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Key role of specialist nurses highlighted by alcohol addiction inquiry

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The loss of alcoholic specialist roles, such as wellbeing nurses, in local services struggling with cash shortages is preventing alcoholics from getting the help they need, according to a national inquiry.

Public Health England found that budget cuts to local authorities for substance misuse were hitting alcohol-users the hardest.

“In most areas, staff were expected to be competent to treat both alcohol and drug users”

PHE report

The government arms’-length body was tasked with carrying out a “rapid inquiry” to find out why only one in five people in need of alcohol addiction treatment were receiving it.

PHE launched a “deep dive” with 14 local authorities across the country – nine where there had been a fall in numbers in alcohol treatment and five where there had been a rise between 2013 and 2017.

In a report on its findings, PHE revealed that in all areas where there had been a drop in numbers, services had been “reconfigured” mostly due to the need to cost save.

In seven of the nine sites where that been a reduction, alcohol and drug services had been merged into one substance misuse hub. All but one of the nine areas reported budget reductions between 15% and 35%.

“It’s also very important that alcohol treatment expertise is maintained or enhanced”

PHE report

PHE determined: ”Our analysis suggests that the context in which treatment is currently commissioned and provided, including financial pressures and service reconfiguration, has affected alcohol treatment numbers more than treatment numbers for other substances.”

Some providers told PHE that the “reconfiguration” in services resulted in a loss of focus on the specific needs of alcohol users and that limited resources had been prioritised for drug treatment.

The report also raised concerns over a decline in alcohol specialists within workforces where services had been integrated. Staff were expected to take care of both alcohol and drug users without necessarily having the training to do so, PHE noted.

It said: “Managers, alcohol specialist staff and service users all felt that the loss of alcohol specialist roles and competences could stop service users engaging in treatment.

“Some managers said that fewer alcohol specialist staff had transferred over into new service configurations and several had struggled to recruit skilled staff, particularly nurses,” it stated.

“In most areas, staff were expected to be competent to treat both alcohol and drug users,” it said. “Stakeholders said that without sufficient training and support, staff who were previously drug specialists were not always competent to deliver effective alcohol treatment interventions (and the other way round).

“It’s a whole issue around making the third sector an attractive place to work”

Gill Campbell

It added: “Some stakeholders also felt that alcohol specialists had less time to deliver effective alcohol interventions where they were required to carry mixed caseloads.

“Service users said that it was very important to them that staff members who first assessed them had good understanding of alcohol harms and dependence and that this had a very significant impact on their willingness to engage with treatment,” said the report.

However, the inquiry found evidence that integrated substance misuse services “can be deliver effectively”, as some services that had been through this change had seen an increase in alcoholics accessing treatment. PHE highlighted the importance of nurturing the alcohol specialist workforce.

In the conclusion to the report, PHE said: “There is a risk that the falling trend in the numbers in alcohol treatment will continue unless local areas ensure that their strategic and commissioning plans, service specifications and referral pathways meet alcohol-specific treatment needs.

“It’s also very important that alcohol treatment expertise is maintained or enhanced,” it warned.

Gill Campbell, head of nursing at social enterprise Turning Point and a substance misuse nurse with 20 years’ experience, said it was essential that even if substance misuse provision was integrated that separate, specialist pathways for alcohol and drug users were maintained.

“If the service looks as if it is designed for a very different group of people then that can create a real barrier”

James Nicholls

She did not oppose the idea of asking nurses to work across both fields, but said it was vital that they were given the evidence-based support and training to do so. However, in light of shrinking public health budgets, Ms Campbell said employers often struggles to find the funding to offer nurses such training.

Furthermore, with the pool of nurses in England drying up, Ms Campbell said substance misuse treatment providers faced additional challenges in recruiting as most were run by charities, social enterprises or community interest companies. 

She told Nursing Times: “There’s a national problem with the recruitment of nurses and, because a lot of substance treatment services are third sector, it’s a whole issue around making the third sector an attractive place to work in terms of their own development and their career and what they can offer the service users.”

However, Ms Campbell said this was a challenge that “we are going to have to rise to”, because “the nursing role is key within substances misuse”.

gill campbell

gill campbell

Gill Campbell

Ms Campbell said she went into nursing herself because she wanted to support people struggling with addiction and she encouraged other nurses to consider entering a career in substance misuse care.

She said: “It’s a wonderful place to work as a nurse because you get to do really great interventions and you can see the impact of what you are doing, you can follow service users through into recovery.

“It’s a great job as a nurse and that’s one of the challenges of my role to make sure lots of nurses who are passionate and have compassion for our service users want to work for us.”

Responding to the PHE report, Dr James Nicholls, director of research and policy development at Alcohol Concern and Alcohol Research UK, said the proposals for improvements made in the document were “promising”.

But he warned: “Services must be commissioned and delivered in a way that pays careful attention to the needs of alcohol users, because otherwise they risk being deprioritised.

“Services also need to be conscious that for many alcohol users, an environment that seems to be geared primarily towards illicit drugs can be alienating,” he said. “Seeking treatment is hard enough, and if the service looks as if it is designed for a very different group of people then that can create a real barrier.

“While PHE’s proposals will be helpful, it is essential that the whole treatment system be given the support it needs – political and financial – so that it can provide vital support to the 600,000 people in the UK who desperately need it,” he added.

A spokesman for the Local Government Association said it had ”long argued” that reductions in funding for councils from the goverment for drug and alcohol prevention and treatment services was a ”short-term approach” that would compound pressures for criminal justice and NHS services further down the line.

“Some areas have responded well to the fall, with a focus on alcohol within integrated services”

Rosanna O’Connor

Commenting on the report, Rosanna O’Connor, director of drugs, alcohol and tobacco at PHE, said: ”The impact of the current operating environment – wide reconfiguration of services across the country, largely motivated by cost savings – have led to many more integrated alcohol and drugs services and this appears to have resulted in alcohol numbers being affected more than drug treatment numbers. In some areas this is compounded by poor referral pathways into treatment.

“Despite this, we still found examples of alcohol treatment being delivered effectively within integrated services, some even seeing increases in numbers, proving it can work,” she said.

She added: “Some areas have responded well to the fall, with a focus on alcohol within integrated services, in particular increasing the level of staff alcohol specialism and the number of alcohol specific interventions.”

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