Fifty-Fourth Report - Alcohol treatment services

Select Committee
Public Accounts Committee HC 1001 24 May 2023
Report Status Response document linked Recorded deadline: 24 Jul 2023

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Conclusions & Recommendations 25 items (3 recs)
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Government response
Treasury minutes: Government response to the Committee of Public Accounts on the Fifty-fourth report from Session 2022-23 · published 21 Jul 2023
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Recommendations & Conclusions

25 results
2 Conclusion
Undertake work to improve understanding of up-to-date costs of alcohol harm to society
Conclusion
The Department for Health and Social Care, as the lead department, does not have sufficient understanding of total cost of alcohol harm. The harms to individuals and society that alcohol misuse can cause are well-known. Alcohol is linked to over … Read more
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3 Conclusion
Confirm Public Health Grant allocations earlier to provide long-term funding certainty for treatment services
Conclusion
Delays by the Department in finalising the allocation of the Public Health Grant, coupled with short-term funding and reductions to the public health grant, make it difficult for local authorities to plan and commission alcohol treatment services effectively. Since 2015–16, … Read more
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4 Recommendation
Address barriers to alcohol treatment access and improve integrated care for co-occurring conditions
Recommendation
We are concerned that a high proportion of people with alcohol dependency are not in treatment and that there are unnecessary barriers to people in need of treatment. Treatment services for alcohol dependency are commissioned by local authorities. They show … Read more
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5 Conclusion
Identify ways to increase alcohol treatment uptake and share best practice for success rates
Conclusion
There is concerning local variation in reported spending on, and outcomes from, alcohol treatment. In 2021–22, the amount local authorities reported spending on alcohol treatment varied from £4,000 per 100,000 people to over £1 million, with median spending of £313,000. … Read more
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6 Conclusion
Update on implementation progress of the substance misuse workforce strategy
Conclusion
There has been a marked reduction in the size of treatment workforce, in particular, of addiction psychiatrists. Dame Carol Black’s independent review on drugs highlights that a prolonged shortage of funding has depleted the treatment and recovery workforce and resulted … Read more
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1 Conclusion
Committee gathered evidence on alcohol treatment services from key stakeholders
Conclusion
On the basis of a Report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department) on alcohol treatment services.1 We also took evidence from Alice Wiseman, Director of Public Health, … Read more
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7 Conclusion
Government drug strategy begins to address alcohol but lacks sufficient prevention focus
Conclusion
When we asked if government’s drug strategy adequately dealt with alcohol, Dame Carol told us that she thought it began to deal with it. She hoped that of the circa 50,000 new treatment places that came with her independent review, … Read more
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8 Conclusion
Department contests preventative measures while experts cite clear evidence for action
Conclusion
On discussing the merits of preventative measures, the Department told us that what works and does not work on alcohol was very well researched but that the right approach for some areas was highly contested. By way of example, it … Read more
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9 Conclusion
Extensive alcohol harm impacts deprived communities, but cost and dependency data are outdated
Conclusion
Alcohol harm impacts not only drinkers themselves but also their families and wider communities. It is linked to over 100 illnesses, can drive mental disorder, self-harm, and suicide, and is a major cause of preventable death. The Office for National … Read more
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10 Recommendation
The Department's alcohol harm cost calculations are outdated, hindering effective policy decisions.
Recommendation
The NAO’s report shows that drinking patterns have changed considerably since 2012 when the cost of alcohol related harms were last calculated, with young people generally drinking less.21 The Department told us that we had also seen more liver disease … Read more
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11 Conclusion
Significant Public Health Grant cuts have severely reduced funding for alcohol treatment services.
Conclusion
The Department is responsible for allocating the annual ring-fenced Public Health Grant (PHG) to local authorities each year. The PHG fell by £630 million (in 2021–22 prices), from £3.96 billion to £3.32 billion, over the period from 2015–16 to 2021–22.23 … Read more
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12 Conclusion
New substance misuse treatment funding is welcomed, but remains short-term and insufficient.
Conclusion
We heard from Ms Wiseman that local government welcomes the additional £533 million boost to funding for substance misuse treatment services provided through the 10-year drug strategy, and that it was good to have it ringfenced. However, Ms Wiseman cautioned … Read more
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13 Recommendation
Late allocation of the Public Health Grant creates significant uncertainty for local authorities.
Recommendation
When we asked the Department why, at 2 March 2023, it had not yet awarded its PHG for 2023–24, the Department acknowledged that it was very late but not unusually so. The Department explained that over the last three years … Read more
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14 Conclusion
Alcohol treatment is effective and cost-efficient, yet only a small minority access it.
Conclusion
There is convincing evidence that alcohol treatment services are accessible, successful, and cost effective. As the NAO’s report sets out, data from the National Drug Treatment Monitoring System show that around 60% of those leaving treatment for problems with alcohol … Read more
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15 Conclusion
Low public awareness and poor NHS identification hinder access to effective alcohol treatment.
Conclusion
When we asked Ms Wiseman what was preventing people from accessing treatment, she explained that there was a big issue with people being able to accept that they have a problem in the first place. We heard that drinking alcohol … Read more
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16 Conclusion
Stigma surrounding alcohol dependency, especially with drug users, prevents people seeking treatment.
Conclusion
Even once people accept they may have a problem, issues with stigma can prevent them from accessing help. For example, we heard that people often feel a sense of shame at being unable to “drink responsibly”.36 Dame Carol described the … Read more
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17 Conclusion
Health services are failing to adequately identify and refer alcohol-dependent individuals for treatment.
Conclusion
Most people entering treatment for alcohol dependency in England self-refer. In 2021– 22, only 23% of referrals were from health services.40 Our expert witnesses thought much more could be done to identify people early and direct them towards treatment. Ms … Read more
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18 Conclusion
Co-occurring mental health and alcohol problems frequently result in denial of vital treatment.
Conclusion
Dame Carol, Sir Ian, Ms Taylor and Ms Wiseman all raised concerns about the relationship between mental ill health and alcohol. Sir Ian told us that an estimated 70% of people entering treatment for alcohol dependency have co-occurring mental health … Read more
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19 Conclusion
A lack of in-patient and residential alcohol treatment creates significant access barriers.
Conclusion
Sir Ian and Ms Wiseman spoke of the cost effectiveness of in-patient and residential treatment services. We heard examples of how the lack of in-patient and residential services in some areas of the country meant patients were left either bouncing … Read more
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20 Conclusion
Local authority alcohol treatment spending varies significantly, actual figures obscured by poor data.
Conclusion
In 2021–22, the amount individual local authorities reported spending on alcohol treatment varied from £4,000 per 100,000 people to over £1 million, with median spending of £313,000. Three local authorities reported spending £0 on alcohol treatment services.45 In her independent … Read more
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21 Conclusion
Wide local variation in alcohol treatment coverage and patient success rates exists.
Conclusion
The NAO’s report showed considerable local variation in both the proportion of dependent drinkers in treatment and the success rates from those treatments. Nationally, an estimated 82% of alcohol dependent adults in England were not in treatment in 2018– 41 … Read more
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22 Conclusion
Department believes local authorities effectively commission public health services, despite regional performance variations.
Conclusion
While noting the variation in performance outlined in the NAO’s report, the Department told us that local authorities broadly did “a great job of commissioning public health services.” The Department told us that it had published a set of guidelines … Read more
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23 Conclusion
Chronic underfunding and staff shortages severely deplete the addiction treatment workforce and skills.
Conclusion
Dame Carol’s independent review on drugs highlighted that a prolonged shortage of funding and frequent retendering of treatment services had led to a high turnover of staff and depletion of skills. During the session, Dame Carol explained that the number … Read more
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24 Conclusion
Department acknowledges workforce shortages, developing strategy to increase mental health and addiction professionals.
Conclusion
The Department acknowledged the fall in clinical psychiatrists and mental health practitioners and agreed that services needed access to the full set of professionals.54 The Department noted that it had already committed to securing an additional 800 mental health and … Read more
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25 Conclusion
Additional funding aims to reintroduce health professionals, yet stable funding is crucial for specialist staff.
Conclusion
The Department assured us that, as part of its monitoring activity, it would be looking closely at the numbers of people employed. We heard it was keen that the additional funding (£533 million) serve to reintroduce health professionals into treatment … Read more
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