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Her involvement in the sector then ‘just went from there’, she says. Before
becoming substance misuse manager – a post she held for just under ten years –
she’d worked in the PCT. ‘I feel incredibly lucky to be able to have been in on the birth
of something. When I was first involved it covered a much wider area of
responsibility and [the budget] was less than half a million. When I left Bristol we
had a budget of over £15m for drug services, so it’s been a massive growth which has
been wonderful to see. And now really we’ve got to consolidate and move forward
together, rather than in this desperate way of everybody fighting each other.’
*****
It’s well documented that the challenges facing the field are changing, with fewer
people using heroin and crack and growing problems with newer substances.
Bristol, however, was seeing acute problems with ketamine use long before it
became a significant issue in many other places, partly connected to the city’s well-
established squatting scene. ‘There’s that, and also where it’s placed
geographically,’ she says. ‘Bristol is very much the gateway to the South West with
very good links to lots of other places.
‘When I was first involved, there was no voluntary sector drugs service,’ she
continues. ‘I was involved in putting together the bid for the Department of Health
for a very small sum of money to start what has become Bristol Drugs Project
(BDP), which is now a massive voluntary organisation providing services. So we’ve
always worked, if you like, bureaucrats and providers together, across the voluntary
and statutory sectors, and core to that has been working with service users very
much at the centre.’
There’s also been a culture of ‘trying to see what was coming next’, she points
out. ‘So ketamine was about working with urologists, and we also had someone
working in Bristol prison way before the days of a national prison drugs strategy. It
was about all partners working together, getting early warnings about what’s
happening and then looking at developing responses. We had an integrated
maternity service with social workers, specialist midwives and the voluntary sector
very early on, and I personally visited virtually every GP surgery in what was then
Avon and got about six GPs to start prescribing – now about 95 per cent of
practices prescribe. So we always tried to look at what’s coming and prepare for it,
not wait for some directive from somebody like the NTA to tell us to do it. In fact
sometimes they’d tell us not to do things.’
Did she take any notice? ‘I’m not a person who does what I’m told unless I think
there’s plenty of evidence for it,’ she says.
As someone responsible for commissioning services, obviously the last few
years would have been to some extent defined by the squeeze on budgets and the
austerity agenda. How much of an impact did that have on a day-to-day basis? ‘I
think I’ve been very lucky in that we were able to have what I believe was a truly
joined-up budget, so that health put its money into the local authority, and NHS-
type services were commissioned alongside housing, alongside money from the
probation services, alongside money from the police, and also, sometimes, a bit
from the prison service,’ she says.
The result was a pooled budget that allowed the commissioning of genuinely
joined-up services, she says. ‘The budget grew, most of the time, and we always
planned in terms of looking at what happened when that pot of money ended. I do
think budget constraints mean that you do focus on what’s core and what works,
and make you look at re-designed services so you don’t get complacent. I know it’s
really hard in terms of having to tender for services, but it also does sharpen up
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Sue Bandcroft
services an awful lot. There can be quite a bit of complacency about what’s offered.’
A recurrent challenge, she states, was trying to ‘break down some of the legislation
that made it quite difficult to do things’, despite that well-established culture of joint
working. ‘We worked very closely with the police and looked at how things could be
done rather than why you couldn’t do them – with the needle exchanges and things
like that – and some of our biggest supporters were the police. So in some ways it’s
about finding the right person in the right place in some of the statutory
organisations and then picking your way through the bureaucracy and the legislation.
Rather than just going “oh no, you can’t do it”, it’s about trying to find a win-win way.
And, obviously, when you can’t do anything, recognising that and moving on.’
Overall, what have been the most significant changes she’s seen in the sector?
‘Money’s an easy one. But also, although it’s still stigmatised, there’s much more
recognition of this being a health issue. And then there’s also the recognition that
one of the things that got us additional funding was the links to criminal activity,
so actually this has been the shift – the joint working of organisations, rather than
“us and them”.’
All that has gone alongside a recognition of the value of harm reduction, she says,
as well as ‘looking much more at self-help and supporting people to make changes
themselves, rather than telling them to make changes. It’s a subtle shift but I think
it’s quite different. I hate the term “empowerment” but I think that is the thing.
That’s what my inspiration is, seeing people making changes and developing, and
not being – or labelling themselves – a service user or drug user any more.’
*****
When Adfam published its report on OST and safeguarding children (
DDN
, May,
page 4) she said that the sector often hadn’t been very good at looking at people in
terms of couples or relationships, let alone families (
DDN
, June, page 6). Does she
think there’s any sign of that starting to change?
‘I think it is, but for a long time the view was of the service user just as an
individual. You might look at what else was happening in their life, but there was
almost a sense of dismissing families as part of the problem – and sometimes they
are. There’s a greater recognition of carer support, “significant others” – I hate
these terminologies, but people who are close to people – and more joint working
around those things. But I do think there’s a long way to go in terms of really
thinking about what children’s experiences are.’
So is she optimistic about the sector’s future? ‘I’m optimistic if it doesn’t get
engaged in infighting and sitting in one camp or another. Individuals need lots of
different approaches. I do think the growth of recovery communities is very
positive and I’m really pleased to see initiatives like SMART being taken forward, so
it’s not one particular dogmatic approach or the other.’
Some of those divisions do seem to be finally breaking down now, though. ‘I
think it’s quite slow, and I think there’s quite a lot of language attached that’s
quite stigmatising,’ she states. ‘So I am optimistic but I do think there has to be a
realism about the tight constraints, and workers do a disservice to their clients if
they don’t look at what’s happening in the rest of the world with all the welfare
reforms and so on. That’s what daily living is going to be for people and we do
need to get involved in those sorts of discussions.’
Her main message, however, would always be ‘work together’, she stresses.
‘Don’t fight each other, because this is a critical time. As with all public sector
funding, this isn’t about us and them. We’ve got to make the most of it, because
it’s the service users who’ll lose out.’
DDN
ing the years