Public service union Unison and the Royal College of Nursing (RCN) have criticised plans for Manchester’s drug services to be handed over from the Greater Manchester West Mental Health NHS Foundation Trust to the charitable sector this week. The services will be provided by Addiction Dependency Solutions (ADS), Crime Reduction Initiatives (CRI) and Lifeline.
There is a ‘serious lack of clarity’ over future service provision, claims North West Unison, with services falling victim to the ‘ideological mantra of competition’. Unison is ‘seriously concerned that the outsourcing of an essential service will lead to chaos,’ said its north west head of health, Paul Foley. ‘There is no clear structure in place to ensure that vulnerable clients and their families will continue to receive the services currently in place. Already we have been told that the needle exchange programme in the south of the city will close.’
The RCN has stated that clients were anxious and unclear about how the changes would affect them. ‘Carving up the service may also see some individuals fall through the net and return to a life of addiction,’ said its officer for central Manchester, Maria Bryant. Chair of the Royal College of Practitioners (RCGP) Clare Gerada has also been critical of services shifting from the NHS to the voluntary sector – as charities take on contracts tendered by local authorities – warning that there were now ‘very few specialist addiction services’ and that little would be achieved ‘if we only have the third sector and general practice’.
Unison and the RCN’s claims, however, have been refuted by the providers and the local authority. ‘First and foremost this is not a cost-saving exercise – it’s about providing a better service to tackle drug addiction,’ said Manchester City Council’s executive member for adult health and wellbeing, Glynn Evans. ‘During an 18-month long consultation service users told us the existing provision was too complicated with a lot of duplication. We’ve streamlined the service into three stages so that there is a very clear entry point into the service, support system and then an exit point aimed at avoiding relapses.’ Removing duplication from the service would save money which would then be ploughed back into provision, he added.
‘We’re going through some major changes in the services in Manchester at the moment,’ said Michael Linnell, Lifeline’s director of communications. ‘What we’re trying to do is to ensure the disruption is as minimal as possible in terms of the effect on the client group.’ Lady Rhona Bradley, chief executive of ADS (Addiction Dependency Solutions) added that ADS was ‘concentrating on delivering a new drug service for the people of Manchester drawing on its 40 years’ experience of working in the city. We will continue to improve the lives of individuals, families and communities affected by addiction.’
‘Obviously CRI only has part of the new service model, but I think it’s extremely clear how the service is going to be delivered – it’s evolution rather than revolution,’ said CRI’s director of operations, Mark Moody. ‘It’s a much more community-based and asset-based approach, it’s more accessible and based on models that CRI has worked up over many years, and where CRI has taken over services from NHS providers in the past it’s a demonstrable fact that they are better for service users than what was there before – recent examples would be places like East Lancashire and Halton, where the waiting list for alcohol detox has gone down from four months to no waiting list. I do understand why people would be anxious when a big change in an important service takes place, but as far not being clear and potentially leading to poorer outcomes for service users, I’m afraid there’s just no evidence that that’s likely to be the case.’
Alliance chief executive Ken Stringer said it was ‘too early to say’ if clients were likely to be put at risk. ‘Our job at the moment is to reassure people who are calling us about this, but I’m concerned that we’ve been unable to get a response from the DAT. One of the questions I asked the DAT is about the quality impact assessments that have been conducted, and it would be comforting to see that those have been appropriately done. But we can’t answer people’s questions, which is very frustrating.’