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June 2013 |
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Primary care conference
user council is going to find it very difficult to be heard.’
Pete Burkinshaw, skills and development manager, Public Health England,
acknowledged the difficulties faced by a substance misuse sector that was
‘waking up to clinical governance and the importance of research’. Localism
would bring ‘all kinds of permutations’, he said, with some areas having a ‘grossly
inaccurate’ idea of their spending.
‘Local engagement is absolutely key,’ he said. ‘Take your seatbelts off and get
out of the chair. Don’t let stuff happen to you, because the game is local – power
and autonomy are in local areas.’
Integrating effectively with the new public health agenda meant acknowledging
that public health colleagues had ‘different DNA’, he said. ‘Public health naturally
goes upstream – they want to be mending the hole in the bridge, not hauling bodies
out of the water. They’ve never been responsible for trawlers in the estuary before –
we need to remind our public health colleagues about the trawlers.’
Despite the challenges, Burkinshaw believed that voicing such concerns was
having an impact: ‘Because these things are said a lot, we’re starting to see
embryonic change,’ he said. ‘We need to build on that.’
Mark Gilman, strategic recovery lead, PHE, saw public health as bringing
ambition and aspiration to the world of treatment. ‘We know from public health
that you are influenced by the people you hang out with. If you want recovery,
identify someone in your network who’s already got it. Move away from the
negatives – it’s like a barrel of crabs dragging each other down; misery loves
company, and that’s what’s happening in areas where recovery’s not catching on.’
…ISSUE BY ISSUE
HOWCANWE ENGAGEWITH PARENTS ABOUT SUBSTANCE MISUSE?
‘It’s difficult,’ said Prof Donald Forrester, director of the Tilda Goldberg Centre for
Social Work and Social Care. ‘They often lie as they’re in denial or likely to minimise
problems.’ Good practice required combining both cynicism and optimism.
‘I recommend you engage, focus, elicit, plan and action,’ he said. It’s all about
building a relationship, building a plan and making people believe they can change.
‘You can’t make people change, so the key is to try and make people explore
their own motivations. The more you push, the more people push back,’ he said.
‘Motivation is created in differences between your life now and the life you want to
lead – seeing the difference between who we want to be and the life we’re
providing. The skill is how you get people to do this for themselves.’
HOW CAN WE PROVIDE SEXUAL HEALTH SERVICES?
We need to communicate effectively with women of fertile age, said Rosie Mundt-
Leach of SLAM.
‘One of the reasons we’re not engaging is we don’t want to give the impression
that if you’re a substance user, you shouldn’t be having a baby. But it’s about
delaying it until stability in drug and alcohol use has been reached.’
Educating women about the effects of drugs on their fertility would help to
avoid unwanted pregnancy – and those who did want to get pregnant would
benefit from advice on taking folic acid and giving up smoking.
Delegates in the sexual health workshop highlighted the difficulty of getting
these services into different projects – and those that did often found it difficult to
engage effectively. ‘Our clients aren’t ready to think about contraception. They
think it won’t happen to them,’ said a worker at a homeless hostel.
Dr Bernadette Hard, a GP inWales, said that all women should have easy access
to impartial advice. ‘People in addiction are used to high-risk situations – when
you’re injecting, your threshold for risk is much higher and acute intoxication
makes women vulnerable to risky sexual practice.’
Practitioners also needed to be aware that treatment and support services –
such as providing housing – was likely to increase fertility. On the plus side, there
had been a cultural change, she said, with clients now embracing the fact that
substance misuse services asked about contraception and bbv risk.
Dr MatthewYoung said that contraception, bbv screening and smears should be
incorporated in treatment as a matter of course and called for RCGP to incorporate
easy streamlined standards in their management of drug misuse qualifications.
WHAT SHOULD WE KNOW ABOUT FOETAL ALCOHOL
SPECTRUM DISORDER (FASD)?
This condition is more prevalent than we realise, said Dr Shirrin Howell. Usually
a hidden disability, it causes birth detects, commonly to the heart or kidneys,
effects on the nervous system, and complex learning disabilities. ‘In talking
‘We worry that our clients will be
low on the priority list..the top
priority for politicians is potholes
in the road.’
DELEGATE
‘I have faith in local authorities
to do the right thing...’
ANNA SOUBRY MP
Photography: www.prestigephotography.co.uk