Representatives from the NTA, general practice and service user activism set out their priorities for the new treatment system in the dynamic opening session of Be The Change.
‘The words “change” and “recovery” can mean a lot of different things to a lot of different people,’ service user involvement officer for Camden, Alex Boyt, told delegates as he introduced Be the change’s opening session. ‘Going from spending all your money on crack, with a little bit left over for food, to spending your money on food with a bit left over for crack is change for some people. For others, it’s more substantial.’
Change, however, should never be something that’s imposed, he stressed. ‘We’ve moved from listening to people about when services are not working to listening to them about when they are working. But it’s vital that we continue to do both.’
It was also vital to tackle stigma, said service user and activist Lee Collingham, particularly in terms of the barriers it created to accessing healthcare. Describing the experiences of service user peers, he told delegates that people were regularly and blatantly stigmatised in pharmacists, hospitals and a range of other settings. ‘In the chemist it’s supposed to be first come, first served, but people are left till last, as if they’re not as important as the other customers.’ When they dared to complain about this they were often met with hostility, he added.
Service users also described how they were invariably followed by security guards, and similar occurrences. ‘Many times in the workplace I’ve been overlooked for promotion because I’m open about my history, and you can see the attitudes of A&E staff change instantly,’ said Collingham. ‘It’s everybody’s responsibility to challenge stigma – in the workplace, in healthcare and in their lives in general.’
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One environment that aimed to be non-stigmatising was general practice, said GP and DDN columnist Dr Steve Brinksman. ‘There are a lot of my colleagues, I know, who still won’t work with substance users. It’s seen as a specialist area, and it’s also difficult to shift attitudes. Not everyone is brilliant in primary care, and we have to face up to that. But as newer people come in, things will move forward.’
One strong and obvious advantage of primary care was the medical knowledge of the practitioners, he stressed. ‘It means we can work with people in a holistic way. There’s also a recovery focus, but recovery in its broadest sense – it’s not a time-limited thing.’ Other benefits were universal coverage – as GPs should be readily available – and rapid response.
There were threats, however, he pointed out. The move from the NTA to PHE, the disappearance of PCTs and commissioning’s shift to local authorities meant there was a potential for fragmentation and the creation of postcode lotteries. There was also a reluctance to change on the part of some practitioners and organisations, and a lack of universally applied standards.
GPs in some areas had also been told that they could not do shared care, he said – ‘a real issue for us moving forward’ – and there were also concerns around tenders. ‘If you have a contract you are less likely to get it when it comes up for tender than if you are applying from elsewhere.’ Other growing challenges included the plethora of newer drugs, the increasing population of elderly users and the misuse of prescription and over-the-counter drugs.
Stigma would also need to be properly addressed, he stated. ‘It’s just normal people living their lives, and they need to be supported.’ Peer support was vital in this – ‘we need groups making those links’ – as was social capital. ‘I can’t write a prescription for a job or a house or meaningful training.’ Links with the right agencies were crucial here, he told the conference, and needed to be ‘really embedded’ in primary care.
‘There’s a lot of change happening, and you need to talk to GPs, commissioners and everyone involved in commissioning these services,’ he urged delegates. ‘And you need to do it now.’
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Service users had played a ‘very significant’ part in improving treatment, shaping services and ‘challenging us at the centre to do more and do better,’ the NTA’s director of delivery Rosanna O’Connor told the conference. ‘And long may that last.’
The last decade had seen drug use declining, fewer people injecting and more drug users recovering, she said. ‘Treatment systems and services are much better, in that people are not dropping out as they used to, and the prospects for people coming into treatment today are much better than they were a decade ago.’ Treatment also stopped around 5m crimes a year and saved £2.50 for every pound spent. ‘Those are powerful messages to people in local authorities,’ she stated.
‘Drug treatment is in reasonably good shape, alcohol treatment is catching up, and drug and alcohol treatment and recovery are priorities for Public Health England. The political interest is still there, and that holds the money in.’
However the system was about to shift from a central funding body to 151 local authorities, all of which would have differing priorities, she said, although local commissioning would also bring new opportunities. ‘Hopefully there’ll be opportunities to join things up better – around families, housing, training – but disinvestment is still a risk.’
Nonetheless those local authorities would still be required to report on how much they spent on alcohol treatment, drug treatment for adults and drug treatment for younger people, she explained. Recovery ambition would need to be maintained and championed, and it was crucial to make the best of what the new arrangements offered.
‘Your voice, and the voices of carers and families, the people who care about you, have been, and will continue to be, vital in shaping and improving local services,’ she said. ‘There’s been no substitute for the power that comes with people like me being able to say, “Well, service users would challenge you on that”. People in commissioning and in provider land will claim things that won’t stand up to scrutiny, and you have a vital role in challenging that. Maintain your voice locally – it’s really important.’
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Alliance CEO Ken Stringer stated that his organisation was ‘snowed under to the point of dysfunction’, however, as a result of people being ‘forced off scripts’ and out of treatment. ‘That’s not to say there’s not a lot of good practice out there – there is. But there’s some very bad practice as well.’
‘Tell us where it’s happening and we’ll do something about it,’ O’Connor replied. ‘It shouldn’t be happening – it’s not policy.’
It was vital to forge new alliances to make the case for continuing investment, she said. ‘The bit of the NTA that I’m responsible for – the parts that do the guidance and documents, and the local teams – will still be there in Public Health England, so keep in touch. We need you. There’s no success without you.’ DDN