Alcohol treatment: when the cuts become a false economy

In this blog, we look at two reports published this week: one highlighting the implications of the recent changes in the commissioning process; the other looking more at the knock-on effects in the community.

The first study is from an Alcohol Change UK-funded report on ‘Local alcohol treatment and recovery service commissioning practices’ by Penny Buykx, Andy Irving and Lucy Gavens.

The researchers set out to explore the range of experiences of the commissioning process for alcohol services in five local authority areas. Although these areas were chosen for their diversity of location, wealth and alcohol use, common themes did emerge. The researchers conducted in-depth interviews with people involved in the most recent commissioning process and undertook documentary analysis of local reports, strategy documents and service provision contract plans. They used the interviews to get to the heart of what those most closely involved in commissioning felt about both their local area and the wider system.

What did they find?

Funding

1. A strong thread which was found in all the local authority areas was the driving force to make ‘substantial savings’.

This unfortunately is not new to the sector. Since the shift in responsibility to local authorities in 2013/14 to provide alcohol services, funding has been slashed. Indeed, as previously reported in an Alcohol Change UK briefing paper, expenditure on alcohol treatment fell by 16% between 2015 and 2018.

2. Buykx et al also found that “many stakeholders are of the view that their community has reached the limit of funding cuts that can be absorbed without significant impact upon the availability of services and client outcomes”.

In other words, some of these communities are concerned they will no longer be able to provide adequate services if funding is reduced any further. Although we may well see a delay in planned reforms to the Business Rates Retention Scheme due to the coronavirus outbreak, the threat of further cuts or even a complete abolition of the Public Health Grant which funds alcohol services still looms.

Access

3. Another finding from this research is the reduction in representation of people accessing alcohol treatment compared with the level of need. Despite commissioners emphasising the importance of access to services for people with alcohol problems, including hard to reach groups and support for family members of those affected by alcohol, the researchers found that some participants expressed concern that not all groups who could benefit from services were well-represented in treatment.

The lack of access finding is echoed by a 2018 inquiry by Public Health England into the fall in numbers of people accessing alcohol treatment. They found that between 2013/14 and 2016/17 there has been a 19% fall in those accessing alcohol treatment compared to only a 5% fall for drugs. This suggests this is not just a case of those with alcohol problems being able to spontaneously recover without formal support from services. Such a marked decrease in numbers accessing treatment over just a few years, coupled with the fact that access to drugs services had a much smaller decrease, shows that alcohol services have been struggling in a unique way. Public Health England’s deep dive found that, to echo this study, the system has been pushed to the breaking point and more funding is urgently needed.

Innovation

4. The researchers found examples of service system innovation. Common developments include integrating alcohol with other services, greater outreach due to building closures, an increased focus on peer workers for support and a reduction in staff numbers. While such changes were seen by some to be beneficial in reshaping the service system and delivering necessary efficiencies, in other instances, they were viewed as an uncomfortable compromise in order to maintain a service. Worryingly, in one local authority, interviewees reported that service integration meant that “alcohol clients with less severe problems may now be less well served than previously”.

When we have 1.26 million hospital admissions related to alcohol each year, we can’t afford only to provide alcohol services to those with the most severe problems. As part of the public health system, alcohol services must act as both treatment for alcohol problems and prevention for further health issues caused by alcohol.

As shown in the second report published recently, the increases in the number of alcohol-related hospital admissions is linked with the decreases in funding for alcohol services. In the study, researchers Emmert Roberts, Matthew Hotopf and Colin Drummond used national data to discover that the areas in England with the highest rates of alcohol dependence and deprivation do not receive funding proportional to the level of need. They found that the rate of alcohol-related hospital admissions increased by 3% each year, while the rate of people starting specialist alcohol treatment decreased by 5% each year, as an average across all local authorities in England. When looking at the statistical associations between these factors, they found that, for an average local authority, every 5% reduction in yearly spending on alcohol treatment would see an extra 60 alcohol-related hospital admissions per 100,000 people in the population. This suggests that the cost savings made by spending less on alcohol treatment are not truly saved, but are simply displaced onto the NHS.

The findings from these studies once again emphasise the need for a well-funded alcohol treatment system. Alcohol treatment needs to be seen as both ‘treatment’ and ‘prevention’ in the complex system of health care and public health. Alcohol treatment can not only prevent future health complications and the resulting increase in hospital admissions but can also lead to huge cost savings in the process. As shown in the first study, many commissioners believe that alcohol should be “more strongly reflected” in national level strategy so that they can highlight the need for local investment. We believe this too and we will continue to work to ensure that alcohol is not the ‘forgotten cousin’ of public health services.

We’ve seen both how vulnerable the system is to risks such as pandemics, and how vital public health is to society. Alcohol services are an essential part of the fabric of public health services and these studies add further weight to the urgent call for a national alcohol harm reduction strategy to support those most in need.