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The public health reforms first proposed by the government in the White Paper Healthy Lives, Healthy People ([2] Department of Health (DH), 2011a) will completely transform the environment in which drug and alcohol services operate in England, sweeping away systems and structures that have shaped their development throughout the New Labour period. More recently, the DH published Healthy Lives, Healthy People: Update and Way Forward ([4] DH, 2011c), following the government's "pause" for reflection on the health and social care bill, and consideration of over 2,100 consultation responses. Its central message could be roughly summarised as full steam ahead.
Imagine a report or article or conversation about drug treatment that made no reference to the National Treatment Agency, the pooled treatment budget, primary care trusts or strategic health authorities. The National Treatment Agency will have disappeared by April 2013 with the pooled treatment budget absorbed into a new ring-fenced public health budget. At this time, Public Health England and local Directors of Public Health will assume responsibility for planning and commissioning local drug and alcohol services. Primary care trusts and strategic health authorities will disappear[1] . It is unclear what will happen to other key structures, notably Drug Action Teams, but they may well disappear, or, perhaps more likely, they will be absorbed into the new public health structures. At the same time, the government wants to expand payment by results (PBR) approaches, including the eight pilots for drug recovery PBR that were announced in April and are due to launch in September/October 2011 (but do not be surprised if that timetable shifts) ([5] DH, 2011d). Whatever way you look at it, this is a critical moment in the development of substance misuse services in England, which will be profoundly affected by the plans for a "once in a generation" transformation of the health service.
It is envisaged that the new public health service will assume responsibility from April 2013 for a public health budget including £1 billion of money that is currently invested in drug and alcohol services. This will account for around one quarter of the total budget of Public Health England and perhaps as much as one half of the budget allocated locally by Directors of Public Health[2] . While there will...