The 10-year drug strategy: West Midlands Combined Authority

West Midlands has long adopted a distinctive approach to drug services, characterised by a strong emphasis on public health, a stance largely driven by the Police and Crime Commissioner (PCC). While many regions typically lean towards a council-centric or operationally-driven response, West Midlands PCC 's strategy stands out for its strategic alignment with public health principles from the outset. This unique approach has not only fostered robust relationships within the system but has also positioned West Midlands PCC  favourably in negotiating the delineation of roles and responsibilities among system partners.

In the West Midlands, the combating drug partnerships present a distinct model, with each being led by the Police and Crime Commissioner (PCC) in relation to the drug strategy, rather than being individually led by local councils. This stands in stark contrast to the prevailing trend, where approximately 75 per cent of combating drug partnerships across the UK are led by local authorities.

The combating drug partnerships are widely regarded as a positive development in the region, although there is a consensus that while the focus on treatment is acknowledged, there could be greater emphasis placed on prevention efforts. Despite this, there have been notable advancements in bringing local authorities together to facilitate the sharing of knowledge and best practices.

West Midlands appreciates the clarity of mission from central government down to the frontline police officer regarding the enforcement aspect of the drugs strategy. Local efforts to disrupt supply chains have been coordinated, with the police forces lauded for their swift responses to policy changes. However, there is a perceived discrepancy in the speed of response between the enforcement aspect and the treatment and prevention aspects of the strategy. This disparity may stem from a lack of clarity of mission for these latter categories, as the messaging is not consistently mirrored between government directives and frontline treatment workers.

The SSMTR grant is viewed as a bureaucratic process that aligns more with OHID requirements than with the optimal investment for end service users. While the ring-fenced nature of the funding is seen as positive, the single-year settlements pose a significant risk. Many of the grant's objectives centre around increasing the workforce and reducing caseloads. However, the short funding cycles mean that posts can only be fixed term for one year at a time, making long-term planning challenging and jeopardising staff job security. Moreover, the confirmation of funding often occurs close to the date it goes into effect, presenting challenges for mobilisation. Given that recruitment typically takes three months from start to finish, the one-month notice period upon confirmation of funding creates a difficult balance. The pressure to deliver results from the government clashes with the local areas' need to play catch-up due to these arrangements, further exacerbating the challenges faced by service providers.

West Midlands views the goals of the strategy positively but raises concerns about their potential realism. A key recommendation from the region is to remove drug and alcohol services from the purview of local authorities and transfer them to health services. Specifically, this entails transferring prescribing budgets from local authorities to health organisations. The changes introduced by the Health and Social Care Act in 2013, which resulted in the discontinuation of Primary Care Trusts and the transfer of public health responsibilities to local authorities, had lasting repercussions. With this shift, drug and alcohol funding moved as well, including prescribing budgets for medications like methadone and buprenorphine. Consequently, these budgets have remained fixed at 2013 levels, failing to keep pace with contemporary needs. This lack of funding flexibility makes it challenging to commission more modern interventions, such as buvidal, which are highly effective but come at a greater cost. As a result, improving service quality becomes difficult, as the available formulary does not adequately meet current demands.

West Midlands suggests that OHID (Office for Health Improvement and Disparities) needs to revise its operational approach by engaging with combating drugs partnerships rather than focusing solely on local authorities. This aligns with the recommendation from Dame Carol Black's report, which emphasises the importance of pooling local resources and adopting a joint commissioning approach. It is essential for system partners to collaborate and collectively determine the needs of the region, rather than relying solely on public health initiatives.

West Midlands recognises the absence of a dedicated alcohol strategy within the region. While local authorities manage alcohol-related issues, there's a need for a delicate balance. Allocating resources and funding to address alcohol-related issues could potentially divert attention and resources away from addressing drug-related challenges. West Midlands suggests that a national focus on implementing alcohol interventions and broader policy developments is crucial to effectively address alcohol misuse.

It is widely acknowledged that intervening once drugs are readily available on the streets is challenging and often ineffective. West Midlands advocates for a proactive approach focused on reducing the demand for drugs. However, political motivations often come into play, with governments aiming to portray themselves as tough on drugs. Unfortunately, this approach can sometimes lead to a heavy-handed response from the justice system, hindering individuals' access to treatment and support services.

West Midlands is witnessing an uptick in the number of individuals seeking treatment, although challenges persist in addressing opiate use. While there have been notable enhancements in continuity of care rates, achieving the government's target of 75 per cent of inmates transitioning to community care post-release is viewed as unrealistic. Nonetheless, there has been a significant improvement from 30 per cent to approximately 50 per cent, marking progress in this area.