NEWS FOCUS
SHUTTING UP
The crisis in funding has dominated the sector for years, but
with many big names now closing their doors the situation
for residential facilities is reaching crisis point. DDN reports
I
t’s more than two years since the ACMD declared that funding cuts
were now the ‘single biggest threat’ to recovery outcomes (DDN,
October 2017, page 4) – two years in which drug-related death
rates have continued to rise. Residential rehab facilities have been
particularly hard-hit. According to the latest PHE figures while the
number of adults entering treatment in 2018-19 was up by 4 per cent on the
previous year, the number receiving treatment in residential and inpatient
settings has fallen to less than 17,000 from almost 26,000 in 2014-15.
This year had already seen the closure of City Roads (DDN, April, page 4)
and Broadreach House (DDN, July/August, page 12) when Phoenix Futures’
Grace House became the latest casualty. Rated outstanding by CQC, the
specialist residential service provided ‘trauma-informed’ treatment for
women with complex needs, many of whom had experienced domestic
violence, homelessness or sexual exploitation.
Phoenix Futures chief executive Karen Biggs sees its closure as a
‘bellwether of what’s happening across the country’, she tells DDN. ‘An
outstanding service that served a group who are acutely under-served – it
demonstrates perfectly the lack of equality of access that people increasingly
have to healthcare, certainly people who experience drug issues.’
While she’s grateful to Grace House staff for being ‘brilliant throughout’
and the 46 local authorities that referred there, she believes the concept of
a national health service is increasingly becoming a fallacy for some people.
‘I don’t say that lightly. Our analysis shows there’s a huge discrepancy across
the country. Funding cuts are obviously having an impact, and drug services
aren’t unique in that, but what I’m speaking out about is how in a localised
framework it’s increasingly evident that there’s an inequality of access for
any treatment, but particularly for residential’.
Hannah Shead, chief executive of Trevi House and chair of the Choices
Rehabs group, agrees. ‘Our group began six years ago and we’ve seen our
membership decline at the same time as we’ve seen the need for our
services increase. It’s heartbreaking – we’ve got members saying they have
people phoning them who are absolutely desperate but not able to secure
the funding.’
Clearly, problems in the substance misuse client group are not limited
to drugs and alcohol. According to PHE, a fifth of people entering treatment
last year had problems with housing (rising to a third among those being
treated for opiates), while more than half were struggling with mental
health issues. A fifth of all people starting treatment were living with
children, while 31 per cent were parents not living with their children (44 per
6 • DRINK AND DRUGS NEWS • DEC 2019-JAN 2020
cent among women in treatment
for opiates). So while the argument
is often made that residential
services are closing because they’re
expensive, there’s a stronger case
that they’re cost-effective.
‘When we resource addiction
services effectively we take the
strain off other services like
criminal justice and mental health,’
says Hannah Shead. ‘It’s about
vulnerable people – often trauma
survivors – getting back on their feet
and into society. If you take a wider
perspective it’s really good value
for money.’ Hospital admissions for
these clients also invariably involve
a detox, adds Karen Biggs. ‘But the
commissioners making decisions
around cuts to treatment are not
the same people footing the bill for
a four grand detox.’
Another crucial issue is not just
reluctance to fund but the process
that vulnerable people may have to go through to get that funding, she
stresses. ‘Most decisions around rehab are now done through panels and for
women trying to access Grace House that was a dehumanising process – to
have to sit in front of a panel of professionals when you’re in a really poor
state of physical and mental health and try to argue why you’re worthy of
funding. That’s not a national health system as most people expect it.’ It’s
also discouraging some community services from putting people forward,
she adds. ‘They don’t have the confidence that they’re going to get the
funding, and if they do it’s only going to be for a limited time based on
budgets rather than clinical assessment.
‘I don’t want this to turn into a “rehab is best” argument – we’re way
beyond that,’ she continues. ‘But there is a cohort of people, as all the evidence
shows, who benefit from residential care. I get how hard it is for some local
authorities, and there are pockets of excellence across the country. I also
understand that when people are making day-to-day decisions they’re not
Phoenix Futures’
Grace House has
become the latest
casualty. Rated
outstanding by
CQC, the specialist
residential
service provided
‘trauma-informed’
treatment for
women with
complex needs
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