Drugs and alcohol spending must not lose out

From April 2013, money for drugs and alcohol services will no longer be ringfenced but will be lumped together with money for other public health services

The biggest-ever overhaul of the public health system in England becomes a reality in six months. Local authorities, most without any history of public health management, will take over responsibility for improving the health of local populations. Money currently spent on the delivery of drug, alcohol and sexual health services will contribute about 60% of the funding. But, as of April 2013, money previously ringfenced for those services will be lumped together with money for other public health services.

No one really knows how clinical commissioning groups, responsible for commissioning local services, and local health and wellbeing boards will work together. There are fears that, with an emphasis on localism, access to drug and alcohol services could suffer. Will councillors turn their backs on electorally unpopular services? Or will it lead to joined-up locally led responses that address issues across sectors and tackle the determinants of health and wellbeing?

When galvanised by political will, cities act quicker and more comprehensively than governments. With the identification of Aids in the mid-1980s, several cities in the UK and overseas, including Liverpool, San Francisco and Amsterdam, swiftly provided condoms and syringes to high-risk populations. In Liverpool, the Mersey harm reduction model involved the NHS, communities, primary care, police, church leaders, drug users and sex workers. It led to one of the first needle exchanges in the UK, extensive outreach and an expansion of drug treatment.

Cities can also deliver public health prevention. Community-based alcohol projects of the kind implemented in Glasgow, Birmingham and Cardiff can reduce alcohol-related problems. The projects work best when there is a range of local actions that change the drinking environment, such as promoting responsible serving of alcohol in bars and shops, training bar staff, enforcing licensing laws, and working with transport and fast-food outlets (often a source of friction late at night). In Stockholm, community involvement, bar staff training and stricter enforcement of existing alcohol laws has led to a 29% decrease in violent crimes.

But cities can also get it wrong. In Vancouver's Downtown Eastside, large numbers of drug users with serious physical, mental and social problems were concentrated into an area the size of six blocks, with little or no services.

In the UK, the regeneration of inner cities has concentrated bars and clubs into small areas, with competition for customers leading to unhealthy drinking incentives, overcrowding, lack of public toilets, and large numbers of people leaving at the same time and vying for scarce transport.

Cities need to bring together expertise and powers across local planning, policing, licensing, urban design and transport, and environmental and public health in order to reduce alcohol-related issues. The changes being ushered in for public health provide huge potential to both maintain and improve alcohol, drug and sexual health services, and also to develop truly integrated responses.

The evidence is in – we would be foolish to ignore it as English public health takes its first steps towards a new brave world.

• Professor Gerry Stimson is former executive director of the International Harm Reduction Association and director of Knowledge-Action-Change, co-organiser, with the London Drug and Alcohol Policy Forum, of the City Health 2012 conference

Gerry Stimson

The GuardianTramp

Related Content

Article image
As overdose deaths hit record levels, drug and alcohol services face massive cuts | Caroline Turriff
Investigation finds cuts-hit councils in England are slashing budgets and access to treatment, despite the UK being Europe’s drugs death capital

Caroline Turriff

14, Jun, 2017 @6:30 AM

Article image
Jobseekers who reject help for alcohol and drug addiction face benefits cut
Iain Duncan Smith to signal measures allowing Jobcentre Plus staff to dock allowances for claimants who refuse treatment

Nicholas Watt, chief political correspondent

22, May, 2012 @7:00 PM

Article image
Charities are providing drugs and alcohol services in place of the NHS

Experts accuse the coalition of putting 'vital' NHS programmes at risk by transferring drugs provision to charities

Mary O'Hara

26, Jun, 2012 @4:00 PM

Article image
Drugs policymakers of the 1980s knew the score | Mary O'Hara
Mary O'Hara: This is not the time to undermine harm reduction strategies such as the needle exchange programme, bravely, and surprisingly, initiated by Thatcher and her Tory government

Mary O'Hara

18, Jun, 2013 @1:02 PM

Article image
Mark Gilman: 12-step recovery programmes are best for addicts | James Legge

James Legge: England's addiction recovery champion wants councils to make greater use of mutual aid groups such as Alcoholics Anonymous

James Legge

11, Jun, 2013 @2:29 PM

Article image
‘You can’t arrest your way out of record drug-related deaths,’ say police
Police forces across the UK are offering drug users pre-arrest education and treatment instead of a caution or charge

Mattha Busby

24, Apr, 2019 @6:00 AM

Article image
Closing drug and alcohol rehabs helps no one – I should know | Will Self
When Chandos House in Bristol shuts next month a genuine mechanism through which compassion can operate will be lost

Will Self

17, Oct, 2018 @6:30 AM

Article image
More support is needed for the families of addicts
While drug users are rightly given attention, care and support, their adult family members are often left behind

Roger Howard

14, Mar, 2012 @12:01 AM

Article image
We need to start telling the good news about drug treatment
Paul Hayes: Despite the negative headlines progress is being made on drugs and investment in treatment must be maintained

Paul Hayes

11, Dec, 2012 @12:30 PM

Article image
UK addiction treatment centres braced for new year surge in demand
Self-referrals predicted to reach record levels amid fears that cuts to drug and alcohol services are compounding problem

Haroon Siddique

02, Jan, 2018 @2:51 PM