change in culture and skills through all elements, but we won’t be able to do it
with the same numbers.’
‘Rehab providers say, “we have empty beds and no one refers to us”,’ said
Lord Mancroft. ‘It must be very difficult to run a rehab with 25 or 50 beds if
you’re waiting for individuals and have no guaranteed source of income, whereas
some of the larger organisations seem to be getting telephone number amounts
of money for not making people very much better – just holding onto them and
maintaining them on drugs.’ The problem was that there had been no
‘abstinence modality’, said Kathy Gyngell, so organisations ‘were treated like
failures’. ‘You’ve just got to look at the numbers referred and the amount of
money spent – they’re tiny.’
It was vital to ensure that organisations like AA and NA were able to flourish,
said CRI chief executive David Royce, and that the best in existing practice was
not lost, said Lord Mancroft. ‘It’s a sad fact that in many areas of policy we tend
to go from one extreme to the other.’ Participants were also concerned that the
speed of change in terms of payment by results presented serious risks.
‘There’s recognition, quite early on, that it’s hitting the buffers of complexity,’
said DrugScope chief executive Martin Barnes. ‘How do you set tariffs, and who
shares the cash if, for example, the outcome is someone getting a job? PBR
[payment by results] is also starting to inform – intentionally or otherwise – the
thinking of commissioners and providers, and it’s happening in a vacuum. It’s
the 143 areas that don’t have a pilot that we need to pay attention to.’
‘People come into treatment for drug dependency,’ said Nick Barton. ‘For me
that’s the only result – if you start measuring all the other elements of recovery
capital you’re making it unnecessarily complicated. Those things are just the
accelerators.’ The risk of failure would be passed on to service providers, said David
Royce, and groups of very vulnerable dual diagnosis patients were at particular risk
of losing out, warned Owen Bowden Jones of the Royal College of Psychiatrists.
‘We’re definitely seeing commissioners and providers trying to jump the gun,’
said Karen Biggs. ‘It’s the pace of change that’s the issue – if it was PBR on its
own we could deal with it, but combined with everything else it’s a seismic shift,
and there’s a risk of destabilisation.’ There was, however, a ‘refreshing
willingness’ on the part of government to learn from mistakes, said Paul Hayes.
‘This isn’t something that’s been cooked up in some think tank to be piloted and
then rolled out come hell or high water.’
In terms of the challenge of localism, the mechanisms of transferring funding
from the NHS to local government appeared very complex, said director of public
health for Harrow, Andrew Howe. ‘We’re also cutting managerial commissioning
capacity in the NHS substantially, which means implementation is going to be very
challenging.’
The evidence was already clear that government cuts were having an impact
on young people’s services and many others, stressed Martin Barnes.
‘Delivering on the strategy will be very difficult in a climate of cuts, and it’s naïve
to say we can deliver on recovery capital when services are disappearing, as
they are. People are cutting funding for everything that they’re not statutorily
obliged to provide.’
DDN
7 February 2011 |
drinkanddrugsnews
| 13
Policy |
Drug strategy
My Story |
Mark
www.drinkanddrugsnews.com
‘This isn’t
something
that’s been
cooked up in
some think
tank.’
The day my
life changed
I PITCHED UP AT ‘FOUNDATIONS’ ABOUT SIX MONTHS AGO.
Three months
clean, just out of a hostel, just out of a day programme and just about out of
my mind. Have you seen David Cronenberg’s film
Scanners
– the one where
people explode? That’s me. Man, was I angry.
Andwhy couldn’t I stop thinkingabout drugs?You could say Iwasn’t in thebest
frameofmind–and you’dbe right. And to tell you the truth, Iwasmore thanabit
sceptical aboutWDP Foundations. Imean, I’dhadawhole army of so called
‘professionals’trying tohelpme. For years. Sowhywould this be any different?
I reckoned it’d be some well-meaning do-gooder, who had no clue. Wrong.
I had originally been sent for ETE counselling. Yeah, meant nothing to me
either. It means education, training and employment. But I wasn’t ready for
that at all.
So I started off with one-to-one counselling. Nothing too scary. I just sat
in a room talking. To someone who listened. For an hour. And he came back
at me with stuff that made sense. He picked up on things I said and fed them
back to me in a way that helped me. And he made suggestions on how I
could manage all the crap I was going through. Like how angry I was. And
how I hated this one and hated that one. And somehow, when I came out, I
felt better. A bit lighter. A bit more together.
After a while they asked if I wanted to attend the ‘relapse prevention’ and
‘peer support’ groups. Well, having to interact with a group of strangers
about anything seemed about as much fun as being electrocuted. But I
pitched up eventually and, of course, it was weird at first. But it’s been a
good place for me. It’s hard to say exactly why it’s been good, but I’ll give it a
go.
If you’re anything like me you will have found stopping using drugs hard.
And if you’re anything like me, you’ll have found staying stopped and trying
to build a life even harder. What do you do when you’ve lived in a certain way
for so long that you don’t know any other?
Well, you have to learn a different way of doing things. And if, like me,
you’re used to living in hostels, picking up your script, begging, stealing, and
chucking enough special brew down your neck to sink the average ship, then
it’s going to be a tall order. So I’ve needed a lot of help. And I’ve had to learn
– from the beginning. Eating, sleeping, being a dad, managing rage and
cravings – the whole lot. And I have. And that’s what I’ve got from the
groups, from the one-to-ones, from the shiatsu (are they mad – free
massage?). Even from the outings that I never went on.
So where am I now? Well, I’m sat in the ILT (computer) room at college.
Eventually ETE (remember?) reared its ugly head, and we discussed the idea
of going back to school and trying to learn something new. And they’ve
helped me with that. And here I am, studying, learning new stuff. Clearing
the mental fog that I’ve been in for so long. I’m thinking of going to
university (but will they have me?) and it’s all good. I’m still angry, and I think
about drugs sometimes. But something is different. Maybe it’s me.
FoundationsWestminster is provided in partnership with Red Kite Learning, the
City ofWestminster andWestminster Drugs & Alcohol Action Team. www.rkl.org.uk
When Mark walked into WDP’s abstinence-based
aftercare service ‘Foundations’ in central London, his
expectations had hit rock bottom. As he tells DDN,
he didn’t imagine that he’d now be planning for the
future