82% dependent drinkers not in treatment
Last week (24 May 2023), the House of Commons Public Accounts Committee (one of the most powerful committees in parliament) published a report into alcohol treatment services in which it said that the Government was not taking the “appalling” harms from alcohol seriously enough.
The Committee said that alcohol harm is a huge problem, affecting not only millions of people but also bringing significant costs for society. The financial costs of alcohol harm for the NHS and wider society are estimated at £21 billion per year.
For those in deepest need alcohol treatment services offer real hope. However, despite the alarming increase in alcohol-related deaths over the past twenty years and sharp rises since 2019, the number of people receiving treatment for alcohol dependency has generally been falling. A staggering 82% of the 600,000 dependent drinkers in England are not in treatment. This is despite success rates of around 60% and evidence that, on average, every £1 spent on treatment immediately delivers £3 of benefit and significantly more in the longer term.
Alcohol harm impacts not only drinkers themselves but also their families and wider communities. It is linked to over 100 illnesses, can drive mental disorder, self-harm, and suicide, and is a major cause of preventable death. The Office for National Statistics reported that alcohol was linked to 42% of all violent crime in 2019–20, up from 40% in 2018–19, and there is evidence that it does most harm in our most deprived communities with five times as many liver deaths as the most affluent communities.
The Committee is critical of the fact that, despite rises in ill health and deaths associated with alcohol, the Department last calculated the cost of alcohol harm in 2012. At the time, the Department of Health estimated the annual cost of alcohol-related harms to be around £21 billion, broken down as: £11 billion from alcohol-related crime; £7 billion from lost productivity through unemployment and sickness; and £3.5 billion to the NHS.
As with the cost of harm, the Department’s understanding of the prevalence of alcohol dependency is also out of date. The NAO’s report shows that the estimate of 600,000 dependent drinkers in England dates back to 2018–19, based on survey research from 2014.
An estimated 10 million people in England regularly exceed the Chief Medical Officers’ low-risk drinking guidelines, including 1.7 million who drink at higher risk and around 600,000 who are dependent on alcohol. The Public Accounts Committee report highlights a worrying increase in alcohol-related deaths, which rose by 89% over the past twenty years, with sharp rises since 2019. Despite this, the number of people receiving treatment for alcohol dependency has generally been falling.
The Department of Health awards the annual ring-fenced Public Health Grant (PHG) to local authorities each year. The PHG fell by £630 million (in 2021–22 prices), from £3.96 billion to £3.32 billion, over the period from 2015–16 to 2021–22. This has had inevitable consequences on funding for drug and alcohol treatment services, leaving services “on their knees” according to Dame Carol Black, author of the government’s independent review of drugs.
The government has invested an additional (ringfenced) £533 million boost to funding for substance misuse treatment services provided through the 10-year drug strategy although this does not take funding back to pre-austerity levels.
Complex needs/dual diagnosis
The Committee raised concerns about the relationship between mental ill health and alcohol with an estimated 70% of people entering treatment for alcohol dependency having co-occurring mental health problems. The relationship between substance misuse and mental ill health is well-established yet too many people are denied access to mental health services because of their alcohol dependency (and vice versa).
The Committee said that it was “surprised and disappointed” that the Government is not taking a more proportionate and serious approach to addressing the problem. Despite the widespread harm, there has been no alcohol-focused strategy since 2012 and the latest plans for one were abandoned in 2020.
The Committee says the Department for Health and Social Care must secure a consensus and act on the best available evidence on preventative measures around price, availability, and marketing.
The Committee also urges it to address the key issues of funding uncertainty for local authorities; barriers to accessing treatment; local variations in outcomes and severe and worsening healthcare workforce shortages.