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drinkanddrugsnews
| August 2013
Service provision |
Challenges
www.drinkanddrugsnews.com
The challenge of not losing sight of
the individual in the new public
health landscape was one of the
themes discussed at a recent event
organised by the London Drug and
Alcohol Policy Forum.
DDN
reports
have to move much more in that direction because we’re going to have to make
the most of the resources we’ve got in the community.
‘The key thing is to stop bringing people into services,’ said the organisation’s
recovery and tier 4 lead, Brian Hindmarch. ‘Take the services into the community.’
One of the biggest problems facing treatment was translating its founding
vision across the workforce and to partner organisations, said Counted 4’s
medical director, Dr Martin Weatherhead. ‘We can often say, “for this group of
people we provide a fabulous service”, but I’ve not really come across a system
that provides that across the board.’
While there had been no major change in the evidence base, there had been
changes in the interpretation of that evidence base, he continued. ‘What we’re
guilty of is extrapolation – there have been changes in emphasis, but no huge
changes in fact.’
Keyworking was vital, he told the event. ‘Prescribing is just a little bit of oil in
the engine of treatment – you can’t build everything around that. The medication
hasn’t changed, the facts haven’t changed, but everyone’s now terrified of being
seen as “parking” people on methadone. But there are people who need those
higher doses. We’re moving back into a more regimented treatment world, and that
does concern me.’
One problem that treatment needed to overcome was that NICE guidelines
were constantly employed as obstacles, said one delegate. ‘If they don’t want to
do something, or if they do, then you hear, “ah, it’s the guidelines”.’
‘As an industry, our customers aren’t our first priority,’ said another participant.
‘The drug treatment system has been awash with money for years, but no one
ever says that everything’s working well.’ However it was impossible to commission
‘perfectly individualised’ services for everyone, replied another. ‘It’s a pipe dream.
What you can do is get what’s best for that individual at that time, because it
changes over time – people change, systems change, money flows change. You
need flexible services that are responsive. A lot of it is about relationship
management and being human – it’s a patchwork.’
While the recovery agenda contained a great deal of pros and cons, ‘one
positive thing to come out of it is to try to get the best for your clients,’
commented another delegate. ‘But changing the ethos of an organisation can be
like turning a tanker.’
‘Get to know the client,’ stressed one participant. ‘On paper they may look like
one thing, but you need to get to know them. And continuity is vital.’ Having the
right people with the correct skills set was vital, added another. ‘The right person
for the right role.’
An obvious problem facing the sector was that budgets were no longer ring-
fenced, a delegate stressed. ‘So we need to show that the things we commission
A Vision to
‘W
e were created as a response to what was a frankly
appalling drug and alcohol treatment system in Sunderland,’
CEO of Counted 4, John Devitt, told delegates at the London
Drug and Alcohol Policy Forum’s recent
Our friends in the
north
event. ‘There were six- to nine-month waiting lists and
very rigid prescribing regimes. We were set up to serve the people of Sunderland
– it’s about treating people in the community in the normal way, without
ghettoising them.’
A clinically led organisation and community interest company (CIC), Counted
4 employed doctors, nurses and drug workers, and provided a range of services
in the home. It also tried to work in partnership with key providers, such as
pharmacies, he said, and aimed to be client-focused, non-judgmental, accessible
and community-based.
‘We’re living in a very interesting world – it’s a time of huge social change,’
he said, with welfare reform, funding cuts and the move to Public Health England
all having an impact. While there had been positive changes – such as the focus
on recovery – the poor were now being widely demonised, he stressed, which
was having a profound effect on vulnerable people.
Treatment staff were also worried about their job security, he said. ‘But the
real question is who’s worrying about the clients? It’s also a unique situation in
that the main political parties seem to agree on pretty much everything when it
comes to these changes, and many charities are just toeing the line. Everybody
talks about working in partnership, but partnership is about sharing an ethos,
sharing working practices, sharing the good and bad times. Everyone’s going to