At the recent Alcohol Change UK 2019 conference alcohol treatment was one of the key topics for debate and delegates were passionate about discussing the best ways to meet the challenges facing the sector.
I had the pleasure of helping to host the debate and wanted to share some of the challenges and opportunities facing alcohol treatment as I see them and as identified by our recent work at Public Health England (PHE).
PHE has highlighted a 22 per cent fall in the number of people coming into treatment for alcohol problems between 2013-14 and 2017-18 (analysis of data from National Drug Treatment Monitoring System). This is particularly concerning when only 1 in 5
people in need of alcohol treatment are receiving it.
Last year, PHE carried out an inquiry
to understand the reasons behind the fall in numbers. We spoke to 270 stakeholders across England, including 70 service users. We found that widespread service re-configuration, driven mainly by budget reductions, had affected people who are dependent on alcohol alone, more than it had affected those who use drugs or drugs and alcohol together.
Between 2013-14 and 2016-17, most services had reconfigured to single integrated alcohol and drug treatment systems. We know that integrated alcohol and drug services can deliver effective alcohol treatment but there has to be a specific focus on the needs of alcohol users in both commissioning and service delivery, and this requires strong local leadership to get it right.
We also found that reductions in other health and social care provision and less partnership working were factors.
Widespread service re-configuration, driven mainly by budget reductions, [has] affected people who are dependent on alcohol alone, more than it had affected those who use drugs or drugs and alcohol together.
Despite the challenges, we think that there are opportunities to strengthen alcohol treatment.
We have been developing plans and implementing the recommendations of our inquiry and we continue to highlight unmet need for alcohol treatment in local areas and emphasise the importance of adequate resources in our work with other government departments.
Local authority commissioners and service providers have a lead role to play but they can’t do it alone. Strategic partnerships and aligned commissioning between clinical commissioning groups (CCGs), sustainability and transformation partnerships (STPs) or integrated care systems (ICS) and local authorities are vital. The needs of people with alcohol dependence and their families should feature across integrated local plans leading to more effective referral pathways and joint working on the ground.
It’s great news that the NHS Long Term Plan recommends improving hospital alcohol care teams (ACTs) and promises extra resources for areas with the highest need. ACTs and community alcohol treatment services will need to work as a single system to deliver treatment without gaps in support. NHS England and NHS Improvement (NHSE&I), supported by PHE, is developing resources for Trusts to assist them to optimise ACTs and PHE is working with local authorities to support effective partnership working.
Our inquiry and the Alcohol Change UK report ‘The hardest hit’ both identified the need for more evidence-based alcohol interventions. Service users speak powerfully about the impact of long delays or a lack of access to alcohol detox. Data from the National Drug Treatment Monitoring System shows that the number of alcohol prescribing interventions is lower than could be expected.
Timely detox (community-based or inpatient) is an essential part of safe, evidence-based alcohol treatment. Service users who receive planned detoxes are more likely to complete treatment and avoid being caught in a harmful and costly ‘revolving door’ with the need for crisis intervention. If the number of emergency admissions for alcohol withdrawals increases, this will place a burden on the NHS. This is not good for patients, nor is it a cost-effective use of local resources. Community detox should be available in all treatment systems. Local areas can consider commissioning in-patient detox on a regional basis or within STPs and ICS footprints.
Training is also vital. Staff need to be skilled at working with people who are dependent on alcohol if they are to effectively engage them in treatment. Commissioners and providers should make sure there is enough alcohol expertise within services and that they provide staff with the proper training and supervision to deliver evidence-based interventions. Workforce issues are likely to feature in the work programmes of PHE and the NHS over the coming months - as without the right people doing the right things at the right time, we will not be able to give people the help they need.
