Recently retired substance misuse manager for Bristol City Council, Sue Bandcroft, reflects on decades of change in the sector.
‘There’s nothing like the sun shining to make you think how nice it is not to have to worry about going into work, but I do miss it,’ says Sue Bandcroft. ‘So I’m starting to look around for something else to get involved in.’
Although she retired as substance misuse manager for Bristol City Council in May, she’s been helping to finish off work around a framework for residential rehab services in the city. ‘I’m still dabbling in there, as it were, but I’m trying to say, “I have to let them get on with it” now. I’m just looking at whether I should be still involved in the field, or are there other things I can get involved in? A bit like someone who’s been a service user for a long time – you start to see that actually there are other things in life.’ It’s a field she first came into in the 1980s, but it was while working as a nurse in London in the early ’70s that she really became aware of the impact that drugs and alcohol could have. ‘Even before that, at school, I had friends who’d had not pleasant experiences around drug use,’ she says. ‘So it had always been around.’
While nursing she became involved in health and sex education in schools, and later HIV prevention work. ‘When I came to Bristol I was very much on the sexual health side, and in those days they had things called HIV prevention coordinators, so when the money came along I had responsibility for the drugs budget of that. One of the few things to thank Mrs Thatcher for was actually funding those sort of things.’
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 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.’