Recently in Substance Misuse Category

A fascinating report by the charity Alcohol Concern has suggested profit margins on white cider are significantly bigger than those on other alcoholic drinks, thanks in part to tax breaks designed to help traditional British cider makers.

White Cider and street drinkers, which is backed by homeless charities Thames Reach and St Mungo's, reveals that the Treasury takes 32p in VAT and duty on the sale of an 85p can of White Ace, leaving a remainder of 53p.

As anyone who works with the rough sleeping community, white ciders are a problem for those trying to combat excessive drinking of strong drinks among clients as it leads to all sorts of health-related problems, which we have documented in the past.

The report lists a series of recommendations: 

• To considerably increase tax on ciders above 5% in a bid to get manufacturers to decrease the alcohol levels in white ciders.
• To link cider duty rates to beer duty rates, especially super-strength lagers, and to look at minimum pricing. 
• For the Licensing Act 2003 to be amended to allow local authorities to ban the sale of super-strength drinks across their locality. 
• An end to the practice of selling cider above 5% in two and three litre bottles and one litre cap to be introduced. 

Jeremy Swain, chief executive of Thames Reach, says: "Super-strength drinks are a breed apart. The cheap and strong white ciders are a problem drink which have devastated and cut short the lives of tens of thousands of people since they emerged onto the marketplace. Astonishingly, they are killing more homeless people than heroin or crack cocaine. It's time for the Government and drinks industry to act so that they disappear from the country's supermarket and off-licence shelves."

Photo from Flickr.com courtesy of dichohecho

US anti-drug charity Project Prevention says it has paid 26 female drug addicts in Britain to have contraceptive implants or coils fitted.

Last year the charity tried to sterilise drug misusers, also with a £200 bribe, but had to back down under enormous pressure and instead plumped for long-term contraception.

At the time drugs workers said the concept of paying addicts to be sterilised was unethical.

The charity says its plans will cut the number of babies born in the UK hooked on drugs, though there is doubt that giving cash to drug addicts would cut the numbers of addicts.

A recent report for the charity Kaleidoscope by Bernadette Hard, a GP specialising in substance misuse, estimated that more than 250,000 children are affected by parental drug abuse in the UK.

The study also found that around a third of all social work cases involve substance abuse by parents, costing the taxpayer around £117m a year.

Some interesting stories for readers from the nationals:

1) How the British fell out of love with drugs, from The Guardian

2) Hospital bed numbers set to fall by 20,000 in a year, from the Daily Telegraph

3) Stroke victims receive 'unequal care' under NHS, from the Daily Telegraph

The second is interesting as it makes the point that simple cutting of bed numbers needs to be coordinated with services provided elsewhere and there is little evidence of this of this increase in services being provided elsewhere currently.

Communities secretary Eric Pickles and housing minister Grant Shapps are being threatened with a judicial review over Nottingham's Council's plans to cut 45% from its Supporting People budget next year.

Nottingham-based Framework Housing Association is arguing that the city council's decision is based on information on the department for communities and local government's website that officers used to make calculations for the coming year.

Last year the city council received £22.3m of Supporting People grant, but has said it believed that its SP budget for 2011 to 2012 had fallen to £12.4m - a cut of 45%. Framework has said these cuts, which would take effect from 1 April, will affect 3,000 of its own clients.

The city council's SP consultation finishes in February.

The government however rolled SP into the overall formula grant and has said it is impossible to identify any authority's allocation.

In a letter to DCLG, lawyers acting for Framework said: "It is unreasonable for the Secretary of State to fail to provide the appropriate calculations and formulae to establish clearly the accurate amount of SP allocation for NCC.

"This renders the failure to do so unlawful and susceptible to challenge by way of judicial review."

A Communities and Local Government spokesman declined to comment on the specifics of the threatened action but added: "Ministers are clear that spending decisions are a matter for councils themselves, but they should look to ensure that the most vulnerable in their communities continue to be protected."

Framework is also contemplating action against the city council based on the speed of the decision; that there was no proper consultation and that it was based on misleading information.

A spokesman stressed that no decision had been taken on SP funding, but added that the council was basing its decision upon information on the DCLG website.

He said the city council was looking at providing £2m extra into its SP pot for one year only.

The threat comes as the row over Supporting People cuts intensifying as councils struggle to find ways of maintaining their statutory services.

The outcome of a judicial review is expected today into the legality of London Councils' decision to pull out 12 months early from agreements funding services to the most vulnerable communities across London and to repatriate funds for other services to the 33 London boroughs. The plan would save £3.2m a year.

At the same time the Bishop of Truro, the Rt Revd Tim Thornton, has entered the row in Cornwall where the county council has announced cuts of 40% over three years to its Supporting People programme.

In a letter to Cornwall council leader, Cllr Alec Robertson, Thornton wrote: "I am acutely aware of the problems of homelessness in Cornwall and the precarious funding for many of the voluntary organisations that provide practical help for  such people in a variety of ways.

"I do of course understand the pressures on you and the cuts that have to be made but I do urge you to ensure the cuts to the Supporting People funds are proportionate and are aimed to ensure as little direct affect as possible on the most vulnerable in our society."

Housing minister Grant Shapps recently expressed disappointment that several councils are indicating significant cuts in SP services despite the government largely protecting its £400m budget.

This funding is not ring-fenced but is rolled into councils' overall formula grant, which the government acknowledges is tight but it believes is enough for councils to carry out their responsibilities.

Homelessness umbrella body Homeless Link however found that English councils plan to cut their Supporting People programmes by between 26% and 37% over the next three years.

Last year the National Housing Federation warned that 400,000 people could lose vital support under projected cuts by councils to Supporting People.

Image on Flickr from Department for Communities and Local Government

Two interesting statistics have been published showing reduced alcohol consumption and reduced illegal drug use.

The decline in alcohol consumption appears related to the recession with people having less disposable income, although those that did enjoy a tipple increasingly came from the middle classes, according to the Office for National Statistics (ONS) General Lifestyle survey.

This showed that men in the UK drank 16.3 units of alcohol a week on average in 2009, down from 17.4 in 2008, while women drank eight units a week on average, down from 9.4 in the previous year.

The number of alcohol-related deaths in the UK fell by nearly 13% in 2009 to 8,664, but these were still more than double the figure of the early 1990s. 

However as Don Shenker, chief executive of Alcohol Concern, said it is likely that "It is very likely that alcohol consumption will rise again once the economy picks up."

Clearly though this is a national picture and there are regional spikes. The Eastern Daily Press reported that drink-related hospital admissions for both NHS Norfolk and NHS Great Yarmouth and Waveney primary care trusts are increasing.

In the year to April 2010 there were a total of 20,633 admissions to hospitals in Norfolk and Waveney, up from 9,815 in 2002/03.  

Meanwhile the recession may be partly a cause behind the decline in popularity of illegal substances among all age groups.

The NHS Information Centre's annual survey of drugs misuse in England found that fewer people in England and Wales are taking drugs such as cannabis, cocaine or heroin.

Twenty percent of 16- to 25-year-olds used illegal drugs in 2009-10, down from 22.6% the year before, and well below the 29.7% recorded in 1996.

The survey found 8.6% of those aged 16 to 59, or 2.8 million people, were using illicit substances in 2009-10 - the lowest ever figure since drug-taking trends were first monitored in 1996, down from 10.1% in 2008-09, 11.1% in 1996 and the record 12.3% in 2003-04.

The proportion using class A drugs such as heroin or crack also fell year-on-year (3.7% to 3.1%), as did those taking cannabis (7.9% to 6.6%).

Today has also brought further controversy over the reasons behind the Health and Social Care Bill.

Prime minister David Cameron and health secretary Andrew Lansley cited poor outcomes to justify a £1.4bn restructuring of the NHS that will pass control of budgets from managers to GPs. 

But today the King's Fund's chief economist John Appleby had said that deaths from heart attacks and cancer are falling despite lower spending on health than in countries such as France.

Appleby said: "These trends must challenge one of the government's key justifications for reforming the NHS."

The article, which is published online for the British Medical Journal shows that Britain had the largest fall in death rates from heart attacks of any European country between 1980 and 2006.

Finally nearly all of Leicester's day care centres for some of the city's most vulnerable people face closure.

Leicester City Council is looking at shutting all four centres for people with physical disabilities and for older people with mental health difficulties.

The Leicester Mercury said that if approved new admissions to the centres will end this year. Services would then be run down.

Picture courtesy of Tim Pearce, Los Gatos on Flickr.com

The war of words over cuts in services for the most vulnerable intensifed today after local government chiefs said they had no choice but to go ahead with them, despite government backing for the Supporting People programme.

Cllr David Rogers, chairman of the Local Government Association's community wellbeing board, said even taking taking into account efficiency drives, such as shared services, councils were facing a huge funding shortfall at a time when there are increasing pressures on areas like adult social care and child protection.

Therefore he said cuts to services on which vulnerable and homeless people relied are "inevitable".

He said: "Councils know how vital it is to invest in housing support for vulnerable people, and will do all they can to help those in the greatest need.

"But the ability of local authorities to pay for these services on the scale they would like to is inevitably being constrained by what they can afford in the current climate."

Rogers' comments were made after housing minister Grant Shapps expressed "disappointment" at the scale of cuts by some councils to the £400m Supporting People programme.

In an open letter to the LGA, Shapps urged councils to do all they could to maintain services for the most vulnerable and invited chairman Margaret Eaton to send representatives to a ministerial working group on preventing and tackling homelessness in order to build a "shared sense of direction".

However it continues to insist that councils are free to spend their money as they want according to local priorities.

In the letter Shapps said: "It is disappointing to see several councils are indicating significant cuts in Supporting People services, particularly for the homeless.

"It is difficult to understand why some councils appear to be targeting any disproportionate spending reductions on programmes that support the most vulnerable people in their communities."

The government has projected that councils will see their budgets cut by 4.4% on average in 2011-12, with Supporting People funding receiving a notional cut from government of only 0.9%.

This funding is not ring-fenced but is rolled into councils' overall formula grant, which the government acknowledges is tight but is enough for councils to carry out their responsibilities.

Homelessness umbrella body Homeless Link however found that English councils plan to cut their Supporting People programmes by between 26% and 37% over the next three years.
 
Among planned cuts, Somerset has approved a £3m cut in its Supporting People programme from April 2011, representing an 18% reduction on its £16.5m budget allocation for 2010-11.

Meanwhile a survey for the National Housing Federation of 136 Supporting People providers in England shows a similarly dismal picture.

In some circumstances it found that whole services face closure as cash strapped town halls look to make massive savings over the next four years.

The survey found:

    * Nearly three quarters of respondents (73%) said local authorities they work in had already indicated cuts of greater than 12%. 41% of respondents expected cuts over 20% in their area, and 18% of respondents expecting cuts over 30%.
    * 60% of respondents said their organisation would be forced to reduce the level of service they offered
    * The top five client groups most at risk of cuts are: Single homeless people, older people in need of support, people with drug and alcohol problems, ex-offenders, people with mental health problems.
    * There's still considerable uncertainty, with 42% of respondents saying one or more of the areas they work in were yet to announce cuts.

Last year it warned that 400,000 people could lose vital support under projected cuts by councils to Supporting People.

Federation chief executive David Orr said: "Services which provide a lifeline to thousands of vulnerable people are being hit disproportionately by councils - with the first to declare their hands indicating they intend to cut back their funding by up to 67%.

"Raiding these budgets to pay for other spending priorities runs contrary to what ministers want, what the public wants and most importantly what the vulnerable who rely upon them want to see happen.

"Councils must now be completely transparent with their local communities and account for where they plan to spend their Supporting People cash."

In a recent letter to councils, the Department for Communities and Local Government acknowledged that councils were free to decide how Supporting People should be spent.

It added that ministers did not expect authorities to respond to reductions in their budgets by passing on disproportionate cuts to other service providers, particularly the voluntary sector.

This row over Supporting People brings into sharp focus the doctrine of localism, which has been coming under some strain of late as the cuts begin to hit. Last year communities secretary Eric Pickles said he was "happy to offer a degree of guided localism".

Only recently the Prime Minister was dragged into the Riven Vincent affair, amid similar fears over funding for short respite breaks for carers. This was allocated £800m over four years but is also not ring-fenced.

Vincent, from Bristol, told the online forum Mumsnet that she could no longer cope with the day-to-day care of Celyn, six, who is blind, quadriplegic and has cerebral palsy and epilepsy.

In her message, she wrote that her local authority, South Gloucestershire Council, had refused to provide her with extra respite support to help with her daughter's care.

Picture courtesy of Ed Yourdon on Flickr.com

This is something we missed just before Christmas (apologies!). The National Treatment Agency has issued an invitation to local drugs partnerships to bid to pilot payment by results. This follows the drugs strategy, which set out the government's aim to pay drugs services on their success in helping users recover and become drugs free. This is controversial, both because of doubts over how you can define a "result" in drugs services and concerns over the focus on abstinence.
The results in question will cover reduced offending, employment, health and well-being and drug users not representing for drug treatment within 12 months of being discharged, free of dependence.

Two reports today illustrate the gender dimension to mental illness and mental health care.
Mind and the Men's Health Forum have launched the first guidelines on the mental health needs of men and boys.

In 2009, Mind warned that the economic downturn was putting men's mental health at risk but put statistical flesh on the bones of the widespread belief that men are less likely than women to seek help: 14% said they would seek help from a GP if they felt low, compared with 37% of women.
Today's guidelines stresses that while men and women experience mental ill-health in equal numbers, men are much less likely to be diagnosed and treated for it. As a result 75% of suicides are by men. Besides the stigma of seeking help, other problems identified in the guidelines include the fact that men often don't display the traditional symptoms of depression and are more likely to respond with aggression or self-medication (i.e. drink and drugs).
They call for more mental health advertising to be targeted at men and for male-friendly treatments.

However, a separate report today highlights the specific mental health problems facing women today. Platform 51 (formerly the YWCA) found that three in five girls and women have experienced low-level mental health problems. Its survey found that this triggered problems such as drink, drugs, losing friends, taking time off work, drug taking and promiscuity.
These findings occasioned this jolly headline from the Daily Telegraph -"Women in crisis as depression fuels binge drinking and sex - research"). Nice.

Platform 51 also highlighted the effect of women's mental health on families, given their greater caring responsibilities.

And it's not just men who are not getting the help they need. Platform 51 found 30% of those affected by low-level mental health problems have never sought help.

All of which means that services will need to be vigilant about the differing needs of differing groups of service users.

However, social worker blogger Fighting Monsters - an approved mental health professional -  issued a warning about the Platform 51 research, saying there is a danger in classifying issues such as low self-esteem as a mental health problem.

"I wonder if this is an implicit desire to classify some of a woman's experiences as 'mental  health problems'," she says. "I'm not saying that these matters cannot have a significant effect on mental wellbeing but is there a difference between having a less than positive and secure mental well-being and having a mental health problem?"

(Photo from Flickr from KellyB)

Offenders who misuse alcohol do not get enough support to turn their lives around, according to research published today by the Centre for Mental Health.

A Label for Exclusion finds that offenders who drink harmfully are not offered as much support as those who use illegal drugs even though alcohol misuse is a bigger cause of crime and ill health.

This comes despite statistics showing that six out of 10 male and four out of 10 female prisoners in England are harmful or hazardous drinkers, while almost half of probation clients have an alcohol problem.

Alcohol is also a factor in three-quarters of cases of domestic violence and more than half of assaults.

Among 10 recommendations the policy paper, which is is based on research carried out in the south west of England, calls for commissioners of health and justice services to pool resources and involve service users in planning the support they offer.

It says all front line workers, such as social workers and GPs, should have basic skills in recognising alcohol misuse and referring people on to specialist services if they need them.

It calls for good quality alcohol support to be available to people at any point in the criminal justice system, from first contact with the police to courts, prisons and probation services.

It also promotes the need for a public awareness campaign warning of the risks linked to alcohol misuse and for the cost of drink to be linked to alcohol content, though such an idea has already been dismissed by the government.  

Centre for Mental Health joint chief executive Prof Sean Duggan said: "Having a diagnosis of alcohol dependency or misuse is too often a label for exclusion from both health and drug treatment services."

He added: "We hope that the government will create a more conducive environment to improve responses at all levels and for all who need more help to manage their alcohol use and offending."

Picture courtesy of Tim Dobson on Flickr.com

The government is to introduce an additional duty on beers above 7.5% alcohol by volume, next year the home office has confirmed today.

The plans fit neatly with the government's health white paper, also published today.

They have the intention of driving down the consumption of super strength lagers, which (as Community Care has previously reported) can very damaging to people's health and is prevalent among homeless men.

The government's plans read: "Some of these products, especially "super-strength" lagers, contain more than the Chief Medical Officer's recommended daily alcohol consumption1 in a single can. This makes it difficult for these products to be consumed in a responsible fashion.

"They are consumed disproportionately by men, and by those in lower socio-economic
groups. A submission from a homelessness charity stated that a number of the homeless men and women that they work with are specifically addicted to super-strength lagers, which cause significant health issues."

The new tax will come in next autumn.

Image by N B on Flickr