An analysis in Health Service Journal headed by Dr Dan Poulter, who alongside being a local MP is a psychiatrist at an NHS mental health trust, has found that the move introduced in 2013 to take away responsibility for drugs and alcohol services from the NHS and to hand over to local councils, has failed. This is particularly concerning as the number of adults drinking and using opiates has risen during the pandemic.
Content warning: this article discusses addiction, alcoholism and mortality data related to alcoholism.
In 2013 local councils took on the responsibility for drugs and alcohol services, including detoxification services. This was part of the Health and Social Care Act which was helmed by then health secretary, Andrew Lansley. This was in the hopes of improving the health of the population on a local basis.
This resulted in the majority of addictions services being passed on by local council to third sector and private providers. At the time, Andrew Lansley was convinced that this was a “critical step in the transition towards the establishment of a new public health system”.
However, after Dr Dan Poulter and a team of likeminded colleagues, Jonathon Foster and Dr Emily Finch entered into a Freedom of Information request (FoI), under the suspicion that these services were not operating to the best of their ability, they found the move had been a “failed experiment”.
The series of FoI requests by Dr Dan Poulter, Jonathon Foster and Dr Emily Finch revolved around the provision of alcohol and substance misuse detoxification services, and the availability of inpatient detoxification beds. Combining this with data from the Office for National Statistics on the numbers of people actually receiving this treatment, the picture is seriously concerning, indicating numerous shortcomings in both provision and beds available.
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Between 2013 and 2017 people entering treatment for alcohol dependency decreased by 19% with no correlating figures suggesting alcohol dependency had fallen, on the contrary as mentioned above, as of last year nearly 8.5 million adults are drinking at high risk and the number of people addicted to opiates has been at its highest level since 2015.
With this sharp decrease in individuals accessing treatment, you would think this might mean government spending on these services has also decreased. The reality, however, is quite different.
The data gathered by Dr Daniel Poulter Et Al. reveals that between 2013/14 and 2019/20 the expenditure in England on these treatments rose by 27.5% per annum. This translates to an increase from £27,137,446 to approx. £34,605,303.
In contrast to this increased spending, the number of people accessing inpatient detoxification fell by over 4%
The analysis on Health Service Journal also explains how ‘block-purchased’ detoxification beds, which is a far more beneficial method in providing beds to people in need of inpatient help, have rapidly fallen, being replaced by ad hoc ‘spot-purchasing’ arrangements.
These ‘block-purchased’ beds have fallen so drastically that in London, there are now a total of zero available, despite the fact that it is known to those working in drugs and alcohol services that this is the most effective way to ensure arrangements for inpatient alcohol detoxification.
This issue is important for a number of complex reasons, these ‘spot-purchase’ beds are not always as reliable, but due to the fact that they are often third sector or even sometimes private outsourced facilities by local authorities, most of these inpatient detoxifications now take place in units that are not fully medically staffed.
This all points to one worrying fact, that people who are in need of specialist care may not be provided with the important follow-up care arrangements that prevent relapse. These follow-up arrangements include community and or mental health support which is essential in maintaining abstinence.
The need to correct this neglectful failing is no more obvious than in the data around mortality
In the analysis for Health Service Journal, they state data from the Office for National Statistics that found in the age bracket of under 50s, accidental poisonings, which are majority recorded as being due to accidental alcohol overdose or drug overdose is a leading cause of death.
Last year alone, saw 7,423 people die from alcohol misuse which is a 20% year-on-year increase. This data matches with last year’s research by the Royal College of Psychiatrists that warned of drugs and alcohol services becoming overwhelmed by the drastic increase in high-risk drinking and drugs misuse, and would soon be unable to treat those most at risk, which would inevitably lead to more deaths.
Dr Adrian James, President of the Royal College of Psychiatrists (RcPsych) said last year, “More lives will be needlessly lost to addiction unless the Government acts now and commits to substantial investment in public health”.
The research from RcPsych also noted that those with alcohol use disorder (AUD) are more likely to develop serious complications when catching Covid-19
With less and less people accessing the drugs and alcohol services and in patient detoxification beds but all data suggesting more people are in fact drinking to high risk as well as misusing drugs, there is immediate need for the government approach to these services to be overhauled.
The Covid-19 pandemic has compounded the dire need for more funding and overhaul within drugs and alcohol services provided by local councils.
All of this combined with the fact that pressures from lockdown and the pandemic over the past year have resulted in many people to relapse, with addictions resurfacing under extended periods of time alone, inside or having to tackle multiple responsibilities in a way never seen before such as child-care and work.
A recovering addict speaking to RcPsych, Rachel spoke on her resurfacing addiction during lockdown: “The stresses of caring for my daughter, alongside work-related anxiety, led to me slipping back into old ways of behaving…Taking tranquilisers and daily drinking became the norm”.
To avoid a surge of alcohol and drug related deaths over the coming months/years, attention and funding to drugs and alcohol services must be given now.
Make sure to check out one of our sister sites Rehab-Online an online directory of residential drug and alcohol rehabilitation services in England and Wales.
You can find local support near you via the FRANK website search tool here.
You can also find lots of helpful information about addiction and dependency on Mind's website, as well as their list of support organisations here.