Evaluating the Drug Strategy Investment in Treatment and Recovery (D-SITAR)

Close up of two people holding hands over a wooden table, photo by Yuri Arcurs/peopleimages.com

Photo by Yuri Arcurs/peopleimages.com

What is the issue?

Drug-related deaths were the highest ever recorded in the UK in 2021. The independent review of drugs by Dame Carol Black found that drugs cost an estimated £19 billion to society annually, and that long-term cuts in funding have led to a decline in skills, expertise and capacity in the treatment and recovery system.

In response to this issue, the former UK government published a 10-year drug strategy ‘From Harm to Hope’. This strategy includes an additional £780 million in funding over three years for the treatment and recovery system, along with funding to support treatment for people who experience homelessness, provide job-related support, and increase inpatient detoxification capacity.

How did we help?

RAND Europe and partners at King’s College London Centre National Addiction Centre, the University of Queensland, the University of Manchester and South London and Maudsley NHS Foundation Trust received grant funding from the National Institute for Health and Care Research (NIHR) to evaluate the first three years of the drug strategy’s Treatment and Recovery Portfolio in England.

The evaluation consisted of an overarching process evaluation of the central government implementation of the Treatment and Recovery Portfolio, and five additional evaluations of the following priority areas:

  • The Housing Support Grant
  • Efforts to improve the treatment and recovery workforce
  • Lived experience recovery organisations (LEROs)
  • Mental and physical health service integration
  • The provision of depot buprenorphine.

In the overarching process evaluation, we investigated:

  • What are the challenges, barriers, and enablers of implementation and delivery of the Portfolio?
  • How have contextual factors influenced delivery of the Portfolio?
  • What processes do or do not work, in what context, and for what reasons?
  • Are there areas or mechanisms that could be improved, and if so, how?
  • What are the pathways or mechanisms that influence Portfolio outcomes and impacts?

Over this 2.5 year evaluation, we conducted surveys with local authorities, conducted interviews and focus groups with people who use services and members of the treatment and recovery workforce, analysed administrative datasets and developed case studies exploring in depth how local areas have implemented the Treatment and Recovery Portfolio.

This study was also informed by input from our expert advisory group, public advisory group, workforce advisory group and commissioners advisory group.

Findings

Report 1 Overarching process evaluation

What did we find?

  • Uncertainty regarding long-term funding and restrictions on carrying funding from one year to the next were reported to impede long-term planning.
  • Central government largely implemented the Portfolio as planned. However, there were several significant delays.
  • Many local stakeholders were satisfied with the level of flexibility they had in delivering the Portfolio and commented positively on planning processes with DHSC. However, they viewed reporting and reprofiling requirements onerous, and national targets as unrealistic.

What can be done?

  • Central government should take steps to avoid compromising the quality of treatment by increasing numbers in treatment too quickly, without sufficient resources to maintain quality standards.
  • The Portfolio’s funding structures should align with the ambition of a 10-year strategy to avoid encouraging short-term investments over longer-term improvements.
  • The government should continue to invest in rebuilding the workforce after years of disinvestment.

Read the report

Report 2 Housing Support Grant (HSG)

What did we find?

  • We found that the HSG pilot was generally implemented as planned as an intensive, person-centred approach to address the challenges of housing insecurity for people who use alcohol and/or other drugs.
  • Support was often delivered through a combination of interventions, taking a holistic approach to meet individual needs.
  • Sites varied regarding whether the HSG was provided to those only in structured treatment or included those who use alcohol and/or other drugs and are not in treatment.

What can be done?

  • Central government should continue to fund housing support for those who use alcohol and/or other drugs.
  • Central government should continue to support local authorities (LAs) to tailor housing interventions to the needs of their population and allow LAs to manage financial interventions.
  • Central government should examine the variation in LAs’ interpretation of eligibility for HSG support across the pilot sites, including differing requirements related to abstinence or engagement with treatment.

Read the report

Report 3 Workforce transformation

What did we find?

  • We found that people working in the alcohol and/or other drugs treatment and recovery sector in England were generally very engaged and committed to their work, and that this commitment was maintained over the first three years of the drug strategy investment.
  • Our findings suggest that the investment over the first three years of the drug strategy has already enabled organisations to sustain, increase or strengthen some contextual and attitudinal factors linked to key job resources, improving the experience of people working in the sector.

What can be done?

  • Central government should work with local authorities and treatment and recovery providers to determine a funding timeline and commissioning cycle length that would provide appropriate security for both services and staff.
  • Central government should continue its additional investment in the treatment and recovery workforce, expanding funding to make further recruitment of senior and supervisory positions feasible.
  • Central government, local authorities and treatment and recovery providers should continue, and potentially expand, efforts to develop clear career pathways and career development support for core job roles within the treatment and recovery sector.

Read the report

Report 4 Lived Experience Recovery Organisations (LEROs)

What did we find?

  • Confusion around what a LERO is impedes collaboration and support. LEROs are emerging via different models, each presenting with unique facilitators and barriers to development.
  • Funding models influence the sustainability and autonomy of LEROs.
  • Inclusion in local governance structures was helpful but often informal.
  • Differing views of recovery can undermine system cohesion. While LEROs and treatment providers share a common goal of supporting recovery, they often operate from fundamentally different philosophies.

What can be done?

  • Central government should work with CLERO and existing LEROs to refine and disseminate clear messaging about what constitutes a LERO and what these organisations can contribute to the treatment and recovery system.
  • Central government should continue to work with local authorities to design and implement targeted support for areas seeking to establish a grassroots LERO.
  • Central government and local authorities should develop funding strategies to provide focused, longer-term investment in LEROs.
  • Local authorities should support the inclusion of LEROs in local governance and decision-making structures.

Read the report

Report 5 Integrated care for people who use alcohol and/or other drugs

What did we find?

  • There is substantial variation in what services are offering across different local areas.
  • Levels of stakeholder engagement among treatment and recovery services and mental and physical health services vary considerably, with some local areas demonstrating significant progress while others lag behind.
  • The absence of adequate incentive systems has significantly hampered the depth and sustainability of service integration. To sustain progress on system-wide change, clear incentives are needed.

What can be done?

  • Central government should prioritise the publication of the Physical Health Joint Action Plan.
  • Central government should identify priority interventions for service integration that are easily actionable and can be implemented at scale.
  • Central government should explore ring fenced funding for integrating treatment and recovery services with physical and mental health services, rather than including it within broader, unprotected allocations.

Read the report

Report 6 Provision of depot buprenorphine (DB)

What did we find?

  • The introduction of funding from the Supplemental Substance Misuse Treatment and Recovery grant was followed by a significant increase in DB uptake nationally, with the most sustained growth observed in areas funded earlier and with greater identified need.
  • Uptake and implementation varied between local areas, mainly influenced by differences in how local authorities funded and prioritised DB delivery.
  • People referred from health or social care, treatment and recovery services, or through self/family routes were around three times more likely to complete or remain in treatment than those referred through the criminal justice system.

What can be done?

  • Central government and local commissioners should consider options for delivering sustained and consistent funding for DB provision.
  • Providers and commissioners should consider how DB provision can be integrated within broader recovery pathways.
  • Providers should consider approaches to maintaining engagement and proactive monitoring for people receiving DB.

Read the report

Project Team