On the margins

Marcus-Roberts_2webDrugScope’s annual conference looked at equality and diversity in the sector at a time of shrinking budgets 

‘We seem to be living in an increasingly pinched and mean society, a political climate of intolerance towards marginalised groups,’ said DrugScope’s director of communications, Harry Shapiro, as he introduced Access all areas: equality and diversity in drug and alcohol treatment, the charity’s annual conference.

The UK’s treatment system had been shaped by the heroin epidemic of the 1980s and ‘90s, said chief executive Marcus Roberts, ‘and I’d argue that we’re in the long tail of that now’. An estimated 300,000 problem drug users was ‘still a lot, but significantly less than the 450,000 at the height of the epidemic’, and while the 2010 drug strategy was still built around a notion of dependency inextricably linked with deprivation, this no longer fitted ‘with emerging issues such as drug use among men who have sex with men, or use of image and performance-enhancing drugs’, he said.

These shifts were against a backdrop of an estimated 40 per cent reduction in local authority funding over the course of this Parliament, he pointed out. According to DrugScope’s State of the sector 2013 research, there were signs of disinvestment in services but ‘no sense yet that we’ve reached a cliff edge’, while the political debate was also entering a new terrain. ‘On the one hand there’s an increasing focus on the millions of people who take drugs without experiencing any significant harm, and another discourse focused on the role of drugs in deprived and marginalised communities.’ There were left wing and right-wing versions of both, but the fact remained that in terms of public perception, addiction was seen as the primary cause of child poverty, and it was likely that this was where the focus would be in the run-up to the next election.

‘UK drug policy is in many ways a success, and at a time when we’re asking people to invest in it, it’s important to focus on that,’ he stressed. ‘Discourses around winning and losing the “war on drugs” are not helpful. What happens next is partly dependent on what we say and do.’

Another issue that would be in the news ‘a hell of a lot’ before the election was immigration, said CEO of the Refugee and Migrant Forum of Essex and London (RAMFEL), Rita Chadha. Although access to treatment was a vital issue for her clients there were significant barriers, including difficulties with language and registering with GPs, fear of the authorities, and stigma, something that was also an acute issue with people involved the commercial sex trade, said team manager at Blenheim CDP, Maggie Boreham. ‘What biases do we as practitioners hold?’ she said. ‘Do we know how to ask the right questions? What training do we need for our staff?’

‘Many staff assume that a “white middle-class” culture is neutral, and appears nice and friendly to everyone,’ echoed strategic director for addiction and offender care at CNWL NHS Foundation Trust, Annette Dale-Perera. ‘It isn’t. We need to match services to local needs, so you’ll need “teams within teams”, and local needs assessments are particularly important – if you don’t look you won’t see.’ Stigma and ‘nimbyism’ were the risks that went alongside the opportunities presented by the localism agenda in a climate of ever falling per capita spend on health and social care.

‘One of the things we’ve rather belatedly realised is that the way the state is structured – centralised, in silos – isn’t designed to respond well to complex issues like people with multiple needs,’ said associate director for public service reform at IPPR, Rick Muir. ‘We need to end this fragmentation, and we need to ask people what they want – what will enable them to lead the lives they want to lead.’

Drug use was about three or four times higher in the LGB population, said Alastair Roy of the University of Central Lancashire, partly associated with ‘significant self-esteem issues’ but also changing patterns of use linked to ‘chem sex’ and injecting. ‘Localism might be the name of the game in drug treatment now, but these agendas only move forward with national leadership,’ he said.

‘We need a model that better understands and mobilises the social resources available to us in the community,’ said the RSA’s director of research, Steve Broome. This could mean more diverse partnerships or more co-commissioning, he said, as substance use was a ‘collective, social inclusion’ issue, with the ‘constant cycle of re-commissioning arguably not helpful in this respect’. More investment was also needed in mental health, he stressed, where the gap between rhetoric and reality was ‘shockingly large’.

‘If you can’t ensure that the most vulnerable and marginalised are going to be looked after, is the cost of localism to society too high?’ asked Karen Biggs of Phoenix Futures. ‘Decision making at a local level is generally better than a state, monolithic model,’ said Rupert Oldham-Reid of the Centre for Social Justice, ‘but marginalised groups tend to be less good at advocating for themselves. A statutory requirement for recovery champions on local health and wellbeing boards could be one answer’.

‘We have a world-class treatment system and a lot to be proud of,’ Marcus Roberts told the event’s closing session. ‘But we also have a lot to do and a lot to build.’