Hi - sorry - I am still trying to track down part two of 2008. As soon as I find it I will repost it.

Sara

January brought the extraordinary announcement of an increase in the Pooled Treatment Budget that was in fact a three year shrinking budget nationally and a real decrease for many areas. Largely redistributing funding from deprived inner city boroughs to the more well-to-do suburbs and shires, the overall national budget for drugs was set at £358 million and essentially required "efficiency savings" of £50 million to achieve a standstill. While undeniably many areas had been significantly underfunded for years, the argument that others were over funded was possibly less well founded. Most controversially, a new funding formula was announced that recast the pooled treatment budget as largely a per capita allowance per drug user - with crack and heroin users yielding up twice as much money for local budget holders as people who experienced problems with cannabis, methamphetamine, benzodiazepines or any other drug. Possibly the most significant aspect of this new funding allocation was the implicit shift from a commissioning framework that recognised issues like blood borne viruses, aftercare and support and community services to one which for the first time incorporated the principles underpinning the output based performance management system in the local allocations formula. This, if you like, squared the circle - ensuring for the first time a direct link between NTA performance management and funding. Either a very good thing or a very bad thing depending on your perspective, if DATs were in any doubt about the purpose of their commissioning receipt of the Pooled Treatment Budget was also for the first time made contingent on submission of a treatment plan to the NTA and adherence to NDTMS reporting requirements.

Sharp eyed commentators could be forgiven by being a little confused therefore to read in February's New National Drug Strategy Drugs: Protecting Families and Communities that Government was committed to supporting local areas to deliver a strategy that moved away from central control. The new strategy recognised the importance of meeting the specific needs of communities, emphasised life after treatment and promised enhanced support for people in terms of housing and employment. It also focussed on the needs of the children of people affected by drug use and their carers and prioritised the needs of communities to identify the measures they believe will help them effectively tackle their drug problems. For the new strategy to be operationalised there needed to be an effective, comprehensive and comprehensible structured approach to enabling local areas to develop their responses and for government to monitor the impact of this work in delivering the broad strategic aims of the strategy. What we got instead was disappointing -

Firstly, a set of local indicators which both failed to provide sufficient local levers to ensure drugs got onto the mainstream local agenda and retained a reliance on outdated and inappropriate performance management information, or which were based on fag packet estimates and fallacy while retaining a complexity heretofore only seen in flatpack furniture diagrams. Then a national performance management framework for local areas focussed on delivery of the treatment strand of the 2002 strategy and the still unevaluated DIP programme,(£150 million invested and no clear idea of impact beyond a few snapshots) with no effective performance management of anything other than numbers in treatment, 12 weeks retention, numbers of required assessments and drug tests after arrests. Then finally an action plan from the Home Office within which there's little action and not much that looks like a plan - certainly if one tries to identify what has been achieved against the timetable to date. This in fact is an incredibly interesting exercise to undertake prior to Christmas dinner - maybe a sort of disappointment bingo, where the first person to identify an action set for 2008 that's actually been fulfilled gets to make a wish.

Also in February the London Drug Policy Forum published an updated version of the second edition of its Guide to the National Drug Strategy - including ideas about how to use the non drug specific local indicators to reflect some of the themes of the national strategy.

March brought a plethora of reactions to the new strategy from Drugscope, Addaction, Transform, EATA, and a very curious one from the LGA (Local Government Association) warning of creating a carved out treatment system if criminals were allowed to jump the queue in this new-fangled DIP stuff. The unifying factor about most of the responses - including my own - was a desire to give the Home Office some breathing space to catch up with the critique of the numbers based treatment dominated approach of the past ten years and bring us what the strategy promised - a locally focussed strategy inspired by a strong vision and lead from government informed by an ongoing dialogue with communities, people who use services and the drugs field itself. accordingly responses soft pedalled on policy disasters like benefit sanctions (as if eh?), cannabis reclassification and the Daily Mail language in which much of this was written and concentrated on the positives. The test for government would be how long this détente could last.

In April the drug strategy was debated in parliament - coincidentally in the very same week it was leaked that the ACMD would recommend no change to the classification of Cannabis. Drugs Minister Vernon Coaker indicated he wait to receive the advice of the ACMD before making his decision about cannabis classification:

"We must be confident that we have the right position on classification, which is why the Home Secretary asked the Advisory Council on the Misuse of Drugs to review its position. The ACMD is continuing its review and will submit it and its advice to the Home Secretary at the end of this month. A decision about the reclassification, or not, of cannabis will be taken at that time, when we have received that evidence from the ACMD."

Drugscope launched its Great Debate series, picking up on the rumblings across the field about the purpose of methadone maintenance and the rising concerns about the lack of abstinence focussed options for people in treatment (often expressed in a series of increasingly aggressive statements from the residential sector as they noticed that the trough was getting smaller and they hadn't yet had what they considered their fair share). You can read Mike Ashton's article that kicked the series off here and my own contribution to the debate at Birkbeck College in London here.

Also in April, The MOJ published Matrix's evaluation report on the two Dedicated Drug Court (DDC) pilots in Leeds and West London. The report identified some significant methodological difficulties including poor data collection, lower than expected numbers of drug misusing offenders moving through the Dedicated Drug Courts in the period of the evaluation and - rather astonishly - no available information about the nature and extent of drug treatment people engaged with as part of the DRR. The report concluded that there were some significant operational and practice issues that would need to be taken into account if, as was planned the DDC system was to be expanded. These include having sufficient capacity in treatment and aftercare services to recieve the people from the drug courts, effective partnership working and information sharing, and adequate resources in the court itself - like the ability to field enough magistrates and have enough courtrooms. The report was unable to identify whetehr or not the DCC's represented value for money.

Alcohol Concern published one of the more interesting reports of the year in April. The Poor Relation looked at the state of alcohol treatment commissioning within a localist agenda. Despite poor levels of returns from PCTs (who from the report seemed to have been somewhat bamboozled simply by being asked what they were doing about alcohol), Alcohol Concern concluded that separating out alcohol and drug commissioning was highly problematic for those seeking to increase access to effective alcohol treatment and that the lack of central targets within a local framework hindered success. They identified a massive variation in investment in treatment services across the country as well - and reflected on the low level of commitment to solid needs analysis. One can understand the motivation here - after all, what PCT is going to want to uncover a need they have no capacity to address? Depressingly of course PCTs and their partners are often meeting much higher - if hidden costs - in terms of dealing with the results of alcohol related disorder, accidents and emergencies and the long term health consequences of chronic problem drinking - often evidenced in huge costs for gastro-enterology.

May opened with the spectacular piece of political irresponsibility that was the announcement of the decision by Gordon Brown to reclassify cannabis as a class B drug. This was in the face of reduced levels of use by young people and increased levels of help seeking behaviour since downgrading, and as predicted contrary to the explicit recommendations of the ACMD and the responses to the governments own consultation where of 639 responses received only 121 supported reclassification. This decision at a stroke identified a clear new path for government in terms of drugs. For the first time since 1998, the reduction of harm was not the aim of policy. Government interventions were now to be about "sending out a strong message" - regardless of the impact that had on young people.

The Healthcare Commission and NTA review of commissioning and harm reduction was published. The main surprise in this was how positive the press release was in relation to the report itself. Harm reduction services were revealed as poorly developed - a finding that seems to underpin the publication of new statistics about the prevalence of blood borne viruses in October (more of which in part two). I'd blogged earlier in the year about the lack of followthrough on the Department of Health's 2007 Action Plan for Reducing Drug Related Harm, so it was salutary to see just how much ground needed to be made up as indicated in this report. Worryingly, needle exchange within treatment services was one of the worse developed areas of provision - along with services outside normal working hours. In terms of commissioning, the picture was also mixed - with areas doing well at filling in the forms and developing the strategies, but less well in terms of forging genuine local partnership. You can look at my more detailed analysis here. However, just in case we became too pessimistic, a quick look at the IHRA publication ‘Global State of Harm Reduction 2008: Mapping the response to drug-related HIV and hepatitis C epidemics’ also published in May reveals just how much has been achieved in the UK - particularly in terms of HIV infection - simply through the expansion of treatment services.

Watch out for part 2 of my Drug Policy Review of the Year 2008 - including a look at the political (and that's a very little 'p') battles fought over the terminology and definitions of recovery through the summer, the new look Scottish Drug Strategy, fears of the impact of the recession and the legislative bean feast that brought us not one, not two, but three White Papers that could radically alter the shape of things to come for the drug policy field in 2009 ... until then

Merry Christmas

And a very Happy New Year