This study aims to identify the barriers and facilitators to supporting, commissioning and working with Lived Experience Recovery Organisations in effective systems of care for people who use alcohol and/or other drugs.

The barriers and facilitators to supporting, commissioning and working with Lived Experience Recovery Organisations in systems of care in England

Maggie Bradford, Elle Wadsworth, Emily Hutton, Jennifer Newbould, Lucy Strang, Joanne Neale, Nicola Kalk, Jennifer Bostock, Andrew Jones, Tom Ling, et al.

ResearchPublished Apr 22, 2026

Cover: The barriers and facilitators to supporting, commissioning and working with Lived Experience Recovery Organisations in systems of care in England
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Includes Annex A. Implementation Research Logic Model; Annex B. LERO census template

Lived Experience Recovery Organisations (LEROs) are peer-led groups run by individuals with lived experience of alcohol and/or other drug use, treatment or recovery. They offer direct support to people who use alcohol and/or other drugs or who are in recovery. They are distinct from peer-delivered services and are increasingly recognised in UK policy as vital components of recovery-oriented systems of care (ROSC). Despite this, at the time of data collection, only about one-third of local areas in England had a recognised LERO, although numbers have reportedly increased since study completion. There is limited evidence relating to their effectiveness and integration into treatment and recovery systems.

This study aims to identify the barriers and facilitators to supporting, commissioning and working with LEROs in effective systems of care for people who use alcohol and/or other drugs. It addresses national policy priorities outlined in the former UK government's 10-year drug strategy as well as Dame Carol Black's independent review of drugs, which highlights the need to evidence peer-led recovery support services.

Key Findings

Confusion around what a LERO is impedes collaboration and support.

  • Despite efforts by the Office for Health Improvement and Disparities (OHID), a unit within the Department of Health and Social Care (DHSC), and the College of Lived Experience Recovery Organisations (CLERO), there is no consistent understanding of what constitutes a LERO among stakeholders.

LEROs are emerging via different models, each presenting with unique facilitators and barriers to development.

  • Our analysis identified four approaches to developing LEROs within local systems in England: areas that have not developed a LERO (Type 1), grassroots-led (Type 2), commissioner-initiated (Type 3), and treatment service-initiated (Type 4).

Funding models influence the sustainability and autonomy of LEROs.

  • Direct commissioning and ring-fenced allocations were found to support LERO autonomy, visibility and strategic influence. In contrast, short-term funding cycles and fragmented grants led to LERO leads and treatment staff reporting instability and frequent shifts in service provision within LEROs. As a result, treatment providers report difficulty with consistent engagement.

Inclusion in local governance structures was helpful but often informal.

  • LEROs that were embedded in local governance and decision-making structures (such as multi-agency forums, Combatting Drugs Partnerships, and joint planning meetings) were more likely to influence funding priorities and strategic direction for their local area. However, access to these spaces was reported to be uneven.

Recommendations

  • 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, including guidance on governance structures, access to start-up funding and the provision of infrastructure and physical space.
  • 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, ensuring that lived experience is embedded in strategic planning.
  • Local authorities should foster mutual respect and constructive collaboration between LEROs and treatment services, recognising the value of diverse organisational approaches to recovery.
  • LEROs should collect and share information about what they contribute to the treatment and recovery system.

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Bradford, Maggie, Elle Wadsworth, Emily Hutton, Jennifer Newbould, Lucy Strang, Joanne Neale, Nicola Kalk, Jennifer Bostock, Andrew Jones, Tom Ling, Tim Millar, John Strang, Jon Sussex, and Katherine I. Morley, The barriers and facilitators to supporting, commissioning and working with Lived Experience Recovery Organisations in systems of care in England. Santa Monica, CA: RAND Corporation, 2026. https://www.rand.org/pubs/research_reports/RRA4735-4.html.
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This work was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme and conducted by RAND Europe.

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