05 February 2019
On February 2019, the Assembly will debate the Welsh Government’s substance misuse annual report for 2018.
The Welsh Government published its 10 year substance misuse strategy – Working together to reduce harm – in 2008. This latest annual report provides an overview of activity across Wales during 2017-18, and identifies key challenges for the next 12 months.
What does the data tell us about trends in substance misuse in Wales?
- In 2017-18, hospital admissions for alcohol-specific conditions were 2.4 times higher than for illicit drug use. There were 6,506 admissions related to illicit drugs, and 14,588 alcohol-specific admissions.
- The proportion of patients admitted from the most deprived areas is significantly higher than the least deprived areas – 3.3 times higher for alcohol-specific conditions and 6.1 times higher in relation to illicit drug use.
- The number of people assessed within specialist substance misuse services in Wales in 2017-18 fell by 3.5% compared to the previous year. 51.7% of assessments were for primary problematic alcohol clients, 47.6% were primary problematic drug clients, the remainder reported problematic use of both alcohol and drugs.
- In 2017, there were 185 deaths from drug misuse, a decrease of 4.1% from 2016. There were 540 alcohol deaths in 2017. This represents an increase of 7.1%.
It’s also shown that:
- Hospital admissions have decreased for young people under the age of 25, and for working age adults (age 25-49 years), for both alcohol and drug use.
- In working age adults, opioids (such as heroin) account for considerably more hospital admissions than any other illicit drug. Substance misuse services have seen a substantial increase in the number of assessments where crack/cocaine is reported as the primary problematic substance.
- Among older people, while the number of hospital admissions involving an alcohol-specific condition is lower than the previous year, this figure is 32.6% higher than comparable admissions in 2008-09. Hospital admissions for opioid use in this cohort have increased almost three-fold over the last decade. There has been a notable rise in cannabinoid-related admissions. Admissions following use of cocaine has also increased over the last 5 years, although the numbers remain low.
Source: Public Health Wales, Data mining Wales: The annual profile for substance misuse 2017-18
Minimum price for alcohol
One of the key achievements highlighted in the Welsh Government’s substance misuse annual report is the passing of the Public Health (Minimum Price for Alcohol) (Wales) Act 2018.
Minimum pricing is a targeted measure, which aims to reduce hazardous and harmful levels of drinking. During scrutiny of the Bill, stakeholders repeatedly emphasised that minimum pricing won’t be effective in isolation, and that a range of measures are needed to tackle alcohol misuse. Actions to address potential unintended consequences of the legislation were felt to be particularly important, not least ensuring adequate provision of treatment and support services for vulnerable, dependent drinkers.
There was some conflicting evidence about the capacity of existing services to meet current needs, but it was anticipated that additional resources/services are likely to be needed to respond to an expected increase in demand.
In its stage 1 report, the Heath, Social Care and Sport Committee recommended that the Welsh Government undertake a robust assessment of the demand for alcohol treatment and support services in Wales to ensure adequate, future-proofed provision is in place. It also called for the Welsh Government to monitor the impacts of minimum pricing on alcohol services in Scotland, to inform the approach in Wales.
Review of substance misuse services
Healthcare Inspectorate Wales and Care Inspectorate Wales’ joint report about the quality and safety of substance misuse services across Wales (July 2018) highlighted some positive findings, including that people valued the care they received from services, and that staff are hard-working and passionate about providing high quality, person-centred care.
One of the key areas for improvement identified was the need for greater joint-working between substance misuse services, primary and secondary care, social services and – in particular – mental health services, to better support people with co-occurring mental health and substances misuse issues.
‘People often said they found it difficult to get help with their mental health problems because of their substance misuse and described being bounced around between substance misuse and mental health services’.
These same concerns arose during the Health, Social Care and Sport Committee’s recent inquiry into suicide prevention. The Committee’s report acknowledges the work that has already begun, such as the development of a service framework for the treatment of people with a co-occurring mental health and substance misuse problem. However further progress needs to be made, the Committee states, in developing integrated care pathways for individuals co-presenting with substance misuse and mental health issues in order to reduce suicide risk in this group.
A Welsh Government-commissioned review of the Working together to reduce harm strategy (April 2018) posed some key questions for consideration going forward:
- How is the challenge of addressing the non-devolved areas, where the Welsh Government is tied to UK Government/Home Office policy and Westminster funding, being met?
- In terms of devolved issues, accountability is less obscure. Is there general agreement on the areas of work that are functioning well and those functioning less well?
- In terms of policy decision-making, what is the balance between it being needs-led or led by public perceptions (e.g. drug litter concerns)? How well is this balance managed?
- In terms of a shift from a Substance Misuse specific strategy to a Health and Wellbeing focus:
- Is the current oversight and accountability system fit-for-purpose? How does it need to adapt?
- In which areas have progress/outcomes been limited because of the previous ‘substance misuse’ strategy focus?
The substance misuse annual report states that the Welsh Government has begun work with area planning boards (APBs) and stakeholders to develop substance misuse priorities going forward.
‘These will be informed by a range of evidence and needs and respond to the challenges set out in A Healthier Wales’.
In the interim, the substance misuse delivery plan for 2016-18 will continue to provide the focus of the Welsh Government’s work with partners until April 2019.
Article by Philippa Watkins, National Assembly for Wales Research Service