Samir Jeraj – Freelance Journalist

Drug and alcohol services across England have been slashed by £100m over the past five years.

Over a third of councils have cut spending on treating addiction by 20 per cent, with seventeen councils cutting their budgets by more than a third. Barnsley, Staffordshire, Rochdale, Rutland and the London Boroughs of Ealing and Hounslow have seen the largest cuts – 40 per cent or more.

The cuts have forced local services to close at a time when demand is growing, and the number of drug and alcohol-related deaths is at a record high. NHS figures show 5,843 people died in 2017 from causes directly-linked to alcohol, a seventeen per cent increase in a decade. Drug-related deaths are at the highest levels since records began in 1993. 3756 people died in 2017, and 3744 in 2016, with the North East having the highest rate of deaths.

In Rochdale, the High Level Trust is facing closure by the end of 2019 if it cannot find funding to replace the £390 000 they received from the local council to run rehabilitation programs. “We went from 15 members of staff down to five members of staff and then they told us the year after that we wouldn’t be getting any funding,” explains Callum Jones.

The High Level Trust provided ten different support groups, one-to-one support, and a range of wellbeing activities to help people who had detoxed and needed to stay sober. The organisation now has just two members of staff who, together with some volunteers, are able to put on one support group, and to keep their building open as a social space for a few hours a day.

The one-to-one help they provided has also suffered. The Trust had helped around 300 people at any given time through these sessions, but this has fallen to just 140. “With two of us here we can’t see that many clients, we just wouldn’t be able to give them enough time,” says Jones.

Rochdale Council tendered for a single detox and rehabilitation service in partnership with neighbouring Oldham Council. Turning Point, a large national charity, won the tender. Jones is sceptical about the single-service model. This is because it means people struggling to detox being around those trying to stay sober. Jones says service users trying to maintain their recovery can be triggered by seeing people under the influence, or people who they drank or used with.

The outlook for the charity is bleak: “Come December if that’s all the funding we have got we will still lose one person and It will just become one person working here… We can manage, I can manage it with five, but two we are really stretching it at the minute,” Jones says.

“By the time you get an appointment to see someone the moment has passed.” Sue is a worker in a youth service in the East Midlands. She works with young people leaving care, many of who experience drug and alcohol issues. Sue says the youth services in Northampton are brilliant, the issue they face is getting support at the point when a young person admit they have a problem with drugs and alcohol. It could be a month before they get seen.

“3-4 years ago we could get a drug and alcohol worker to come to our drop in sessions with the young people once a month or every other week,” she explains. This meant the young people got used to them being there and could build the trust needed to start a conversation about drug and alcohol issues. Now, Sue explains, there’s not really time for that and things are very much focused on specific individuals and cases.

The training for staff and other agencies has been cut to almost nothing, according to Sue. “We’re not social workers, we’re support workers,” she says. This training brought together people from housing, domestic violence, mental health, and employment to give them knowledge about drug and alcohol issues and build knowledge and skills across the workforce. For the young people, failure to get clean means they struggle to get back into education or to go into training programmes that might lead to a job.

Elsewhere in the UK, some services have been able to keep going and provide good services, despite of the cuts. Liam is in recovery and has used drug and alcohol services in Nottingham. He also helps other young people struggling with drug and alcohol addiction. He feels being able to access services as soon as possible is crucial to helping people. “I think it is one of the things that Nottingham does heads and shoulders above other places where you have to wait for an appointment. So I have been with another lad and because I was aware of the self-referral place we just walked there. I met him for a coffee and was like let’s go here let’s get you checked out, let’s get you speaking to someone.” He also raises that Nottingham is rare in providing and supporting people to use Naloxone kits, which costs less than £20 and help prevent death from overdoses.

Nottingham uses a holistic approach that brings in housing and employment. They also provide a range of wellbeing services like massage that help people reconnect with themselves. “Offering something like massage when they have probably not had a physical connection with someone that has not been therapeutic, I think really sorts people’s mental health and recovery,” Liam says.

Even here, the cuts have had an impact. According to Liam, caseloads are much higher for staff. The service has also had to move into a council-owned building, which means the council gets to pick and choose what services are provided. Needle exchange and care services were not allowed to move into the building, which Liam thinks is because it is in a tourist area of the city.

“When I first started in this line, we had four times the amount of staff we have now and the level of service we were able to provide was so much better. And you can just see that people don’t respond to the services as well because they are not there.”

Louise is a drug and alcohol worker in the South West. According to her, the cuts to local services mean people are passed around the system, particularly people who also have mental health problems and are homeless. Staff are struggling to to cope with higher workloads. “Turnover is massive. Before I worked with the same people for years and years, whereas now people come in and get burnt out,” Louise says.

She recently had a former client die after they were placed in a homeless hostel Louise felt was unsuitable. The hostel was the only place locally that would accept someone without a home and with both mental health and substance issues. Louise says, “it is really frustrating because you know what needs to be done to help people and you just haven’t got the resource to do that.”

Last year, the government announced a £6m fund to support children growing up in homes with an alcoholic. However, these broader cuts to drug and alcohol services are already having an impact on the life chances of children. Durham Council recently stated growing issues drug and alcohol abuse were one of the reasons for a rise in child protection cases.

“How can I commissioning services when I knew the budgets weren’t sufficient for the need. So I had to walk away from it.” Bernadette Linton was a commissioner of drug and alcohol services in Leicester for eight years. During that time she saw budgets cut after the public health funding ringfence was removed and a shift to a ‘payment by results’ system before deciding to walk away.

The ‘payment by results’ system paid out to providers when someone left clean and did not come back within six months, known as a ‘successful completion’. According to Bernadette this led to providers gaming the system by either finding ways to stop people coming back, or putting them into a lower tier service that would not have to be reported to their funders. “To have a successful completions target goes against what we know about addiction, because it can take people four five, six, seven, eight times of treatment round the cycle,” she says.

There is pressure on staffing, she adds, when drug and alcohol services are recommissioned, providers downgrade the staff so there are fewer clinical specialists and more substance workers. These lower skilled and paid workers are working with 50-60 cases. What this means in practice is people with severe needs are only being seen once a month, rather than weekly, and a move to group-based work instead of intensive one to one treatment.

“The government needs to look again at its policy, the ringfence needs to go back up.”