It’s obvious isn’t it? In state funded rehab the state pays, don’t they?
In community settings, the Local Authority pays for drug treatment as part of a responsibility to provide social care. In prisons and secure settings, the NHS pay as part of healthcare provision.
But, for people who need the combination of multiple services (often substance use, mental health and homelessness) that are best met in a residential setting, who pays?
Local Authorities certainly pay for some of the cost. Although, in many areas they have devolved the responsibility to the community treatment provider. Sometimes this funding is ringfenced, and sometimes it is not. Knowing this, we can be fairly sure it is either the Local Authority or the community drug treatment provider paying for rehab, can’t we?
Looking more closely at the cost of providing residential rehab in a CQC registered Addiction Care Home it becomes less clear. The weekly rates for these rehabs are often approximately benchmarked against older people’s residential care homes, which similarly provide CQC registered care. So, it would be fair to assume that the fees paid to Addiction Care Homes for staffing are equivalent to other Care Homes (e.g. quality management, service management, administration, care staff). We could also assume equivalent non-staff costs for expenses, equipment, food, utilities, building maintenance and property costs.
These benchmarked costs vary widely across the UK but tend on average to be around £650 a week.
So, who pays for the drug treatment programme costs?
This is the healthcare that older people’s care homes wouldn’t be expected to provide. These include the costs related to clinically-supervised detox overseen by a specialist GP and nurse contracted by the Addiction Care Home, the costs of clinical governance, the therapeutic clinicians who deliver the treatment programme and the clinical interventions specialists, such as psychologists, who oversee programme development and the provision of mental health support.
This can add another £200 to £300 a week in costs.
Who pays for this?
Pricing caps and price-scored framework agreements have ensured that on average the rates Local Authorities pay for rehab are suppressed to approximately £600 per week, lower in some areas and slightly higher in others. During the austerity years rehab providers didn’t tend to pass on inflationary costs in recognition of the financial pressures faced by Local Authorities (in 2012 the average weekly rehab rate was £600, if 10 years of inflation had been added rates should be £742).
Despite also facing price caps and price-scored framework agreement Care Homes for older people have been more successful in increasing their weekly rates by an average of 3% per annum over the last decade. (https://www.which.co.uk/news/2021/03/care-home-prices-continue-to-rise/)
Therefore, it doesn’t actually look like Local Authorities, or community providers, are paying for the drug treatment programmes in residential setting.
Reports of how many rehabs have gone out of business in the last 5 years vary but it seems to be between 30% and 50%. 'Rehab is a vital service - it helped me reclaim the life I should have had before addiction got in the way' | UK News | Sky News) Before eventually closing their doors many rehabs had sold every asset they owned to try to keep going and fulfil their charitable mission of caring for people with the greatest needs and the fewest resources. Annual funding for rehabs has reduced by approx. 50% over that time period and, as a result, placements reduced by 50%. Currently, in England, 46% of Local Authorities refer fewer than 5 people a year and 12% make zero referrals. At the same time, typical treatment durations have also decreased from 6-month placements to 3-months. This not only challenges people to get better more quickly, but also increases the costs for rehabs who are assessing client needs on entry, and safely discharging, twice as many people per year. These points of access and exit represents the highest risk to clients and requires the most focused support.
In order to fill the huge funding gap faced by Addiction Care Homes through empty beds, higher client turnover and absorbing inflationary cost increases, the charities which run them have done their best to offer free places, maximise voluntary input and fundraise. Whether through selling assets or running marathons - charities, alongside their supporters and staff, have certainly paid.
As have the people in need of treatment themselves, because the approx. £650 per week that Local Authorities pay for older people’s residential care is the standard rate. If people want more expensive care they can top up the difference from their own pocket. For Addiction Care Homes the standard £600 average per week rate often includes the client contribution, which averages almost £70 per week or £840 across a 12-week treatment programme. Exactly how much clients are expected to pay by Local Authorities for their care is determined by the financial assessment.
We all hate financial assessments for our healthcare.
Remember the financial assessment you had to go through when you had that gardening accident and had to go to A&E? Or when your child had that mysterious infection and raging temperature? It was embarrassing and stressful, wasn’t it? a review of your entire finances in order to determine how much you would be required to fund before you were able to get the treatment you or your loved ones desperately needed. It was degrading, right?
Except… it didn’t happen, because the NHS most likely provided care, free at point of access, regardless of wealth. But a financial assessment is a reality for most people seeking residential drug treatment. The principle that the NHS provides is a fallacy for people accessing drug treatment in residential care.
So, who pays ultimately?
Basic care costs are paid by Local Authorities and community providers. Drug treatment programmes are paid for by charity funds and the people who use the services.
A small number of Local Authorities recognise that fair access to care requires benchmarking the weekly rates they pay for people with mental health care needs against those with physical health care needs. They understand that financial assessments for client contributions are discriminatory, and they recognise the need for sustainable weekly rates to effectively safeguard vulnerable people and support their human right to life. But, the fact that only a small number of Local Authorities make these commitments shows that the system is broken.
Phoenix are calling for a system that recognises the equity for Addiction Care Homes and the rights of people who use them.
