31 July 2019

Massive cuts to alcohol rehab services mean a "national epidemic" of alcohol-related problems is not being tackled, King's College London researchers say.

And people with drink problems in England are less than half as likely to receive the right help as those in Scotland and Wales.

More than £100m has been cut since services in England were reorganised in 2012, the study found.

Councils in England say central government grant cuts are to blame.

The study, published in the British Medical Journal, found that, on average, drug and alcohol services in England had lost approximately 30% of their budgets since 2013-14, when they were handed over to local authority control.

In Scotland and Wales, where there has been investment in alcohol treatment services, people with alcohol dependency are 2.5 times more likely to have access to specialist treatment than those in England, where hospital admissions for alcohol-related conditions have risen 17% in the past decade.

How alcohol care changes lives

For Catherine Maxwell, from Liverpool, it is the little things that count - like just waking up in the morning and not having a hangover.

The first couple of months without a drink "were awful", she says.

"I didn't feel physically that bad, but it was the emotional side of not knowing if I felt depressed I could just drink myself into oblivion."

But with the support she received from the alcohol care team at the Royal Liverpool University Hospital, she discovered the advantages of not drinking.

"Just going for a walk around the park and looking at the flowers. I know that sounds corny, but just seeing things that are beautiful and noticing them and appreciating it," she says.

Last Christmas was her first without a drink. She remembers Christmases in the past when she "just couldn't wait to get home to carry on the drinking".

"I just look back at the way my life was and the way it is now and I compare the two and I'd just say it's so much better now," she says.

"I haven't enjoyed life in this way for decades - you know, if I think about it, because I was always slightly not quite alive."

Last year, the alcohol care team at Royal Liverpool University Hospital - one of the first to be established in England, over a decade ago - saw more than 2,500 people in their clinics.

The team are alerted by colleagues in the accident and emergency department if they suspect a patient's underlying problem is alcohol related.

"What we do is take an opportunity to explain to patients why alcohol might have contributed to or caused their admission," nurse consultant Lynn Owens told BBC News. 

The team can then prescribe the person some anti-craving medication, to help them overcome the initial withdrawal symptoms, and can then work with them over the course of the following months to help them stay sober.

"Treatment for alcohol-related problems in this country is poor," she says.

"The more respect you show a patient, and the more dignity you afford them, the more likely you are to increase their motivation to change."

Further analysis by King's College revealed the inpatient detox support had been cut by 54% since 2011-12, while specialist community support had been reduced by 22% since 2013-14.

"The services that are being cut have a strong evidence base of effectiveness and cost effectiveness," says Colin Drummond, professor of addiction services at King's.

"For every £1 you spend on treatment, you save over £3 in NHS and social care costs, so cutting these services is a false economy."

In separate research published earlier this month, the same team found alcohol-related conditions in NHS hospitals were approximately 20-30 times higher than official government statistics suggested.

NHS England announced earlier this year that as part of its 10-year plan for the NHS, it wanted to create alcohol care teams (ACTs) in the 25% of hospitals with the highest rates of alcohol-related admissions - but Prof Drummond says that is not nearly ambitious enough "in tackling what is evidently a national epidemic".

"Given the prevalence of these conditions within NHS hospitals across England, as a first step an ACT in every hospital would appear warranted, not merely the top 25%."

Prof Drummond told BBC News: "While it's great that the government is to invest more in alcohol care teams in acute hospitals, which is really needed, there is not much point in having a Rolls-Royce hospital-based service when you have a Reliant Robin with a flat tyre waiting in the community to pick you up."

Picking up the bill

The Local Government Association, which represents councils in England, called on the new prime minister to use the upcoming spending review to reverse cuts to local authority budgets.

In particular, the LGA says, public health grants, which, among other things, fund community drug and alcohol services, have been reduced by £700m in real terms since 2015-16.

Ian Hudspeth, who chairs LGA's community wellbeing board, said: "Councils are committed to ensuring that those people affected by alcohol and drug problems get the right support and treatment. So, providing well-funded, targeted and effective substance misuse services is vital.

"However, cuts to councils' public health grant by central government have consequences.

"Leaving councils to pick up the bill for treating new and increasing numbers of users while having fewer resources cannot be an option.

"It is therefore essential that the new prime minister uses the upcoming spending review to reverse these reductions to the public health grant and provides councils with the money needed to invest in cost-effective prevention and recovery work."

Source: BBC