Dr Emmert Roberts is an MRC Clinical Research Fellow in the National Addiction Centre, King’s College London (KCL) and a Specialist Registrar in Substance Misuse Psychiatry at the South London and the Maudsley (SLaM) NHS Foundation Trust. He graduated with distinctions in medicine and epidemiology from the University of Oxford, and the London School of Hygiene and Tropical Medicine (LSHTM). He is a member of both the Royal Colleges of Physicians and Psychiatrists, and his current research focus is on drug and alcohol service provision and its impact on hospitalisation and mortality. Throughout the COVID-19 outbreak he has been working as the clinical lead for the Homeless Hotel Drug and Alcohol Support Service (HDAS-London), the first pan-London commissioned drug and alcohol service providing alcohol, tobacco and drug support to those individuals experiencing rough sleeping temporarily housed in hotel accommodation across the capital.
Specialist community alcohol treatment in England since the introduction of the Health and Social Care Act 2012
Aims: Since 2012 England has seen year-on-year reductions in the number of people accessing specialist community alcohol treatment, and year-on-year increases in alcohol- related hospital admissions. We examined perceived barriers to accessing specialist treatment, and perceived reasons behind hospital admission increases.
Methods: We conducted focus groups (n=4) with service users and semi-structured interviews (n=16) with service providers and service commissioners at four specialist community alcohol services in England, which experience either high or low rates of alcohol dependence prevalence and treatment access. Themes and sub-themes were generated deductively drawing upon Rhodes’ risk environment thesis. Data were organised using the framework approach.
Results: Three major themes emerged revealing a treatment sector profoundly affected at all levels by changes implemented in the Health and Social Care Act (HSCA) 2012. Substantial barriers to access exist, even in services with high access rates. Concerns regarding funding cuts and recommissioning processes are at the forefront of providers and commissioners minds. The lack of cohesion between community and hospital alcohol services, where hospital services exist, has potentially created an environment enabling the reduced numbers of people accessing specialist treatment.
Conclusions: Our study reveals a treatment sector struggling with a multitude of problems; these pervade despite enaction of the HSCA, and are present at the national, service provider, and individual service level. Whilst we acknowledge problems are varied and multifaceted, their existence is echoed by the united voices of service users, service providers and service commissioners.