Treatment capacity continues to shrink
This is the fourth in the series of reports written about the drug and alcohol treatment sector in England. The 2017 report takes a more narrative approach than previous editions, focusing primarily on interviewing key stakeholders and highlighting their experiences in the sector, current concerns and thoughts for the future.
The report’s key conclusion is that the treatment system has moved “beyond the tipping point” into worrying territory.
The key findings are:
- The potential of the sector to absorb funding cuts through efficiency savings has been exhausted;
- Service capacity continues to be eroded;
- Only central government intervention will protect the sector from further cuts;
- Service models must continue to evolve; and
- Commissioning capacity and practices remain of great interest and concern.
The report is based on national data analysis and 23 interviews with key stakeholders, predominantly Chief Execs of substance misuse providers and commissioners.
The report shows the decline in funding of treatment services over the last five years with sharp falls over the last two:
The picture appears to be patchy across England and Wales. Two provider Chief Executives interviewed for the report reported cuts in the range of 20-40% while two others had not experienced any reduction in total contract value. Some stakeholders felt that the transfer of substance misuse budgets to local authorities following the Health and Social Care Act 2012 is key to the de-prioritisation of substance misuse services — local authorities have had to make such very large cuts in their overall budgets, that they have (quite reasonably) not found it possible to protect any particular service from the forces of austerity.
Overall, one of the most important consequences of this reduction in funding appears to be an erosion in treatment capacity. Though the picture is complex, the overall numbers of people in the drug and alcohol treatment system have declined in parallel to the falls in local authority budgets. The total number of people in treatment showed peaks of 311,667 in 2009/10 and 301,944 in 2013/14, with a steady fall thereafter, leaving 279,793 people in treatment now (Public Health England, 2016), a fall of 7%:
It is important to note that the figures of people in treatment are not related to the number of people in need of treatment. This is particularly true for those needing alcohol treatment: the number of people dependent on alcohol and potentially in need of specialist treatment was estimated to be around 600,000 in 2017, but the number of people in treatment is only around 80,000 and has declined by about 12% since its peak in 2013/14 as the next graph shows:
The results of this cut in resources are changes in the ways in which services are commissioned, frequently involving the integration of substance misuse with other related services, but also allowing funds to be moved away from the sector:
The interviews highlight the freedom that local politicians and commissioners have within existing national funding mechanisms to shape services and deploy resources as they see fit. Positively, this gives the flexibility to integrate and balance drug services alongside alcohol treatment and psychosocial interventions alongside prescribing. It also allows for services tailored to the needs of the local population which can be jointly commissioned or at least aligned, with other important services for people with drug and alcohol dependency. However, it is felt that these arrangements also allow funds to be transferred away from substance misuse services. One
The Recovery Partnership echoes the conclusion of the recent ACMD report on commissioning that reductions in funding are harming outcomes and only central government can protect investment in treatment.
The state of the drug and alcohol treatment centre is perhaps most succinctly captured by Viv Evans’ (Adfam’s Chief Executive) in her foreword:
Unsurprisingly money is the first word on many lips. Many people we spoke to felt there may have had been “fat in the system” which absorbed some cuts without serious negative effect. But the fat has now been burnt and the muscle of a system which has changed, and saved, thousands of lives is now at risk of serious damage.
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