Due to the depth of the problem, greater emphasis has been put on increasing the amount of help available via the NHS and other statutory services.
There is still a long way to go to ensure everyone can access the help they need when they need it, both in Manchester and nationally.
It is estimated 799 years of life were lost per 100,000 population in Manchester, in 2018, due to alcohol related conditions.
The number of dependent drinkers in Manchester was last estimated to be 2.35% of the population. That’s 70% higher than the national rate.**
In terms of drugs, the rate of hospital admissions in the city where drug related mental and behavioural disorders is a factor is almost double the national average (183%). In Wigan – part of Greater Manchester – it’s more than double the national average***.
A recent national review into drug harms also named Manchester as one of the major hubs of county lines drugs supply gangs.
The city isn’t alone in facing challenges with drugs and alcohol. Nationally, there is a vast shortage of treatment and recovery resources.
In all the key indicator areas for alcohol harm recorded in Public Health Profiles, Manchester sits within the worst quartile in the country.
Indicator | Period | Manchester | Region | England | England | ||||
Recent Trend | Count | Value | Value | Value | Worst | Range | Best | ||
Admission episodes for alcohol-related conditions (Narrow) | 2018/19 | - | 3,223 | 775 | 742 | 664 | 1,127 | 389 | |
Admission episodes for alcohol-related conditions (Broad) | 2018/19 | - | 12,372 | 3,507 | 2,736 | 2,367 | 4,022 | 1,329 | |
Admission episodes for alcohol-specific conditions | 2018/19 | - | 4,359 | 1,126 | 883 | 626 | 2,074 | 291 | |
Admission episodes for alcohol-specific conditions - Under 18s | 2016/17 -18/19 | - | 160 | 44.1 | 45.9 | 31.6 | 106.7 | 7.8 | |
Alcohol-related mortality | 2018 | - | 194 | 57.8 | 54.9 | 46.5 | 86.1 | 26.9 | |
Alcohol-specific mortality | 2016-18 | - | 164 | 14.9 | 14.7 | 10.8 | 29.8 | 4.8 |
A lot of work is going into trying to increase the support for people with drug and alcohol issues in Greater Manchester – and to reduce the number of people who develop those problems.
Some of that work is seen as trailblazing, it includes:
Manchester is one of the cities trialling a new Housing First model to help homeless people into a home regardless of the challenges they face, including with addiction.
Greater Manchester Health and Social Care Partnership invested in what it described in its 2018/19 annual report as a ‘potentially world leading programme to reduce alcohol consumption in pregnancy’, with an ambition to ultimately prevent all new cases of foetal alcohol spectrum disorder in the area.
The campaign raised awareness of the potential harm to babies if mums-to-be drink during pregnancy and called for all women who may become or are pregnant to abstain from alcohol.
Leaflets and videos were produced as part of the campaign which called for every trimester to be a #drymester and aimed to raise awareness of Foetal Alcohol Spectrum Disorder (FASD).
An innovative Greater Manchester project, which was run with the Royal Society for Public Health (RSPH), Communities in Charge of Alcohol trains volunteers to spread positive messages and champion local action on alcohol.
The RSPH began offering Alcohol Health Champion training across the country after rolling the project out in Manchester.
The Big Alcohol Conversation was a large scale consultation project held in Greater Manchester between November 2018 and February 2019.
The Greater Manchester Health and Social Care Partnership (GMHSCP) and Greater Manchester Centre for Voluntary Organisation (GMCVO) held an event in October (2019) presenting outcomes.
It was said that a ‘Greater Manchester Ambition for Alcohol’ report is being drawn up, but five priorities had been recognised as a result of the Big Alcohol Conversation. They were:
To explore opportunities to seek regulatory and legislative reform, such as around where people can drink and access to alcohol.
To incentivise responsible buying and selling of alcohol and showcase opportunities to socialise with moderate and no alcohol use.
To change attitudes and behaviour in adults’ use of alcohol around children and continue work to prevent the harms caused by drinking alcohol in pregnancy.
To collaborate across services and join up approaches to prevention, early help and supporting the most vulnerable.
To change awareness, attitudes and behaviour among people who drink beyond recommended levels but don’t consider themselves harmful drinkers.
The strategy document did not shy away from the challenges faced.
It said: “The harm caused by drugs and alcohol in Greater Manchester is extensive and affects all our communities and places pressure on many public services.
“We have a far bigger problem than most other places in England.”
In an opening statement within the strategy, Jon Rouse, Chief Officer of the Greater Manchester Health and Social Care Partnership, said that even lifting the area to average levels of drug and alcohol harm would be a significant improvement.
Jon Rouse said:
“We don’t often aspire to be average in Greater Manchester....However, when it comes to drugs and alcohol, being average would be no mean feat and would lead to dramatic improvements in outcomes for local people.“If we were average then, every year, almost 400 fewer people would die early as a direct result of alcohol and there would be over 7,500 fewer alcohol-specific
hospital admissions.
“If we had average levels of drug-related deaths, then over 100 fewer people would die over the life of this strategy.
“Being average would have an enormous impact on the tens of thousands of children living with adults who are drug or alcohol dependent, the adverse childhood experiences that this can bring, and the impact that this has on school and life readiness.”
The rate of alcohol-specific mortality episodes per 100,000 in Greater Manchester is 50% higher than the England rate.
This equates to 1,189 deaths in the latest three-year tracking period (2015-17).
If the figure for Greater Manchester had matched the rate for England there would have been 396 fewer deaths over the three year tracking period (2015-2017).
There was a 74% rise in drug related deaths in Greater Manchester in the 10 years up to 2019.
This translates to 480 deaths in the latest three-year tracking period (2015-17).
If the figure for Greater Manchester matched the average for England, this would equate to 136 fewer deaths per three year period.
The rate of hospital admissions for alcohol-specific conditions is 53% higher in Greater Manchester than the England average.
In the most recent year of data (2016/17), there were over 22,000 admissions of this kind, with an estimated cost in the region of £43m.
If the GM rate was the same as the average for England, this would equate to more than 7,500 fewer admissions and a cost saving approaching £15m per year.
There was a budget of almost £6m for Manchester Integrated Drug & Alcohol Service for the three years up to March 2019, according to a Manchester City Council report. An additional annual budget of £1m helps to fund in patient detox and rehabilitation.
It is possible to get funded residential rehab in Manchester in some cases but, in reality, budgets are stretched and only a few people are awarded access to this kind of support.
Shortages of availability and rehab placements
via publicly funded means are not unique
to Manchester.
Most people who benefit from residential rehab pay privately to receive it, especially in the cases of those individuals who have issues with alcohol or cocaine. Priority for NHS-funded residential rehab tends to be given to people dealing with heroin and opiate issues.
Community based treatment is available, but resources for that are also stretched.
An Independent review of drugs by Professor Dame Carol Black – published at the end of February 2020 – examined the harm that drugs cause and the best ways to prevent drug-taking. It painted a worrying picture regarding availability of alcohol and drug treatment.
The report’s findings of statutory/NHS drug treatment resources were concerning.
It said: “The drugs treatment market operates in a very similar way to that of adult social care. Like in the adult social care market, drug treatment providers have been squeezed, staff are paid relatively badly and there has been high turnover in the sector and a depletion of skills, with the number of medics, psychologists, nurses and social workers in the field falling significantly.
“The unregulated role of drug and alcohol or recovery worker, which is inconsistently and poorly defined, makes up the vast majority of the workforce. The number of training places for addiction psychiatrists has plummeted from around 60 to around 5, meaning there is no capacity to train the next generation of specialists.
“Most current treatment capacity is absorbed by the long-term cohort of opiate users, many of whom have been in treatment for a long time (1 in 6 have been in treatment for over a decade). Some of these are also now using crack cocaine, creating new health problems. Providers often have to prioritise meeting the urgent health needs of this population, meaning the capacity to develop expertise and services to meet the needs of other cohorts is limited.”
Dame Carol said:
“Treatment services have been curtailed by local government funding cuts. The total cost to society of illegal drugs is around £20 billion per year, but only £600 million is spent on treatment and prevention. So the amount of unmet need is growing, some treatment services are disappearing, and the treatment workforce is declining in number and quality.It is this report that notes Manchester has the largest number of county lines drug dealing networks, along with London, Birmingham and Liverpool. A trademark of ‘county lines’ is the exploitation of vulnerable young people and use of them to transport drugs and money.
The report said 20% of people in drug and alcohol treatment have a severe housing problem and the Housing First model, which is being piloted in Greater Manchester, may contribute to an improved situation. This globally-proven scheme helps rough sleepers into homes regardless of whether they have substance use issues (see above).
An evidence pack published alongside Dame Carol Black’s report said that, nationally:
Whilst securing a placement in residential rehab via the NHS may be extremely challenging, there are teams of professionals working hard to provide support to people battling addiction.
Much of the statutory support available takes place in the community.
Free addiction treatment, advice and information is available via:
For adults and children:
Change Grow Live (CGL)
0161 226 5526
For adults:
Acorn
0161 484 000
18 and under:
360° Substance Misuse Service
01204 337 330
Adults:
Achieve Bolton
01204 337 330
18 and under:
Positive Steps
0161 621 9400
Over 18:
Turning Point – Rochdale and Oldham Recovery (ROAR)
0300 555 0234
18 and under:
Early Break
0161 723 3880
Over 18:
Turning Point – Rochdale and Oldham Recovery (ROAR)
0300 555 0234
Aged 25 and under:
MOSAIC (Young People’s Drug & Alcohol Service)
0161 218 1100
Aged 26+:
Change Grow Live (CGL) Stockport
0161 474 1343
Adults:
Pathfinder
0161 474 3141
Change Grow Live – Tameside
0161 474 1343
For those aged 18 and under:
Early Break
0161 723 3880
For adults:
Achieve Trafford
0161 358 0991
*There were 49 cases per 100,000 population of alcohol related cancer in Manchester at the most recent count in 2015-17, Public Health England figures state. The national rate was 38.
**The number of dependent drinkers in Manchester was said to be 2.35% at last count in 2014/15, according to Local Alcohol Profiles. The rate for England was 1.39%.
***Admissions where drug related mental and behavioural disorders were a factor was 321 per 100,000 population in Manchester in 2018/19, NHS Digital figures show. In England it was 175. Wigan was 362.
****There were 8.2 deaths from drugs misuse per 100,000 population in Manchester when figures were most recently collated, in 2016-18. The rate in England was 4.5.
*****The alcohol specific mortality rate in Manchester was 14.9 per 100,000 population in the period 2016-2018, according to Public Health England. The average rate for England was 10.8.
******The rate of hospital admissions for alcohol specific conditions was 1,126 per 100,000 population in Manchester in 2019, according to Public Health England. In England the rate was 626.