Public Health England (PHE) have released Alcohol and drug prevention, treatment and recovery: why invest? for commissioners and providers 'to help make the case for investing in drug and alcohol treatment and interventions'.
The resource collects alcohol-related figures and infographics designed to help make the business case for investing in treatment and early intervention - see the slide set here (includes some commentary and references in PowerPoint version -click 'save' in top right of screen).
PHE: advocating evidence-based policy?
Local commissioners and providers of course may feel a persuasive business case can only go so far when 'disinvestment and the fragmentation of services continue to dominate dialogue and debate'. Politically, even with calls from several high profile MPs to halt the false economy of squeezing public health budgets, cuts to drug and alcohol services are unlikely to capture general public sentiment in the context of broader national policy and economic uncertainty.
As such, local stakeholders are more likely to be seeking to maintain as much service provision as possible - alcohol treatment figures have been falling in recent years - rather than realistically vying for increased investment. However one new area of activity exists in the forthcoming CQUIN to incentivise brief intervention in hospitals, potentially reaching significant numbers of at-risk drinkers. CQUINs though do not offer new money, rather than release the full value of the wider funding contract if achieved. Successful implementation may also raise further issues about the capacity of local treatment services to refer those requiring more than brief advice.
Will Haydock, a local commissioner commented on the new resource:
“This slide set is really a tool to help make the case for investment in prevention and treatment for alcohol and other drugs. For a commissioner based within a local authority, the emphasis on harm to children and families is helpful, because this is a persuasive angle for local decision-makers. My concern is that this doesn’t cover the full spectrum of harm related to alcohol that can be addressed by treatment, and the savings presented mostly relate to the health system rather than local authorities so I’m not sure how persuasive it will end up being.
“While a cash figure is placed on the savings from interventions in primary and secondary healthcare settings, there’s no figure for the more complicated ‘considerable savings’ of working with ‘high impact users’ who could potentially benefit from the treatment services commissioned by local authorities – and who probably aren’t captured by the concern for families and safeguarding either.”
Local and national policy: the role of 'partnerships'?
On how to respond to 'the challenge', the PHE slideset highlights the importance of 'delivering a multi-component approach' including leadership, sharing data, population level prevention, targeting key individuals and providing effective treatment services. Indeed most would agree that multi-component approaches are required to affect real long term impacts on alcohol harm, though the absence of population levers in England including minimum pricing or tighter availability and marketing controls dominates calls from other public health groups.
A further slide titled 'Partnership: the key to success' emphasises the wide range of local agencies and stakeholders with a role to play, though various applications of 'partnership working' has been seen in alcohol policy contexts. Some have made the charge that local partnership approaches led by industry groups are ineffective and their main role 'may be as an alcohol industry corporate social responsibility measure', whilst at national level the former but controversial responsibility deal has also been suggested to have had no impact or contain mostly pledges on actions already being undertaken. The most recent Government nod to any kind of national alcohol strategy, the 2016 crime prevention strategy, echoed a clear partnership message in the context of the night time economy. The current second round of Local Alcohol Action Areas (LAAAs) operate in a similar vein for those areas taking part, though included an expectation of evaluation.
As for the year ahead, the alcohol policy debate focus is likely to remain on minimum unit pricing as Scotland's implementation date fast approaches. Nonetheless, the ability of local areas to invest and deliver in multi-component prevention and treatment activities will continue to be a cause for concern for many, regardless of the impact of other measures such as CQUINs or LAAAs. Other questions are also unlikely to be resolved anytime soon, such as when or whether a national alcohol strategy may appear, or even a refresh of the ever aging £21 billion figure. PHE and local areas though will no doubt continue to make the 'why invest' case as best they can.
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