Elimination

Today is World Hepatitis Day, with the theme of Elimination.

2016 is a crucial year for addressing hepatitis. At the World Health Assembly in May, the World Health Organisation (WHO) Member States endorsed the first ever draft Elimination Strategy for Viral Hepatitis, with the ambitious goal to eliminate hepatitis as a public health threat by 2030.


Hepatitis C is a blood-borne virus that can lead to scarring (cirrhosis) or cancer of the liver if left untreated.

The virus is a serious infectious disease, but with the right early diagnosis and treatment, hepatitis C can be curable.

Hepatitis C disproportionately affects the marginalised groups of people Blenheim works with, including intravenous drug users, prisoners and immigrant populations. Public Health England reported that in 2015 50% of injecting drug users have hepatitis C, up from 45% in 2005.

Therefore, for years, Blenheim has called on NHS England, Public Health England and the Department of Health to make the elimination of hepatitis C a clear priority. We advocate that substance misuse services, the NHS and local authorities must do more to test, treat and cure those with hepatitis C.

In 2014, Blenheim became a member of the Hepatitis C Coalition – along with a group of leading clinicians, patients, organisations and other interested parties, we are committed to the reduction of morbidity and mortality associated with hepatitis C, and its eventual elimination.

To achieve elimination of hepatitis C, we need:

  • greater awareness about the virus,
  • better prevention – including harm reduction such as injection safety,
  • increased testing and diagnosis, and

Greater Awareness, Better Prevention

Injecting drug use continues to be the most important risk factor for contracting the infection because the virus is able to directly enter the blood stream via a needle. Approximately 50% of intravenous drug users are thought to be infected with the virus. Other forms of drug use, like sharing bank notes or straws to snort powders, also pose a significant risk of transmission. More information about risk factors can be found on the Hepatitis C Trust website.

Increased Testing and Diagnosis

You can always go to your GP or GUM Clinic and ask to be tested for the virus. If you are accessing a drug or alcohol service then you should speak to your keyworker or a member of staff about having the test. Services can provide a blood-borne virus (BBV) test for you, but if this isn’t available then they will support you to arrange this with your GP, or another healthcare provider.

Hepatitis C is a ‘silent epidemic’ because it is often asymptomatic in the early stages and can be difficult to diagnose. This means that in most cases, the symptoms are absent, mild, or simply vague. It is important to get tested if you have ever shared injecting equipment, even if it was many years ago, because you may not experience any symptoms. Although there are no set symptoms, common complaints related to the disease can include:

  • Problems with concentration and memory
  • Chronic fatigue
  • Flu-like symptoms, including sweating or headaches
  • Alcohol intolerance
  • Depression or mood swings
  • Digestive problems, including nausea, loss of appetite or weight loss
  • General aches and pains, or specific discomfort in the area of the liver

These symptoms can usually be alleviated with therapy. However, the symptoms people suffer are not necessarily an indication of whether they have liver damage or not.

Better Treatment

Anti-viral therapies have advanced greatly in recent years and are now able to clear the virus, thus preventing the progression of liver disease. These NICE approved treatments cure the virus for around 70-80% of people. Treatment has been shown to reduce both inflammation of the liver and fibrosis. There is also evidence that cases of cirrhosis can sometimes be reversed through treatment.

Decisions about treatment options should be made with your doctor. You can also contact the Hepatitis C Trust’s helpline on 0845 223 4424 for more information.

Blenheim: Test, Treat, Cure

In order to address the low levels of hepatitis treatment amongst our service users, in 2014/15, we introduced a range of initiatives in partnership with PHE, Hepatitis C Trust and the London Working Party on Hepatitis C. We have trained over 100 hepatitis champions throughout the organisation to identify the levels of hepatitis amongst our service users and to support the people affected with accessing treatment.

And progress is being made. Last year, 94% of Blenheim’s new clients that inject drugs or have previously injected drugs, had a Hepatitis C test – an increase from 87% in 2014/2015.

Furthermore, we are currently supporting the I’m Worth… campaign, which has been created to support people living with hepatitis C. It aims to address the stigma that many people with hepatitis C face, encouraging and empowering people living with hepatitis C to access care and services. It emphasises that everyone living with hepatitis C is entitled to the best care.


To find out more about Hepatitis C, please take a look at the factsheet on our website.

Test, Treat, Cure.

Stigma: One of the greatest barriers to employment

If we are to help people into employment we need to remove the stigma around substance misuse treatment, make a real effort to tackle barriers, and provide empathetic education, training and employment (ETE) support to both employees and employers. Local Authorities and other public bodies must take a leading role in providing employment opportunities.

People enter substance misuse treatment with a wide range of health and social needs. These need to be addressed alongside building motivation and aspiration for sustainable change.

Stigma is one of the greatest barriers to employment for those who have completed treatment or who are in treatment for drug and alcohol use. The double whammy of belonging to a group of people that is stigmatised is that those affected begin to believe the messages that they encounter everyday. While two thirds of employers would not employ someone who had a history of heroin or crack use*, many of those with a history of substance misuse believe they would not be employed either. There is an urgent need to develop employment ‘in-reach’** and other initiatives to provide employers with the confidence to employ people with a history of drug and alcohol misuse.

The journey for many people towards good health, recovery and being ready for employment is often slow. New skills need to be learnt and old habits left behind. At the point of accessing treatment for drug and alcohol misuse, people often have a wide range of physical and mental health issues which are often compounded by a myriad of social problems. It may take an extended period of time for people learn or re-learn softer but essential skills such as communication alongside building self-confidence/esteem. This is alongside getting treatment for physical and mental health conditions including their drug and alcohol use.

Some people have either no housing or insecure housing. This alone is a barrier to employment since employers require an address. Conversely housing is difficult to secure without a job therefore a vicious circle operates which continually pushes people further away from mainstream society.

Many people using a Blenheim ETE service were left feeling ashamed and stigmatised when accessing Job Centre Plus. They also reported that “work programmes are too intense” and as a result those who are either “not in treatment and/or subject to easements” struggle to keep up with the rigors of the programme and are therefore at risk of losing benefits. This can result in a return to the old pattern of offending and re-offending. There was a general consensus amongst the groups that the Job Centre wasn’t very helpful and the atmosphere was often poor.

In contrast people using specialist ETE services, felt they were good, offering the opportunity to get onto courses, gave an incentive to change and helped people think about and prepare for employment as they resolved or came to terms with other issues.

We are looking for employers in London to provide volunteer, employment and training opportunities for our service users. If you or know anyone that can help please contact us.


Blenheim has ETE services in Redbridge, Lewisham, and Kensington and Chelsea.

*Getting Serious about Stigma: The problem with stigmatising drug users UKDPC 2010

**In-Reach means where employees starting work with a history of drug or alcohol use are provided with additional support in the work place, as are their employers, to overcome any anxiety they have about employing those with a history of drug and alcohol problems.

How are funding cuts affecting drug and alcohol services?

The State of the Sector report, conducted by the Recovery Partnership, is documenting serious concerns about the declining ability of the substance misuse sector to meet the needs of those it serves.

The first survey, covering 2013, provided a snapshot of the experiences of drug and alcohol treatment services as they entered a new delivery landscape. This landscape was characterised by the closure of the National Treatment Agency (NTA) and its absorption into Public Health England (PHE), as well as the transfer of budgets and commissioning responsibilities for substance use services to local authorities.

While the first report found no evidence of deep and widespread disinvestment, in its second year (2014) the survey found that many respondents were experiencing or anticipating substantial funding reductions. This trend has continued into 2015, with a considerable proportion of both community and residential providers reporting a reduction in funding. Overall, the 2015 report finds that 38% of community drug services and 58% of residential services reported a decrease in funding. Given the announcement in the Autumn Spending Review that public health funding will be reduced by 3.9% per year for the rest of the current Parliament, challenges around resourcing safe and high quality services clearly remain.

Reductions in funding are causing significant disruption to service delivery. In London, reliable sources have indicated that over the last five years up to 50% of the funding for substance misuse services has been cut. The impact of cuts can include; larger caseloads, declining access to workforce development, limited core services, less outreach, less access to employment, training and education provision, and less capacity to respond to complex needs.

Frequent recommissioning is another disruption to service delivery. The 2015 State of the Sector report finds that 44% of services had been through tendering or contract re-negotiation in the previous year and half (49%) expected to go through one of these processes during the year ahead. Furthermore, the income volatility is putting many smaller excellent providers under significant financial strain.

Funding is not the only cause for concern. The challenge of offering effective, joined-up support to service users with multiple and complex needs, and in particular individuals with co-occurring substance use and mental health issues, is a thread which runs through the three reports.

Beyond addressing substance use, the most significant support needs of those using services are: self-esteem, physical and mental health, employment support and financial support and advice. A fifth of respondents in the 2015 State of the Sector report felt that access to mental health services and housing/housing support has worsened over the last year, indicating that better joined-up support for people with dual diagnosis and multiple and complex needs is still required. This is particularly concerning given the documented view in 2014 was that services had got worse. This reflects a worrying downward trend.

I know these concerns are shared by frontline staff, commissioners and providers, and as funds are cut further there is an increasing risk of unmet need and unsafe service models. Unless Local Authorities are careful we may find services being closed as result of serious concerns being identified by the Care Quality Commission. Another risk is Local Authorities are forced to cut substance misuse services to the extent that they can no longer provide community-based alternatives to custody for those with drug and alcohol problems, placing additional pressure on a prison service already in crisis and struggling to cope with drug-use in many establishments.

When the drugs strategy is published this year perhaps the first job should be a long hard look at its affordability.

Negative Impact

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.

Conclusion

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

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

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.

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

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

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

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

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

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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

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.