We conducted a mixed-methods process evaluation of the first three years of implementation of the Treatment and Recovery Portfolio of the UK government's 10-year drug strategy, From Harm to Hope. We found that the Portfolio brought welcomed funding into the treatment and recovery sector after an extended period of disinvestment. The Portfolio has largely been implemented as planned, despite challenges related to funding uncertainty and some delays. Stakeholders involved in local implementation agreed with the Portfolio's priorities, highlighting the positive focus on boosting capacity within the sector, supporting collaboration between treatment and recovery and other parts of the system, and incorporating lived experience and recovery into treatment. However, the Portfolio has not yet achieved its aim of creating a world-class treatment system or a whole-system approach to alcohol and/or other drugs. The treatment and recovery sector has been negatively impacted by years of disinvestment, which has diminished the workforce's and the system's capacity and capabilities. These long-standing challenges cannot be quickly reversed with funding injections alone, and were under-estimated by the UK government when initially implementing the Portfolio. Addressing these issues requires long-term investment, improved training and professional development standards, and action within the health and social care system that makes it easier to collaborate with treatment and recovery services. Increasing the number of people in treatment without addressing these fundamental challenges.

Key Findings

• Ring-fenced funding provided through the Portfolio was welcomed. However, uncertainty regarding long-term funding and restrictions on carrying funding from one year to the next were reported to impede long-term planning.
• Central government departments largely implemented the Portfolio as planned. However, there were several significant delays, including the plans to integrate with physical and mental health services.
• Many local stakeholders were satisfied with the level of flexibility they had in delivering the Portfolio, and commented positively on planning processes with OHID. However, they viewed reporting and reprofiling requirements of the Portfolio as onerous, and national targets set by DHSC as unrealistic.
• Local stakeholders largely agreed with the Portfolio's priorities of boosting capacity, supporting collaboration with other parts of the system, and incorporating lived experience and recovery into treatment. However, they also identified gaps, including a perceived lack of focus on alcohol and prescription drugs.
• The Portfolio's aims of creating a world-class treatment system and whole-system approach to alcohol and other drugs have not yet been achieved. The central government underestimated the scale of the challenges faced after years of disinvestment, which has diminished capacity and capabilities within the system. Long-standing challenges cannot be quickly reversed with funding injections alone.
• Study participants expressed concern that the quality of services may decrease due to the push to increase numbers in treatment without adequate improvements to maintain a minimum standard of care. Achieving a world-class system will require balancing numbers in treatment with the need to ensure that each person receives good-quality care.

Recommendations

• The government should take steps to avoid compromising the quality of treatment by increasing numbers in treatment too quickly, without sufficient resources to maintain quality standards.
• The Portfolio's funding structures should align with the ambition of a 10-year strategy to avoid encouraging short-term investments over longer-term improvements.
• The government should continue to invest in rebuilding the workforce after years of disinvestment.
• The government should publish the action plan for integrating with physical health services and should address barriers that inhibit a whole-system approach.
• The Portfolio should place greater emphasis on alcohol and clearly communicate this to local areas.
  The government should implement the test-and-learn approach more systematically, expanding its roles in gathering evidence on what works to provide guidance to local areas.
• The government should ensure that future plans include measures to address long-standing challenges in the treatment and recovery sector.