Only 2 in 100: Residential Rehab Is Starved of the Investment It Desperately Needs

In response to a parliamentary question, Parliamentary Under-Secretary for Health and Social Care Ashley Dalton MP reconfirmed that “The Department set an ambition that 2% of the drug and alcohol treatment population should be accessing residential treatment” and listed a range of tactics aimed at improving outcomes for people with substance dependencies.

While these statements signal intent, they fail to address the sector’s most urgent problem: there simply are not enough residential rehab placements. A 2% target may sound modest, but many local authorities are struggling to reach even a fraction of that ambition due to workforce shortages, limited bed availability, and long-term underfunding.

“Two out of 100 is already an unacceptably low bar. Failing to reach even that is a political choice.”

The Limits of Guidance

Much of the Department’s strategy relies on toolkits, forums, self-assessment frameworks, and guidance documents. While these can help identify gaps or streamline commissioning, they do not create beds, recruit nurses, or fund detox units. In reality, these initiatives can give the appearance of progress without materially increasing access to residential care.

In parts of the North East and other regions, real access is closer to 0.2%, leaving highly dependent individuals either turned away or placed on interminable waiting lists—with some tragically dying before a place becomes available.

Structural Barriers

Residential rehabilitation requires significant, sustained investment, yet the sector faces multiple systemic obstacles:

• Understaffing: Specialist nurses and addiction professionals have left the sector after years of real-terms pay cuts.

• Funding gaps: Fifteen years of public health funding reductions have left many councils unable to commission additional residential placements.

• Regional disparities: Access is uneven, with some areas facing severe shortages while others maintain only minimal capacity.

Quasi-residential programs and day-hab alternatives, while useful in some contexts, cannot replace full residential care for individuals with complex addiction, trauma, mental illness, or histories of failed community interventions.

Funding vs. Delivery

The Department has pledged “additional funding”, yet it remains unclear how much of this will be directed to residential services versus bolstering already overstretched community programs. Without ring-fenced investment, the resources required to expand bed capacity, modernise facilities, and sustain a skilled workforce will remain unavailable.

Local authorities are tasked with assessing needs and commissioning services, but deep cuts to public health grants leave many councils unable to act effectively. Expecting them to meet national ambitions with limited resources is less delegation than abdication.

Why Residential Rehab Matters

Residential rehabilitation is not a luxury. For people with severe or complex substance dependencies, it is often the only path to sustained recovery. Without it:

• Lives are placed at unnecessary risk.

• Costs are shifted to the NHS, criminal justice system, and social services.

• Opportunities for lasting recovery are lost, perpetuating cycles of addiction and harm.

Conclusion

A target of 2% access is already inadequate. Failing to reach even that level, while continuing to rely on toolkits and guidance documents, represents a political choice with real human consequences.

If the government is serious about saving lives and reducing the £20 billion societal cost of addiction, it must move beyond guidance and set clear, ring-fenced investment targets for beds, buildings, and specialist staff.

Until that happens, the “2 out of 100” target will remain a statistic that sounds like progress but feels like abandonment to the families and individuals who need residential care most.