Note to Nick Clegg: If You Want a Treatment-Led Drug Strategy, Keep It in the Home Office

Nick Clegg’s most recent contribution to the drugs debate has been to call for an end to imprisonment for the possession of drugs for personal use, and to move leadership of the UK drug strategy from what he sees as an enforcement obsessed Home Office to a treatment focused Department of Health. His rationale for this is that we are currently wasting resources locking up the ” victims “of the drug trade while allowing “health harm to go untreated”. 

Ending the use of imprisonment to protect people from themselves has much to commend it. The detailed legal drafting will be trickier than the deputy PM seems to realise, and it is unlikely to free up much resource, given the small numbers involved and the short periods actually served in custody. Nevertheless this reform, particularly if it were allied to amendments to the Rehabilitation of Offenders Act to prevent minor convictions having a disproportionate impact on people’s future life chances, offers a sensible measured step to correct the negative consequences of the Misuse of Drugs Act. Furthermore this could be achieved without opening the Pandora’s box of legalisation, from which may flow increased drug use, and increasing harm, reversing the trend of young people turning away from drugs we have seen over the last decade.

So three cheers for proposal number one. Proposal number two, at first glance seems like common sense. If you want to focus on treatment the Department of Health is the obvious home for policy. My view based on 12 years in Whitehall responsible for the English treatment system is that it could be a disaster. Here is why.

Drug policy and drug treatment has never been a priority for the Department of Health or the NHS. The financial crisis, the interface between health and social care, waiting times, cancer, dementia, and a host of other issues dominate the DH/NHS agenda. Even when policies focus on the wider social determinants of health in an effort to reduce the burden on scarce NHS resources the priorities are :smoking: 80,000 deaths a year, obesity 30,000 deaths a year, alcohol 6500 deaths a year, not illegal drugs: 2000 deaths a year. Drug use simply doesn’t kill enough people or cause as much ill-health as over risky behaviours, and the priority accorded to it by successive Health leaderships reflects that.

Although illegal drug use causes less health harm than either alcohol or tobacco it is neither safe nor harmless. Overall, government estimate drug misuse causes £15 billion worth of harm to society, dwarfing the 5 billion of health harm from smoking. 13 billion of this is the cost of drug-related crime. Home Office research estimates that 50% of the marked rise in crime that occurred in the 1980s and 90s is attributable to the successive waves of heroin epidemics that swept over the country during those decades. Addressing this escalation in criminality by making treatment readily available across the country was the rationale behind the government’s hugely increased investment in treatment following 2001, up from 50 million a year to 600 million. Public Health England estimate that providing rapid access to treatment for around 200,000 individuals, more than twice as many as in 2001, currently prevents almost 5 million crimes each year.

Given the Home Secretary’s responsibility for crime it is not surprising that the Home Office have a very different view of the priority of drug treatment to the Department of Health. The private view in the Department of Health is that the current level of drug spend is a misdirection of scarce health resources which are needed to respond to more pressing health priorities. The Home Office view is that the current spend on treatment is cost-effective yielding, according to the National Audit Office, £2.50 worth of value for the taxpayer from every £1 invested, largely from reduced crime.

Put simply the Home Office see drug treatment as value for money the Department of Health see it as a misallocation of resources. On a number of occasions over the last decade the Department of Health has sought to disinvest from drug treatment, only stepping back when this has been resisted by successive Home Secretaries. These different orientations are particularly important at the moment as the resources currently spent on drug treatment across England come under threat of disinvestment by hard-pressed Local Authorities(who were given responsibility for drug treatment under the Lansley NHS reforms) looking to raid their public health grants to prop up core services.

So what may appear at first sight as commonsense will be very likely to result in drug policy becoming the responsibility of a department that isn’t very interested, has a wealth of competing priorities, and a track record of seeking to disinvest from the very intervention that the proposal is designed to promote. Meanwhile a department that has a powerful rationale for championing treatment, and a track record of doing so, is sidelined. If Mr Clegg is as committed to drug policy based on evidence as he maintains, perhaps he needs to reconsider.

Source:  9th March 2015

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