We are Fearless Women; exploring how women been impacted by changes in commissioning processes in English drug treatment services over the past 10 years?
1
Criminology, University of Manchester, Manchester, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A2224
ABSTRACT
BACKGROUND:
Since 2010, the drug and alcohol treatment sector in England has undergone substantial transformation. The adoption of New Public Management (NPM) principles, alongside increased market competition and changes to procurement processes, has affected treatment providers’ capacity to support people who use drugs. A consequence of these reforms has been the consolidation of service provision by large national organisations, often at the expense of smaller, community-rooted providers that are less able to compete on cost. While a small but growing body of literature has examined the implications of these developments for service delivery, there remains a lack of research exploring their impact on women’s access to drug treatment.
METHODS:
Drawing on trauma-informed and participatory methodologies, this qualitative study compares two models of drug service delivery: an ecosystem of community-rooted provision and a single-provider model. Women’s experiences of, and barriers to, drug treatment are explored through the analytical lenses of feminist theory and NPM.
RESULTS:
The findings demonstrate the gender-blind consequences of sectoral restructuring for women who use drugs. Key issues include fears associated with maternal drug use, criminalisation, and stigma. A critique of responsibilisation highlights how contemporary service models increasingly fail to reach the most marginalised women, as they implicitly assume levels of social capital and stability that many vulnerable women do not possess. Furthermore, the limited community embeddedness of large national providers, and their weak connections with local charities supporting highly marginalised women, generate additional barriers to engagement with services.
CONCLUSIONS:
While the former ecosystem of community-based provision cannot be fully restored without substantial government intervention, greater collaboration between large national providers and smaller, community-rooted organisations could improve access for women. Drug treatment services must also routinely consider the needs of women who are not currently engaged with services, in order to prevent the continued development of gender-blind provision.
Since 2010, the drug and alcohol treatment sector in England has undergone substantial transformation. The adoption of New Public Management (NPM) principles, alongside increased market competition and changes to procurement processes, has affected treatment providers’ capacity to support people who use drugs. A consequence of these reforms has been the consolidation of service provision by large national organisations, often at the expense of smaller, community-rooted providers that are less able to compete on cost. While a small but growing body of literature has examined the implications of these developments for service delivery, there remains a lack of research exploring their impact on women’s access to drug treatment.
METHODS:
Drawing on trauma-informed and participatory methodologies, this qualitative study compares two models of drug service delivery: an ecosystem of community-rooted provision and a single-provider model. Women’s experiences of, and barriers to, drug treatment are explored through the analytical lenses of feminist theory and NPM.
RESULTS:
The findings demonstrate the gender-blind consequences of sectoral restructuring for women who use drugs. Key issues include fears associated with maternal drug use, criminalisation, and stigma. A critique of responsibilisation highlights how contemporary service models increasingly fail to reach the most marginalised women, as they implicitly assume levels of social capital and stability that many vulnerable women do not possess. Furthermore, the limited community embeddedness of large national providers, and their weak connections with local charities supporting highly marginalised women, generate additional barriers to engagement with services.
CONCLUSIONS:
While the former ecosystem of community-based provision cannot be fully restored without substantial government intervention, greater collaboration between large national providers and smaller, community-rooted organisations could improve access for women. Drug treatment services must also routinely consider the needs of women who are not currently engaged with services, in order to prevent the continued development of gender-blind provision.
| eISSN: | 2654-1459 |
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