2021 Spending Review: The NHS APA calls for a renewed focus and investment in the addictions sector.

Following the publication of the Government's multi-year spending review, the NHS APA supports the new Health and Social Care Levy which is predicted to help raise roughly £13 billion for public health, the NHS, and wider healthcare services. We also welcome the proposed £639 million resource funding by 2024/25 as part of the commitment to end rough sleeping, some of which will provide drug and alcohol support. However, it remains to be seen if the budget announcements will result in adequate and recurrent funding for drug & alcohol treatment services to ensure that people with addiction receive the same level of care as those with other chronic health conditions.

In her recent landmark report, Professor Dame Carol Black set out 32 recommendations to the government for much-needed improvement in the drug treatment sector, citing the current service model as “not fit for purpose”. Her report focused on drug treatment, prevention, and recovery, communicated across three objectives:

  • increasing access to treatment and recovery support for those who misuse drugs

  • ensuring a high-quality package for treatment and recovery

  • reducing drug demand and problematic drug use.

The requirement for these recommendations to be implemented became even more urgent following the latest ONS report, which shed a disturbing light on the reality of drug-related deaths in England and Wales. Deaths related to drug poisoning had risen for the eighth year in a row, and 2020 held the highest number of deaths since comparable records began in 1993.


Professor Dame Carol Black’s review took a whole-systems approach, which she emphasised at the NHS APA Virtual Conference 2021, stating that “it’s a problem for many ministries, and we need improved systems of accountability both centrally and locally.” To get drug treatment services back on track, Black estimated a five-year investment plan reaching £552 million by the 5th year would be required to address deficiencies in housing, treatment, mental health, trauma-informed care, peer support, national ownership and leadership, workforce and research. In January of this year, the Government announced an investment of £148 million to cut drugs crime, £80 million of which was ring-fenced for drug treatment services. This investment represented the largest increase in drug treatment funding for 15 years, mirroring the NHS APA’s absolute commitment to reducing drug-related deaths and tackling substance misuse.


We must ensure the pressure remains firmly on the government to act on the Dame Carol Black recommendations and ensure that the full, multi-year funding that she recommended is allocated and ring-fenced. Dan Carden, Labour MP for Liverpool & Walton who has lived experience of alcohol addiction, called for Dame Carol Black’s recommendation for a £1.78 billion investment in treatment and recovery services over the next 5 years. He made his case at a parliamentary debate in Westminster, receiving support from 60 MPs including some also with lived experience. Carden said that the recommendations held in Dame Carol Black’s part 2 review are, “too important to be left gathering dust on ministerial bookshelves” and wants “Dame Carol’s words ringing in MP’s ears”. Fittingly, this debate occurred directly after the spending review. Dan Carden highlighted the current economic cost of drug misuse, which is estimated at more than £20 billion annually, contrasting it with the current spending on prevention and treatment, which is significantly lower at £650 million.


The Chancellor of the Exchequer announced £42 million ring-fenced for programmes that reduce crime and drug misuse. Whilst this is welcomed, a heavy focus on criminal justice can create further stigma for those experiencing addiction. As an alliance we urge for a holistic, whole-systems approach to support treatment and recovery, working in partnership not only with criminal justice, but also with health, housing, and employment support.


We view the proposed reduction in alcohol duty, and the permanent 3 pence cut in the cost of a pint, as concerning for public health, especially considering the record-high number of alcohol-related deaths in 2020, according to the ONS. The APA also urged the government to restore the Public Health Grant to previous levels, allocating roughly an additional £1bn per year, however, the commitment as outlined in the review has simply been to maintain the grant in real terms.


Levelling up the addiction sector so that it has parity with other mainstream health care services is long overdue. Not only is an increase in funding necessary for helping more people enter into recovery, reducing drug & alcohol-related deaths and putting an end to the cycle of substance misuse, it also represents a chance to reduce the stigma faced by those with addiction. Addiction has remained in the shadows of other serious health conditions for a long time, a theme largely represented at the NHS APA Virtual Conference 2021. Stigma has become ingrained in the way policies are set and funding of services is commissioned fueling the stigma which is so wrongly imposed on people with addiction. Until a commitment is made by the UK government to adequately fund services real change can not take place.


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