Spending on residential drug and alcohol treatment is being “significantly de-prioritised” by local authorities in England, forcing centres to close or downgrade services, figures have revealed.
The latest casualty is Chandos House in Bristol, which has just announced it is being forced to close in the face of “swingeing austerity” cuts, leaving the city without a single residential rehab centre.
As the number of drug-related deaths rises each year, leading figures in the drug and alcohol treatment sector argue that spending on treatment should be going up, and that the cuts may even be contributing to the rise in numbers.
The figures obtained by a Freedom of Information request by a leading private addiction treatment service, UKAT, show spending on residential rehab and detox treatment in England has been reduced by 15% since 2013/14.
It was in that year that the government removed the ring-fence which had forced local authorities to spend certain amounts on drug and alcohol treatment.
UKAT say this decision was a “catalyst for disaster” as overall drugs deaths hit record levels for the fourth year in a row.
Residential rehab and detox services are often the best option for the most vulnerable addicts, who are at the highest risk of dying from drug and alcohol problems. This is because it takes them out of situations where they will be exposed to other addicts and their mental and physical health is looked after alongside their treatment, according to the experts.
However, the picture is likely to be much worse as only 61 local authorities responded to the request for information.
The total amount spent on rehab and detox services has plummeted by almost £4 million over the last four years. There has also been a reduction in the percentage of spend on rehab and detox, even though the actual Public Health Grant for the 61 councils went up by £233m.
Analysis by HuffPost UK found that over two-thirds of councils who responded to the FOI request have budgeted to spend less on residential rehab and detox services.
Some local authorities have made significants cuts this year, including Bolton which has cut the budget by 58%; Lambeth, which has cut its budget by 57%; and West Sussex and Leeds, which had both cut budgets by 54%.
All of the ten councils who have cut their budgets the most have seen a rise in drug-related deaths during the last six years, according to the latest ONS figures.
Of the worst, Bolton has seen a 13% rise, Lambeth a 69% rise, West Sussex a 55% rise and Leeds, where 159 people died from drug related deaths in 2017, has seen a 89% rise since 2010-12.
It’s not just residential treatment which has seen cuts. Earlier this year, it was revealed that £162m (18%) has been cut from the budgets for drug and alcohol services in England since 2013-14.
Seven out of 10 councils in England made cuts to the amount they planned to spend on drug and alcohol services and of those councils, 83% saw an increase in drug-related deaths.
The problems began when the coalition government of 2011 decided to transfer responsibility for drug and alcohol treatment to local authorities, Jan Melichar, a fellow and spokesman for the Royal College of Psychiatrists, said.
The later removal of the ringfencing exacerbated the problem as it meant local authorities put spending for drug and alcohol treatment to the “bottom of the pile”, he said.
The most vulnerable are often those most likely to benefit from residential treatment, he said.
He said: “The saddest thing is some of my addicts, who have committed a crime, will say ‘I’m glad I have been caught because I can go to prison for a bit of time out.’ That’s how bad their lives are.
“When they want to turn it around and get better and move on, rehab offers them that opportunity by allowing them to stay somewhere and be surrounded by people who accept where they have been and what’s happened to them but want them to continue moving on with their lives rather than getting back into using drugs.”
When rehab centres like Chandos House close, it’s those people who “just won’t get better”, he added.
The cuts to budgets for treatment don’t just contribute to the rise in drug-related deaths but put additional pressure on other already stretched services, especially the NHS and the prison service, he said.
″The people that are really tough to treat, the services have gone for them. What you see is repeated A&E visits, long hospital stays to treat illnesses such as liver disease, more crime and prison sentences.
“You see more homeless people on the streets these days because they’ve got nowhere to go to get better. That’s the heaviest and saddest part of it.
“In the future, [the cuts] will have massive costs to society. More will occupy hospital beds, more will be sent to prison for extended stays where they are just being held and not treated, more will be homeless. More will die. It’s very sad.”
Eytan Alexander, founder of UKAT, said: “More and more government-funded rehabs are closing because of budget cuts, yet overall, more and more people are dying from drug misuse than ever before; the way in which the Public Health Grant is being spent just doesn’t make sense.
“Removing the ring-fenced drug and alcohol treatment services budget was a catalyst for disaster. We urge councils to make better decisions with regards to investing in public rehab and detox facilities rather than forcing this free treatment to disappear.”
Paul Hayes of Collective Voice, which represents eight of the largest third sector providers of drug and alcohol treatment services, said local authorities weren’t to blame as the cuts were happening within the context of austerity.
“People aren’t going to demonstrate on the streets because budgets for drug and alcohol treatment have been cut like they might if it was a library”
- Paul Hayes, Collective Voice
“As the amount of money available reduces, and some councils have cut significantly more than others, local authorities themselves have had their budgets cut [by government]. Everyone knows the pressures that Northamptonshire are under, for example.
“This is happening within that context so it’s important that we’re not seen to be blaming local authorities as such. They have been placed in very difficult positions and the reality is that drug and alcohol treatment is particularly vulnerable.”
He said the entire system is under pressure so it doesn’t surprise him that residential centres such as Chandos House in Bristol are facing closure.
“It’s a population that isn’t politically popular either with local politicians, the electorate or the media. People aren’t going to demonstrate on the streets because budgets for drug and alcohol treatment have been cut like they might if it was a library.
“It’s a population that to a large extent is hidden and the consequences are hidden,” he said.
He said that it’s the quality of care which reduces rather than necessarily the numbers being treated. Access to residential rehab is one of the areas which is affected as people are offered much cheaper treatment services such as those offered in community settings.
“The number of people being treated has held up well and the waiting times has held up well. They are the key numbers that Public Health England are interested in but that’s been bought at a price.”
Even the government’s own drug strategy, which was brought out in 2017, says that treatment isn’t enough. It recognises that in order for people to fully recover from drugs, they need to have a job, a place to live, have access to mental health treatment and that their physical health needs to be looked after.
Hayes said a “lifetime of drug use, smoking and inappropriate alcohol use” leaves addicts particularly vulnerable as they often have numerous health conditions particularly their heart, lung and liver function. This is what makes them prone to overdose, he said.
“What you’ve got is not a situation of people being trapped outside the system, but what we’re able to offer the people within the system is becoming truncated. There is less choice and less opportunities to work on all the things that need to sit alongside the bare bones of treatment for them to actually recover in the long term.”
Steve Moffatt, public policy manager of leading addiction charity Addaction, said that residential rehabs are relatively expensive compared to other services.
“I’m not querying the validity of people using them because there can be huge benefits and we definitely support them when it’s evidenced that an individual can benefit from them.
“But within some areas local commissioners will look at the expense, and because cuts are being made, they’ll just try to keep as much primary service in tact ... so they might say that if they have to cut the budget for drug and alcohol treatment, this is where we’ll cut it.”
A spokesman for the Local Government Association, which represents local authorities, said that councils are committed to ensuring that those people affected by drug and alcohol problems get the right support and treatment.
“Providing well-funded, targeted and effective substance misuse services is vital,” he said. “In the past year, local authorities spent more than £700 million on tackling substance misuse and are commissioning services to enable people to beat addiction and sustain their recovery.
“However, cuts to councils’ public health grant by central government means have consequences. We have long argued that reductions by central government to the public health grant in local government is a short-term approach and one that will only compound acute pressures for the NHS and other services further down the line.
“Reductions in the public health grant to councils need to be reversed and more money needs to be invested in cost-effective prevention and recovery work.”
A Department of Health and Social Care spokeswoman said: “Both alcohol consumption and drug misuse have fallen in recent years, and addiction services remain free of charge and available to all.
“However, we are committed to doing more. We are working to protect the most vulnerable from the illicit drug trade – and developing a new alcohol strategy.
“We are also giving local authorities £16 billion over the current spending period for public health services including addiction treatment.”
The government also said that while local authorities have responsibility for how they spend their public health grant, the conditions of the grant make it clear that they must have regard for the need to improve the take up of, and outcomes from, their drug and alcohol misuse treatment services as well as the need to reduce health inequalities.
