Dr Jennifer Newbould is Duty Director of Health and Care and Senior Research Leader at RAND Europe. She specialises in qualitative approaches and has a particular interest in patient and service user perspectives. Jennifer has led a range of projects including recently co-leading a study of rare diseases in children (CONCORD 2) and leading a project on smoking cessation for those with serious mental illness. She recently Co-Led the Evaluating the Drug Strategy Investment in Treatment and Recovery (D-SITAR) study, that comprised six evaluations of aspects of the funding.

Abstract

Implementation of the treatment and recovery portfolio of the ‘From Harm to Hope’ drug strategy in England: Results from a process evaluation

Aims: To understand the first three years of the portfolio’s implementation, this evaluation aimed to explore: whether it has been implemented as intended; key contextual factors, challenges, and drivers that influence its delivery; its contribution to the drug strategy’s whole-system approach; how the overall strategy for central implementation of the portfolio influenced its local implementation; and what mechanisms do or do not work its delivery.

Methods: We conducted a mixed-methods process evaluation consisting of desk research, quantitative analysis of grant financial returns, and primary data collection with experts and delivery stakeholders, including workshops with service commissioners and interviews with experts, central government stakeholders, local implementation leads, and treatment and recovery service leads. The evaluation also draws on findings from case studies of how ten local areas across England implemented the portfolio.

Results: Central government largely implemented the portfolio as planned. However, they underestimated the scale of the challenges faced after years of disinvestment and there were several significant delays. Ring-fenced funding provided through the portfolio was welcomed. However, uncertainty regarding long-term funding was reported to impede long-term planning. The portfolio’s aims of creating a world-class treatment system and whole-system approach have not yet been achieved.

Conclusions: The portfolio’s funding structures should align with the ambition of a ten-year strategy to avoid encouraging short-term investments over longer-term improvements. Barriers that inhibit a whole-system approach should be addressed and the action plan for integrating mental and physical health services should be published. Any future plans should include measures to address long-standing challenges in the treatment and recovery sector.