Two years on: a progress review of ‘From harm to hope': A 10-year drugs plan to cut crime and save lives’

Public Sector Access (PSA) is a consultancy firm committed to delivering comprehensive research, evaluation, and strategic reviews tailored for public sector organisations. Our team of seasoned consultants bring a wealth of expertise spanning health, social care, education, sustainability, and public transformation initiatives.

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It has been fascinating to collaborate with the Local Government Association (LGA) on this progress review. We are eager to sustain this momentum in supporting drug and alcohol treatment services, whilst fostering positive transformation within our communities.

This publication was authored by Ciarán Hastie and Mark Cole, Directors of PSA.

I welcome this Local Government Association publication, which provides insight into how nine local councils have started to deliver the Government's 10-year drug strategy 'From Harm to Hope'.

Underpinning the strategy is the important principle that combating drug use and harm is a priority for all relevant organisations, working as a single team. At the national level in England, a Combating Drugs Minister has been appointed and a cross-government central unit has been established. Mirroring this at local level is the creation of Combating Drugs Partnerships (CDPs), each with a local Senior Responsible Owner (SRO).

Nine local councils now tell us about their journeys to date, their successes as well as challenges. Common themes emerge, but also interesting differences. Most heartening is the evidence of local commitment and innovation.

The engagement and leadership of local councils in this important agenda is crucial to success, and the report highlights key issues and interesting proposals. I look forward to working with local government to continue to improve drug treatment, with this publication as a useful source of experience and ideas.

Professor Dame Carol Black FRCP FMedSci

It remains a stark fact that more people die from drug misuse every year than from all knife crime and road traffic incidents combined.

People with untreated drug and alcohol dependencies have a disproportionate impact on our communities. In a typical English secondary school, 40 pupils will be living with a parent with a drug or alcohol problem.

About one in six ‘child in need’ assessments carried out by local authorities last year recorded parental alcohol problems, with a similar proportion for drug use. Problem parental alcohol or drug use was also recorded in more than a third of serious case reviews where a child died or was seriously harmed.

Almost half of homicides every year are drug-related, and, in almost a fifth, the suspect is under the influence of alcohol, while nearly half of ‘acquisitive’ crime – such as shoplifting, theft, burglary and robbery – is drug-related.

Two years ago, ‘From harm to hope: a 10-year drugs plan to cut crime and save lives’ – a cross-departmental government strategy – was published. Both the strategy and the funding that accompanied it were welcomed, especially after years of reductions to the public health grant, but future funding to realise the ambitions of the strategy face a funding cliff-edge next March. If the government continues to invest in building up skills and capacity in the sector, we can turn the tide, enabling people previously struggling with substance use to thrive within their community. It is essential the Spending Review commits to continuing drug strategy funding – ensuring the substance use sector and wider public services can continue to deliver.

We need to work together to make the most of these developments, and I welcome this report as an important contribution to our shared thinking about the future.

Councillor David Fothergill 
Chairman, LGA Community Wellbeing Board

PSA has engaged with nine councils across the nation to review the progress of ‘From harm to hope: A 10-year drugs plan to cut crime and save lives’. This progress review provides a snapshot of the strides made, the challenges faced, and the opportunities uncovered in the pursuit of creating healthier, safer communities.

Over the past two years, the strategy has served as a key driver, to revitalise and guide councils in their efforts to combat drug misuse, enhance treatment and recovery services, and address the complex socio-economic factors underlying substance abuse. From metropolitan hubs to rural landscapes, each local authority brings a unique perspective, challenges, and successes to the table.

At the heart of this review lies a recognition of the multifaceted nature of substance misuse, encompassing not only the clinical dimensions but also the broader social, economic, and environmental factors that shape patterns of drug and alcohol use. It is within this context that the recommendations derived from the insights of the councils take on added significance, representing a holistic approach to tackling the root causes and consequences of substance misuse.

Through in-depth consultations, the review highlights the imperative of fostering collaborative working through CDPs and the urgent need to address barriers to treatment access for drug users, underscoring the importance of a coordinated and multifaceted response. Furthermore, the recommendations highlight the critical role of prevention initiatives, innovative treatment pathways, the necessity of stable funding streams, and the imperative of integrating lived experience into service delivery models.

As the landscape of drug and alcohol misuse continues to evolve, so too must the strategies and frameworks aimed at addressing these complex challenges. Against this backdrop, this review serves as a critical examination of current practices and a roadmap for future enhancements, to guide the ongoing development and implementation of the strategy.

PSA aims to shed light on the collective achievements and lessons learned, offering insights through nine regional sections, to inform future policy development, resource allocation and service delivery. By amplifying the voices of local authorities and stakeholders, we strive to catalyse meaningful change, foster collaboration, and ultimately, pave the way towards a future where individuals and communities thrive, free from the harms of substance misuse.

There are a number of prevalent themes across the nine councils which form a set of recommendations for the strategy’s ongoing development and implementation. This section will work through each of these key recommendations, taking an overarching view.

Combating Drugs Partnerships (CDPs)

Overall, mandating CDPs has been perceived as an overwhelmingly positive development. This has helped to improve collaboration and communication between system partners and ensure more joined up approaches to drug and alcohol treatment. It is noteworthy that regions that had strong pre-existing relationships in place have made more significant progress in the past two years than those that did not. This is because the historical governance structures in these regions mirrored the requirements of CDPs and acted as an effective precursor. The recommendation is that councils are continued to be encouraged to develop the effectiveness of their CDPs to promote a high degree of system wide ownership.

Opiate users in treatment

It was recognised across all regions, that there are challenges in increasing the number of opiate users in treatment. Progress has been made in increasing non-opiate and alcohol users into treatment, but this progress has not been mirrored amongst opiate use. The reasons for this are not fully understood, but it is inferred that the criminality element and stigma attached to this group of substances may inhibit people from seeking help due to the fear of the consequences within the justice system. There could also be wider factors at play, which are harder to measure, such as long-term opiate users having limited social support. Clinical guidelines are also perceived as obstructive at times, as daily methadone visits can deter people from engaging with treatment. Prescribers can be hesitant to take more creative approaches to treatment due to the fear of litigation. The recommendation is for the national strategy to explore this issue in greater detail and review the approach of the justice system and health services, ensuring that policies are implemented in a modern way that facilitates access to treatment.

Reporting requirements

There were mixed perceptions of the reporting requirements across the councils. Overall, the relationship with the Office for Health Improvement and Disparities (OHID) was seen as positive, and local visits have helped to strengthen council relationships with the reporting body. However, some councils did experience increased administrative burden and complexity due to the strategy’s reporting requirements. This complexity was heightened when councils were the recipients of multiple grants. The recommendation is to reduce fragmentation in the funding and reporting processes, and that the services would have more time to focus on service delivery if these processes were more consolidated.

Inclusion of alcohol

It is widely recognised by councils that there is no dedicated national strategy for alcohol treatment and that they must work at a local level to ensure that this group is effectively cared for. Restrictions on how much of the funding can be used to fund alcohol treatment can put resource pressures on councils who need to make provisions locally to fund these services. Overall, the recommendation is for the extent of the harm to society posed by alcohol to be recognised at a national level, and more strongly reflected in strategy KPIs. Many people with drug problems also have alcohol issues, and therefore, this needs to be given the appropriate level of attention at a national level.

Greater focus on prevention

Whilst councils have made impressive progress in thinking creatively to develop prevention mechanisms at a local level, it is felt that the priority of prevention is not reflected at a national level. The strategy KPIs are focussed on increasing treatment levels, and councils are restricted in regards to the extent they can utilise the budget for prevention initiatives. This would include investing more in the youth, sports, employment and education offers within the regions. It is recommended that prevention is integrated into the core strategy in a more meaningful way.

Councils emphasise that merely taking drugs off the streets may be insufficient to impact treatment levels and may, in fact, be counterproductive. Instead, the focus should be on reducing demand through prevention and treatment, which ultimately impacts crime rates. Thus, the key message is that addressing drug-related issues requires a holistic approach, that prioritises prevention and treatment over solely law enforcement measures.

Guarantee of funding

The short funding cycles were consistently cited as a key risk to local strategy implementation. Having a guarantee of funding beyond one year would make it easier to plan for the long term.

In addition to this, the funding cycles do not align with the practicalities from a recruitment perspective. For example, funding is awarded and then councils must work quickly to recruit people into recovery worker and clinical roles. This can take time, as the recruitment processes can take three months. Having secure funding streams would enable councils to dedicate more resources to plan ahead with recruitment strategies as well as give the workforce greater job security. Staff leave roles due to being on fixed term contracts.

Synthetic drugs

The growing presence and dangers of synthetic drugs was noted amongst all councils. Local research indicates that this is due to supply chain disruptions due to the ever evolving landscape in the middle east. This has pushed individuals involved in the drugs supply chain to steer people towards alternatives. A key recommendation is the implementation of early warning systems which enable effective communication channels to be implemented by system partners. This means that changes at street level can be responded to in real time. It is also recommended that samples of new substances should be tested as soon as possible, although these processes can sometimes take time.

Continued alignment of system partners

The CDPs have made exceptional progress within the last two years. However, some councils noted that the NHS and criminal justice system do not always prioritise drug treatment to the same extent as local authorities. The recommendation is to continue to build upon the early successes of CDPs to strengthen relationships and ensure system wide sustainability.

Integrated approach to co-occurring conditions

A key theme that arose in the progress review was the interconnectedness between physical and mental health and drug and alcohol treatment services. Local and national datasets show that people who use drugs are likely to have a mental health condition or are at heightened risk of developing one throughout the course of their drug use. Councils recommend the wider adoption of dual diagnosis pathways, ensuring that treatment services take a joined-up approach to both mental health and drug treatment. Furthermore, some councils collocate physical health clinics within drug treatment centres, which act as a conduit to identify individuals who are using drugs and strengthen the interface between physical and mental health and local drug and alcohol treatment services.

Early warning systems and data sharing

Councils who had local processes in place for early warning systems enabled real time response to developments on the street, such as dangerous batches of drugs and synthetic substances. These systems are crucial to enabling effective communication between agencies and notifying trusted key decision makers. This approach also helped to promote shared ownership of the strategy between councils, the NHS, Police, voluntary sector and wider system partners. This serves as a clear sign that the CDPs are improving communication.

Centralisation vs local control

At a central national level, it is recommended that clear outcomes be outlined, while advocating for support from the central government to remove barriers to successful implementation. Councils emphasise the importance of establishing clear communication structures to strengthen the interface between local and national levels, facilitating effective collaboration. It is recommended that there is freedom at a local level for service design and leadership to meet the specific needs of populations whilst national oversight is maintained. Overall, localised control of funding is advocated for enabling system partners with the appropriate level of control to meet the needs of each individual region. Some flexibility in the strategy KPIs would support this.

Academic partnerships

Academic partnerships have been hugely beneficial to some councils in helping them to better understand the exact needs of their populations and produce meaningful longitudinal datasets. This goes as far as to directly engage with members of the local population to gather qualitative and quantitative insight to improve services. A gap in the evidence base was also identified during the progress review, which is to understand the drivers behind recreational drug use in young adults who perceive a lower level of risk. This is often an overlooked group but has significant implications on the wider impacts of drug use and the associated supply chains.

Effective diversion

It is recommended that effective diversion strategies continue to be implemented. For example, distinguishing between dangerous career criminals and young people on the fringes of gang activity. Having the latter group enter the justice system does not serve any real purpose and it is perceived as being far more beneficial to help these individuals access education programmes and opportunities within their communities.

Recruitment

The short funding cycles can make recruitment challenging, posing the risk of job security to staff. Recruitment into statutory roles appears to be far more challenging than recruitment into voluntary sector roles. Councils cited that a greater focus needs to be placed on making statutory services an attractive place to work and the lack of job security does not support this. However, it must be recognised that the strategy has played a key role in providing the funds to recruit both recovery workers and trained medical professionals. The increased availability of clinical, psychology and social worker roles has helped to strengthen the services offered as well as cater to individuals with complex needs. Longer guarantee of funding would help to sustain the progress that has been made in regards to recruitment.

Interface with law enforcement

An effective interface with law enforcement is critical, as councils recognise the drug supply chain as a vast criminal network that continually adapts to changes in drug supply and policy. However, the emphasis on law enforcement within the drug strategy is perceived at times as inefficient in targeting resources. For instance, the criminalisation of substances like nitrous oxide may hinder individuals from seeking support even with more dangerous substances. The overarching message of "getting tough" on drugs from the government may not effectively encourage people to enter treatment. Depicting drug use as a purely moral choice to take and be dependent on drugs disregards the range of complex drivers, as well as the social, economic and cultural reasons for why a person may take drugs.

Rough sleeping

Councils understand the interdependencies between drug use and rough sleeping. The funding is perceived as being health focussed so it can be challenging to fully address the wider social needs that contribute to drug use. Some creative work has been undertaken in collaboration with local housing associations, hostels and shelters. Supplementary rough sleeping grants have helped to support this work. Some regions have dedicated rough sleeping teams who provide proactive outreach and same day prescribing which has helped to reduce the numbers of people exiting treatment programmes prematurely. The recommendation is for councils to continue to implement these strategies at a local level and for the national strategy to make more specific provision for rough sleeping.

Accessibility and inclusion

Councils must take proactive steps to identify areas of unmet need, particularly amongst marginalised groups such as people from minority ethnic, traveller and LGBT+ backgrounds. Councils need to understand the unique demographics of their specific region and ensure that barriers to particular groups engaging with treatment and support services are being identified and acted upon. In some cases, this means initiating projects which are specifically designed to increase engagement and uptake amongst these groups.

Importance of lived experience

Connecting with people with lived experience of drug and alcohol use and treatment services was consistently cited as a key way to make local implementations more relatable and aligned with real world contexts. The key recommendation is for councils to continue to promote the importance of integrating lived experience into their local implementation plans and utilising tangible measures to achieve this such as proactive outreach, service feedback, focus groups and creating employment opportunities within both statutory and voluntary services for people recovering from addiction.

In conclusion, this comprehensive review of the drug strategy underscores the critical need for continued evolution and refinement to effectively address the multifaceted challenges associated with substance misuse. The recommendations derived from the insights of the nine councils offer a roadmap for enhancing the strategy's efficacy and responsiveness to the dynamic landscape of drug and alcohol treatment. Firstly, the endorsement of CDPs highlights their instrumental role in fostering collaboration and cohesive approaches across system partners. Building upon existing relationships and incentivising the development of effective CDPs at the local level is pivotal in ensuring sustained progress.

Moreover, addressing barriers to accessing treatment for opiate users emerges as a pressing concern. This entails a comprehensive review of existing clinical guidelines and justice system practices to mitigate stigma and facilitate greater engagement with treatment options. Additionally, recognising the interconnectedness of mental health and substance misuse underscores the importance of integrated approaches to co-occurring conditions.

The imperative to prioritise prevention initiatives, backed by adequate funding and strategic alignment, resonates throughout the recommendations. By integrating prevention efforts more robustly into the core strategy and alleviating administrative burdens, councils can better allocate resources towards proactive measures aimed at youth, sports, employment, and education.

Furthermore, the call for greater stability in funding cycles and flexibility in service design underscores the necessity of ensuring sustained commitment and adaptability to local needs. Central to this is the recognition of the importance of lived experience in shaping interventions and fostering community engagement.

The review also underscores the urgency of addressing emerging challenges such as synthetic drugs through proactive surveillance and rapid response mechanisms. Strengthening diversion strategies and recognising the nuanced needs of vulnerable populations, particularly those experiencing rough sleeping, are pivotal in promoting holistic and effective interventions.

Ultimately, the recommendations advocate for a balanced approach that combines robust clinical interventions with community-centred initiatives, underpinned by collaboration, innovation, and a steadfast commitment to addressing the complex realities of substance misuse. By following these recommendations, the future implementation of ‘From Harm to Hope’ can continue on its path to becoming an even more dynamic and responsive framework, better equipped to navigate the evolving landscape of drug and alcohol treatment, reducing harm and caring for some of the most vulnerable groups in society.