How budget cuts have affected England’s alcohol and drug treatment services

By Suzie Roscoe

A bit about me: I am in my final year of my PhD at ScHARR, which is funded by a University scholarship I won in 2017. Prior to this, I had been working in the public sector for over 15 years leading commissioning and strategy for community safety, alcohol and drugs; a job I left to complete this PhD. Why? There are two main reasons. First is my passion for the subject. My study focusses on the impact of budget cuts from alcohol and drug treatment services and due to my professional experiences, I wanted to help better understand the effects to support treatment policy. Second, after completing my Masters part-time alongside a demanding job, I decided complete my PhD on a full-time basis. When I’m not studying, you can usually find me walking my rescue dogs or running in the hills.

A bit of background to my study: In England, an estimated 900,000 adults need specialist treatment for alcohol or drug dependence. Whilst this is only about 2% of the adult population, the associated harms are substantial and far-reaching. Alcohol and drug dependence can negatively affect an individual’s physical and mental health, their wellbeing, working lives, and local communities. It can affect their relationships, quality of life and life expectancy and create pressure on publicly funded services, including hospitals, social care and the police. Specialist treatment forms an important part of national policy to reduce this harm as it is evidenced to improve health and social outcomes for individuals, their families and broader society. Local authorities are responsible for funding and monitoring treatment services in England; with most of the funding being made available by the Public Health Grant. This is money given to local authorities by national Government to fund public health services, including alcohol and drug treatment. Since 2013/14, there have been reports of substantial budget cuts to Public Health Grant funding and the money allocated to alcohol and drug treatment. Whist there have been no declines in the estimated number of people who would benefit from treatment, there have been reductions in the number of people engaging in treatment but we do not know if this is connected to the budget cuts. Fewer people engaging in treatment may contribute to increased health and social harms and, in recent years, there have been increases in related hospital admissions and deaths.

Study design: This blog focuses on the results from phase one (of three) of a mixed method study (Figure 1); designed after completing a systematic review of the available evidence. Phase one matched routine quantitative data from the Ministry of Housing and Local Government, the National Health Service, the Office for National Statistics and the National Drug Treatment Monitoring System. Phases two and three build upon this by interviewing, and then surveying, people responsible for funding treatment services to understand their views and experiences of the effects of budget cuts.

Figure 1: Diagrammatic overview of my PhD multimethod study design

What did I do? In phase one, I matched readily available data from administrative reports on each local authority. I then looked at whether local authorities that had experienced larger changes in public health grant spending had also experienced larger changes in the following outcomes: treatment engagement, successful completions, alcohol-specific hospital admissions, alcohol-specific mortality, and drug-related deaths.

What did I find? Treatment services in England have lost more than £212.21 million (-27%) of Public Health Grant funding between 2013/14 and 2018/19. By 2018/19, 34,000 fewer (-11%) people were engaging in treatment and 44,000 fewer were successfully completing (-21%) alcohol and drug treatment despite overall increases in the estimated number of people who would benefit from treatment. During the same time period, there were increases in alcohol-specific hospital admissions (+9%), alcohol-specific mortality (+4%) and drug-related deaths (+24%). Areas that had experienced bigger cuts in treatment spending saw fewer people accessing and successfully completing treatment. However, areas that had experienced bigger cuts did not experience bigger increases in admissions or deaths. In my published paper, I encourage caution in interpreting these results for several reasons. For example, most people who would benefit from alcohol or drug treatment do not access treatment, so any relationships may be more identifiable by matching patient data. Also, the study focuses on a six-year period but it may take much longer for the full effects to be seen.

Figure 2: Dual axis chart showing trends in mean local authority public health grant investment in treatment and mean treatment access and successful completion numbers

These results might help policy makers make decisions about treatment funding. Fewer people engaging in, and successfully completing, treatment might increase relating harm and increase cost pressures elsewhere, including health and social care and criminal justice services.

Where can you find out more? If you are interested, you can read the full paper in Drug and Alcohol Review.

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