AFC0017

Written evidence submitted by Tom Harrison House.

Introduction

Tom Harrison House is a registered charity and the only CQC regulated veterans’ residential addiction treatment centre in the UK.  We support 60+ of the most vulnerable veterans, together with an increasing number of serving personnel, each year, and we currently have a waiting list of 40+ veterans in need of residential addiction treatment.

Our response to the Defence Committee focuses specifically on the health inequalities for both veterans and serving personnel throughout the UK.

Veteran Addiction Support

Please may we draw your attention to Dame Carol Black’s government commissioned independent report into drugs:  https://www.gov.uk/government/publications/review-of-drugs-phase-two-report/review-of-drugs-part-two-prevention-treatment-and-recovery

The commissioning of addiction treatment is the responsibility of the respective local authority.  As such, veterans compete for funding with everyone who seeks substance misuse services, and in turn these generic addiction services must compete with all other adult health & social care services from ever shrinking local authority budgets. Unfortunately, addiction treatment is never high on a local authorities’ priority list, and residential addiction treatment funding is not ring fenced, despite the recommendations and additional funding that came out of Dame Carol Black’s report.  We believe that local authorities still don’t understand the unique needs of armed forces veterans and the relevance of the armed forces covenant when commissioning effective addiction treatment.

Ten years experience delivering effective residential addiction treatment to veterans, together with their personal testimonies, highlights the key barriers for them seeking support.

• Lack of hope or belief that support is available for them.
• Lack of knowledge about addiction and addiction treatment.
• Fear, sense of dishonour and shame.
• Social exclusion and stigma
• Mainstream services which lack expertise and resources to recognise the specific needs that veterans have.

Our work with the families of our beneficiaries consistently reports their isolation as they often become the primary carers for vulnerable veterans because of these barriers. This is a catalyst for the escalation of many co-morbidities, including domestic abuse and suicidal ideation.

In-Service Provision of Addiction Support

There are no funded pathways for serving personnel in addiction (alcoholism, drugs, gambling, sex) to attend specialist residential addiction treatment.

Unlike many civilian employers, the MoD has a policy of zero tolerance on drugs and uses the Compulsory Drugs Testing (CDT) framework to conduct quality assurance within the in-service community. 

When individuals fail a CDT, it’s treated as a disciplinary matter – not a medical condition with associated co-morbidities.  Routinely, service personnel are discharged from the military without a clinical needs assessment, care plan, or a coordinated handover of care to the NHS. This, at a time when they are at their most vulnerable.

With alcoholism, we understand that there is a Defence Medical Service policy to allow for an in-patient detox before discharge from service, however these spaces are extremely limited and having no specialist residential addiction treatment provision to follow is at odds with NHS best practice and NICE guidelines.

When regiments do wish to commission residential addiction treatment, they turn to their regimental charities and most do not have a pathway for funding, so it becomes ad-hoc and a cap-badge lottery as to which regimental charities are more sympathetic, informed and pragmatic about addiction treatment.

Service Charity Sector

Our experience continues to highlight a lack of understanding about the unique needs of veterans in addiction, that limits the effectiveness and efficiency of support.  Chaotic, vulnerable veterans are routinely supported with housing, furniture, food, travel expenses in a revolving (expensive) cycle, creating an enabling and counter-productive range of interventions that fail to address the underpinning co-morbidity of addiction and poor mental health. 

The service charity sector is increasingly becoming the grant funder of last resort when local authority commissioners fail to meet their statutory duties. Note - residential addiction treatment, which is a NICE approved CQC-registered provision, has been marginalised over the last decade due to both cuts to treatment budgets and inappropriate and inefficient commissioning mechanisms. As a result, 50% of services have closed over the last 10 years.  This is an expensive burden falling on the service charity sector with no established pathway for lessons identified and remedial action with both social care and healthcare commissioners.

Summary

The Armed Forces Covenant specifically details its goal to prevent healthcare inequalities for veteran and serving personnel.  As set out above, residential addiction treatment across the UK, in-service and veteran, is a cap badge and post-code lottery with sub-optimal triage and prioritisation of resources. 

16th January 2025