Improve support for those in need

Introduce a 'treatment levy' by increasing alcohol duties by 1% above RPI to generate additional funding for alcohol treatment services to increase the proportion of dependent drinkers accessing treatment. Furthermore, set a target date for when treatment services will be available for all who need access.

The heaviest drinking 4% of the population currently consumes around a third of all the alcohol purchased. Fourteen in every 1000 people are in need of treatment, but only one in five of those in need of treatment are currently accessing it. The under-provision of alcohol treatment is felt more keenly by certain populations. For example, less than half of local authorities in England and only 23% of Welsh unitary authorities provide substance misuse services specifically for women.

Cutting treatment provision does not save money, it simply adds to costs further down the line, while leaving dependent drinkers and their families to fall through the net.

A 1% treatment levy on alcohol duties, used to create a central top-up fund for local treatment budgets would provide an additional £100 million for treatment each year, as well as reducing costs to other public services – leading to estimated savings of around £300 million.

Mandate local authorities to provide and promote a 'ring-fenced' resource for alcohol treatment, early alcohol intervention provision, and prevention services.

While the public health grant to local authorities is currently ring-fenced, funding for alcohol treatment within this grant is not. Between 2016 and 2018 alone, over two-thirds of local authorities in England cut their alcohol treatment budgets, with 17 local authorities seeing cuts of more than 50%. This situation looks set to worsen as the ring-fencing of the public health grant is due to be removed altogether in 2020.

Cuts have damaged the workforce leading to fewer specialist staff in hospitals and community alcohol services. Additionally, in an attempt to cut costs, the ‘payment by results’ model which has been implemented in some local authorities leaves patients with complex needs overlooked in favour of patients who represent quicker wins.

There has been a recent commitment in the NHS Long Term Plan to introduce Alcohol Care Teams across 50 of the most-affected hospitals in England, however there are concerns that these teams won’t have the number of staff and level of expertise needed, and that Alcohol Care Teams are needed in at least 100 more hospitals across the country.

By providing a dedicated, ring-fenced funding stream for alcohol treatment, more expensive complications can be prevented. Public Health England’s 2016 evidence review of alcohol harm reduction policies concluded that the success of treatment interventions “depends on large-scale implementation and dedicated treatment staffing and funding streams”.

Address the needs of older alcohol drinkers by enforcing action against age inequalities in existing services and developing a range of specialist services to support older adults who drink.

Older people today are relatively heavier drinkers than previous generations. Alcohol-related deaths are highest among those aged 55-69 and alcohol-related hospital admissions for over-65s have risen by 14% in the last 10 years.

There is evidence of age discrimination in alcohol treatment services, including arbitrary age limits which prevent older adults accessing alcohol rehabs, and younger clients being prioritised for treatment. Public Health England has responded to research on these age thresholds by removing the filter from their website’s search engine. However, this doesn’t guarantee that individual services are not still discriminating against older adults in their service design.

We need to remove arbitrary age limits and make sure services are adaptable to older adults’ needs, for example by offering home visits for those who are less mobile and unable to travel to the treatment centre.

Ensure local areas have adequate service provision for those with complex needs, especially those with both alcohol and mental health conditions. One way to achieve this is to ensure assertive outreach and multi-agency partnerships are in place.

86% of people in alcohol treatment services also have a co-occurring mental health condition. However, experiencing both a mental health condition and an alcohol use disorder makes it much harder to access treatment for either. Lack of understanding and joined-up working between services, funding and workforce shortages, and stigma facing those with two or more diseases or conditions were highlighted as major problems in a survey of mental health and alcohol service professionals.

Services are also unable to meet the needs of women who have experienced domestic abuse, who may feel unable to attend mixed-gender alcohol treatment services. Women who have experienced domestic abuse are twice as likely as their violent partner to drink alcohol after abuse. There needs to be increased availability of and access to residential treatment for women with children and anonymous support services for women, such as online portals.

Recent estimates have found that 1 in 5 people in hospital are using alcohol harmfully and 1 in 10 are alcohol dependent, and in England the number of alcohol-related hospital admissions is 15% higher than it was 10 years ago. To tackle this, the NHS Long Term Plan has committed to supporting hospitals with the highest rate of admissions to establish Alcohol Care Teams (ACTs).

The NHS Long Term Plan does not define an ‘Alcohol Care Team’ and there is a danger that small ‘teams’ of one or two alcohol specialist nurses (ASNs) will be implemented, which would not be sufficient to address the problem of high rates of alcohol-related hospital admissions, In 2016, 83% of UK hospitals had one or more ASNs, although many did not have the 3-4 ASNs required to provide a 7-day ASN service.

Develop a funded national programme of advice, guidance and support for those concerned about alcohol including families, carers and children of alcohol-dependent parents.

Public Health England estimates that there around 190,000 children living with at least one alcohol-dependent adult in England. 51,000 children live with an alcohol-dependent parent or carer in Scotland. Parental alcohol use is the most common reason children have for calling Childline.

Other affected family members can experience financial problems, relationship issues, mental ill health, bereavement, and domestic abuse due to a relative’s alcohol misuse. Caring for affected children or the alcohol-dependent adult themselves can cause family members to experience financial difficulties and declines in workplace performance. A 2018 study found that 19% of people were fired or suspended for their jobs while their family member was in active addiction compared to 8% when they were not.

For more family-based alcohol policy recommendations, see Families First from the Alcohol and Families Alliance.

Ensure that relevant health and social care professionals are trained to provide early identification and brief advice, in particular GPs, paramedics and A&E staff, and create apprenticeships based on nationally recognised qualifications for the specialist alcohol and drugs treatment workforce.

There is potential for alcohol’s burden on the health service to be eased if hazardous, non-dependent drinking were identified before it develops into serious health complications.

Early identification and brief advice involves a quick questionnaire about the patient’s drinking behaviour, followed by appropriate information and advice. If patients are identified as being alcohol-dependent they can then be referred for treatment. Since they can be delivered quickly and easily, brief interventions can be delivered in a range of settings such as GP surgeries, schools, job centres, pharmacies, emergency departments and in the workplace.

Public Health England estimates that for every 5,000 people screened through such interventions, 61 hospital admissions and 57 A&E visits could be avoided.

Extending training to all relevant health and social care and criminal justice professionals would have a huge public health benefit. Similarly, strengthening the existing implementation of brief interventions is also needed.