Negative Impact

18 Nov

At Blenheim we have serious concerns about the commissioning, procurement, tendering, payment terms and the application of payment by results in the drug and alcohol sector. We also have great sympathy for the impossible funding environment that Local Authorities have been placed in by Central Government. This is not helped by the latest 6.2% cut in Public Health England (PHE) funding to Local Authorities, a £200 million in year cut. We share the growing concern that cutting £800 million from the PHE budget over the next four years will only be the tip of the iceberg, with some expecting the PHE budget to be decimated by the spending review in November or in subsequent years. Given that drug and alcohol treatment and indeed all PHE services provided by Local Authorities are subject to the NHS constitution it is outrageous that PHE spending, which is mainly invested in services for stigmatised and vulnerable groups is under attack.

It is right that local authorities now responsible for the provision of community based drug and alcohol treatment in England have a process for retendering the work provided to them by organisations such as Blenheim, however there needs to be a level playing field for charities of varying sizes, large private sector companies, NHS and local authorities. More importantly any recommissioning needs to be aware of the impact on service users.

Poor and frequent commissioning and procurement has a number of serious consequences not least of which is the cost. An exercise done by a provider to quantify the costs of tendering services over 10 years ago came up with a figure of £300,000 as the cost expended by all bidders and the commissioning authority per tender. Unintended impacts include deteriorating service provision, poor staff morale, and more importantly the fact that transitions between providers along with early exits from treatment are known factors in drug and alcohol related deaths. For example 1 in 200 injecting heroin users released from prison die within a month of release.

Increasingly charities like Blenheim seem to be in the business of tendering rather than in the business of caring for people in desperate need. In the last two years nearly 100% of drug and alcohol services have been through retendering processes according to a Drugscope survey.

A report, ‘Review of Alcohol Treatment Services’ published in August 2015 by the Recovery Partnership funded by the Department of Health into the state of alcohol services raises serious concerns about the impact of the current commissioning environment as did the ‘State of the Sector’ report, by Drugscope in 2014 into drugs and alcohol services.

Transfer of Financial Risks

The move from NHS to Local Authority commissioning has often seen a switch from payment in advance to payment quarterly in arrears. This has had a significant negative effect on cash-flow within many provider organisations. Many charities are facing increasing delays in Local Authorities paying invoices some waiting up to 6 months for payment in relation to money expended on delivering contracts. There is often little meaningful compliance with new regulations requiring payment of undisputed invoices within 30 days in the Public Contracts Regulations 2015.

Payment by Results (PbR)

Inappropriate poorly designed PbR schemes are a significant financial risk to charities. This is due to delayed payment of the PbR element for lengthy periods of time which impacts on cash-flow and because PbR is usually in our sector set against the cost of service delivery rather than as an incentive above this.

PbR is often set against stretch targets, which is appropriate where PbR operates as an incentive scheme. However almost all PbR schemes operate in our sector as repayment or non-payment schemes with funding deducted from core operating costs when often aspirational/stretch targets are not met.

When used PbR would be better to be clearly separated from core costs in contracts and be an incentive for excellent performance. Where non-payment or repayment conditions apply these we believe should be set in relation to under performance rather than against stretch targets and be clearly labelled as such and linked to processes in the contract related to under performance.

Procurement, tendering and contracts

All providers in the current environment need to accept that the tendering of services is here to stay and that charities like Blenheim will win and lose contracts, however we think there is a case to be made to increase from the standard 3 year contract to a 7-10 year minimum contract length or possibly longer to avoid regular disruption to the treatment of a vulnerable group of people. Such a move would allow providers to invest in equipment, staff training and buildings of the highest quality and build long term community links.

A recent ACMD report “How can opioid substitution therapy (and drug treatment and recovery systems) be optimised to maximise recovery outcomes for service users?” Published in Oct 2015 stated

“The ACMD has early evidence of the negative impacts of frequent re-procurement on local drug treatment systems and service users’ outcomes. It is very concerned that this ‘churn’ in the system, together with significant cuts in resources, is mitigating against stability in drug treatment systems, hampering quality and the implementation of evidence-based interventions (especially if they are deemed ‘expensive’) and may result in negative impacts on recovery outcomes. Furthermore, localism and the lack of ‘levers’ by bodies such as Public Health England and the Local Government Association may hinder government efforts to positively influence local systems.”

Local Authority contracts are often inequitable and allow cancelation by the local authority with three or six months notice, paying little regard to provider infrastructure costs and lease commitments. Often providers are asked to agree to contracts as a condition of being allowed to tender.  We would like to see contracts that are far less easy for Local Authorities to cancel once signed with the expectation that any but the most major changes required are done via contract variation rather than retendering. We fully understand and support contracts enabling cancellation where there are clear performance issues.

Minimum Turnover Requirements

At Blenheim we are concerned about the minimum turnover requirements that increasingly limit the ability of even large and major charities to tender for contracts they currently deliver. This is where to bid for work you have to have a minimum organisational turnover of say £10 million or £15 million. Whilst we realise this is a way of assessing the ability of an organisation to financially manage large contracts we believe it unfairly discriminates against smaller charities many of whom can easily manage larger contracts and that more sophisticated and more appropriate methods of assessing organisations should be applied.

I am aware of many smallish and medium sized charities that have not been able to bid for their existing contracts in their own right. This forces them into shot gun marriages with other charities as sub-contractors. Partnerships have a lot to offer and Blenheim is in many great and highly effective partnerships but they rarely work well when they are marriages of convenience or haste.

Tendering Processes

At Blenheim we are deeply troubled about the many instances of poorly managed tendering processes which create huge wastes of time and effort both at commissioning level and within provider organisations. Issues of concern include;

  • A lack of transparency about the process.
  • The number of tendering processes which have to be suspended due to flaws in the process.
  • A lack of knowledge about tendering and procurement within tendering teams
  • A lack of understanding by many commissioners of TUPE rules
  • A significant pension liability on incoming organisations where NHS or LA is the outgoing organisation particularly where down sizing is managed via a retendering process transferring liabilities for redundancy whilst often hiding cuts.
  • Unworkable specifications
  • Transfer of risk from Local Authorities to providers via Payment by Results with poor data to assess risk and often in relation to performance targets the provider has little control over.

Equally we would reflect that we have seen some excellent examples of commissioning regardless of whether we were successful.


If we want a thriving drug and alcohol sector we need to create a funding and commissioning environment where it can survive. Otherwise we face the risk of a choice of four or five mega charities as all but the largest go the way of the corner shop and the local butcher. Like banks and NHS Trusts these large charities maybe too big to let fail, but get into financial difficulty some will in the not to distant future as cuts in funding and huge public sector liabilities catch up with them.

Guest blog: ITEP goes to India by Kim Maouhoub

30 Sep

Anyone that knows me or has been in my airspace for more than five minutes knows of my love for India.

There was a time when Delhi was a place I zipped through on the way to either south India or the Himalayas, scooping up the odd friend for a whirlwind coffee/dinner/shopping spree/enfield admiration party and leaving them in my wake.

This year I have been lucky to spend more time in Delhi and have increasingly grown to love this beautiful, chaotic, breath taking (literally, and at times not in a good way) city.

It was an idea I had entertained for awhile but a last minute breath of inspiration pushed me to google drug treatment facilities in Delhi and send out a template email offering my services for a two day ITEP training a couple of days before I left London.

I got few responses but with a blur of emails and whatsapps I eventually arrived at Shafa in Rohini, Delhi and was asked to take a seat in the cool lobby, which offered sanctuary from the searing heat outside. There were a number of people there watching an information film about the facility so I watched whilst I collected my thoughts.

The CEO of the organisation soon came to collect me and ushered me into his office. I had the sense that he was really trying to get the measure of me and we proceeded to take it in turns to offer snippets of our CVs in the work that we did and as general human beings. We built on our many shared values and quickly established a rapport with lots of laughter and easy conversation.

My test was not over yet I suspect, even though I was there to talk to him about training his staff team he wanted me to meet ‘the guys’ as he called the residents. We went upstairs and my heart came out of my chest as we entered a huge hall with men sitting cross legged in rows…it was at that point I started to get an idea of the size of the programme they were running. So with the aid of a translator and a grand introduction from Ranjan I spoke to the residents of the programme.

12004145_523265787836998_5883855277377995444_nI am used to standing up and talking in front of groups of people but to do it with the aid of a translator to an audience some of whom are in withdrawal is quite an experience. It is hard to keep your nerve and maintain eye contact and the normal means with which I communicate were put to the test. And oh did I mention the fact I was being filmed, photographed and monitored from the side-lines by the entire staff team? It was extremely gratifying to see expressions start to soften and nods of the head as they started to get why I was there. When I had finished speaking there was a chance for them to ask questions which they did by first raising their hand and being invited to stand and speak.

Many took the opportunity to do so and when they had finished a member of the group seemingly overwhelmed by the whole occasion jumped up and said thankyou ma’am which made the whole room laugh. Even as I write this now I feel the tightness in my throat his beautifully spontaneous action provoked.

Having met ‘the guys’ I went downstairs to meet with the staff team and some of the senior peers to discuss the mapping training I proposed to run. They were extremely enthusiastic and it was agreed that the first of two days training would take place the next day.12036849_523266397836937_4921126196957729621_n

I cannot tell you how much fun it was to go home, amend my material to suit the purpose and then go to work in rush hour on the Delhi metro. I think my metro experiences alone could be a blog in themselves but suffice to say as with every human interaction it gave me lots of opportunity for growth and enough anecdotes to dine on for the foreseeable future!

It was my first experience of delivering this training to a mix of staff and senior peers and I had to give careful consideration to my amendments to maintain safe boundaries without compromising the work. In all honesty I saw it as more of a challenge so I was taken aback with delight when I saw the value of staff experiencing not only their own journey with maps but their amazement witnessing the changes in those they had worked with for almost a year. As with every training the mapping sells itself but with the hundreds of times I have facilitated this process I have never seen anything quite as beautiful as this.

Due to the confidentiality agreed which is crucial to support the integrity of this training I cannot say more but I can say that everybody engaged with a passion and joy that was infectious and it soon became apparent that some members of the group were thinking of their own sessions and planning their own bespoke maps.

At the end of our session mindful that I would be returning to the UK I wanted to formulate an action plan with the team to ensure that this would be carried forward.

12009785_523265867836990_5857122002329707386_nTogether we agreed phases of implementation including cascading the training to absent staff, showcasing the maps to clients, adapting maps to client need in terms of language and a Skype call with me to review actions achieved and actions to complete.

Shafa published their own experience of the training. Tushar said “I take the whole concept of mapping as one of the most important tools that someone has given to me to play with. Session continued for two days and still I felt that it was not enough. The whole technique enables you to find out the solutions of your problems by using out own inputs to any situation. More over I would like to add to it that it also helps to identify our true self like our strengths, our weaknesses, our challenges, the people who matters in our life the most etc. It allows a counsellor to record all the necessary information about the counselee in a more systematic order” Sachin said “Attended this session on Mapping which would be so informative i had never expected. It was like peeling an onion layer by layer, same was the case with this session on mapping it had different layers of valuable information within it. A very thoughtful innovation to get information related to any body and any sort. By attending this session I feel more powerful and confident, because for the first time I saw things from a different perspective and tried to find out solutions for my problems with the resources available with me. This was really motivating and skilful technique for life.”

It is not uncommon at the end of the two day training that there are emotional goodbyes, tears and hugs from 12032923_523271207836456_1180870037899864262_ndelegates. Over the years I have been privileged to witness huge events unfold, decisions made and action plans put into place through mapping over the two days. ITEP node-link mapping is one of my favourite trainings to run, the privilege of facilitating such powerful change is not lost on me and is always an honour. I have forged powerful connections with delegates I may never meet again but the link will never be broken.

I found it so hard to go after such an emotional three days but I know that I will meet the Shafa family again. I want to thank them for allowing me to work with them and am grateful for all the learning I underwent whilst with them. I know because of them I left a better trainer.

By Kim Maouhoub, Training Manager at Blenheim

To find out more information or to book training please contact our training team using this enquiry form.

Shocked and saddened by drug related deaths figures for 2014

23 Sep

At the DAAT conference in early September 2015 I heard the drug related death figures for 2014. Despite having warned people they would be worse than the previous year I was shocked and deeply saddened. I have waited to write this blog to get my thoughts together.

Last year I was shocked by the inaction of Government and many Local Authorities to the 2013 figures.

I was going to talk about the Naloxone Action Group, positive action by the Department of Health, questions in Parliament and early day motions on naloxone. I was going to talk about the fact that since the 2013 drug related death figures came out, I and so many others have worked to try and understand what is happening and the cause.

Personally I believe that increased heroin purity, poor heath and financial pressures on the drug treatment system are key factors in increasing drug related deaths. I also believe that action to increase naloxone availability in England will avert a significant proportion of these deaths. Without naloxone the figures would already have been, in my view, significantly higher.

However the 2014 figures are shocking to me, every death represents a person, perhaps a father or grandmother, certainly someone’s child, grief and the waste of a life. I picture the funerals as a silent rebuke to do more. The figures are the highest since records began.

As you read the statistics below, from the Office of National Statistics, take time to consider the people the figures represent.

Screen Shot 2015-09-17 at 15.22.32

Heroin and morphine deaths rise by two-thirds in the past 2 years.

Screen Shot 2015-09-17 at 15.23.31

Within England, the North East has the highest mortality rate from drug misuse, London the lowest.

Screen Shot 2015-09-17 at 15.21.48

2014 registrations show drug related deaths reaching the highest level since records began.

Screen Shot 2015-09-17 at 15.28.18

Majority of heroin deaths were among the 30-49 year old age groups.

Screen Shot 2015-09-17 at 15.22.04

Males were over 2.5 times more likely to die from drug misuse than females.

Screen Shot 2015-09-17 at 15.21.37

Two issues seemed important to understand after the 2013 figures and they remain the same after the 2014 set. Firstly what is causing the rise in deaths? And secondly what is being done to prevent them?

A naloxone summit, hosted by Blenheim, bought together a campaign for a national naloxone programme in England. Through a FOI request we discovered the true extent of under provision of naloxone with only 32% of local authorities in England saying Naloxone was available. We formed the Naloxone Action Group England to ensure the regulations were changed, to ensure effective guidance was produced, and to ensure provision of naloxone across England. We got MPs to ask a range of questions in Parliament and gained support for an early day motion, sponsored by amongst others the current leader of the opposition Jeremy Corbyn and signed by the current Shadow Chancellor, John McDonald. This was not a party political issue; the EDM was also supported by current Conservative Minister Tracey Crouch. In total 32 MPs signed up to support wider naloxone availability.

Letters to the Minister from the Drug Alcohol and Justice Parliamentary group, chaired by Lord Ramsbotham secured firm assurance that the Government would make the changes recommended by ACMD to make naloxone more widely available from October this year.

Sadly, at the Naloxone Action Group we believe around 50% of local authorities continue to fail to provide naloxone. We will do a further FOI this year.

Meetings at Chatham House with senior officials revealed clear evidence that entering and leaving drug treatment and/or prison are particularly dangerous times for overdose and death. Thus pressure to leave treatment early and failure to adequately manage transfer of those with drug problems from residential settings could seriously endanger lives.

A drug related death summit held at the beginning of this year, hosted by Drugscope, Public Health England (PHE) and the Local Government Association, examined what might be causing the rise and to look at what might be done to reduce overdose deaths in future years. The attendees included policy makers from across government, commissioners, clinical and service provider leaders, and service user representatives.

The key messages from the summit were:

  • The availability of accurate, timely and easily accessible data is important in order to make the appropriate adjustments to policy and practice in order to reduce drug-related deaths;
  • The majority of drug misuse deaths still involve opiates, in particular heroin and methadone;
  • Being in contact with a treatment service would appear to be a significant protective factor for drug-related deaths;
  • Services and practitioners should pay attention to the elevated risk for those in treatment who are regularly overdosing, are drinking excessively, live alone in temporary accommodation or are homeless, or as a result of smoking-related diseases have compromised respiratory systems;
  • Policy makers and commissioners should think about providing timely and accurate alerts to drug users who are not in the treatment system – including drug users who don’t use opiates;
  • Commissioners and services should look at how they could supply naloxone more widely in the community to ensure those vulnerable to heroin overdose (including those not in treatment), their families, peers and carers are able to access the medicine.

Over the last year we have seen PHE nationally, clearly assert the need for action to reduce drug related harm and publish significant guidance on naloxone and reducing drug related deaths. However, at a time when drug related deaths are at their highest ever level, to cut £200million from Public Heath funding to local authorities is truly outrageous.

I am still ashamed to live in a country where things like the PHE £200 million cut happen at a time of evident need and many local authorities look the other way as people die as a result of the negligent failure to follow guidelines and supply naloxone.

Offer support not stigma

26 Aug

With the Black review looking at alcohol, drugs, obesity and welfare (including the possibility of sanctioning the benefits) it is hard not to see this as an outrageous attempt to stigmatise people whose lives are often difficult enough. Many have recognised physical and mental health conditions underlying their drug, alcohol and obesity. This is often compounded by deprivation and a lack of social capital. Many are too ill, too old, or lack the skills necessary to enter the workforce. I do not believe that it is right to sanction people’s benefits where they do not access treatment.

I do believe that Government and the drug and alcohol sector need to seriously consider whether and how more people addicted to drugs and/or alcohol, and those in recovery can be supported into sustainable employment something many are desperate to achieve.

A chaotic lifestyle is common for many in treatment for problem drug and alcohol use and most are far from ready for employment.  Many are unlikely to have experience of recent employment and so are detached from the labour market. They often face a series of additional issues at the beginning of the process of recovery, such as managing their addiction and the associated health problems, and a lack of stable accommodation, all of which may hinder the gaining of employment.

One of the central aims of the treatment system I believe needs to be to help people resolve these problems and where possible assist them to become ‘job ready’ whilst acknowledging that gaining and sustaining employment is unlikely to be successful unless the primary issues are addressed and there is evidence of stability.

The Work Programme and its Payment by Results funding has resulted in a focus on those easiest to get back into the workplace whilst those furthest from being ready to enter the job market are often parked with little support. Specific services working with drug and alcohol misusers around employment and training were an early casualty of the Works Programme as were many services commissioned by the treatment system to address employment issues.

There is in my view a clear consensus about what is required (see UK Drug Policy Commission) to assist drug and alcohol users to re-enter the workplace or in some cases enter for the first time.

  1. Treatment for physical and mental health problems
  2. Building motivation and aspirations
  3. Stabilise drug use
  4. Provide appropriate stable accommodation
  5. Develop soft skills e.g. through volunteering
  6. Formal training and skills development
  7. Work trials and job placements
  8. In-work support

Given the recovery agenda and the importance of employment in sustaining recovery I believe that employment support and ETE advisors should be part of drug and alcohol treatment provision and commissioned as such, rather than part of wider DWP initiatives such as the Works Programme. Many drug and alcohol charities run excellent such services but such initiatives remain rare. Current employment initiatives via the Works Programme fail Blenheim’s beneficiaries and where we are able to get people job ready do not seem to be able to deliver employment.

There are two clear challenges in getting more service users into employment

‘Job-readiness’ – an individual’s beliefs and feelings about their readiness for work;

‘Employability’ – employers’ perceptions of the suitability for employment of individual jobseekers

Until the Government puts pressure onto employers to ring fence placements for disadvantaged people, then our service users will continue to face an up hill battle and further disappointment.  Perhaps local authorities and public services should be expected to offer employment opportunities for those seeking re-entry into the labour market or it could be a condition on agencies taking public sector contracts.

Many will need significant help in overcoming some of the common barriers to being job ready which include:

  • low levels of education or skills;
  • poor physical or mental health;
  • evidence of multiple forms of deprivation;
  • gaps in provision of support services;
  • personal and presentation barriers;
  • and interpersonal barriers

There are significant dangers of rushing people back in to employment too soon becoming ‘job ready’ incorporates a range of factors, from primary issues of stabilising drug/alcohol use and accommodation, and related health issues, to re-engaging with the labour market, including volunteering, to build up a CV and a skills base.Helping people develop a positive and realistic attitude to work, through building confidence and motivation (e.g. undergoing training, volunteering etc.), is an important task for services. It is important to provide practical support in the search for employment along with aftercare support to help sustain employment.Currently recruitment processes are used in different ways to manage these perceived risks. This can range from ‘blanket’ recruitment policies that rule out employing those with a history of problematic substance misuse, through to a more discerning individual approach. A central concern is whether an individual is ‘fit for the job’ in terms of being reliable, capable and punctual.

Any worthwhile ETE programme needs to have an Employment Engagement worker who can job broker for those returning to work and carve out local employers to get on board and contacting employers directly for clients on an individual basis, selling it as a free recruitment service for people we know and have worked with for a long time. It will be important to negotiate work placements to give people and employers an opportunity to see if it will work out or to provide valuable experience for the CV.

The active engagement of willing local employers to offer work placements and employment opportunities is crucial. There is an on-going need to allay the fears of employers who are generally reluctant to take on potentially ‘risky’ job applicants. The development of in-work support packages would greatly assist with this.

There needs to be a process of matching the expectations between people and those helping them with ETE regarding suitable employment. This will include the need to recognise that health and drug status along with education, age and experience will play a fundamental part in the types and number of job opportunities available.

There remains a lack of access to specialist support for drug and alcohol users, services need to incorporate ‘specialist trained ETE workers’ in the field as part of the treatment system not something to refer onto

There is a need to create an ‘appropriate’ ETE environment to aid with employment search/links. Work programmes are not set up to deal with our client group, JCP does not have the time or resources and staff in most drugs and alcohol agencies are not skilled or equipped or tasked to deal with this area whilst clients are  in treatment.

DWP, Government and local authority have a responsibility to put pressure on employers to ring fence work placements and offer work based apprenticeships.  Some ex-offender charities and organisations have made huge progress in this area.

Stigmatising people who are overweight, or have drink and/or drugs problems does little to improve their employment prospects.  Instead providing targeted ETE support and finding supportive employers to offer opportunities for employment provides a positive and potentially much more effective response.

It’s time to stand and fight

1 Jul

Disinvestment in drug and alcohol treatment is putting lives at risk.

Blenheim has four strategic aims: number two is to actively and effectively campaign on behalf of people stigmatized by alcohol & drug use. So here goes…

Cuts in drugs and alcohol funding, along with the lack of political leadership, along with a lack of priority in England is having a major negative impact on some of the most vulnerable people in our communities. The moving of drugs funding into Public Health England (PHE), where illicit drug use is not a strategic priority, has given a green light to local authorities to disinvest in substance misuse services.

There has never been a more urgent need to have clear English government leadership spelling out the responsibilities of local authorities along with the levers to ensure they deliver. What we have is localism, a post code lottery, a government washing their hands of responsibility like Pontius Pilate and senior political figures actively conspiring to undermine evidenced based practice. Indeed it is not clear whether under the current Government in England will even have drug and alcohol policies.

We are witnessing the end of the best drug and alcohol treatment system in the world and the time to act to defend it is now. Its decline is being marked by lost opportunities and an increasing death toll as we fail to respond to rapidly increasing numbers of drug related deaths, health needs, and fail to tackle issues such as hepatitis C, HIV and liver disease. We are also failing to resource “harm reduction”, a phrase banished from the Government lexicon like a dirty word.

Over the next 3 years, spending on drug and alcohol services is predicted by some officials to fall between 25% and 50%.

Prior to Drugscope falling victim to Government cuts it’s recently published State of the Sector Report revealed;

  • Evidence of deep and widespread disinvestment and planned disinvestment in drug and alcohol services. (Over 70 services indicating cuts in funding with an average net reduction of 16.5%)
  • A third of local authorities indicating decisions to reduce funding in 2014/15 and 2015/16
  • The massive scale of re-commissioning and tender renegotiation leading to the widespread disruption of services. (54% of services since Sept 13 with another 49% indicating re-commissioning between Sept 14 – Sept 15)
  • Cuts in frontline drug and alcohol staff across the country and increasing caseloads
  • Worsening access to mental health services
  • Worsening provision of outreach services
  • Worsening access to housing and resettlement provision
  • Worsening access to employment support
  • Lack of provision for older clients
  • Negative impact of prison staffing cuts on access to treatment
  • Little confidence in Police and Crime plans and Joint Strategic needs Assessments/Joint Health and Wellbeing strategies reflected local needs
  • Reduction’s in harm reduction services at a time of increases in drug related deaths
  • Commissioning processes that discriminate against excellent small and medium-sized organisations delivering excellent local services

There has been a change in the focus away from the needs of vulnerable heavily addicted people with often multiple economic, social and health problems onto the needs of the wider population. The not insignificant needs of this far larger population will mean fewer resources to support those heavily dependent on drugs and alcohol with multiple and complex needs.

The provision of services to people with significant and multiple needs is being disrupted by frequent re-commissioning and system redesign. It has a hugely detrimental impact on the ability of organisations to care for people accessing services. It has had a significant negative affect on staff morale and the ability of organisations to invest their resources into the provision of services which are increasingly diverted to funding tendering capacity. Sadly at Blenheim, and I suspect other providers, staff work through the night not to help those in need but to win the right to deliver services with significant reductions in funding, challenging targets and poorly thought out PbR requirements. The costs and transfer of liabilities to the voluntary sector are driving all but the largest providers out of existence.

There is an increasing failure to address housing, complex needs, mental health and employment. There is a shocking lack of access to the employment market for people with a history of drug and alcohol misuse particularly where this is associated with criminal convictions. Specialist services addressing employment for this group were decimated in the Government commissioning of the Works Programme. Changes to welfare benefits have impacted detrimentally on housing stability and the level of homelessness experienced by those who are drug and/or alcohol dependent is rapidly increasing. The decommissioning of many NHS providers is resulting in a decline in many areas in access to specialist mental health service provision.

People with drugs and alcohol problems suffer prejudice and discrimination particularly if they commit the crime of being poor. Sadly this right to discriminate is enshrined in UK equality legislation. Yet again we see policies being suggested which focus on drug and alcohol users as being the undeserving benefit claimant if they are not in treatment. A requirement on local authorities to provide employment paying the living wage would be more constructive. It’s often not that people with drugs and alcohol problems are reluctant to work but that employers are reluctant to provide employment. We need a system of regulation that supports those experiencing problems with alcohol and drugs rather than criminalizing and stigmatizing people for being ill and vulnerable.

People who inject drugs are the group most affected by hepatitis C in the UK: around 90% of the hepatitis C infections diagnosed in the UK will have been acquired through injecting drug use. Across the UK 13,758 hepatitis C infections were diagnosed during 2013.

Around 2 in 5 people who inject psychoactive drugs such as heroin, crack and amphetamines are now living with hepatitis C, but half of these infections remain undiagnosed. PHE state “Interventions to diagnose infections earlier, reduce transmission and treat those infected need to be continued and expanded, with the goal of reducing the prevalence of hepatitis C.”

Often, hepatitis C infection remains asymptomatic and is only diagnosed after liver damage has occurred. Left untreated hepatitis C infection can result in severe liver damage, liver cancer, liver failure and death.

This year we will leave 97% of people with hepatitis C untreated. Imagine the outrage if this was breast cancer or lung cancer, particularly if the death rate was climbing year on year as it is with hepatitis C.  Now imagine if you could completely cure everyone with breast cancer or lung cancer but decided to only treat 3% a year. Outrage! This is precisely what happens to those with hepatitis C.  There is a real risk now that even this appallingly low figure will become unachievable as a result of changes in funding.

Lets move on to Naloxone: the failure of Government to roll out Naloxone in England along with a lack of emphasis on harm reduction and disinvestment in drugs services are likely factors in a 32% increase in heroin/morphine related deaths.

The ONS figures (2013) for drug related deaths show that there were 765 deaths involving heroin/morphine; a sharp rise of 32% from 579 deaths in 2012. Many of these fatalities could possibly have been prevented by the use of Naloxone as an intervention.

Naloxone is a medicine that is a safe, effective and with no dependence-forming potential. Its only action is to reverse the effects of opioid overdoses. Naloxone provision reduces rates of drug-related death particularly when combined with training in all aspects of overdose response.

The Advisory Council on the Misuse of Drugs (ACMD) undertook a review of Naloxone availability in the UK in May 2012, its report to the Government strongly recommended that Naloxone should be made more widely available, to prevent future drug-related deaths.

Scotland and Wales have national programmes to make Naloxone widely available but there has been no similar programme in England. This has led to a failure across England to supply Naloxone in over of 50% of local authorities.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of Naloxone would reduce these deaths overnight. Perhaps we should conclude that English opiate users lives are worth less than the Welsh and Scottish ones.

There is a growing palpable sense “old school activism” in the sector. There’s no time, no money, no staff, no resource but up and down the country people, organisations and service user groups are rising to the challenge. There is a palpable sense of determination; the power of networking is gearing up, sharing ideas, inspiration and the need to stand strong in the face of cutbacks.

Unless Service User Groups and a powerful alliance of GP’s, NHS and third sector providers and charities are prepared to fight in the corridors of Whitehall and Westminster, and on the beaches of local authority cuts, I fear that the worlds best treatment system is about to be decimated in 2015/16. I fear for the people we help and I pray that I am wrong. It’s time to stand and fight.

Tories – England needs you to show strong, inclusive leadership

14 May

England has the best drug treatment system in the world; it exists because of the vision of far sighted people from all political parties and the dedication of amazing staff, organisations, charities and public officials over the last 50 years.

Cuts in drugs and alcohol funding, along with the lack of political leadership and the lack of priority in England may in the coming years have a major negative impact on some of the most vulnerable people in our communities.

The moving of drugs funding into Public Health England, where illicit drug use is not a strategic priority, has given a green light to some local authorities to make heart breaking cuts in services, Birmingham being one example.

There has never been a more urgent need to have clear English government leadership matching that of Scotland. Spelling out the responsibilities of local authorities along with the levers to ensure they deliver. I would like the next government to take clear action to protect the best drug and alcohol treatment system in the world. Provide better opportunities for those in recovery and significantly reduce the death toll by committing to harm reduction, responding more robustly to rapidly increasing numbers of drug and alcohol related death and serious illness. I also would like to see a greater emphasis on responding to other health needs of those with drug and alcohol problems.

Any government with an ounce of decency would follow the Portuguese example and move rapidly to bring hepatitis C treatment up to the standards of HIV treatment. If hepatitis C treatment was running trains only 3 in every 100 would get to work and many would die on the platform.

I would like to see the incoming government do the following things with drug and alcohol treatment policy and funding;

  • Identify and appoint a single Senior Government Minister to be responsible for drug and alcohol policy, accountable to Parliament
  • Commit to evidenced-based practice
  • Ensure everyone in recovery from drug and alcohol problems has opportunities to rebuild their lives
  • Develop a national harm-reduction strategy to reduce drug and alcohol related deaths and ill health
  • Widen of the access to residential treatment focusing on need rather than the failure of everything else
  • A minimum unit price for alcoholic drinks is introduced along with health warnings on labels and prominent display of calorie’s
  • Create a national commissioning Ombudsman, to ensure transparency and accountability for local commissioning decisions
  • Widen the remit of the Care Quality Commission (CQC) to include all local authority-commissioned drug and alcohol services
  • Ensure the competence and appropriate accreditation of the drugs and alcohol sector workforce, in line with other areas of health and social welfare, by investing in an independent association
  • Follow the guidance provided by the Advisory Council on the Misuse of Drugs (ACMD)
  • Reinvigorate independent research on drugs and alcohol to fill the gap left by the UK Drug Policy Commission (UKDPC)
  • Ensure comprehensive access to the life-saving drug Naloxone, across the whole of the United Kingdom, in line with World Health Organization (WHO), ACMD and public health guidelines and advice.
  • Ensure the availability of services and National Institute for Health and Care Excellence (NICE) -approved treatments for all patients diagnosed with hepatitis C, in line with international guidelines
  • Everyone in recovery from drug and alcohol problems has opportunities to rebuild their lives,
  • Ensure access to safe and secure housing, employment and meaningful activity and support for health and mental health
  • Investment is provided for a national programme to tackle the stigma and discrimination experienced by people in recovery from drug and alcohol problems
  • ensures expenditure on drugs and alcohol treatment is maintained at a time of severe budgetary pressure on local authorities

Guest Blog – Working for Blenheim by Noor Salik

27 Mar

I first heard of my six-month posting to Blenheim in a tiny internet café in Sicily.  I was on holiday and taking a break from the heat by checking emails. A message from the fast stream civil service resourcing team informed me that my next posting would be a secondment to the voluntary sector.  My mood, already happy from days of sea, sun and pasta, was cheered enormously by the prospect of joining Blenheim.

My good feelings were confirmed once I’d arrived.  Blenheim’s central office staff were enormously welcoming.  Cathy, my line manager for the posting, organised a brilliant induction and I got to meet the Chief Executive and other senior staff immediately.  I was part of the Business Development Unit at Blenheim, an important part of the organisation dedicated to ensuring that it is able to submit high quality bids to provide drug and alcohol services. I was astonished by the sheer amount of information required to fill in a tender (and all within such short deadlines)!  I never thought I’d develop so much knowledge about how to undertake First Aid at Work assessments nor about drug and alcohol training courses.

It was fascinating to see the tender process from end to end – from attending a buyer’s event and then helping the team make decisions on which services to bid for and to then moving from the Pre-Qualification questionnaire (PQQ) stage to the final tender.  For a small charity such as Blenheim, I was impressed by the ambition and professionalism with which tenders were undertaken – on occasions Blenheim led bids for multi-million pound contracts with NHS and other voluntary sector partners. I was happy that I was able to help a team that had won six of its last seven tender applications.

As part of my time with Blenheim, I also got to visit a couple of Blenheim’s frontline services.  I won’t forget going to the police station, including visiting cells, to see how Blenheim works in partnership with police and other agencies as part of its Drug Intervention Programme. I also attended Blenheim’s KC North Hub service and was impressed with the staff’s commitment to their service users (for example adjusting opening times to accommodate service users who wished to keep visits discrete).

Part of the scheme I am on encourages us to think about how things could be done differently.  I would definitely look at procurement processes for public sector contracts.  I did find it remarkable that external organisations were given little time to develop proposals for services lasting several years.  This is an area the Government has recognised and my previous job posting at the Cabinet Office had been looking at how the public sector could procure more effectively and efficiently.

I’ve had a fantastic time at Blenheim.  I will miss the camaraderie of the team led, admirably by Cathy, and the dedication and commitment of individuals working with some of society’s most vulnerable individuals.  I wish the organisation all the best as it expands in future!

Noor Salik, Civil Service secondee on the Charity Next scheme.

Is everything going well with the reform of the Probation Service?

24 Feb

Not if you read a recent exchange this month (Feb 2015) on the floor of the House of Lords.

Following what must have been a lacklustre response from the Minister Lord Ramsbotham said “When I was Chief Inspector of Prisons, I used to tell Ministers that they could accept either observed facts from me or unobserved fudge from officials, but that improvements could follow only on facts. Since the Secretary of State denied parliamentary approval of the rushed Transforming Rehabilitation timetable, it has slipped. Among many other problems, community rehabilitation companies have been given only a bare five weeks to mobilise when they say that they need six months, and community probation service officers, for example, are having to perform tasks with high-risk offenders for which they are not qualified. Clearly, all is not well. Will the Minister please tell the House when the Government will give the public the facts rather than fudge about the delivery of probation services?”

Lord Beecham then put the boot in further “In the course of court hearings over a challenge to the legality of the Government’s proceeding with the contracts for the 21 community rehabilitation companies, a number of concerns were raised. These related to problems with IT, the management of sensitive victim information, lost records of offender contacts, staff shortages, delays in pre-sentence and standard reports, and more besides.”

​What have the 21 community rehabilitation companies have to say? Well very little as apparently rumour has it  they have all been instructed to act like the 3 wise monkey’s, hear no evil, speak no evil, see no evil, until after the general election in May or face dire consequences.

In the meantime what we really need to do is set up a service to advise, assist and befriend offenders, rather than create shareholder value.

My apologies to the Government but I edited out “unobserved fudge” it is after all my blog.

“Do not let me die”

11 Feb

At the beginning of last year (2014) I committed Blenheim to campaign on behalf of people with drug and alcohol problems, more specifically for the organisation to campaign around the issues of declining investment in services and the failure to treat those with hepatitis C. By the middle of 2014 I had added the failure to provide access to the life saving drug Naloxone and the need to review drugs legislation to bring it into the 21st century. Interestingly a view shared by a majority of ex Government Ministers responsible for drugs and a significant proportion of ex Chief Constables. Well done Nick Barton the Chief Constable in Durham and Norman Baker MP for daring to say so whilst still in office.

At a time of public sector cuts and funding for drugs and alcohol services delegated to Local Authorities along with a lack of clarity about what they are legally required to provide, there has never been a more urgent need to have clear English government lead spelling out the responsibilities of Local Authorities along with the levers to ensure they deliver. What we have is Localism, a post code lottery and a Government acting like Pontius Pilate. Over the next 3 years spending on drug and alcohol services is predicted, on average, to fall between 25% and 50%.

I and other dedicated determined people have meet with Ministers, MP’s, officials, signed letters of outrage, letters consensus, got questions asked in the House of Lords and the House of Commons and received promises of change and assurances of a Government commitment to action. Thank you to those committed MP’s, Lord’s and Baroness’s who have supported our cause.

Such promises vanish quickly into interdepartmental committees, policy forums and committee sign off, and if all else fails denial of responsibility or power and the words “the funding and responsibility has been devolved we no longer have control and few levers”.

Over the last year there has been a lot of talk, lots of meetings, and little action or change on the ground. There has been little improvement in access to hepatitis C treatment. We still fail to treat 97% of people with this life threatening illness. Imagine the outrage if this was breast cancer or lung cancer, particularly if the death rate was climbing year on year as it is with hepatitis C.  Now imagine if you could completely cure everyone with breast cancer or lung cancer but decided to only cure 3% a year. Outrage! This is precisely what happens to those with hepatitis C.  There is a real risk now that even this appallingly low figure will become unachievable as a result of changes in funding.

Lets move on to Naloxone, I am going to plagiarise an article by Chris Ford and Sebastian Saville, otherwise known as creative swiping (sorry).

What do we do with a medicine that prevents certain death for people with a particular condition—and is safe, cheap, and easy to administer?

  1. Immediately make it accessible to those who can administer it when such a life-or-death situation arises.
  2. Make it available to no one except doctors and emergency room workers.
  3. Endlessly debate the particulars of how and when it should be widely introduced.

If you picked number one that would seem to be a reasonable choice. Unfortunately, it would also be incorrect. With few exceptions, answers two or three apply in the vast majority of the world when it comes to the medicine naloxone.

I was outraged when I heard of a 3 year delay in responding to the ACMD recommendations to make Naloxone more available to families, peers and friends. Blenheim hosted a summit and a wide coalition of agencies and service users formed the Naloxone Action Group (NAG) England. We quickly found a wider scandal of widespread failure across England to supply Naloxone to anyone in over of 50% of Local Authorities.  This is shameful and NAG England will seek to hold authorities accountable.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of Naloxone would reduce these deaths overnight.

We await important guidance from PHE on Naloxone, due this month, which local authorities are unfortunately free to ignore unless we give those who are failing to implement a reason to change and somehow hold them to account.

Now this could get depressing and I could go all Shakespeare on you and the following Macbeth quote springs to mind.

“To-morrow, and to-morrow, and to-morrow,

Creeps in this petty pace from day to day

To the last syllable of recorded time,

And all our yesterdays have lighted fools

The way to dusty death.

Out, out, brief candle!

Life’s but a walking shadow, a poor player

That struts and frets his hour upon the stage

And then is heard no more: it is a tale

Told by an idiot, full of sound and fury,

Signifying nothing.”

But last week something amazing happened in Portugal!

“Do not let me die, I want to live” shouted Jose Carlos Saldanha a patient awaiting treatment for hepatitis C, to the Minister of Health during a hearing taking place at a Parliamentary Committee on Health before being escorted from the room.

José Carlos Saldanha was attending several hours of debate on access to treatment for hepatitis C.  He was accompanied by the children of two other patients with hepatitis C one of whom had recently died. Speaking to journalists outside José Carlos Saldanha said that “only in this country, do you see this little shame and that the minister is a “killer” (unfortunately Jose is wrong the same is true in England).

Interviewed on TV the following day José Carlos Saldanha revealed that his treatment had been agreed a year ago and spoke of a “war” that has waged as he struggled to gain access to treatment.

“I am not an imaginary patient, I’m real. The war has been great and my air time is very short. […] There is a cure and I do not understand what they are waiting for.”

This issue has now been a leading political story in Portugal for the last week with the politian’s under fire not only for the failure to supply treatment but for the way in which they initially treated Mr Saldanha and the two people with him.

A week later and Mr Saldanha has started hepatitis C treatment and Portugal is well on the way to putting in place a national programme of treatment for those with hepatitis C.

The extortionate prices of new hepatitis C treatments are also under attack as Medecins du Monde an NGO are challenging the patent on Sofosbuvir with the possibility of dramatic reductions in cost.

Later this month is the DDN Service User Conference, perhaps the time for talking is over, perhaps the time for war is here, and perhaps the time to demand the right to treatment is now. The time to demand “Do not let me die” has arrived.

“We make a living by what we get, but we make a life by what we give.”

29 Dec

As the clock ticks towards the end of 2014 and our 50th year I look back on what has been an amazing year for Blenheim. A new sense of direction, new state of the art central training and management facility, huge investment in upgrading buildings and infrastructure across the organisation and a shift to put the charitable purpose and our beneficiaries even more at the heart of what we do. It has also been the year when we have focused on investing in our capacity to be a business focused highly competitive organisation with the capacity to take on multi-national organisations and win.  Not withstanding this we are determined to work in partnership and support the increasingly threatened smaller providers in our sector.

In a changing landscape for charities Blenheim chooses to say focused on the needs of those with drug and alcohol problems, we choose to focus on the skills of our staff and delivering high quality services, and most of all we choose to stand up for and campaign on behalf of our beneficiaries who are mothers, brothers, sisters and grandparents, work colleagues and friends not just people to be defined and stigmatized by their drug and alcohol use.

Blenheim’s has a proud history based on the work and dedication of its staff and volunteers both past and present. Blenheim has made such a difference to so many lives down the generations. A book “London Calling” documents this history via the memories of current and former service users, staff, volunteers, trustees, and leaders in the drug and alcohol sector.

Throughout 2014 we have actively challenged the stigmatisation of people with drug and alcohol problems by enabling them to tell their moving and humbling stories of recovery, and argue in the corridors of power for a system of regulation that supports those experiencing problems with alcohol and drugs rather than criminalises people for being ill and vulnerable.  In 2015 we will publish a book of 50 recovery stories which shows the impact not just of Blenheim but of the drugs and alcohol sector in the voices of our beneficiaries.

I am appalled at the shameful fact that 97% people with hepatitis C go untreated and that despite a 32% rise in heroin and opiate deaths Naloxone availability (which may have averted some of these) in the England is highly variable with little sense of Government urgency.  Blenheim challenges this clear inequality of care for the people we work with, it is wrong and we will take action. Currently I am chairing the Naloxone Action Group England and Blenheim is a member of both the Hepatitis C Coalition and the London Working Party on Hepatitis C.

As we move forward into 2015 I am determined that Blenheim remains focused on the individual and their holistic needs. The need for friendship, love, employment, somewhere to live, something to eat, support with often deeply troubled lives, and help with a range of physical and mental health problems.

However unless Drugscope along with a powerful alliance of providers are prepared to fight in the corridors of Whitehall and Westminster, and on the beaches of Local Authority cuts I fear that the worlds best treatment system is about to be decimated in April 2015. I fear for the people we help. I fear that commercial self interest will mean as a sector we will walk quietly off the cliff. I am determined that Blenheim will go shouting whilst learning to rock climb or even better fly.

As we enter the next 50 years I am determined Blenheim will continue to dedicate itself to improving the quality of life of people the organisation supports. Everyone deserves a better future.


A fine site

life writ large

Germaine de Larch | Artist Writer Trans* & Gender Activist. Transmasculine feminist. Follow my non-binary transition & my attempts to dodge male privilege and stick it to the patriarchy. Recovering addict and depressive learning to live life large, one day at a time.

Blenheim's Recovery Stories

In 2014 Blenheim is celebrating 50 years of social action and every week we will be sharing a story of recovery from our service users


To end dependency by enabling people to change

DS Daily Blog

To end dependency by enabling people to change

Druglink Magazine Blog

To end dependency by enabling people to change

DrugScope Comment

To end dependency by enabling people to change

GOV.UK departments and policy - all updates

To end dependency by enabling people to change

The Drug Sector Partnership

To end dependency by enabling people to change


Get every new post delivered to your Inbox.

Join 92 other followers