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Question 4:
Payment by results (PbR)
– will this threaten fairer
treatment for all?
‘THE ISSUE WITH PAYMENT BY RESULTS
is that the devil is in the detail,’ said
Niamh Eastwood. The six PbR pilot progra-
mmes would have two levels of outcomes,
national and local, she said, and service
providers would need to make sure they
were meeting both. ‘We don’t know exactly
how these models are going to work but
we need to be really flexible, otherwise
we’ll be in a situation where service
providers are cherry-picking clients.
‘There are a lot of changes going on
with this government,’ she continued.
‘They seem to want to do everything at
once but aren’t quite sure how it will all
work. The good news is that there’s
two years of pilots before we see this
on the ground, so we’ll be able to see
how it works and challenge it where it
seems problematic.’
‘With payment by results it seems
like we’re just numbers on a piece of
paper,’ said one delegate. ‘What’s to
stop services from just keeping us on
their books and stopping us from moving
on?’ Annemarie Ward agreed that PbR
ran counter to the recovery model. ‘It’s
reinforcing the role of agencies and the
state at the expense of the individual
and the community,’ she said.
Paul Hayes, however, told the confer-
ence that not only would PbR be piloted,
there would also be a six-month period
where the schemes would be co-design-
ed with the areas delivering them. ‘If
you live in one of the pilot areas, I would
say to you to get involved in that co-
design so that issues like cherry-picking
will be addressed.’
country, for example. We need legis-
lation to suppor t this.’ It was
important to challenge the debate –
much of it carried on in the letters
pages of
DDN
– that stigma could be
a positive force by discouraging drug
use, said Niamh Eastwood. ‘That’s
just rubbish – the reality of what
happens is people being denied pain-
relieving drugs in hospital, and that is
a shocking indictment of our society.’
‘I’m six months abstinent but that
stigma is always there with my GP or
if I go into hospital,’ agreed one
delegate. ‘It’s always my primar y
diagnosis, even though it’s not what
I’m actually there for.’ Some speakers
from the audience, however, felt it
was pointless and self-defeating to
‘get caught up worrying what other
people think of us’, while others felt
that one way stigma could prove
useful was by acting as a powerful
rallying tool. ‘Stigma can make us
unite, and we can fight this,’ said one.
‘Let’s unite and fight.’
‘Be aware, be educated,’ urged
Beryl Poole. ‘Know your rights.’
Question 5:
Is the recovery movement
being hijacked by the
mainstream treatment
and policy agenda?
‘HIJACKING IS PERHAPS TOO
STRONG A WORD
but what we are
seeing are attempts to co-opt, colonise
and degrade it,’ said Annemarie Ward.
‘We’re seeing the rise of recovery
capitalists and profiteers, and they are
being backed by government agencies.’
One of the reasons this was allowed
to happen was a lack of clarity in the
field about what recovery was and what
recovery-orientated services should
look like, she told the conference.
‘Some providers are now saying that
they are providers of “full recovery” –
well that’s a new one on me.’
‘I want to know what recovery is,’
said one delegate. ‘To me, being on a
script is a road to recovery.’ However
treatment needed to change,
Annemarie Ward told the conference.
‘Let’s get this perfectly straight.
Services and policy makers can’t
hijack the recovery movement,
because they can’t do recovery – the
recovery movement is a social justice
movement. We might be on the ropes
as the coalition government hacks
away at communities, but we are not
going to go away.’
DDN
7 March 2011 |
drinkanddrugsnews
| 11
Seize the day |
Question time
www.drinkanddrugsnews.com
‘Will we see the
same old mistakes
being made in the
new system?’
Annemarie Ward
‘In terms of the
professionals who
just give out a
script – and that’s
all they do – that
is not treatment.’
Dr Chris Ford
‘I’ve actually
become immune to
stigma because
I’ve experienced it
for so long.’
Beryl Poole
‘There are real
opportunities to
join things up, but
we need to do it
in the right way.’
Paul Hayes
‘The reality of
what happens is
people being
denied pain-
relieving drugs in
hospital and that
is a shocking
indictment of our
society.’
Niamh Eastwood