AUDIT Scotland 10 years on: explaining how funding decisions link to increased risk for drug related deaths among the poor

Abstract

Purpose In response to Scottish Government assertions that an ageing cohort explained increases in drug-related death (DRD), the previous research by the authors established that socio-economic inequalities were additional risk factors explaining the significant increases in DRD in Scotland. This paper aims to subject the drug policy narratives provided by Scottish Government in relation to the governance of drug and alcohol services to critical scrutiny and reveal the social consequences of the funding formula used to direct funding to services via NHS Scotland Boards, and Alcohol and Drug Partnerships (ADP). Design/methodology/approach The paper provides a narrative review in the context of the AUDIT Scotland reports “Drug and Alcohol Services in Scotland” from 2009 and follow-up report published in 2019. The authors refer to the recommendations made in the 2009 report on effectiveness of drug and alcohol services and subject Scottish Government funding processes, and governance of drug and alcohol services to critical scrutiny. Findings This analysis provides robust evidence that Scottish Government funding processes and governance of drug and alcohol services increased risk to vulnerable drug users and document evidence that link these risk factors to increased DRD. Research limitations/implications The authors have focused on Scottish drug policy and drug services funding. Alcohol services funding is not subject to critical analysis due to limitations of time and resources. Practical implications This case study investigates AUDIT Scotland’s recommendations in 2009 to Scottish Government to provide researchers, government policy advisors and media with robust critical analysis that links drug policy decisions to increased DRD. Social implications Drug policy governance by the Scottish Government and NHS Scotland since 2009 have disproportionately affected communities of interest and communities of place already experiencing stark inequalities. These budget decisions have resulted in widening inequalities, and increased DRD within communities in Scotland. The authors conclude that in diverging politically and ideologically from Public Health England, and the Westminster Parliament, Scottish Government drug policy and financial governance of drugs services contributes to increased risk factors explaining DRD within deprived communities. Originality/value The 2009 AUDIT Scotland recommendations to Scottish Government subject their governance of drug services to critical scrutiny. This analysis provides a counterpoint to the explanations that rising DRD are unconnected to drug policy and drug services governance.

‘It’s not 9 to 5 recovery’: the role of a recovery community in producing social bonds that support recovery

“…In Scotland, and the rest of the UK, the concept of recovery, first advocated by user-activists challenging the top-down treatment system, is now a largely professionalised discourse that shapes policy and practice (Duke, 2013;Scottish Government, 2018). Harm-reduction approaches, although evidence-based, have been critiqued for failing to help people build the drug-free lives aspired to in government policy (McKeganey, 2012) and the shift to a strengths-based recovery approach coincided with significant funding cuts for drug and alcohol services (McPhee & Sheridan, 2020). The development of the recovery movement during a decade of austerity risks framing recovery within an austerity logic, creating a paradox between the grassroots movement for community empowerment and the more individualised recovery processes that could relocate responsibility onto marginalised communties (Roy & Buchanan, 2016).…”

From the clinic to the street: the changing role of benzodiazepines in the Scottish overdose epidemic

“…The rapidly changing social, economic and political context of the 1980s contributed to a cohort effect of increased drug-related death rates during the 1990s, especially among males living in the most deprived areas born between 1960 and 1980 (Parkinson et al, 2018). Additionally, Scottish Government funding decisions, alongside the UK Government austerity drive from 2010, contributed to a decade of budget cuts to frontline drug treatment services which disproportionately affected the poorest and most vulnerable communities (McPhee & Sheridan, 2020). These cuts were compounded by a further 22% cut in funding in 2015 from £69 million to £53 million (Audit Scotland, 2019).…”

Look what’s coming over the hill: DAST-10 problem severity among non treatment seeking young people

“…At the onset of austerity in the UK, alcohol and drug partnerships in Scotland were expected to deliver essential services with significantly reduced annual budgets. NHS Scotland Health board areas with high rates of DRD experienced the severest impact from centralising services and closures of third and voluntary sector treatment services (McPhee and Sheridan, 2020). A key policy area impacted by these changes to funding arrangements were prevention services crucial in working with young people at risk of developing problems.…”

“…Glasgow City local authority area, Edinburgh, Dundee and North Lanarkshire Council areas have high responses rates, and corresponding high rates of DAST-10 problem severity scores. These are local authority areas with high incidence of reported socio-economic inequalities, and higher rates of PDU and DRD relative to the Scottish average (McPhee and Sheridan, 2020).…”

“…An ageing cohort of individuals aged 35 and over considered a high risk for drug related death (DRD) are targeted. However the ageing cohort narrative has been successfully criticised demonstrating additional risk factors for DRD require consideration in service planning (McPhee et al , 2018; McPhee and Sheridan, 2020; Cousins and Bennet, 2022).…”