WHAT A WASTE AS DRUGS TSAR KEITH HELLAWELL PUBLISHES HIS FIRST ANNUAL
AUDIT

Howard Parker argues that millions have been poured down the drain on
prevention and enforcement rather than treatment

There are few public service sectors left which are not now subject to
routine audit and inspection. Each service has mission statements,
charters, performance indicators and effectiveness reviews. Most are
published and public debate is routine. Best value has even found its way
into local authority services.

Yet one burgeoning service industry, drugs interventions - through
prevention, enforcement and treatment - remains largely unaccountable.
Despite an annual bill of pounds 1.5 billion, rising rapidly, there are no
routine audits, inspections or league tables.

The treatment sector is funded by an odd mix of local authority community
care money plus large doses of health trust money (from the DoH). And
because `voluntaries' play a key role, the whole industry is propped up by
vast amounts of ad hoc money from the European social fund and the National
Lotteries Board - whose audits are regarded as superficial and easily
satisfied. The `effective' manager here is the one who gets early wind of
the visit and manages to get enough staff and punters into the day room,
workshop or drop-in to give the impression of activity while persuading
the critical staff to take their flexi- time. This dash for cash culture
pervades drugs services.

Extraordinarily, there is still no formal education and training route into
the industry. With no national standards and few courses in further or
higher education, nursing, teaching, youth and community and social work
qualifications are all accepted, as are degrees from the University of Life
as an ex-addict. Appointing medical practitioners is equally `flexible',
with national adverts routinely producing no high quality applicants:
specialists in the industry are often migrants from psychiatry or general
practice who are self learners in the specialism.

All this was understandable during the 1980s, but no government since then
has taken responsibility. This neglect will, unless rectified, lead to a
crisis - particularly in treatment delivery - early in the new millennium.

For the first time in the UK we have a drugs co-ordination strategy. There
are targets to reduce over 10 years adolescent drug taking and heroin use
among under 25s; to increase the number of problem drug users receiving
treatment and to reduce drug related crime. Some of these targets will be
met (reducing drug related school exclusions), some will not (reducing the
number of heroin users) and some are probably unmeasurable.

This strategy is being managed by the UK anti drugs coordinator unit, drugs
tsars and a network of over 100 drug action teams (in England and Wales)
to provide the delivery infrastructure.

And over the next few years further new money will flow into the industry
from the voluntary sector and the treasury. England and Wales will receive
an additional pounds 214 million of taxpayers' money. Most of this is to
provide a new option to the courts to coerce drug driven offenders into
treatment as an alternative to custody. This policy is based on robust
`what works' evidence, and is likely to do well if the courts are
imaginative enough and the supervision and treatment services are of a
high enough standard. Prisons are also receiving a significant testing and
treatment provision.

Other areas which will benefit include dedicated young persons' services
and rehabilitation schemes which are funded at the local
authority/community care level.

However, all this will still not be enough. We already have waiting lists
of up to six months at drug units, and there is a new, largely `untreated'
population of heroin and crack cocaine users netted in the criminal justice
system who are not on any waiting lists.

Despite having the largest recreational drugs scene in Europe across the
1990s, the UK has not had the most problematic. During the first half of
the 1990s heroin use and crack use were climbing fairly slowly. However as
we leave the 1990s the prognosis looks bleak. Britain (not Northern
Ireland) is in the early stages of a second heroin epidemic involving very
young users which is particularly affecting Scotland and north and south
west England. The new heroin users are in small cities and towns with no
heroin history and therefore no services.

Those metropolitan areas in England which hosted heroin outbreaks in the
1980s - London, Manchester and Liverpool - are currently not as affected,
but they are seeing an increase in cocaine powder and crack cocaine use.
This is a worrying scenario - a high demand for treatment services for
heroin in the regions with few services and high levels of stimulant, and
crack use in the metropolitan areas which are traditionally geared to
prescribing methadone. Yet we don't have a cocaine substitute to prescribe
- - there is no cocadone. The epidemiological forecast is thus bleak as the
traditionally separate recreational and problem drugs arenas begin to overlap.

The coming shortfall in treatment provision could have been avoided but for
misplaced faith in prevention and enforcement. The overall budget is biased
against treatment, even though we know what works, because the other two
sectors are generously funded for political, not proficiency, reasons. The
rhetoric says we must educate our children from the nursery to resist drugs
and we must lock up the dealers of death and throw away the key.

Alas neither approach works - more people are taking more drugs more often
- - and as insiders well know millions of pounds of taxpayers' money have
been wasted in both sectors. Yet this cannot be discussed because there is
no impartial, `objective' scrutiny. No one has the authority to ask the
right questions beyond ad hoc parliamentary committees.

Instead, the whole apparatus bumbles on in bad faith. No scrutinies are
undertaken and what little inspectorial apparatus there was is now
delegated to help health trusts commission new drugs services. All three
staff of the substance misuse advisory service are this way employed!
Symbolic gestures at templating good practice are under way, and local
drug action teams are being pressed to be more articulate about the local
plans. But all this is window dressing. The big picture remains unshown.
This is why we need an Offdrug to provide a comprehensive review of the
industry and ensure it becomes more effective and efficient and far more
subject to both parliamentary and public scrutiny.

The government is missing the boat over drugs because having devolved -
some would say unloaded - the problem on to the drug tsar's office, Labour
is muffling the significance of the unfolding situation.

If political credibility becomes the lever for change then so be it. A more
fitting motivation would be the thousands of very young, increasingly
addicted heroin users around Britain whom no one is currently helping until
they become burglars or chaotic injecting poly drug users.

Professor Howard Parker directs the drugs research centre in the department
of social policy and social work at Manchester University.