A new research report has issued a stark warning over England’s drug and alcohol treatment system in the context of ongoing cuts to public health budgets. The report was released by Adfam on behalf of the Recovery Partnership who have been releasing annual 'state of the sector' reports.
Key findings include:
- The potential of the sector to absorb funding cuts through efficiency savings has been exhausted – there has been substantial service redesign and some hard decisions made.
- Service capacity continues to be eroded – there are mounting pressures on the workforce, with caseloads rising and some areas losing valuable one-to-one support.
- Only central government intervention will protect the sector from further cuts – there appears to be high variation locally in priorities and ways of working.
- Service models continue to evolve, with partnerships with smaller community and charity providers, wide use of volunteers and innovation driven by necessity.
- Commissioning capacity and practices remain of great interest and concern. There has been a high turnover of substance misuse commissioners, which has led to worries about loss of expertise in some areas.
Within the broader drug and alcohol treatment field, policy debates have been ongoing and often heated following the release of the 2017 Drug Strategy, attracting many critics. It's release also prompted calls for a single national alcohol strategy, currently absent beyond the crime prevention strategy and single initiatives such as the second round of LAAAs or the brief intervention CQUIN being implemented in hospital settings from next year. Notably, alcohol treatment numbers have been declining in recent years; down 5% in the last year (down to 80,454 alcohol only service users) and a 12% fall from the 91,651 peak seen in 2013-14.
Last year the Recovery Partnership released a set of quality standards to support the delivery of community and residential treatment services, though PHE also release annually updated JSNA support packs to support local commissioning. In 2015 a review of alcohol treatment in England highlighted key issues and themes facing the sector, including pressures of frequent commissioning cycles. The Recovery Partnerhsip also released a subsequent briefing on the need to engage alcohol misusers beyond those who traditionally access alcohol services.
Care Quality Commission review of residential detox services
The Care Quality Commision (CQC) has released a briefing on the quality and safety of residential services for people withdrawing from drugs or alcohol. The briefing follows the announcement in 2014 that the CQC would do so as part of its duty to regulate and inspect health and social care services in England.
The report paints a critical picture, stating nearly three in four providers failed in at least one of the fundamental standards of care that everyone has the right to expect, and that many of the clinics were not:
- assessing the risks to the safety of people prior to their admission
- following recognised national clinical guidance on treating people who are withdrawing from alcohol or drugs
- storing, dispensing and handling medicines appropriately
- carrying out full employment checks or sufficiently training their staff
The CQC says 'We have required all of the providers in breach of regulations to improve. Some providers already have improved and we will be re-inspecting the others to ensure that they have done so too. Four of the services are no longer operating following the concerns raised by our inspections.'
However writing in Drink and Drug News (DDN), Solicitor Nicole Ridgwell said the report 'contains no reference to the hard work of frontline staff; no recognition of providers choosing to work with some of the most vulnerable in society; and no thanks for the benefits to individuals and society'.
The number of closures to residential detox facilities has arguably been starker than the broader treatment system, where many services have merged in order to survive. Warnings though that cuts to addiction services are a false economy are likely to continue, whilst other groups such as older adults are also reportedly marginalised from addiction support.
One area though where the issue of lack of support appears to have some political interest appears for 'children of alcoholics', an issue several MPs have been speaking personally on and now reportedly with the Health Secretary's ear. The future for the treatment sector as a whole though looks set to faces many further challenges in the coming years.
Comments