My Journey: 9. Cracks in the UK Drug Strategy

Describes a piece of research I conducted relating to a 2003 article by Nick Davies for The Guardian newspaper in which he claimed that the UK Drug Strategy was failing as a result of government bureaucracy. I followed up this report by contacting  Drug Action Team (DAT) co-ordinators to see how prevalent the problems Nick identified were across the country. (2,896 words)

 ‘The government is so determined to control every aspect of the delivery of policy that the control itself becomes the object of the project, disrupting and obstructing, delaying and destroying.’ Nick Davies, The Guardian, 22 May 2003

On 22 May 2003, leading investigative journalist Nick Davies, the man who first revealed the News of the World phone hacking story six years later, had a long article, How Britain is Losing the Drug War, published in The Guardian newspaper.

In brief, Davies argued that the central government-produced bureaucracy surrounding Drug Action Teams (DATs), local multi-agency partnerships created to help government deliver and monitor elements of the UK drugs strategy, was at such a high level that the DATs were unable to do their work properly. This was resulting in a failure to provide adequate treatment for people with a substance use problem. He went on to say that the whole system might collapse and with it the UK drugs strategy.

Nick’s article had certainly resonated with me because I had seen many of the problems that he identified when I was leading the Drug and Alcohol Treatment Fund (DATF) National Evaluation in Wales. But how widespread were these problems in England—Nick had focused on one DAT, that for the Bristol area—and were they as bad as he was implying? 

I decided that the only way to find out was to get feedback from additional DAT co-ordinators. I decided to email all DAT co-ordinators in England and Northern Ireland and ask them if they would answer three simple questions and provide additional comments if they wanted:

(1) ‘In general, was the Nick Davies article accurate?’; (2) ‘Is there too much central management stopping the DATs doing their job properly?”; (3) ‘Do you feel too much stress in your job?’ I wanted to ascertain the major concerns of DAT co-ordinators in relation to government-related bureaucracy, and consider and suggest solutions to these problems.

1. The UK Drugs Strategy

A major foundation of the 1998 UK National Drug Strategy was partnership working. It was argued that many parts of the community need to be involved in tackling the problem of substance misuse, since it affects so many parts of society.

Moreover, many people who misuse drugs and/or alcohol present to treatment services with a variety of other intimately related problems. Thus, a person may be homeless, jobless and experiencing problems with personal relationships, have a history of criminal activity, and/or have a mental health problem. Therefore, tackling substance misuse must involve treatment services, GPs, health organisations, social services, education, police, probation, the prison service, etc.

In the late 1990s, the UK government created DATs and by 2001 there were a network of 153 across England and Northern Ireland, each of which comprised representatives from the sectors described above.

A DAT co-ordinator was appointed in each area whose job was to co-ordinate activities at a local level and act as an interface with central government. The DAT co-ordinators were expected to help ensure quality partnership working and sound commissioning practices, help distribute funding, and arrange the collection of various pieces of data that would show that treatment and prevention were working.

A key aspect underlying development of the UK drug strategy was the purported link between crime and the Class A drugs heroin and crack cocaine. The government claimed that the major costs to society of drugs were from these Class A drugs. Drug users were blamed for 7.5 million offences a year and up to 90% of property crime in some areas. An important part of the government’s strategy against crime was to reduce use of heroin and crack cocaine.

2. Nick Davies ‘Insights’

Nick Davies had highlighted the problem of government-produced bureaucracy which was making it very difficult, if not impossible, for DAT co-ordinators and their DATs to do their work properly. He provided the example of the former Bristol DAT co-ordinator Richard Elliott who had recently quit his job. The previous co-ordinator had also quit because she could stand it no longer and Davies talked about other DAT co-ordinators going off sick. He described how Elliott couldn’t stand the bureaucracy in Bristol:

‘… the 44 different funding streams, each one with its own detailed guidance and micro targets from the centre, each one with its own demand for a detailed business plan and quarterly reports back to the centre; the endless service agreements he had to sign with every local provider with their own micro targets and a demand for quarterly reports back to him so that he could collate them and pass them back to the centre; the new annual drugs availability report to the centre; the annual treatment plan to the centre over 68 pages and nine planning grids with 82 objectives…

‘… the funding announced too late for planning and then handed over too late to be spent and finally spent for spending’s sake to prevent it being reclaimed by the centre; the staff hired and trained and then suddenly sacked when funding or targets were switched by the centre, (or just quitting because they couldn’t stand it any more). He reckoned he and his staff spent only 40% of their time organising services for drug users; the rest of the time was consumed by preparing paper plans and paper reports for Whitehall [central government].’ 

‘… the culture of control in Whitehall, their “monitoring fetish” and their short-term thinking, and he wrote: “Monitoring has become almost religious in its status, as has centralised control … The demand for quick hits and early wins is driven by a central desire analogous to the instant gratification demands made by drug users themselves …”’

Nick Davies continued:

‘Richard Elliott describes an organisation which is being managed to death, where centralised direction has mutated into systematic suffocation. The government says the DATs must do the work; so the DATs must prove they are working; and very quickly the proving becomes their work. Elliott’s explanation is simple: “They don’t know very much about drugs, but they do know about management and monitoring and data collection. So that’s what they do.”’ Nick Davies, The Guardian, 22 May 2003

2. The Views of DAT Co-ordinators

I wanted to contact all 153 DAT co-ordinators in England and Northern Ireland, knowing that I could obtain email addresses from the website. I sent an email to the 149 addresses I found. A total of 69 emails were rejected, presumably because these addresses was no longer relevant. Did this mean that the NTA could not contact nearly half of the DATs, or were they just not updating email addresses on their website? 

I received a reply from 30 DAT co-ordinators, either to a first or second request to participate in our study. This number of responses represented 37.5% of the DATs which received my email.

I was unsure whether the low response rate was due to people being off work with stress and/or sickness or having resigned from their position. One person informed us that 25% of DAT co-ordinators in his part of the country seemed to be off on long-term sick at any one time. Maybe the DAT co-ordinators were just too busy? Or maybe they did not wish ‘to speak out’ against the NTA?

Almost all the respondents agreed that Nick Davies’s article was accurate. Moreover, almost all the DAT co-ordinators agreed that there was too much central management stopping the DATs doing their job. I received a wealth of comments, illustrative examples provided below:

‘… the bodies to which DATs report have timetables for implementation and targets that are wholly unrealistic. There is little if any chance of the majority of DATs meeting them, causing disillusionment all round.’

‘The micro management is all pervading, the targets are arbitrary, the aims too numerous and the bureaucracy over-mighty and bullying. There is little or no ‘joined up’ thinking between Government departments and money is channelled towards projects that are political (or departmental) favourites …’

‘I can honestly say that in the two years I worked in the DAT we did not have a chance to plan, deliver or evaluate any new drug projects due to the short-termism and needless data collection requirements of the Centre … The annual return is a nightmare and a complete waste of time—we have been asked to provide data that other Government departments already hold, asked for data relating to age groups that aren’t collated (could somebody define a young person???) and asked to collate information to timescales that aren’t the same (financial years, academic years and calendar years). Moreover, no two returns have been the same—how can you compare this?

‘… the ether has been blue over the past fortnight as DAT co-ordinators reached the limit of their tethers. The final straw was the constant breakdown of the electronic annual reporting system and the blasé way that civil servants simply assumed that, if they moved the deadline 24 hrs, everyone would have free diaries and backup to enable them to repeat this thankless task yet again. Having spent most of the previous month gathering, chasing and collating information for this annual bean count, the majority had postponed meetings until May, which was consequently chock-a-block. Mass e-mailings broke out, at least five co-ordinators that I have heard about resigned and many more are rumoured to be off sick.’

The majority of the respondents felt stressed in their job. They were also very frustrated. One person said the following:

‘I have bent over backwards both to jump through the constantly changing hoops and to influence those at the centre to consider better ways of approaching the issue. In the last year, with increasing numbers of DAT coordinators going off sick, it has been obvious that the system was going to crack. Many of us warned the centre that this was inevitable and generally we have received responses such as, ‘You’ll have to bear with us’, ‘It will probably get worse before it gets better’ or ‘We’re trying, but…….’

‘… In the last couple of weeks the cracks in the system have become wider. If we continue to do nothing they will become gaping holes. Co-ordinators are resigning in significant numbers. No-one in their right mind would want to fill the vacancies so their workload is falling on other, already overburdened shoulders. The domino effect will shortly set in and the Government will get what its seems to want, but certainly does not need, drugs strategies run by non-experts in crime and disorder partnerships.’

The responses I received from DAT co-ordinators suggested that Nick Davies was correct. There were so many different sorts of problem existing within the system that were resulting in a negative impact on the health of DAT co-ordinators. If DAT co-ordinators continued to resign at the rate they were resigning, then there would be serious problems for the UK strategy.

Several co-ordinators pointed out to me that they thought government wasn’t concerned because they knew that they had people in the Crime Reduction Partnerships who would run the strategy. If this is the case, the naivety of government was concerning, since it was very unlikely that the appropriate expertise would be found in these Partnerships.

The critical questions were whether government appreciated there was the problem and whether it was willing to do something about it. My phone discussions with a small number of DAT co-ordinators left me rather pessimistic, but one person said:

‘In the last six months, regional representatives have suggested to Home Office colleagues that they should seriously examine the attrition rate for coordinators in terms of long-term sickness and staff turn-over and, if it was as bad as colleagues in the field were suggesting, they should consider swift action to remedy this. This has not been done but a group of consultants has been engaged to try to rationalise the system. Unfortunately, this will have no outcomes until at least the autumn.’

Despite all this gloom, DAT co-ordinators felt they were making some progress and this was resulting in positive changes in the treatment system. 

‘Local partners are signed up to both the vision and the action plan and our DAT is achieving remarkable progress. Users, carers and communities are noticing the changes. However, this is despite central micro-management, rather than because of it.’

My research confirmed that problems in central management of the UK drug strategy were impacting negatively on the work and wellbeing of DAT co-ordinators, which ultimately would have a ripple effect through each local system.

It is important to emphasise again that the DAT co-ordinators (and their staff, assuming they have staff) were the key individuals in seeing that the UK strategy was implemented in each area of the country. They were expected to help ensure quality partnership working and sound commissioning practices, help distribute funding, and arrange the collection of various pieces of data that would show that treatment was working. 

The DAT co-ordinators acted as an interface between central government and all the substance misuse related activities that are occurring in each DAT region. They were the central cog. If they went down with a stress-related illness and/or resign then there was potentially a considerable effect on the local systems and activities. People working in the substance misuse field emphasised to me that you cannot train a DAT co-ordinator overnight.

In the report I wrote at the time, I emphasised a number of points. Firstly, the scale of the task in implementing various elements of the UK drug strategy could not be underestimated. The UK strategy was deeply rooted in the philosophy of partnership working, meant that the system in which substance misuse treatment was delivered was very large and extremely complex.

It was no surprise that there were problems—you don’t create such a successful complex system overnight. At the same time, it was essential that problems were recognised and acted upon, rather than ignored. Good communication was essential.

Secondly, when we were conducting the National Evaluation in Wales, we very quickly realised that the key to a successful treatment programme was having a well-oiled system within which the treatment services and their commissioners operated. We pointed out in our first and subsequent reports that this was the critical initial issue—a far more important issue than the development of outcome measures, which were never properly thought out. If your system doesn’t work, nothing else will.

We understood at one stage that the civil service had taken on board what we were saying in the reports, but we never heard from them. And our ideas were never implemented—or even published. Good communication is essential!

Thirdly, we were operating in a society where everything “must be” audited and be shown to be of value. It seemed to me that it didn’t matter whether something actually worked; it was the fact that it had been audited and someone had said something positive (or at least not too negative) that was important. It didn’t seem to matter if it was the truth or not.

The government felt that it must show to the voters that it was doing a good job. Everyone who was part of a government action must be seen to be doing the same. Education, health, criminal justice—they were all affected. The DAT coordinators had all of this and their own accountability.

In my report, I agreed that we must be accountable. There’s nothing worse than having useless systems that are taking tax payers’ money (mind you, that happens even in our auditing world). However, we must get the right balance. There is no point in people spending almost all their time justifying what they are doing, which was something that seemed to be happening to DAT co-ordinators. I strongly believed that we had gone too far down this road—the only things benefiting were auditor’s wallets. A better balance had to be struck.

Fourthly, I pointed out that we must remember that whatever the criticisms of the present system, some progress had made. Many systems had been put in place that would in the long-term benefit the provision of substance misuse treatment. More money was being put into the system. There was a real commitment from government and from those engaged in tacking substance use problems.

However, this did not mean that we should ignore the problems in the system. All our good work would go down the drain if we don’t deal with the problems in the system. It was ironic that with all the commitment made, to a large extent government was ignoring problems.

In fact, I was saddened by the response of the NTA to the Nick Davies article—it defended itself and the government (and talked about putting “pressure” on DATs) without accepting that there may be a problem. I’m sorry to say that I read the NTA letter and realised further why the DAT coordinators were so frustrated, disillusioned, and stressed. ‘Accept there is a problem and deal with it!’ was what I said in my report.

I never heard from the NTA. In contrast, Nick Davies responded to my communication and we had a conversation.

> 10. Voices of Loved Ones Indirectly Affected by Substance Use Problems

> ‘My Journey’ chapter links (and biography)