Alcohol misuse: tackling the UK epidemic - London

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BMA Board of Science
treatment services. The inadequate provision of specialised alcohol treatment services in the UK is a
significant area of concern. The 2004 ANARP found that:
many of the patients with alcohol use disorders identified by GPs and who were felt to need
specialist treatment, were not referred because of perceived difficulties in access (with
waiting lists for specialist treatment being the main reason given), and patient preference
not to engage in specialist treatment
there was a high level of satisfaction with specialist services once access was achieved
86 per cent of drug action team professionals indicated that their alcohol treatment budgets
were much lower than drug budgets, and that there was a ‘very large gap’ between the
provision of alcohol treatment and need or demand
considerable regional variation in the number of agencies exists across England, with
London having the largest number of agencies and the North East the fewest
the largest proportion of referrals to alcohol agencies were self referrals (36%) followed by
GP/primary care referrals (24%)
the estimated annual spend on specialist alcohol treatment to be £217 million, and the
number of whole time equivalent personnel working in specialist alcohol agencies across
England to be approximately 4,250
the average waiting time for assessment to be 4.6 weeks (ranging from 3.3 weeks to
6.5 weeks)
only 5.6 per cent (one in 18) of the alcohol dependent population were accessing
specialised alcohol services per annum. 13
While not all individuals who are alcohol dependent will need continuous structured treatment,
and many may not be willing to accept treatment places, the proportion in treatment is
disproportionately low. Similar assessments of alcohol treatment services have not been
conducted in Wales, Scotland and Northern Ireland; however, it is generally accepted that the
provision of specialised treatment services is deficient in most countries globally. 234
The lack of
necessary funding and unequal provision of specialised alcohol services is a significant concern.
Only £15 million has been allocated to primary care trusts (PCTs) in England for alcohol
interventions in 2007/08, 235
and the average amount spent on alcohol treatment by a PCT in 2006
was £273,495. 236
The SEHD allocated £13 million over 2005/06 and 2006/07 to support local
alcohol treatment, support and prevention activities. 237
The absence of a ring-fenced funding
stream for specialist services means that any funding allocated for these services may be
withdrawn and allocated to other priorities by healthcare service commissioning bodies. It is
essential that specialised alcohol treatment services are provided consistantly throughout the UK,
are adequately resourced and funded, and that this funding is ring-fenced. High-level commitment
is also required to ensure that the alcohol treatment services frameworks are prioritised when
commissioning services. v
The need for and provision of alcohol treatment services must also be
continually reviewed and assessed, building on the 2004 ANARP in England, and ensuring similar
assessments are undertaken in Scotland, Wales and Northern Ireland.
v The alcohol treatment services framework for England is set out in Models of care for alcohol misusers (DH, 2006); for
Scotland in Alcohol problems support and treatment services framework (Scottish Executive, 2002); for Wales in Substance
misuse treatment framework for Wales (Welsh Assembly Government, 2003); and for Northern Ireland in New strategic
direction for alcohol and drugs 2006–2011 (DHSSPS, 2006).
Alcohol misuse: tackling the UK epidemic