Alcohol Treatment Services: The state of the sector and where we go from here

In March, Collective Voice vice chair, Clare Taylor (Chief Operating Officer at Turning Point) gave evidence to the Public Accounts Committee inquiry on alcohol treatment services. Clare highlighted how the sector is faring, the trends in need and treatment delivered in response, and what we want to see from government. The PAC’S inquiry followed publication of the National Audit Office’s report on the subject, and Clare was joined in giving evidence by Dame Carol Black and Sir Ian Gilmore.

The Public Accounts Committee have now published their report from this inquiry, making recommendations to the Department of Health and Social Care (DHSC). The oral evidence provided to the Committee and their conclusions are summarised below.

1. Strategy and leadership (1)

The report states plainly that the Committee lack confidence in the government’s understanding of, and commitment to, tackling alcohol harm. There has not been an alcohol strategy published since 2012, and Collective Voice’s sponsor organisations, in written submissions to the Committee, called for the creation of a dedicated, long-term strategy for improving alcohol treatment and reducing alcohol harm (see submissions by Change Grow Live, Forward Trust, Turning Point, and With You). Departmental representatives of DHSC and the Office for Health Improvement and Disparities (OHID) stated in the Committee hearing that the government is not intending to produce such a strategy, in which case the Committee has recommended that DHSC do the following:

Recommendation 1: In the absence of a formal strategy, the Department should:

1. a) set out how it will tackle the significant costs to the NHS and society of alcohol harm, with targets and performance measures and
2. b) publish its assessment of the available evidence of effective strategies to tackle alcohol harm.

2. Strategy and leadership (2)

In addition to this, the Committee’s report contends that DHSC lacks an up-to-date understanding of the total cost of alcohol harm. The most recent figures on the cost of alcohol harm to the NHS were compiled in 2012, and Departmental estimates, while being inflation-adjusted, may fail to capture recent changes to consumption patterns and health risks. With alcohol-specific deaths having reached a record high, the Committee has recommended that:

Recommendation 2: The Department should undertake the work necessary to improve its understanding of the up-to-date costs of alcohol harm to the NHS and wider society.

3. Funding

Since 2015-16, local authorities have seen a real-terms reduction of £630m in the grant they receive from central government to help fund public health services. On top of this, Clare informed the Committee that announcements to the value of the Public Health Grant come late, and this uncertainty has “a significant impact on planning, particularly as one of our priorities is to build up the workforce and recruit more specialist staff to the sector. […]  It would be helpful for the sector in general to have a longer-term, stable commitment to funding to allow for better planning.” It is therefore welcome that the Committee have recommended:

Recommendation 3: To improve certainty around funding for drug and alcohol treatment services, the Department should:

• commit to an earlier date by which it will confirm allocations of the Public Health Grant for 2024–25 and subsequent financial years; and
• explain how it can provide greater long-term certainty to local authorities so they can plan and deliver the right investments to make a difference in their areas.

4. Treatment

The Committee heard evidence of the number of people falling through the gaps and not accessing treatment, with only 18% of alcohol-dependent people being in treatment. Barriers to accessing treatment were described as arising from limited public and individual awareness, failures by health staff to recognize high-risk drinking, missed opportunities to make referrals, and stigma. Concerns were also raised regarding whether people using alcohol only had ‘lost out’ in terms of services available compared to those using drugs and alcohol or drugs only, and challenges were also described around accessing treatment for persons with co-occurring substance misuse and mental health needs. In light of this, the Committee has recommended:

Recommendation 4: The Department should set out:

• how it is working with local authorities to address the barriers to people with alcohol dependency from getting the treatment they need; and
• what it is doing to help improve integrated care for people with co-occurring alcohol and mental health problems and to ensure that they receive the support that they need.

5. Local variation

The availability of and expenditure on alcohol treatment services differs greatly between areas. In 2021-22, local authorities’ reported spending per-100,000-people on alcohol treatment services ranged from £4,000 to over £1,000,000. The penetration rates vary too, with the percentage of people estimated to be alcohol dependent but not in treatment ranging from 58% at the lowest to 93% at the highest. In terms of outcomes, the proportion of people successfully completing treatment ranges from 29% to 90%. This extensive variability of service funding, penetration rates, and outcomes led the Committee to recommend that:

Recommendation 5: Working with local and national partners, the Department should:

1. a) identify ways to increase uptake of treatment services in areas where the proportion of alcohol dependent people in treatment is lower; and
2. b) seek to understand why success rates are particularly low or high in some areas and to identify opportunities to share best practice.

6. Workforce

There has been a marked reduction in the size of the treatment workforce, and Dame Carol Black’s Independent Review on Drugs described a sector experiencing shortages in skills, expertise, and capacity. Dame Carol this in the oral evidence session, stating that ‘the treatment workforce has been decimated’, while Sir Ian Gilmore furthermore raised the issue of specialist positions, particularly addiction psychiatrists, for whom both levels of staffing and training are declining significantly. While Departmental representatives responded that they are working with Health Education England (HEE) to ensure that the right number of people are being trained, the Committee recommended that:

Recommendation 6: The Department should update us on how it is progressing with the implementation of its substance misuse workforce strategy as set out in the 10 -year drug strategy.

The Public Accounts Committee’s report and recommendations highlight the need for greater prioritisation of addressing alcohol related harm than is currently the case. It is disappointing, though, that Committee’s report falls short of recommending that government set out a national strategy. In addition recommendations were not made by the Committee in relation to the possible improvements to commissioning, treatment settings including the availability of residential rehabilitation, and partnership and integrated working that were discussed during the evidence session.

Following publication of the inquiry’s report, Clare stated that:

“This report shines a spotlight on the damage done by alcohol not only to individuals but also to families, communities and public services. 

“It is unacceptable that deaths from drinking rose by 89% in the last two decades. Turning Point has continually raised concerns that the government is not taking alcohol-related harm seriously enough. 

“Ministers should make it a priority to reduce the widespread impact including on the NHS. Yet there has been no national alcohol strategy for over ten years. 

“This has led to lead to an uneven and uncoordinated response to public health and alcohol use. An integrated agenda is needed that cuts across sectors to provide a level of service that gives people to the best opportunities to access support.” 

“Turning Point supports more than 160,000 people a year with alcohol-related issues. We see first-hand the need for greater long-term funding for drug and alcohol treatment services and better integrated care for individuals with complex needs. 

“Action must be coordinated to addresses barriers and inequalities which prevent people with alcohol dependency from getting the treatment they need.” 

At Collective Voice we will monitor and keep the field informed of DHSC’s response to the inquiry’s recommendations and work to ensure sector engagement with any future implementation.

The National Audit Office’s report on alcohol treatment services can be accessed here.

The full minutes of the oral evidence session can be accessed here.

The Public Accounts Committee’s report can be accessed here.