(DRU0084)
Evidence submitted by Local Government Association DRU0084
1. About the Local Government Association
1.1. The Local Government Association (LGA) is the national voice of local government. We are a politically led, cross-party membership organisation, representing councils from England and Wales.
1.2. Our role is to support, promote and improve local government, and raise national awareness of the work of councils. Our ultimate ambition is to support councils to deliver local solutions to national problems.
2. Summary
2.1. Councils are absolutely committed to ensuring drug users get the right treatment and support, as part of their public health and other wider responsibilities. This includes helping vulnerable people being given another chance to find work, rebuild relationships, improve their physical and mental health and find safe and secure accommodation. Working with the Government alongside local NHS, community groups and other partners, councils want to ensure everyone gets the support they need wherever possible.
2.2. Local authorities commission drug and alcohol treatment services through the Public Health Grant. It is a condition of the 2021/22 grant that local authorities improve the take up of, and outcomes from, its drug and alcohol misuse treatment services, based on an assessment of local need and a plan which has been developed with local health and criminal justice partners.
2.3. These services, working in partnership with other local services, can and do help thousands of people to stabilise and turn their lives around every year; reducing the risks to the individuals, their families and wider community and the burden on a range of other local services. For every £1 spent on drug treatment, there is a social return of £4. For every £1 spent on alcohol, it is £3. That means these services are helping to save society more than £2 billion every year.
2.4. However, funding for addiction services has not kept pace with demand and certainty over long-term funding is needed. According to the Health Foundation, the public health grant allocations to local councils used to fund drug treatment and recovery have fallen in real terms from £4.2 billion in 2015/16 to £3.3 billion in 2021/22. On a per head basis that equates to a 24 per cent cut since initial allocations were made in 2015/16.
2.5. On 7 February 2022, the public health grant for 2022/23 was announced, which provided no real-terms increase in public health funding. This will cause challenges for councils to provide drug treatment services and runs contrary to our shared ambition with government to address the stark health inequalities exposed by COVID-19.
2.6. While the announcement provided immediate certainty, we still need a clear long-term plan on the future which recognises the public health challenges we face as a country, addresses the current and future pressures on the public health workforce and recognises the interconnectedness with other parts of the health and care system.
2.7. The Government’s 10 Year Drug Strategy, published in December 2021, included almost £780 million extra funding for drug treatment services. Councils share the ambition of the strategy and want to see vulnerable people being given another chance to find work, rebuild relationships and find safe and secure accommodation. As the strategy outlines, investing in drug prevention and treatment now will reap benefits for everyone longer-term, including for the NHS, criminal justice and other public services. This needs to be supported by extra opportunities for users to gain employment, housing, mental health care and help from other agencies.
2.8. Boosting direct funding for drug treatment and recovery is helpful to meet rising demand, but we also need to see significant investment in the services which help prevent problems before they occur, such as in housing, youth services, mental health and children’s services.
2.9. Commissioning workforces in local authority public health teams have been hit by major reductions in funding which has shrunk the workforce and led to specialist substance use commissioners spreading their time and energy across the whole range of public health, and conversely brought those from other areas of public health into substance use.
2.10. Commissioners are concerned that one of the biggest challenges they face is ensuring the sustainability of drug and alcohol services. Uncertainties over resources remain: particularly future funding; commissioning efficient and effective services to give better value to taxpayers; and the impact of short commissioning cycles on creating a sustainable service.
The UK drug framework
3. How effective is the UK drug framework in today’s society? This may consider its effectiveness in dealing with drug use and addiction; effectiveness in preventing drug related deaths; effectiveness in deterring drug related offending; drugs classification under the Misuse of Drugs Act 1971; and what (if any) impact the Psychoactive Substances Act 2016 has had since it came into force.
3.1. The Government’s 10 Year Drug Strategy identified “the global availability of drugs is higher than ever before, fuelling rises in the purity of heroin and crack cocaine. It found the UK is now Europe’s largest heroin market and a target for international drug trafficking gangs”.
3.2. The Office for National Statistics found that while new psychoactive substances (NPS) or nitrous oxide were most commonly obtained through a friend, neighbour or colleague (34.5 per cent), a considerable proportion of NPS or nitrous oxide users aged 16 to 59 years (14.8 per cent) reported that they had sourced their NPS or nitrous oxide from shops.
3.3. This is despite the Psychoactive Substances Act making the sale of NPS (and nitrous oxide for use as an intoxicant) illegal. The ONS Survey “Drug misuse in England and Wales: year ending March 2020” found this is most likely because nitrous oxide is currently still legal to sell for certain purposes.
3.4. It will be important for any reform of the UK drug framework to work alongside the forthcoming serious violence duty proposed in the Police, Crime, Sentencing and Courts Bill.
3.5. We have long called for the Government to expand the Violence Reduction Unit (VRU) model beyond the 18 police forces areas and commit to long-term funding of VRUs for over a five-year period. It was positive to see the Government recognise this call, as part of the Police and Crime Commissioner Review Part 2 Update, which said the Government would consider moving away from one-year funding cycles for VRU towards multi-year funding following the 2022/23 Spending Review. Longer-term funding certainty could allow greater development of preventative strategies and instil greater confidence in partners around the longevity of VRUs.
3.6. We welcome the Government’s commitment to update the existing VRU guidance, and hope this will work cohesively with the Government’s 10-year drug strategy.
3.7. We also welcome the expansion of Project Adder, outlined in the Government’s recent Beating Crime Plan. It would be helpful for the Government to share any best practice or findings, to help local authorities and partners adopt this approach locally.
3.8. The Government has also proposed a forthcoming Community Safety Partnership Review, so it will be useful for any proposed reforms to take account of the CSP Review’s findings.
4. Should a ‘right to recovery’ (the right of a person dependent on drugs to seek drug treatment and services) be legally enshrined in UK law?
4.1. Councils are absolutely committed to ensuring drug users get the right treatment and support, as part of their public health and other wider responsibilities. This includes helping vulnerable people being given another chance to find work, rebuild relationships, improve their physical and mental health and find safe and secure accommodation. Working with the Government alongside local NHS, community groups and other partners, councils want to ensure everyone gets the support they need wherever possible.
4.2. Substance misuse does not respect local authority boundaries and residents in need of support should be able to have access to comprehensive, open access treatment services. There should be an additional mandate to strengthen partnership working through the requirement to have multi agency and stakeholder engagement of local plans and strategies. All new burdens on local authorities through any additional mandation, duty or right must be properly assessed and fully funded.
4.3. Local authorities commission drug and alcohol treatment services through the Public Health Grant. It is a condition of the 2021/22 grant that local authorities improve the take up of, and outcomes from, its drug and alcohol misuse treatment services, based on an assessment of local need and a plan which has been developed with local health and criminal justice partners.
4.4. These services, working in partnership with other local services, can and do help thousands of people to stabilise and turn their lives around every year; reducing the risks to the individuals, their families and wider community and the burden on a range of other local services. Every pound spent on drug treatment saves at total of £21 over the course of ten years.
4.5. According to the Health Foundation, the public health grant allocations to local councils used to fund drug treatment and recovery have fallen in real terms from £4.2 billion in 2015/16 to £3.3 billion in 2021/22. On a per head basis that equates to a 24 per cent cut since initial allocations were made in 2015/16.
4.6. On 7 February 2022, the public health grant for 2022/23 was announced, which provided no real-terms increase in public health funding. This will cause challenges for councils to provide drug treatment services and runs contrary to our shared ambition with government to address the stark health inequalities exposed by COVID-19.
4.7. While the announcement provided immediate certainty, we still need a clear long-term plan on the future which recognises the public health challenges we face as a country, addresses the current and future pressures on the public health workforce and recognises the interconnectedness with other parts of the health and care system.
UK drug policy
5. What are the trends and patterns in drug use across the four UK nations? Responses to this may speak to some or all of the nations.
5.1. The Government’s Beating Crime Plan outlined that “neighbourhoods blighted by the presence of highly damaging Class A drugs cannot prosper and provide the happy, healthy environment that their citizens deserve”.
5.2. It found the most deprived areas face the highest prevalence of drug-driven crime and health harms associated with drug use. They also experience more of the harms caused by illegal drug markets.
5.3. According to the National Crime Agency, violence at the street level is often linked to drugs supply, including county lines. One third of victims and two thirds of suspects in homicide cases are either known drugs users or suppliers. There remains a strong connection between drugs supply and the use of firearms, with firearms regularly found at drugs incidents. Similarly, organised acquisitive crime is clearly linked to other serious organised crime, whether perpetrated by the same group or as a pre-cursor to, or funder of, other crimes.
5.4. We continue to work with the Home Office on tackling serious and organised crime and in particular welcome the expansion of Project Adder, which seeks to ensure that more people get effective treatment, with enhanced treatment and recovery provision, including housing and employment support, and improved communication between treatment providers and courts, prisons, and hospitals.
5.5. It should be highlighted the Welsh Government published a revised Substance Misuse Delivery Plan 2019-22 in January 2021 in response to the COVID-19 pandemic.
6. What is your view on the UK Government’s 10-Year Drug Strategy for England and Wales, which was published in December 2021?
6.1. People with drug and alcohol problems should be able to get the right support and treatment when they need it, which this comprehensive 10-year strategy sets out to achieve.
6.2. For many problem users, their first experience of treatment is the catalyst for getting the help they need to address their physical and mental health problems.
6.3. Councils, which are responsible for public health, share this ambition and want to see vulnerable people being given another chance to find work, rebuild relationships and find safe and secure accommodation.
6.4. Boosting direct funding for drug treatment and recovery is helpful to meet rising demand, but we also need to see significant investment in the services which help prevent problems before they occur, such as in housing, youth services, mental health and children’s services.
6.5. Rural areas are faced with a range of additional cost pressures including higher unit costs. Service pressures are incurred by rural authorities providing additional services to meet the needs of dispersed populations, such as providing transport. Rural residents will often have less access to services than their urban counterparts, and rural authorities are often able to spend less on discretionary services. Current public health grant funding has largely been created with reference to past expenditure patterns, and because urban authorities have historically spent more, so this is perpetuated in funding formulae.
6.6. Investing in drug prevention and treatment now will reap benefits for everyone longer-term, including for the NHS, criminal justice and other public services. This needs to be supported by extra opportunities for users to gain employment, housing, mental health care and help from other agencies.
6.7. Commissioning workforces in local authority public health teams have been hit by major reductions in funding which has shrunk the workforce and led to specialist substance use commissioners spreading their time and energy across the whole range of public health, and conversely brought those from other areas of public health into substance use.
6.8. Commissioners are concerned that one of the biggest challenges they face is ensuring the sustainability of drug and alcohol services. Uncertainties over resources remain: particularly future funding; commissioning efficient and effective services to give better value to taxpayers; and the impact of short commissioning cycles on creating a sustainable service.
7. Are there particular policies at national or local level across the four UK nations that have been effective in reducing drug use; drug related deaths and/or drug related offending?
7.1. We remain firmly of the view that local government is best placed to assess and meet the need for public health interventions, including substance misuse treatment and prevention. Far too much time has been spent debating about who is best to commission drug treatment. The outcome of this inquiry needs to be about how we ensure people get into the right services for their needs. This means clear pathways for drug treatment needs, and for other needs like physical health, mental health, employment and housing.
7.2. As well as saving and improving human life, drug treatment provides huge savings to the public purse. The case for investment is well established. According to a Public Health England (PHE) 2018 report 'Alcohol and drug prevention treatment and recovery: why invest?', providing well-funded drug and services is good value for money because it keeps people alive, cuts crime, improves health, and can support individuals and families on the road to recovery. Drug treatment reflects a return on investment of £4 for every £1 invested, which increases to £21 over 10 years.
7.3. Over recent years, the priority for alcohol services has increased in some parts of the country. This reflected a growing awareness of the need to increase alcohol provision to reflect the wider range of need, from identification and brief interventions to treatment for dependency.
7.4. Councils have indicated a desire to maintain and accelerate the recovery focus of drug treatment, particularly for opiate users, but also want to address emerging issues such as new psychoactive substances and addiction to medicines.
7.5. There has been an ambition for closer links with sexual health, criminal justice, and housing and youth services. There was also mention of integration with family focused initiatives, closer links with GPs, improved coordination on domestic violence, and a strong and consistent link to sexual health – teenage conception and sexually transmitted diseases.
7.6. We have seen a narrative over recent years that reported increases in Drug Related Deaths in England has been down to the changes in commissioning in England. We do not agree with this. Scotland has had no changes in commissioning of drug treatment and has seen numbers of deaths rise far beyond England rates, and continue to rise, year on year. Similarly, the rise in England started in 2011, well before transfer of responsibility in April 2013.
7.7. The PHE and LGA joint national review of drug related deaths concluded there were multiple factors including the age, immune system and respiratory health of some cohorts of opiate and opioid users, access to a range of treatment including NHS treatment and supply of drugs. We also know overdosing becomes more likely if your treatment is not properly calibrated and you use drugs on top of what is prescribed.
7.8. There are a number LGA of case studies from councils which tackle drug use and drug-related deaths. For instance:
7.9. Southampton City Council has a centralised warning system to alert people who use drugs about the substances that are in circulation. The system was set up in 2011 after being run informally for several years. In Southampton, regular warnings are sent out to known drug users to alert them about possible dangers. The system is coordinated by the council and involves the local service user group as well as other partners including the police and NHS. It is credited with playing a part in saving lives following a spike in overdoses in 2014. The city council’s public health team provides the funding to help with the communications, which are handled by MORPH, a local service user advocacy service.
7.10. Newcastle City Council was one of the first areas in the country that made greater use of anti-overdose drug naloxone since a change in legislation in October 2015. The relaxation in the rules prompted Newcastle City Council, which had been reviewing its procedures following a spike in deaths in 2013/14, to start rolling out a naloxone programme. The local drug treatment provider, Northumberland Tyne and Wear NHS Trust (NTW), now supplies naloxone kits to people deemed at risk, at seven centres, about half the supported accommodation in the city. These include people who have recently been released from prison and have low tolerance levels, have had a recent overdose or are struggling to engage with treatment services.
7.11. Norfolk County Council has been working closely with partners on the project Addiction, Diversion, Disruption, Enforcement, and Recovery (ADDER) pilot to reduce instances of drug related crime and deaths within the county. The key to success has been partnership working, with a number of individuals being helped through the coordinated approach. Recognising that drug abuse does not have one simple solution, cross-cutting work has taken place across multiple organisations to tackle treatment, housing, and employment issues.
The impact of drug use in the UK
8. What is the impact of drug use? In particular on drug users and their loved ones; local communities and wider society; the economy.
8.1. As the Government’s 10 Year Drug Strategy highlights: “The financial cost of drug misuse is absolutely staggering. It currently costs society almost £20 billion a year, something like £350 for every man, woman and child in England. But the human toll is incalculably larger…Nearly 3,000 people tragically lost their lives through drug misuse deaths in England and Wales last year”.
8.2. The harrowing exploitation of children and young people by county lines drugs gangs, is a significant and increasing concern for councils who are working hard to identity and protect those at risk of abuse. County Lines incorporates multiple forms of exploitation including coercion, trafficking, child sexual exploitation, gun and knife crime. It is an issue affecting not just the major cities, but all local areas – both rural and urban.
8.3. According to Public Health England, there are thought to be around 1,000 different county lines operating across the country, each generating an estimated £800,000 a year in criminal profits. The consequences of joining a county lines gang can be horrific and life-threatening. The gangs use violence, intimidation, sexual exploitation and the offer of money or drugs to threaten people to stay in the group.
8.4. The impact of drug use in communities is stark. For instance:
8.4.1. Last year 17,000 households assessed by local authorities as being statutorily homeless were recorded as being drug dependent. Almost half of homicides every year are drug-related. Nearly half of acquisitive crime is drug-related and one-third of the people in our prisons committed drug-related crimes, including acquisitive crime. More people die from drug misuse every year than from all knife crime and road traffic incidents combined.
8.4.2. Drug use by children aged 11-15 has increased by over 40 per cent since 2014, following a long-term downward trend. Two in five (38 per cent) of 15 year olds report having taken drugs at least once in their lives.
8.4.3. There were 160,000 adults receiving treatment for drug problems in local authority commissioned services between April 2019 and March 2020. Of these 141,000 were being treated for opiate problems.
8.4.4. Half of adults starting drug treatment are parents. While many don’t currently live with their children there were 19,000 children living with adults who started drug treatment last year.
8.4.5. There were over 14,000 young people under the age of 18 years in contact with alcohol and drug services between April 2019 and March 2020. This is a 3 per cent reduction on the number the previous year and a 42 per cent reduction on the number in treatment since 2008 to 2009
8.4.6. At least 27,000 children in England have been identified as a member of a county lines gang. Children aged 15 to 17 are those most commonly identified as victims of county lines exploitation, but children as young as seven have been known to be recruited by gangs.
8.5. Tackling serious violent crime requires multi-agency working across a range of partners, including health, education, local government, the police and the voluntary sector. An early intervention and prevention must be central to our understanding of a public health approach to tackling serious violent crime.
8.6. Case studies from our 2019 report “Breaking the Cycle of Youth Violence” identify how local authorities are working in partnership to tackle serious youth violence, including county lines activity locally. Examples of case studies to tackle county lines include:
8.6.1. Southend Borough Council - Southend has been on the frontline of the fight against county lines. As a coastal town just outside London, organised gangs have targeted young people to help them supply drugs. As part of the process of responding to the emerging trend, Southend decided to review how its approach was coordinated. There were four separate boards which were having input into county lines work – the community safety partnership, two safeguarding boards and the health and wellbeing board. The decision was taken in early 2018 to set up a violence and vulnerability steering group to coordinate the work. It is a joint sub group of all four boards, chaired by the chief executive and involving representatives from each.
8.6.2. North East Lincolnshire Council - North East Lincolnshire Council became aware of child criminal exploitation as a local issue in the spring of 2015. This became apparent following the emergence of children reporting exploitation and several violent incidents. An analysis revealed a link to drug supply and the exploitation of children. One of the first steps taken was the formation of a Child Criminal Exploitation (CCE) Partnership Board. It was set up in 2016 and is composed of representatives from the police, council, health and other partnership agencies. The creation of the board soon prompted changes, including the appointment of a CCE link worker at the council, while the police identified a police community support officer who acted as the conduit for them. Together they have worked closely to ensure that workforce development and knowledge around the agenda has been a primary consideration. GPs and other primary care staff have been given training to ensure they know what to look out for. Police officers, social workers and health staff have also been given an easy-to-use screening tool to help identify those at risk of being exploited through county lines. Safeguarding level two training on exploitation and trafficking has also been rolled out. Meanwhile, projects have been undertaken with groups of young people involved in county lines exploitation. These include theatre and photography-based projects. So far 11 children have taken part in these.
March 2022