Earlier this month Alcohol Concern/Alcohol Research UK released a new report “The hardest hit: addressing the crisis in alcohol treatment services”, calling for action to address the many issues arising from funding cuts and other challenges facing the sector.
Subsequently the Government has made the surprise announcement that it will develop a new alcohol strategy, though whether this will include any commitments to further resourcing alcohol services remains to be seen.
Indeed the strategy announcement may largely be a reflection of Scotland's recent Minimum Unit Pricing implementation and includes a pledge to further review MUP for England. As things stand, Alcohol Concern state treatment services 'are entering into a cycle of disinvestment, staff depletion, and reduced capacity, and this is due to get worse; in 2020 ring-fenced public health funding will end, posing additional risk to the areas of highest need.'
More than a funding crisis?
Certainly the squeeze on public health budgets - from which local authorities are expected to fund a range of activities including substance misuse services - appears the key issue, with cuts of between 10% and 58% identified in the report; just 12% of respondents felt that resources were sufficient in their area. The report states the cuts are a false economy - indeed Public Health England estimates that every £1 invested in alcohol treatment brings £3 in social return - and that there is an 'urgent need for action to ensure that treatment services do not enter a vicious cycle of disinvestment, staff depletion, and reduced capacity'.
Twelve key recommendations are made, which include calls for an independent review of alcohol commissioning, and that Government partners 'establish effective systems for transparently monitoring the scale of ongoing investment.' PHE should review why alcohol only treatment figures have declined in recent years and the impact of the widespread merging of drug and alcohol service. It states consideration should be given to the introduction of ‘treatment tax’: a small increase in alcohol duties earmarked to ensure that all local areas can meet their treatment needs.'
Whilst investment may be the bottom line, the role of skills and leadership is also identified, with calls for a national system of qualification and accreditation for workers and ensuring competencies for those responsible for commissioning services. Local authorities 'must ensure that staff from non-specialist services are well trained in how to work with heavy drinking and alcohol dependent clients' indicating the role of pathways and joint working across a range of services.
Co-existing mental health and alcohol problems still requires 'better guidance' and has indeed been a long running issue. Alcohol Concern have previously called for better coordination between services and again the report highlights instances of services excluding dual-diagnosis clients. Others have also highlighted such issues with the Institute of Alcohol Studies (IAS) and Centre for Mental Health, recently releasing a report identifying many of the same issues, but ultimately calling for leadership from the top. Further attention to other key groups are also identified, including the needs of older adults, 'high impact' drinkers and the needs of families.
In recent years similar warnings have been made including the 2017 State of the Sector and a report from the Care Quality Commission (CQC) on the quality and safety of residential services for people withdrawing from drugs or alcohol. Other reports have previously called for the need to engage a broader range of harmful drinkers into treatment or support; a 2016 Recovery Partnership report identified a 'largely hidden population' of drinkers as an opportunity to do more 'upstream'.
The politics of alcohol policy?
To launch the report, an event at the Houses of Parliament saw politicians, service providers, researchers and charities hear key speakers and discuss the issues. Indeed further political will may be considered the crucial factor in turning around the fortunes of the alcohol treatment sector.
Whilst the Independent has reported on cuts to treatment services of £105 million since 2013, such issues may seem small fry in the broader political context of Brexit or even compared to alcohol stories that readers may feel more directly impacts on their own drinking. In a blog on the launch of the report, Dr James Nicholls noted that whilst 'the media loves to talk about whether a glass of wine might add or take a few weeks from your life... it is surprisingly silent on the ongoing crisis occurring in alcohol treatment services'. Alcohol problems also remain highly stigmatised which may reflect limited concern over publicly funded help, whilst others may view peer led recovery routes such as Alcoholics Anonymous as the the only required route.
Indeed alcohol treatment has never received its own dedicated national funding source. Prior to the transfer of substance misuse commissioning to local authority lead public health teams, alcohol funding essentially piggy backed from investment for drug treatment and targets as overseen by the National Treatment Agency (NTA) in the 2000's. Alcohol services have as such been referred to as 'Cinderella services' for some time, though following the recent scale of the merging of specialist alcohol providers with larger substance treatment providers, very few alcohol only services now appear to exist.
This month (PHE) announced details of a £4.5 million innovation fund to support up to eight local authorities in addressing the needs of children of dependent drinkers, following ongoing campaigning by several high profile MPs including a parliamentary group Manifesto for 'Children of Alcoholics'. Meanwhile MPs pressed on the issue of the wider funding constraints and ongoing issues continue to re-iterate the availability of PHE guidance and tools for local authorities. Without further political will, financial resources look set to remain increasingly limited, and with it the capacity for commissioners and providers to support for those who are coming forward for help.
Comments