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.