Illegal drugs: Progress mixed on Government harm reduction efforts, PAC report finds

Fastest rise in drug use is in younger people as their treatment levels fall sharply

PAC calls for funding certainty for local authorities for strategy that requires sustained investment and relentless focus

Government’s efforts to reduce the harm from illegal drugs are seeing mixed progress. In a report published today, the Public Accounts Committee (PAC), while welcoming achievements including drug worker recruitment and disruption to supply, finds less clear progress in reducing drug use and related harms. Particularly concerning is that drug use is rising fastest in younger people as the number of under-18s in treatment has fallen sharply.

Unacceptably, drug-related deaths in England increased by 80% between 2011 and 2021, to nearly 3,000 people each year. In June 2022, 19% of 16–24-year-olds reported having taken drugs, with 5% reporting having taken Class A drugs. The report finds that though the Government has made a 10-year commitment to reduce drug use, crime and deaths, requiring sustained investment and relentless focus, Government has only committed funding until 2024-25, creating uncertainty that could hinder its own strategy.

This funding uncertainty also makes it difficult for local authorities to recruit staff and rebuild the treatment workforce, with further delays in funding allocations from Government hindering early progress. The PAC is disappointed that government departments seem unwilling to explore how to provide local authorities with more confidence over long-term funding.

This comes against the background of a significant erosion of councils’ capacity and capability to deliver in this area. The PAC’s report highlights that annual spending on drug and alcohol treatment services fell by 40% in real terms between 2014-15 and 2021-22, leading to a reduction in availability and variations in local outcomes which Government has not yet addressed.

The report also underlines concerns that reductions in treatment services over the past decade have led to an insufficient focus on targeting different cohorts of people affected by drugs and addressing their specific needs. For example, the number of young people in treatment for substance misuse fell by 50% between 2010-11 and 2021-22. Despite high drug use in particular amongst young people, the Government’s strategy makes little reference to age, gender, ethnicity, or how people with different characteristics may experience drug misuse and treatment. The report therefore calls for the Government to properly understand the barriers facing differing cohorts of people who use drugs and ensure that councils are sufficiently targeting these groups.

Dame Meg Hillier MP, Chair of the Committee, said: “The tragic deaths and harms caused by illegal drug use are a desperate blight on our whole society. Professor Dame Carol Black’s independent review of drugs did so much to articulate the challenges in this area. Her evidence and those of other experts to our inquiry make clear that a steely-eyed focus on investment in treatment and prevention from Government is required to improve the lives of those affected by drugs, and bring down their economic and social costs.

“As with our previous alcohol treatment services report, our Committee is having to remind Government that local authorities need long-term certainty to carry out what is some of the most challenging treatment there is to provide. Some progress has been made, in particular in recruiting 1,200 new alcohol and drug workers and bearing down on county lines drugs supply. But deaths continue to rise, drug use showed no reduction in the last 10 years, and the harm caused by illegal drugs is growing. The Government must now dig deep and prove that it is serious about delivering the long-term change implicit in its own strategy.”

PAC report conclusions and recommendations  

The progress achieved to-date will be wasted if the JCDU and departments fail to develop a compelling case for the sustained investment needed to reduce the harms from illegal drugs. The harm caused by illegal drugs is growing, with the government estimating that drug-related crime cost society nearly £10 billion in 2021. The National Audit Office report and evidence from expert witnesses makes clear that a relentless focus is required to achieve the government’s long-term objectives of reducing drug use, crime and deaths. Investing in treatment and, crucially, prevention will result in reduced economic and social costs to the taxpayer, as well as improving the lives of those affected by drugs. The DHSC Permanent Secretary, Sir Chris Wormald KCB, stated that the strategy is a 10-year commitment, although the government has only committed funding until 2024-25 thereby creating funding uncertainty that could hinder the strategy’s achievement, as we consider below in paragraph 8. Further, the £768 million of funding for treatment and recovery services has not replaced the funding decline seen over the last decade. To ensure the value of strategy funding is not lost, the JCDU and departments will need to build a compelling case for continued investment at the next spending review. However, the JCDU has limited evaluation resources and needs to work closely with departments to understand the impact of funding and develop an informed bid. With limited time to demonstrate impacts, the JCDU and HM Treasury also need to consider what can reasonably be achieved in three years as a long-term funding commitment is needed to achieve the strategy’s intended outcomes. 

Recommendation 1: The JCDU should work with the departments to build the case for sustained investment – based on a deeper understanding of the cost of not addressing the harms from illegal drugs - to ensure that the strategy is appropriately prioritised at the next spending review.

Achieving the long-term aim of reducing drug-related harms will only be possible if departments work collaboratively and adapt their approach to the evolving threats. The government has created new national and local structures to enable a co-ordinated response to implementing the strategy and tackling the harms caused by illegal drugs. We welcome these positive steps, and the progress made in recruiting 1,200 new alcohol and drug workers and the 15% increase in the closure of county lines. The JCDU has a key role to play in providing strategic leadership, disseminating good practices and holding departments to account for progress against the strategy’s intended outcomes. But departments have mainly used funding to maintain or expand existing activities and, so far, this has not led to a fundamental shift in the approach to tackling illegal drugs. Dame Carol Black called for ‘whole-system change’ but expert witnesses consider that the strategy has not yet led to a joined-up cross-sector response to help people recover from addiction. The JCDU and departments have not yet established how the existing approach needs to change to achieve long-term aims. They also need to be aware of emerging trends in illegal drugs markets and adapt their approaches to new threats, such as synthetic opioids which are increasingly emerging as a problem in the UK.

Recommendation 2: The JCDU and departments should assess how the next phase of the strategy can build on progress in the first three years and embed a system-level focus on the difficult issues involved in tackling drug-related harms. In doing so, they will need to address structural barriers (e.g., to recovery and continuity of care), take account of changing threats and set clear accountabilities for delivery. 

Uncertainty over funding allocations has made it difficult for local authorities to commission and deliver the high-quality treatment and recovery services that are needed. In 2022-23 and 2023-24, DHSC encountered delays in allocating substance misuse treatment funding to local authorities. These delays hindered early progress by making it harder for local authorities to commission services. We welcome that DHSC has confirmed substance misuse treatment funding for 2024-25 though note that at the time of our evidence session in December it had yet to award its public health grant. As we said in our report on Alcohol Treatment Services, DHSC should set out annual funding allocations to local authorities in good time. Further, as strategy funding is only committed to 2024-25, it is difficult for local authorities to recruit staff and contract with service providers to rebuild the treatment workforce. We are disappointed that departments seem unwilling to explore how to provide local authorities with more confidence over long-term funding.

Recommendation 3: To improve certainty around funding for drug treatment services, the DHSC and Home Office should:

• ensure allocations of drug-related funding and public health grant are confirmed well before the start of the relevant financial year; and,
• consider what comfort they can provide to local authorities to allow them to plan for the longer term and deliver the right investments to make a difference in their areas. 

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.

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. 

The JCDU and departments have not put sufficient emphasis on the importance of addressing the specific needs of different cohorts of people who use drugs. It is unacceptable that drug-related deaths in England increased by 80% between 2011 and 2021, to nearly 3,000 people each year. Drug use is highest amongst younger people. In June 2022, 19% of 16–24-year-olds reported having taken drugs, with 5% reporting having taken Class A drugs.  Despite this, the 2021 strategy makes little reference to age, gender or ethnicity, nor how people with different characteristics may experience drug misuse and treatment. We were also concerned to hear that reductions in treatment services over the past decade have meant there is insufficient focus on targeting different cohorts of people affected by drugs. For example, the number of young people in treatment for substance misuse fell by 50% between 2010-11 and 2021-22. Further, the JCDU says that it recognises the barriers and challenges faced by women needing drug treatment, but could not provide any specific examples of local treatment services for women.

Recommendation 5: The JCDU and departments should ensure that the barriers faced by differing cohorts of people who use drugs (such as women, young people, people from minority ethnic backgrounds) are properly understood and assure themselves that local authorities are sufficiently targeting these groups.

Despite previous attempts to reduce the demand for illegal drugs, the JCDU and departments still do not understand how to change behaviours and prevent people from taking drugs. Reducing the demand for illegal drugs is crucial to mitigating the harms caused by their supply. Effective prevention can also represent better value for money than an enforcement-led approach, as it avoids future economic and social costs. However, drug use has shown no reduction in the last 10 years, with some 3 million people taking drugs each year. The government has attempted to reduce the demand for drugs in previous strategies but, despite this, the JCDU and Home Office still do not have an evidence base from which to develop effective interventions. It is striking that just £300,000 – 0.03% of strategy funding – has been committed to research drivers of increasing drug use among children and younger people. Preventing vulnerable people from taking drugs requires a holistic, cross-cutting response and long-term interventions must consider wider socio-economic factors. Vulnerability to illegal drug is often linked to trauma and wider social issues such as deprivation and, as we have reported previously, there is a well-established relationship between substance misuse and mental health.

Recommendation 6: As a matter of urgency, the JCDU should co-ordinate work to develop an evidence-based plan for achieving the strategy’s aim of reducing demand for illegal drugs to a 30-year low. It should draw research together to provide a compelling evidence base, understand the impact of local initiatives and work with other departments to build on related government strategies (e.g. deprivation, vulnerable families, mental health, homelessness etc).