Market Failure and the Funding Crisis in Substance Misuse Treatment: NHS SMPA’s Dr David Manley comments on key points made at InterAction 2018


NHS SMPA Representative Dr David Manley comments:

This week I was fortunate to be invited to represent the NHS SMPA on the discussion panel at Adfam and Alcohol Research UK’s InterAction2018 conference. On stepping into the large conference room at Lift, the first thing that struck me was a vibrant, discursive and fundamentally different forum, full of families and carers seated alongside providers, some academics, and commissioners from a range of localities. I don’t intend to give a full overview of the day as this has already been expertly done by William Haydock here

However, I am keen to prompt more thought and discussion on one of the topics discussed which is relevant to all participants in the sector: market failure and the funding crisis in substance misuse treatment.

Sector staff, our service users and their families know that drug and alcohol services have faced deep funding cuts for a number of years. While cuts are reportedly at 30%, they are as high as 45% in some local areas. This has led to diminishing support for people with multiple complex needs associated with their substance use, and a shift from systemic (integrated) provision to simple service provision in many areas of the UK. The consequential significant and rapid increase in drug related deaths in the UK is well reported. 

Paul Hayes’ (now of Collective Voice but previously known to many as the CEO of the National Treatment Agency) earlier address to InterAction2108 entitled ‘How England won the War on Drugs and Why Nobody Noticed’ challenged the room to think about the importance of crisis in drawing attention to funding and resource need: 

The last thing you want as a civil servant in Whitehall is to claim success; that only leads to withdrawal of ministerial attention & budget reductions. A crisis, by contrast, can lead to focus, resources & innovation”.

During one part of the plenary discussion, Paul raised a further challenge to the sector, one he has made before, that service providers should stop trying to do everything. In particular, we should stop providing free resources to shore up what should be funded. In the past, a whole host of functions have been provided by services and their service users in addition to what was commissioned. However, in the increasingly competitive and austere environment we operate in, these things are being used to supplant elements of treatment and service delivery that were previously funded.

Other questions from ‘the floor’ led the panel to discuss the capacity within our sector to continue to do all we had done previously that so systemically supported a rich and diverse treatment system. GP prescribing and other primary care support (which is so vital to the general health and well-being of our service users) was one example. 

In reality, I think the issue, and tension, is one of passion versus pragmatism. What I witness amongst my nursing, medical, drug worker, service user and diverse colleague group is a constant passion to do well for an increasingly poorly served, most certainly highly stigmatised group of patients and their families. Our passion frequently leads us to go the extra mile and sometimes (probably increasingly frequently) plugging gaps. 

What I think Paul Hayes was challenging us on is the morality of continuing to ‘bail out’ an increasingly impoverished sector through our good will. My sense, and I said this in conclusion on the panel, is that we need to collaborate more across the sector in highlighting the crisis of funding and prevent our well-intentioned conscience from plugging the gaps. If we don’t, I fear the funding crisis, which we are so clearly now in and that brings attention to our service users’ need, will forever go unnoticed. 

Dr David Manley – Nottinghamshire Healthcare NHS Foundation Trust & NHS SMPA