And you said that the issues with drug and alcohol in the UK at the moment are at some of the highest levels that they've been. The

highest levels. The

highest levels.

The highest ever recorded levels,

yeah. Ever. Which is, I mean, awful in terms of the suffering and the difficulties that that must bring people. What, I guess, what are your thoughts on the issues at the moment? Yeah,

so I mean, if you talk to most people in there who work in drug and alcohol treatment services, there's a lot of burnout workforce is very, very difficult. People have very high caseloads. And part of the problem has come from a significant reduction in funding over the last 10 or so years. So yeah, just to give people a bit of an idea as to the drug and alcohol treatment landscape in England. Prior to 2012, the majority of services were run by the NHS. Subsequent to 2012 and the implementation of the Health and Social Care Act, drug and alcohol treatment services, the responsibility for them was devolved to local authorities. And that meant that the money going towards drug and alcohol services was part of the public health grant, and individual local authorities could choose how to spend that money as they wished on a variety of services, drug and alcohol being one particular part of that. And what it has resulted in over the last 10 years is about a £250 million reduction overall in disinvestment from drug and alcohol services, which has obviously had huge amounts of knock-on problems in terms of staffing, in terms of outcomes, in terms of morale, in terms of ability to train addiction psychiatrists, but also nurses, psychologists, recovery workers. And so the sector has been really, really struggling. What has happened over the last year is that we've had a landmark review published by Dame Carol Black, the Independent Review of Drugs, made a number of recommendations around drug and alcohol treatment, one of the keystones of which was a restoration or indeed an increase in funding the entire sector. For the back of that, we had the new drug strategy published around about six months ago, which promised to basically reverse the disinvestment and has a staggered sort of amount of funding that's going to be increased to the sector over the next three to five years. And whilst that's obviously very, very welcome and absolutely what the sector needs, you know, you can't undo the damage of the last 10 years over the course of a short amount of time and with a return to funding levels as they were 10 years ago. So, you know, it's going to take some time with the build-up workforce to build up resilience, to build up innovation across the sector. And hopefully, you know, we can start turning around a disastrous trend of outcomes over the last 10 to 15 years but it's going to take time and I think it's going to take a huge amount of work across the sector but it's it's a very positive first step and I don't want to sound too negative you know the new drug strategy has some good stuff in it some bad stuff in it I'm very very welcome to the return of adequately funding a sector that's been in desperate need and decimated over the last 15 years.

Would your vision be for drug and alcohol services to be provided within the NHS, like other mental health services, or are there benefits to the current system that you would want to see continued? I

think that's a really interesting question. And I don't think there's a simple answer to that. And I think that too often within drug and alcohol work, the world of addiction, we end up having these really sort of forced, unhelpful dichotomies. funded or sorry entirely nhs provided or entirely third sector or voluntary sector provided or people should entirely become abstinent or people should only focus on reducing harms from substances that they take and and i think yeah too often we get sort of pigeonholed into these very binary decisions none of which you know there's no binary as a medicine as far as i'm concerned and so yeah i think you know the third sector has done some really interesting and innovative work over the last 10 years in England. It's obviously done that at a time when the system has been completely, well, has completely changed and also has been hugely disinvested in. That being said, you know, I'm an NHS psychiatrist. I work with NHS systems. I find it insane that we all work on different electronic record systems. It's very difficult to access patients' drug and alcohol information compared to other parts of their health care. There's obviously way, you know, splitting up in terms of lots of different treatment providers reduces integration. When the whole idea is that you produce, you know, everyone's always talking about integrated health systems, you know, integrated health systems for physical care, mental health care and substance misuse. And if we're devolving things to local authorities and devolving things to other providers, that often has the impact of reducing, not improving integration. And so I think there are problems around that and it can create barriers for some people in terms of accessing different and ensuring that they can access services. And those barriers are really important, actually, particularly for people who have, who can have very chaotic lives and struggle to access healthcare and drug and alcohol services at the best of terms. Sorry, I've not really answered your question there, but I'm gonna...

No, no, you have. I mean, it's, well, like you say, that there's no, there's no straightforward answer. And it's and I guess it's about figuring out what might serve the people best and what how we can be flexible.

Flexibility is sort of the watchword and the cornerstone of providing care to this very vulnerable and marginalized group.

It's something that you've talked about doing work on before, as in looking at the barriers or the challenges that people might have in accessing services. So I guess I wonder what you think about what kind of problems exist in offering treatment or providing treatment for people who have problematic substance use.

Yeah, I mean, how long have you got?

So yes,

there are a number of barriers. And I suppose we typically break them down in terms of barriers surrounding the individual and then barriers surrounding a more systemic or systems-based approach. My work is largely focused on the latter. I think there's lots we can do to try and improve access and reduce barriers in attendance. I'll just give you a few examples. if we look at the population of people experiencing rough sleeping or who obviously they have a huge amount of substance misuse comorbidity compared to the general population and they typically really really struggle to access services and all sorts of weird and wonderful barriers are put in place like some services would say you need identification or you need to prove that you live in the in the in which the service that you're receiving care from or being served by. Or, you know, you need various immigration documents or blah, blah, blah. Anyway, none of this is true. So we have very good explicit national guidance that says drug and alcohol services are akin to GP practices so they provide what is legally termed primary medical care and so any overseas visitor irrespective of immigration status irrespective of statuses like no recourse to public funds can access drug and alcohol services you do not need documentation to prove your address and services that are doing that can be reported to their local health watch and they're in breach of national guidance now obviously i understand that you know what you don't want is someone that you don't know anything about starting prescribing for them or taking them on but they shouldn't be barriers in terms of getting people to access services particularly people who are so ultimately disenfranchised and don't access services at the best of times, if you get them on the phone or you can get them through the door, we should be doing all we can in our power to engage these people in, you know, what's the appropriate support and trying to keep them there.