Dr David Bremner, consultant addictions psychiatrist and medical director at Turning Point, explains why the NHS and the third sector both must play a part in providing safe, effective substance misuse services.
Recent articles in the Health Service Journal and the Guardian expressed concerns about the quality of drug and alcohol treatment in this country, calling for a greater role for the NHS in the commissioning and delivery of services.
Today, the third sector (primarily large, national, specialist organisations run on a not-for-profit basis) deliver the majority (approximately two thirds) of drug and alcohol services with the remainder delivered by the NHS. Services are commissioned by local authority public health teams.
Between 2001 and 2008, investment in drug treatment rose from £250 million a year to £750 million a year. During this period, many local services transferred from the NHS across to the third sector. Numbers in treatment increased from 80,000 to 230,000 and waiting times reduced from nine weeks to five days.
There were steady improvements in treatment quality with reduced early dropout, increasing successful completions and a dramatic reduction in drug related crime. Ready access to treatment is responsible for a third of the overall reduction in crime this century according to Home Office research.
Substance misuse services delivered by the third sector are clinically robust and, importantly, are judged on the very same quality standards as NHS services with regulation from the Care Quality Commission (CQC). At Turning Point, 93% of our services are rated Good or Outstanding by the CQC.
More than this though, third sector providers are strongly rooted in their local communities. They see the person not just the problem and work collaboratively with partner agencies – including NHS Trusts – to help people access support on a range of issues, whether that be education, employment or training, benefits, housing or mental health, all crucial ingredients in a person’s recovery from addiction.
The HSJ and Guardian articles argued that the unit cost of inpatient detox and residential rehab services has increased. This may be the case, although there is no nationally published information on the costs of residential treatment and the authors acknowledge the data they have gathered is potentially unreliable. We currently have a mixed market with a range of different providers providing different types of treatment.
It is certainly the case that the NHS is best placed to provide hospital based detox for patients with complex needs. However, the third sector provide high-quality, medically-managed detoxes at a lower cost for lower risk patients with lots of options to choose from. We need to ensure we deliver the right intervention for each individual while balancing cost and service user choice.
Both pieces correctly highlight the fact that there is a public health crisis at play here. The number of drug related deaths increased by 52% over the past 10 years. The Institute for Government concluded that “a decade of budget pressures meant that public services entered the [COVID] crisis with ailing performance levels, severe staffing pressures and having underinvested in buildings and equipment.”
This is certainly the case for the substance misuse sector, which has been underfunded for many years. Nationally, funding reduced by 24% between 2014 and 2019. Inflation over this period was 13%, which means that the effective real term cut to drug and alcohol service budgets over this time period has actually been 37%. This public health crisis is the making of a decade of cuts, not the shift to local authority commissioning.
Read the full blog post here.
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