Specialist Residential Drug and Alcohol Treatment role in reducing health inequalities

4th July 2024

In 2021 the Government launched a new 10-year drug strategy with an initial commitment of an additional £532m for drug and alcohol treatment and recovery services from 2022/23 to 2024/25. The strategy followed the recommendations of the Black Review, that set out the full impact of disinvestment on the sector and the people and communities we serve. Whilst the funding promised has reached the sector and delivered some benefits, the impact of it is limited by current funding mechanisms and the lack of strategic leadership and oversight possible in the current structure. Larger generic services have absorbed the vast majority of recent additional funding. Smaller specialist services such as residential treatment have missed out.

Despite the Government’s commitment to increasing access to residential treatment in each local authority area to 2% of people in treatment (a modest ambition compared to an average 11% in Europe), we still have swathes of the country where no one can access this specialist form of treatment. The Black Review recognised residential placements have been in severe decline since 2014 despite increasing need. This means people with multiple and complex needs aren’t getting the treatment that would support them to recover, including women who have experienced trauma, people with co-occurring mental health conditions and people leaving prison. This in turn exacerbates pressures elsewhere in the system, including NHS services such as A&E and Mental Health provision, Police and the wider criminal justice system, and the other parts of the Health & Social Care system. 

Residential services are specialist services but not commissioned, they are spot purchased by local authorities. There is no strategic ownership of residential provision nationally, regionally, or locally. Whilst there is nothing preventing local authorities from including investment in individual residential treatment provision in their drug strategy improvement plans, the lack of strategic accountability for residential provision by many local authorities means they have failed to do so. 

As a result, many residential treatment services are still at risk of closure because of lack of funding, including specialist women’s services, services that support families in addiction and services that provide support for people leaving prison. Without this being addressed residential treatment services are forecast to disappear by the end of the decade.

We are calling on the next Government to 

  • Recognise the vital role of specialist residential treatment provision to reducing pressure on our health systems, our criminal justice systems and improving health inequalities for many people who face barriers to treatment
  • Fix the systemic issues highlighted by expert reviews and select committee reports that create a postcode lottery to specialist services and exacerbate health inequalities across the country. Some of the areas of England with greatest levels of deprivation are most affected by loss of access to residential treatment.

There are straightforward fixes to these issues, there has been a lack of engagement with residential providers in the solutions to these issue, however we are willing and able to work with the next Government to reduce inequality.