Exploring the impact of national changes in public health policy on service delivery for people who require drug treatment in Liverpool: A qualitative research study

Abstract

Background: Since 2010 there have been major changes in the objectives of UK drug policy, and how drug treatment services in England have been commissioned and funded. Liverpool in North West England has more than twice the national average of both the rate of people receiving drug treatment services (9.6/1000 vs 4.4) and deaths from drug use (11/100,000 vs 4.7). This study investigates how changes in public health policy have impacted on service delivery for people who require drug treatment in Liverpool.  

Methods: Six semi structured interviews were undertaken with professionals working within the drug treatment field in Liverpool. Interviews explored the changes to drug service provision, how changes in funding and UK drug policy have impacted upon service provision and current challenges which are seen by professionals working with people who use drugs. The use of qualitative methods enabled the researcher to consider first-hand experience and views of professionals directly involved in service delivery, which is a gap in current research. Data from the interviews was thematically analysed using inductive and deductive approaches into 7 key overarching themes.

Results: The interviews show the main challenges which are being faced by both local commissioners and treatment providers in relation to drug treatment service provision in Liverpool. High treatment thresholds, high caseloads, and complexity in relation to people with multiple comorbidities which is also made more challenging due to the disconnect between drug services and other parts of the system such as mental health service provision. The changing need in relation to young adult’s drug use and service provision to meet this need was highlighted by the participants. For example, provision of advice and intervention for people who use drugs other than opioids and cocaine. Participants highlighted a lack of set training standards and opportunities for professional development within the field with this leading to some participants feeling devalued. A lack of ongoing funding for services were raised as a risk, with participants highlighting the issues with short term funding for projects and pilots which reduce opportunities for innovation and service growth. Participants felt that the implications of these challenges are reduced opportunity for intervention at an early stage resulting in potentially poorer outcomes for the person.

Conclusions: The need for a whole system integrated approach to care for people who use drugs was considered the key to reducing risk and providing improved outcomes.