Title: A qualitative study exploring and evaluating the impact of additional new funding for Inpatient Detoxification Beds across England.
Funder: Department of Health and Social Care

Abstract: Research question: This project will investigate the impact that the additional (new) investment in detox programmes across England during 2021-22 has made in relation to improving drug recovery outcomes. Background: Part One of Dame Carol Black's Independent Review of Drugs found that treatment services have been curtailed by local government funding cuts, and that inpatient detoxification has been rationed and almost disappeared in some parts of the country resulting in significant unmet need. Part Two of the Black Review focused on prevention, treatment and recovery and recommended that a significant uplift in funding for drug treatment and recovery services is needed. In January 2021, the government announced that there would be an &pound;10m investment in additional inpatient detox capacity across the country during 2021-22 to help drive down the crime associated with the drug market. Qualitative research is required to fully understand the impact of this additional investment. Aims and objectives: The study will evaluate the investment by exploring both clients expectations and experiences of detox provision and continuing care as well as identifying potential impact of inpatient detox on clients' substance use, wellbeing, criminal activities and wider life circumstances. Additionally, professionals' views will be gauged on inpatient capacity and the value of inpatient provision. The data collected will be combined to consider how the regional/sub-regional commissioning process for inpatient detox has worked from the client and professional perspective and to provide information that will inform future integrated clinical practice and commissioning. Methods: The research will be conducted across England in five research sites (identified by Public Health England from the total of 15 local authority consortia who have received a share of the &pound;10m investment). The study will be a Longitudinal Qualitative Research design and will include two work packages: (WP1) a series of 30 repeat client interviews at three time intervals (pre-detox; immediately post-detox; 10-12 weeks post-detox); and (WP2) a set of 20 extended interviews with professionals from the consortia involved in referring to the additional detox capacity. The research project will consult with panels of people with lived and living experiences of substance use to ensure the project plan is feasible and acceptable and a designated PPI-Lead will support their involvement. A designated Inclusivity-Lead will ensure that the research includes a sufficiently diverse and representative group of participants. Anticipated Impact/Dissemination: To maximise impact, data analyses and dissemination will be ongoing throughout the 14-month study period (November 2021 to January 2023). In addition to formal (interim and final) NIHR reports, a presentation of findings will be delivered to a policy and stakeholder audience. The research team will also write a Peer Reviewed Paper. Commissioners and referrers will benefit from a better understanding of how and when to refer people to detox. People experiencing addiction will benefit from better data on the experience of inpatient detox (e.g. what to expect and how they might benefit).

Lay abstract: Dame Carol Black's Independent Review of Drugs found that the number of treatment services across England have been curtailed by local government funding cuts, with inpatient detoxification being disproportionately affected - all of which has led to significant unmet need. Dame Black has subsequently recommended a significant uplift in funding for treatment and recovery services. In January 2021, the government announced an &pound;80m investment (2021/22) to enhance drug treatment services as part of a &pound;148 million funding package. A key aim of this funding is to help drive down the crime associated with the drug market by specifically targeting the commissioning of inpatient detoxification beds, for which &pound;10m out of the &pound;80m was allocated. The overall purpose of the project is to contribute to the evidence base around the impact of this &pound;10m fund. The main aims of the research are to firstly explore patient experience of inpatient detoxication and the continuing care pathways in which it sits, in order to inform future integrated clinical practice and commissioning, and secondly to explore the views of healthcare professions on the impact of the additional investment in inpatient alcohol and drug detoxification. The research design is a Longitudinal Qualitative Research study and will consist of repeated interviews with 30 patients (at three time intervals - between referral and entry into detox; immediately following detox; and 10-12 weeks post-detox). Patients will be recruited to the study through five of the local authority consortia that have received a portion of the &pound;80m grant. The five consortia included in the study will be identified by Public Health England and then key personnel from each will be introduced to the research team. Through these initial links, other consortia professionals who refer clients to detox units will be identified and supplied with information about the study to pass to prospective interviewees. Consent will be sought for contact with a member of the research team prior to individual discussions about potential participation in the study. In addition, research team members will identify consortia professionals with diverse roles and backgrounds (including referrers and non-referrers to the detox units) to participate in a set of 20 separate professional interviews. The research project will be supported at each key stage by people with lived and living experience of problematic substance use. This will help to make sure that the research covers the right issues in the right way at the right time with the right people. The research team will deliver interim (April 2022) and final (Jan 2023) project reports. A presentation of findings to a policy and stakeholder audience will also be provided at the end of the study and the research team will finally write a Peer Reviewed Paper.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH