We broadly welcome the approach in the strategy document Healthy Lives Healthy People, which places drug misuse and dependence in a Public Health context that recognises the role of inequality and disadvantage, and a range of social, environmental and economic factors in promoting and sustaining poor health outcomes. We also support the strong focus on using and developing the evidence base in support of interventions, and that the budget devolved to local authorities will be ring-fenced.
However, across the strategy and associated consultation documents, we have a number of concerns that specifically relate to the provision of services. Our key concerns are that:
1. The strategy and associated documents contain very few references to drug dependence and related services despite the fact that the current drug treatment budget will make up a significant part of the total budget for Public Health (about a quarter of it). Although we recognise the need for flexibility to enable local areas to meet local needs we are concerned that, for a range of reasons that include the widespread stigma attached to drug users even when they are trying to address their problems, there may be significant reduction in investment in drugs interventions.
2. The strategy is largely silent with respect to the important ‘harm-reduction’ services, such as needle exchanges and vaccination programmes, which have been largely responsible for the comparatively low rates of HIV infection among injecting drug users (IDUs) in the UK. If these services are not protected there is a danger that they will be neglected.
3. As mental health services are to be commissioned through GP consortia while drug treatment services will be within the Public Health remit, there is a danger that the difficulties already encountered by people with mental health and substance misuse dual diagnosis will be exacerbated, and they will increasingly suffer from the gap between services.