Thursday 9 June 2016

The good old days of the NTA?

Over the past few months, I’ve been working on two key projects as part of my role at Public Health Dorset.  First, we’ve been developing a joint strategy for alcohol and other drugs that applies across the three upper-tier local authorities of Bournemouth, Poole and Dorset.  Second, we’re starting work reviewing our existing treatment services and thinking about what we might put in place when we need to recommission in the next year or so.

Both of these projects have really brought home to me two points: there’s a huge range of ‘problems’ and ‘solutions’ that can be ascribed to alcohol and other drugs; and without the NTA and centrally-dictated policy, locally areas have a huge amount of autonomy in defining and pursuing these problems or solutions.

Neither of these points will be much of a surprise to regular readers of this blog, as they’re themes I often mention.

Now there are definite positives in this new environment of local autonomy: rural areas without any significant level of crack use don’t have to spend valuable time and energy writing a dedicated crack strategy, for example.  But that process of trying to identify ‘what is the problem’ and ‘what are we going to do about it’ isn’t simple.

We can sometimes think that ‘evidence’ or ‘needs assessment’ are going to provide the answers about what we should do locally, but that’s to overlook the fact that the only reason that was the case under the NTA was that they’d already set not only the terms of the debate, but also the answer.  The debate was set in terms of how we can best reduce crime and blood borne virus transmission, and the answer was methadone maintenance treatment for a sustained period of time (with a bit of emphasis later on completing treatment).

Now, because there are myriad problems that relate to substance use, and no single organisation dictating the answer, neither the aims nor solutions are clear.  And it can be a challenge to bottom out all those discussions.

As I say, there are positives.  It means a genuinely joint approach can be taken to commissioning and policymaking locally, which is what our strategy in Dorset is all about.  And commissioners of substance misuse treatment services are less likely to try to do everything in isolation from other areas (though that’s partly down to financial imperatives).

But going through that process isn’t just challenging; it’s time consuming – which means resource-intensive.  And those discussions then have to take place in all the 150 or so areas that commission services in England, not just in Whitehall.  And those discussions about whether this was an issue worth investing in just weren’t on the agenda at all.

I’m not saying it’s a bad thing one way or the other, and as well as opening the possibility of better local policymaking the change could be said to make policymaking more democratic and accountable to local residents.

But I do want to highlight how complacent it was possible to be, and how easy it was to demonise Paul Hayes for making a bargain with the government to get funding that was dependent on stigmatising drug users.  (As he put it, ‘Because you are seen as a threat, the government is prepared to spend money on drug treatment.’)

I wonder how many of those former critics would like to go back to those simpler times now?