Dame Carol Black's independent review of drugs - press statement from NHS APA

The second part of Dame Carol Black's independent review of drugs has been published today (8th July 2021). The report, which was commissioned by the Home Office, focuses on drug treatment, prevention, and recovery and it outlines 33 individual policy recommendations to the government.

In response to the report Danny Hames, NHS APA Chair said: “As an alliance, we welcome the scope and ambition of Dame Carol Black’s Review and its recommendations which represents a landmark opportunity to reset and renew our treatment and recovery system which has been severely defunded for over a decade.

“Funding pressures have left some local treatment systems ‘on their knees’, so we applaud the recommended increases for funding which will be essential in order for services to deliver the recommendations effectively. Real impact requires real investment – Dame Carol is right to make a call for major, sustained and protected investment where funding is ring fenced specifically for treatment and recovery along with medically managed inpatient detox and broader tier 4 commissioning.

“We also welcome the call for strong, sustained local and national leadership at the centre of government with the creation of a new cross-departmental unit. However for this structure to be most effective we need clear structures, real accountability and an integrated approach across the agencies.

“Focusing on what is in the best interest of those who use our services will continue to be our mantra as an alliance of NHS Trusts providing addiction treatment services; this includes tackling the stigma around addictions that has enabled inequalities to grow. As an NHS alliance we want to ensure that drug and alcohol services sit across the Integrated Care System and are regarded with the parity of esteem that other health care services hold.

“Efforts to address ‘addiction’ without work with partners in criminal justice, health, homelessness and mental health fields are futile. We believe a ‘whole system’ approach based on accountability, collaboration and partnership is essential. The Review’s recommendation for a local government-led joint approach with health, housing and employment support, and criminal justice is welcome, as is the suggestion for closer working between the Ministry of Justice and NHS England over prison-based treatment. It is also a welcome move that care pathways will be underpinned by effective strong partnerships that will be accountable, funded, and organised on the principle of need and addressing disadvantage.”

Jon Shorrock, Chair of the NHS Inpatient Network, a subgroup of NHS APA, stated: “Drug dependency is much more than an isolated health issue. It is a chronic relapsing health condition, often with comorbid factors and often requiring acute care, something which has been clearly acknowledged in the report.

“We welcome the recognition that inpatient detox needs to be invested in through regional and sub-regional commissioning models which have now been established across the country with universal 12 months of funding. It also aligns directly with the NHS APA business case for securing NHS medically managed detox units under Tier 4 specialist commissioning models. There is however, a lot of work that needs to be done to train and educate the workforce and establish service effective pathways into treatment.

“The reports focus on co-existing mental health problems and drug dependence is also welcome and echoes the NHS APA’s position in this area. We also echo the call for additional investment from NHSE to high quality physical and mental health services. NHS inpatient detox units currently manage a high level of complexity that relieve burden from other areas of the healthcare system. We believe this provision should be seen at the heart of the developing integrated care systems as outlined in the report. Today’s report provides a critical opportunity to secure long-term funding of medically managed NHS and community detox services.”

Dr Emily Finch, Clinical Director and Consultant Psychiatrist with responsibility for addiction services across Lambeth, Bexley, Greenwich and Wandsworth, vice-chair of the Royal College of Psychiatrists Addictions and Vice Chair for the NHS Addictions Provider Alliance, commented: “The situation has become intolerable and significant change is urgently needed in the addictions treatment sector; the recommendations in the second part of Dame Carol Black's independent review of drugs will create a fundamental step change in the right direction.

“We strongly advocate for the reformation of pathways to strengthen integrated partnership working and standards and ensure effective accountability is reinstated to reverse the steady decline of these standards that have become tolerated over recent years.

“The role of professionally qualified disciplines is essential, as per the recommendations, it is important that strong emphasis is placed on the development of the workforce in the addictions treatment sector. Dame Carol’s suggestion that Health Education England take a leadership role in developing a strategy for the workforce is welcome and should include a broad focus on competence in order to successfully bolster our quality, appropriately qualified, skilled, and experienced workforce.”