The crisis in funding has dominated the sector for years, but with many big names now closing their doors the situation for residential facilities is reaching crisis point. DDN reports.
It’s more than two years since the ACMD declared that funding cuts were now the ‘single biggest threat’ to recovery outcomes (DDN, October 2017, page 4) – two years in which drug-related death rates have continued to rise. Residential rehab facilities have been particularly hard-hit. According to the latest PHE figures while the number of adults entering treatment in 2018-19 was up by 4 per cent on the previous year, the number receiving treatment in residential and inpatient settings has fallen to less than 17,000 from almost 26,000 in 2014-15.
This year had already seen the closure of City Roads (DDN, April, page 4) and Broadreach House (DDN, July/August, page 12) when Phoenix Futures’ Grace House became the latest casualty. Rated outstanding by CQC, the specialist residential service provided ‘trauma-informed’ treatment for women with complex needs, many of whom had experienced domestic violence, homelessness or sexual exploitation.
Phoenix Futures chief executive Karen Biggs sees its closure as a ‘bellwether of what’s happening across the country’, she tells DDN. ‘An outstanding service that served a group who are acutely under-served – it demonstrates perfectly the lack of equality of access that people increasingly have to healthcare, certainly people who experience drug issues.’
While she’s grateful to Grace House staff for being ‘brilliant throughout’ and the 46 local authorities that referred there, she believes the concept of a national health service is increasingly becoming a fallacy for some people. ‘I don’t say that lightly. Our analysis shows there’s a huge discrepancy across the country. Funding cuts are obviously having an impact, and drug services aren’t unique in that, but what I’m speaking out about is how in a localised framework it’s increasingly evident that there’s an inequality of access for any treatment, but particularly for residential’.
Hannah Shead, chief executive of Trevi House and chair of the Choices Rehabs group, agrees. ‘Our group began six years ago and we’ve seen our membership decline at the same time as we’ve seen the need for our services increase. It’s heartbreaking – we’ve got members saying they have people phoning them who are absolutely desperate but not able to secure the funding.’
Clearly, problems in the substance misuse client group are not limited to drugs and alcohol. According to PHE, a fifth of people entering treatment last year had problems with housing (rising to a third among those being treated for opiates), while more than half were struggling with mental health issues. A fifth of all people starting treatment were living with children, while 31 per cent were parents not living with their children (44 per cent among women in treatment for opiates). So while the argument is often made that residential services are closing because they’re expensive, there’s a stronger case that they’re cost-effective.
‘When we resource addiction services effectively we take the strain off other services like criminal justice and mental health,’ says Hannah Shead. ‘It’s about vulnerable people – often trauma survivors – getting back on their feet and into society. If you take a wider perspective it’s really good value for money.’ Hospital admissions for these clients also invariably involve a detox, adds Karen Biggs. ‘But the commissioners making decisions around cuts to treatment are not the same people footing the bill for a four grand detox.’
Another crucial issue is not just reluctance to fund but the process that vulnerable people may have to go through to get that funding, she stresses. ‘Most decisions around rehab are now done through panels and for women trying to access Grace House that was a dehumanising process – to have to sit in front of a panel of professionals when you’re in a really poor state of physical and mental health and try to argue why you’re worthy of funding. That’s not a national health system as most people expect it.’ It’s also discouraging some community services from putting people forward, she adds. ‘They don’t have the confidence that they’re going to get the funding, and if they do it’s only going to be for a limited time based on budgets rather than clinical assessment.
‘I don’t want this to turn into a “rehab is best” argument – we’re way beyond that,’ she continues. ‘But there is a cohort of people, as all the evidence shows, who benefit from residential care. I get how hard it is for some local authorities, and there are pockets of excellence across the country. I also understand that when people are making day-to-day decisions they’re not necessarily thinking it’s going to result in another rehab closing. But I don’t want a situation where the only way you can get residential rehab is to pay for it yourself, and increasingly we’re getting to that point.’
Many services are having to be more creative, says Hannah Shead. ‘We’ve sort of accepted that we’re not going to be able to meet our running costs from local authorities so we’ve set up a bursary scheme, and I know other rehabs have done the same. The days of thinking we’ll be able to keep going because we’ve got enough residents in are long gone.’
So what happens now? ‘We’ve got a number of asks, but the biggest is that we need some proper national leadership,’ says Karen Biggs. ‘As a sector we’re passionate and committed and we’ve got a really clear national and international evidence base. We just need some effective national leadership to pull all that experience and skill and energy together.’
That’s not about moving policy to DHSC, as recent select committee reports have recommended, she says. ‘For me what’s going to make the difference is some form of engaged national leadership that can steer and direct at local level – when the decisions were made to lose that we were in a very different time. But we do have a public health emergency, and we do know how to respond to it. All the ingredients are there, we just need to pull that together.’
Adult substance misuse treatment statistics 2018-19 at www.gov.uk
More on Choices Rehabs at www.choicesrehabs.com
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