The current state of alcohol treatment
The Recovery Partnership review of the current state of alcohol treatment in England makes for interesting reading.
The report was funded by the Department Health and undertaken by Alcohol Concern; it examined how recent changes in health and social care have impacted on:
- service user journey
- the training of staff and
- the needs of specific groups, especially carers.
The review was based on three national surveys, 46 individual interviews and 14 workshops with a mixture of commissioners, service providers, service users and other stakeholders.
The review highlights five main findings which are discussed below:
1: The alcohol treatment system has been through a period of great change in the last three years.
Almost 70% of survey respondents reported that their local services have been recommissioned in this three-year period. Nonetheless the majority of respondents felt that alcohol services were improving:
- Alcohol treatment appears to have benefited from joining with drug services and accessing the resources in the former pooled treatment budget, although it should be remembered that alcohol treatment is starting from a low baseline.
- Investment in alcohol hospital liaison has increased.
- Public health commissioners across the country consider alcohol a priority.
2: There were however a number of concerns
- Problems with the tendering process suggest the need for a review and guidance on how to balance competition and service user needs when tendering in the alcohol field.
- Linkages are breaking down between agencies because of the turnover in provision. Non-specialists may be uncertain about the local provider.
- Agencies are being turned into competitors with a detrimental effect on care pathways. Previous providers may continue to run parts of the treatment system and may feel reluctant to share their proprietary material with a competitor.
3: A relatively positive view also prevailed regarding the quality of alcohol services
Those consulted for the review held a generally positive opinion on key issues such as waiting times, length of intervention, assessment and care planning as well as the interventions available.
- Public education / social marketing was identified as a gap but not a major priority.
- Access to residential services was the biggest gap among the key treatment modalities. Access to these resources is variable and respondents highlighted many areas where funding was very hard to secure.
4: There was concern over meeting the needs of different groups of users
- There was a consensus that service users with mental health and alcohol misuse problems were not getting their needs met and that the provision of dual diagnosis services was worsening because budgets have been cut in mental health services and they are now commissioned by a separate body (CCGs) from alcohol services (Public Health). This represents a real blockage in the pathway of care for problem drinkers which was proving very difficult to resolve at the local level. Concern was also expressed about Alcohol Related Brain Injury.
- A widely held view was that the physical health of alcohol service users is worsening. This links to national concerns about the rising rate of alcohol related liver disease. This raised questions about professional training and whether the pressure to reduce costs is reducing knowledge about physical ill-health.
- Chaotic, change-resistant service users have higher rates of both mental and physical health problems and because they are treatment resistant can be missed in target driven re-commissioning structures. There was a strong feeling that this a group whose needs should be prioritised.
- The needs of eastern European drinkers were frequently highlighted .
- The needs of carers and concerned others were also seen as a group that received too little help and would benefit from further support.
5: Concerns about professional training
There was a strong view that the alcohol field requires a robust system of professional accreditation to ensure the maintenance of standards.
The review’s authors, Mike Ward, Mark Holmes and Lauren Booker, concluded that underpinning all of these findings was the need for much greater guidance at a national level without which it was felt that local commissioners would struggle to address many of the issues identified in the review.