To address this, the government is making substantial investment to increase the capacity and quality of local services. It has also established a National Treatment Agency (NTA) to drive up standards. However, there are still challenges ahead. Local services remain thin on the ground and the quality of support can still be poor. For example:
* under-developed care management and high workloads can mean that clients who drop out of treatment are not followed up
* poor links between different treatment agencies and with other services - such as mental health and prisons - often mean that those with complex needs struggle most to get help
Many GPs can also be reluctant to provide specialist help, often because they lack expertise and support. Of 1,574 GPs who responded to a commission survey, two-thirds felt they lack sufficient training to support drug misusers and did not have easy access to specialist advice and support.
The commission argues that some of the current problems stem from historic under-investment, different views about 'what works' and low levels of staff training across the treatment sector. But fragmented local responsibility for purchasing treatment services - and poor information about the needs of drug misusers and the performance of existing services does not help. A national emphasis on new initiatives and short-term planning and funding arrangements has also discouraged a more strategic approach to service development.
Improvements are urgently needed to stop more drug misusers falling through the net. The report recommends that central government should do more to increase understanding of what works, collect better comparative information about service performance and build the capacity and skills of treatment staff. The NTA has already started to take this agenda forward. But local agencies must also work together to ensure that new monies for treatment are well spent. Successful approaches will depend upon:
* fundamental service reviews that can test whether local provision is fit for purpose and ensure that key blockages, such as long waiting lists, are addressed
* clear performance targets and indicators to enable comparison of progress, and learning from best practice
* providing services in new ways to attract and retain a wider range of drugmisusers, including women and crack cocaine drug misusers
* a stronger emphasis on co-ordinating care as drug misusers move between services and agencies
* organising input from other services, such as mental health and housing; and
better partnership working between primary care and specialist staff, to increase the amount of clinical support available
Andrew Foster, Audit Commission controller said:
'Tackling drug misuse is a major issue for local communities and is at the top of policy agendas across England and Wales. We know that effective treatment services can help, but the current pattern of service means that too many drug misusers still struggle to get the help they need, when they need it. As a result, many end up trapped in a cycle of dependency and drug-related crime.
'The time for action is now: the advent of the new National Treatment Agency and new government investment in treatment, gives local agencies the opportunity to step back and evaluate how well drug treatment services are working. Providing effective support will not only help more drug misusers to rebuild their lives but also improve the quality of life in many local communities'.