Introduction

This section is intended to give the reader an understanding of drugs services in the United Kingdom. It's intended to allow someone approaching work with drug users for the first time to have an understanding of how policy has been developed, and equally importantly, how this policy has been integrated at a local level in the development of new projects and in the refocusing of more traditional services.

This chapter also seeks to highlight key issues for those reviewing or rethinking their services in the light of HIV infection. This chapter cannot and should not replace the process of needs assessment, and it is vital to recognise that each area will have its own distinct drug scenes and cultures.

The development of drug services

In order to understand the current position concerning the provision of drug services, it is necessary to provide a brief overview of the development of services in Britain.

The 1980s in Britain was an era in which the recorded prevalence and spread of drug use increased among most sectors of the population. In the last five years of the decade, the Home Office Notifications of new drug users (Misuse of Drugs Act, Class 1) increased by 46% (from 12,424 to 26,954) and the number of re-notifications has also continued to increase. However, these statistics perhaps represent as little as 10% of the overall number of long-term users. The Home Office has now discontinued its notification system for new drug users.

The Advisory Committee on the Misuse of Drugs (ACMD) was established in 1981 to advise central government on developing responses to drug use. In 1982 in their Treatment and Rehabilitation Report, the ACMD recommended the development of Drug Advisory Committees to coordinate local services both within the voluntary and statutory sectors. The ACMD first report, AIDS and Drug Misuse (1989) stated that 'the spread of HIV is a greater danger to individual and public than drug misuse'. This promoted a shift towards harm reduction policies. It became a priority to draw as many drug users into services in order to prevent the spread of HIV infection and minimise drug related harm.

With the Criminal Justice Act (1991) community agencies were encouraged to consider offering community sentence options for drug users. It is the Probation Service's role to promote these developments and drug treatment services, including residential rehabilitation projects now offer alternatives to custody or parole packages for drug using offenders.

The Children Act (1989) has implications for those working with drug users with children or younger drug users and this provides an alternative route to funding through social services.

Funding of drugs services

Services for drug users are provided across the voluntary, statutory and private sectors and funding will vary according to the provider's status.

The NHS and Community Care Act (1990) introduced an internal market into health and social care. Primary Care Trusts (PCT’s) were given the resources and the responsibility for purchasing services to meet the health needs of their population. In practice, needs far outstripped the available budget and difficult decisions have to be made about choices and priorities. The role of regional Health Authorities (RHA) also changed to an advisory role and to monitoring the development of the purchaser/provider split.

While the NHS traditionally has been the largest statutory provider of drug services, other statutory agencies such as Social Services, the Probation Service, and the Youth Service have become increasingly active in providing or funding drug services. In particular, Social Services (within the framework of the Community Care legislation and the Children Act) and the Probation Service (within the framework of the Criminal Justice Act) provide top–up funding for residential rehabilitation projects. Social Services also had new responsibilities under the Act and were required to produce a Community Care Plan, outlining social care provision.

The voluntary sector tends to have a more eclectic funding base and draws money from the commercial and charitable sectors but also receives money from health and local authorities and central government. Many services are increasingly seeking to generate income, and a number of drug training agencies receive significant percentages of their finance from this source.

The coexistence of different approaches

Direct services for people who use drugs have been developed from a number of traditions and beliefs. Many services have been developed by concerned local people in the voluntary sector, or following bursts of central government monies.

The development of district drug advisory committees and the implementation of the NHS and Community Care Act sought to promote a better understanding of what services where required and also clarity in how these services were provided.