The Movement is the Medicine! The radical reinvention of addiction services in Essex holds lessons for the whole public sector.

Forget everything you’ve ever known or imagined about how an addiction recovery service works. The Essex Recovery Foundation doesn’t prescribe methadone, doesn’t offer professional counselling and doesn’t run rehab facilities. Instead, the ERF is a movement for personal and system change that now numbers over 1,000 members across the county made up of people in recovery, their friends and families and public and voluntary sector workers. And, perhaps most surprisingly, it’s the brainchild of Essex County Council which initiated and now funds the Foundation.

For members, the ERF offers the trusted mutual peer support which the conventional, medicalised approach to recovery often fails to provide. That support grows organically out of bringing people in recovery together with a shared mission for personal change. It inevitably also leads to other activities: help getting into employment, public speaking boot camps, a mountain biking club, walk and talk groups, a recovery festival, and even recovery cafes. And there’s a host of other activities developed, pitched, chosen and funded Dragon’s Den style by the ERF members. 

But, despite all this activity, maybe the ERF’s biggest contribution to its members’ recovery is just allowing them to be part of something big and challenging with a collective sense of purpose. ‘The movement is the medicine’ could well be the ERF’s slogan.

Shifting the System

Crucially, and in true movement style, the Foundation isn’t just about personal change, it’s also about transforming the way the system works, or often does not work, for those in recovery. Members are deeply involved in the design, commissioning and procurement of conventional recovery services. 

‘Community researchers’ drawn from the ERF membership explore the issues and options for any tender and are part of the council team procuring services. But their ultimate accountability is to the wider ERF membership with commissions, contracts and services being discussed at a quarterly Community Voice meeting that regularly attracts around 100 ERF members. One notable outcome of this is that efforts are now underway to ensure that all recovery services in Essex include people in recovery on their delivery teams. Indeed, the ERF itself is now not far off being 90% staffed by people in recovery. 

The goal in the next three or so years is for the Council to transfer its entire £15m recovery budget over to the ERF so that the whole process of commissioning services is  controlled and run by people in recovery themselves with council officers offering only technical support as and when required.

A Radical Trend

It’s early days for the ERF which only got fully underway after the pandemic, so the full impact is not yet clear or quantified. But already the anecdotal and lived experience of ERF members speaks of a major boost to their success in getting and staying sober, improving the impact of contracted recovery services, and changing public perceptions of addiction.

The Foundation speaks to a wider radicalising trend in public sector innovation that places communities and movements rather than the public sector institution at the centre of redesigned services. I was very struck recently at how a new health and well-being centre in Fleetwood is being designed so a vast community hub and cafe is at its core rather than consulting and triaging spaces. Indeed, Mark Spencer, the GP who has catalysed that and much else in Fleetwood, describes the remarkable work happening there as creating a “social movement for positive disruption”.

It is difficult to underestimate how transformational and impactful such a trend could be if it were to become the organising principle of the public sector. It would mean an end to public services that rely solely on the expertise of public servants or the resources they control. An approach that has such a disempowering and isolating effect on those in need of support and care. Instead, the public sector would come to see its prime role as releasing the enormous power of human connection and agency as the most effective route to good health and well-being.