Local solutions to national crisis

As we continue to digest news of Scotland’s appalling number of annual drug-related deaths, viable solutions on offer to this growing national tragedy remain thin on the ground.

 The Scottish Government has already advocated the importance of a health-based to substance abuse, publishing a new national strategy to tackle the issue in November 2018.

However, with the UK Government refusing to revisit the devolved issue of drug legislation, there remains an element of finger pointing between the two legislatures in relation to who ultimately bears responsibility for a social problem which has spiralled dangerously out of control.

While the debate over legislation remains intractable for the time being, it would be worthwhile considering the options we do have at our disposal, such as expanding the scope for community-based organisations to deliver public health services at a local level.

Scotland’s social enterprise ecosystem already provides countless vital health services related to substance abuse in communities across Scotland – working in the most deprived areas to ameliorate the more acute effects of failed social policy. 

Services are often free at the point of contact, funded through a mixture of core funding, grants and enterprising activity. These services are not designed to duplicate or replace existing core health services, but rather support a system struggling under the weight of a national health crisis.

 Consider Community Food Initiatives North East (CFINE), based in Aberdeen where drug-related deaths doubled over the course of a single year. Primarily concerned with tackling food insecurity, CFINE has recognised the link between low incomes and substance abuse now supports people trying to navigate the benefits system. Beneficiaries are supported back into work through volunteering opportunities, while the most vulnerable individuals are signposted to local intervention and recovery services.

 Then there’s Street Fit Scotland, an Edinburgh-based social enterprise which runs a health, fitness and wellbeing programme for people experiencing homelessness or housing insecurity. The programme combines fitness classes such as boxercise and circuit training with wellbeing workshops covering issues such as suicide prevention, Naloxone training and boosting self-esteem.

In Erskine, Crisis Counselling has been offering free early intervention counselling services for over 23 years. Founder Jean Cumming noticed that the only services available through the NHS were acute interventions, often leaving individuals with a limited chance of making a robust recovery. Crisis Counselling now takes over 2000 NHS referrals a year, providing free support to individuals experiencing substance addiction and mental health issues. 

In Glasgow, Thriving Survivors supports men, women and children affected by trauma through its eight-week recovery programme, Discovering Me. Set up in 2017, Thriving Survivors has so far supported 350 vulnerable people, with 60% of clients presenting themselves to the organisation as having an addiction or being in recovery. Three quarters of Thriving Survivors’ current workforce completed the Discovering Me programme, having previously experienced an addiction issue.

By reducing the impact of social factors linked to problematic drug use, social enterprises across Scotland are already having a hugely positive impact on our complicated relationship with drugs – at a local level.

Rooted in their communities, they have the sort of trusting relationship with beneficiaries which is often lacking in centralised services, meaning people are more likely to access these services than they are to present themselves to the NHS. 

Smaller, community-based organisations often have a much better picture of the localised social factors which are contributing to substance abuse, including unemployment, homelessness, mental health issues, and low incomes.

Their strength lies in being able to identify hyperlocal needs and put in place a programme of services which address the causes of substance abuse and not simply react to the symptoms. Often surviving on miniscule budgets and year-on-year funding applications, they continue to return an impressive social impact with the adaptive services they develop.

In which case, the solution is not to take one effective model and attempt to roll it out nationwide, or to inject huge amounts of cash into small organisations and expect them to be able to achieve rapid growth both in terms of capacity and social impact. Rather, we should aim to support this network of small, successful operations to become appropriately funded through the delivery of local public services in the communities they already serve so well.

The procurement process by which the Scottish Government can subcontract public services can be extremely difficult for smaller organisations to navigate. Smaller social enterprises often report struggling to access opportunities due to lacking in capacity to fulfil contracts, or being outbid or undercut by larger organisations. 

Ultimately, a procurement process which is heavily weighted towards larger organisations potentially runs the risk of more and more public health services are ending up in the hands of private businesses – a trend which public opinion is decidedly against.

Recent YouGov polling indicated that 51% of people consider it a risk to subcontract local public services to private businesses, whereas only 24% would consider it a risk for social enterprises to deliver these services. The figures also revealed that social enterprises were trusted to deliver better value for money in relation to public services.

Tellingly, when asked to make a choice between social enterprise or private business being handed local council or NHS subcontracts, 90% of people who had a preference indicated that they would choose social enterprise. 

Despite this striking level of public support for social enterprises delivering public services, the vast majority of Scotland’s £11bn public procurement spend remains incredibly hard to access for small, community-based organisations – with private businesses and national charities enjoying the most lucrative contracts. 

This is backed up by figures in the 2017 Social Enterprise Census which indicate that 80% of social enterprises in Scotland did not bid for a public service contract in the past 12 months. Only 15% of these community organisations end up successfully navigating the procurement process. 

The Scottish Government has made a commitment to “public service reform which will see increasingly localised, preventative and personalised public services”, but for this to be a success the onus must be on widening the access to smaller organisations – not encouraging social enterprises and other community organisations to rapidly increase their capacity.

The strength of Scotland’s social enterprise sector is that it provides a nationwide network of small, effective organisations that can breathe lives into their communities precisely because they know them inside out.

Expecting social enterprises to expand and increase their capacity until fit the current model not only jeopardizes their innate nature, it also runs the risk of eventually replicating the system already in place which has proven to be so deeply flawed. 

The introduction of new legislation to reduce the problematic use of drugs in Scotland might not be an option on the table right now, and that’s not likely to change any time soon 

The Procurement Reform Act Scotland (2014) was lofty in its aims in this regard, but unfortunately follows a trend for well-written strategies which have not been backed up by a robust implementation and a faithful interpretation.

Substance abuse is closely related to the social condition of a community. The longer we delay in widening access to public service contracts to this nationwide network of small but effective community organisations, the greater the risk of Scotland sliding further and further into a public health crisis which so far shows few signs of abating.

Eddie Nisbet is research and communications officer at Senscot