Source · Select Committees · Public Accounts Committee
Recommendation 4
4
Accepted
Build understanding of local variations, disseminate good practice, support authorities and review performance metrics.
Conclusion
There are variations in local outcomes which the JCDU and DHSC have not yet addressed. The capacity and capability of local authorities to deliver drug treatment and recovery services have been significantly eroded in recent years. Between 2014–15 and 2021–22, local authorities saw annual spending on drug and alcohol treatment services fall by 40% in real terms, leading to reductions in the availability of treatment services and variations in the quality of local services. As the £0.5 billion of strategy funding to local authorities for treatment and recovery was not sufficient to rebuild services across the whole of England, DHSC adopted a phased approach and prioritised initial funding to local areas experiencing the greatest harms. There are examples of innovative new approaches, but variations in outcomes between local areas remain and some areas are lagging behind. The JCDU and DHSC do not yet fully understand the extent of these differences, inhibiting learning about ‘what works’ and the dissemination of good practice. DHSC says it is considering withholding a proportion of funding if local areas do not meet certain targets, such as treatment and continuity of care. However, it is not clear that the strategy’s performance measures incentivise the right behaviours. We are also concerned about the extent to which treatment and recovery measures focus on quantity over quality and may risk incentivising the wrong things. Reducing the harm from illegal drugs 7 Recommendation 4: The JCDU and DHSC should build a comprehensive understanding of variations in local approaches, disseminating examples of good practice and innovation; providing support to local authorities that need it; and engage with local authorities to understand and address the incentives created by the strategy’s performance metrics.
Government Response Summary
The government states a Shared Outcomes Fund evaluation is underway, and the JCDU regularly disseminates good practice via guidance and events. DHSC is undertaking targeted work with 19 high-need local areas, including support for London and rolling out an Unmet Need Toolkit.
Government Response
Accepted
HM Government
Accepted
The government agrees with the Committee’s recommendation. Partnerships, reflecting their varying levels of maturity and local need. A Shared Outcomes Fund evaluation, now underway, will improve the government’s understanding of how the whole-system approach is being delivered locally. The JCDU disseminates good practice regularly, including through new guidance, webinars, regional/sector specific events, and an online forum for Combating Drugs Partnerships to support networking and improvements in local delivery. This has increased the sharing of practice with several local areas specifically collaborating to improve their Drug and Alcohol Related Death processes. DHSC is undertaking targeted work with the 19 local authority areas identified as having the greatest need to improve outcomes, including agreeing tailored performance improvement plans. For example, London, as the poorest performing region on continuity of care between prison and community treatment, is being supported with a focused action plan. DHSC also continues to work with all local areas to address unmet need and drug misuse deaths and to drive improvements in continuity of care. This includes the recently rolled out Unmet Need Toolkit which can be used by local areas to assess gaps in referral pathways. HM Prison and Probation Service is supporting local areas to improve join up, including through recruitment of Health and Justice Partnership Coordinators nationwide and Drug Strategy Leads in key prisons, as well as through rollout of the Probation Notification and Actioning Project, helping probation support attendance at treatment. JCDU and departments will continue to engage with local partners to oversee delivery, including through regular meetings with the Association of Directors of Public Health lead for drugs and alcohol, local authority commissioners, and providers. This dialogue, along with DHSC’s extensive impact evaluations, helps ensure departments understand how the metrics set out in the Drug Strategy shape delivery and performance across key pathways.