cambridgeshire have laid a solid foundation for their joint approach to tackling drug-related issues. Even before the implementation of the strategy, strong partnerships had been established, exemplified by the existence of a high harms board and local drug and alcohol partnerships. This existing framework provided a robust platform upon which to build their strategy, allowing for a more formalised approach with enhanced accountability structures.

Peterborough and Cambridgeshire have adopted a coordinated approach to address drug-related challenges, tailoring interventions to suit the specific needs of their local populations. The impact of the COVID-19 pandemic differed between the two regions, with Cambridgeshire experiencing an increase in individuals seeking treatment while Peterborough saw a decline. This discrepancy created varying starting points for the implementation of the 10-year strategy in each area.

Despite initial differences, both regions have witnessed increases in treatment admissions over the past two years, with Peterborough experiencing particularly notable growth. Similarly, Cambridgeshire's numbers are now on the rise after a slower initial growth rate, reflecting the evolving nature of their strategies.

Peterborough stands out for its high treatment numbers and effective utilisation of a voluntary sector provider, earning recognition as one of the providers top-performing regions. The consistent visits and reviews from OHID have provided valuable feedback and facilitated positive developments in the region's drug strategy implementation.

The funding provided has been instrumental in establishing new posts dedicated to the drug strategy in both Peterborough and Cambridgeshire. Moreover, the regions have benefited from additional funding grants, including supplementary, inpatient support, housing and support, and rough sleeping grants. These grants have significantly bolstered the implementation efforts, with the funding often surpassing local investment. However, the short-term funding cycles pose challenges, as they raise expectations for continuous high performance from the service, with the risk of many service users and staff being impacted if funding was to be discontinued.

In both Peterborough and Cambridgeshire, there has been notable progress in engaging with criminal justice agencies and securing grant support for probation services. While it takes time for the numbers to respond, both regions are witnessing increases in the number of people entering treatment. In Peterborough, the Integrated Care Board has commissioned an additional hospital role, highlighting robust system support and ensuring continuity of care for individuals transitioning from hospital to the community. Moreover, there is strong integration with primary care services, particularly for individuals on prescription medications or those who face challenges in engaging with traditional treatment providers, as they can receive support in primary care settings.

The rough sleeping teams in both Peterborough and Cambridgeshire have emerged as areas of notable success, evolving from individual roles to comprehensive teams aimed at bolstering provision for individuals experiencing homelessness.

An independent evaluation of these teams in both regions has highlighted a strong local interface between rough sleeping and drug treatment services, emphasising the importance of having an interconnected approach to these challenges. However, local issues persist, particularly concerning housing shortages, especially for individuals with complex needs who are not adequately accommodated in appropriate housing.

The initiation of a tier 4 pathway in Peterborough marks a significant advancement, ensuring continuity of care for individuals transitioning from inpatient stays to residential settings. Additionally, the implementation of buvidal clinics across all sites in Peterborough and Cambridgeshire, and extending this offer within the prison service, has further fortified the continuity of care. This comprehensive approach has yielded positive outcomes for 30 service users across Cambridgeshire and Peterborough, facilitating their reintegration into society, enhancing their overall well-being, and enabling them to re-enter the workforce.

The funding allocated through the strategy has played a crucial role in strengthening the workforce, enabling the provision of additional clinical, psychology, and social worker posts. This expansion has enhanced the depth of skills and expertise available within the workforce, particularly in areas such as safeguarding and clinical care, where dedicated clinicians within rough sleeping teams can provide same day prescribing support. This proactive and integrated approach has been instrumental in preventing premature exits from treatment programs. Moreover, the investment has empowered the service to exceed basic requirements, allowing for targeted provision tailored to individuals with complex needs, thereby offering a higher level of intervention and support.

The concerted efforts and strengthened infrastructure within the region have led to the achievement of micro-elimination of hepatitis C within the locality of Wisbech and work is on-going with good progress being achieved across Cambridgeshire and Peterborough. This success can be attributed to the enhanced reach and effectiveness of frontline agencies, which are now better equipped to engage with individuals in need. This marks a significant milestone in public health achievement.

Peterborough and Cambridgeshire acknowledge the importance of integrating alcohol treatment and prevention into their local approach, despite the national strategy's focus primarily on drugs. However, this poses challenges as the supplementary grant money allocated cannot be utilised for prevention initiatives, and certain components of alcohol treatment. This limitation restricts their ability to address issues such as supporting children with substance-using parents, highlighting a gap in prevention strategies at both the local and national levels. The regions emphasise the need to develop comprehensive prevention strategies to address the harm caused by alcohol, recognising its significant impact on physical health and overall population well-being.

The 10-year drug strategy has facilitated positive outcomes in terms of increasing the number of people entering treatment, and the challenge now lies in sustaining these interventions. The Integrated Care System has provided a prevention lens for broader work related to alcohol and drugs, indicating strong traction within the system. The COVID-19 pandemic has also played a role in strengthening partnerships and communication with system partners, leading to better integration of drug and alcohol support in the court and probation systems. However, there is concern about the potential repercussions if funding were to cease, as it may result in a return to working in silos and hinder progress made in collaborative efforts.

The absence of guaranteed funding poses significant risks to the sustainability of treatment services. If funding were to discontinue after significant progress has been made, there would likely be swollen treatment systems without sufficient staff to manage the workload. This could result in increased pressure on the workforce and potentially lead to backlogs in service delivery. Therefore, it is crucial to secure ongoing funding to maintain the progress achieved and ensure the continued effectiveness of treatment services.

Large national third sector providers demonstrate a willingness to shoulder risk and collaborate with councils despite the challenges posed by short funding cycles. However, these cycles place undue pressure on councils, particularly in challenging economic climates. Long-term funding guarantees are essential for a 10-year strategy to succeed, as they provide stability and reassurance to trained staff who may otherwise seek alternative employment due to job insecurity.

Furthermore, the fragmentation of grants complicates forward planning and creates additional administrative burdens. Grant reporting, in particular, is perceived as complex and labour-intensive, adding to the workload of already busy service providers. This quarterly commitment detracts from the primary focus of delivering services effectively and efficiently.

The collaborative approach between Peterborough and Cambridgeshire, despite separate budgets, has yielded several positive outcomes. One key advantage is the sharing of learning between the two regions, facilitated by their historical joint authority structure. Additionally, the presence of the Integrated Care System operating across both areas has been beneficial.

Strong local leadership has supported efforts in service co-production and gathering independent feedback from service users across the regions. Some funding has been allocated to support transport to clinical appointments, which has helped to address accessibility challenges.

While the separation of funding ensures that services remain tailored to each area's specific needs, the collaborative efforts capitalise on shared processes and expertise, ultimately enhancing the overall effectiveness of the strategy.

While Peterborough and Cambridgeshire acknowledge the importance of national coordination in drug strategy, they also recognise some fragmentation at the ground level in terms of service provision. For instance, funding from National Health Service England (NHSE) for certain parts of the treatment system can result in variation in local priorities. There is occasionally tension between the criminal justice drug strategy and the health drug strategy, as they often have separate goals. This can lead to a perception that the overall strategy is mostly oriented toward criminal justice rather than holistic health outcomes. Despite these challenges, efforts are underway to foster greater alignment and coordination between different stakeholders involved in drug strategy implementation.