Hep C, harm reduction, the changing face of drug and alcohol use and services in an age of austerity for the public sector

I was asked to be on a panel this week at the DAAT conference in Brighton and to pick some themes to talk about for 5 minutes.

The realisation that we have let down a generation of drug users by failing to test, treat and cure, Hep C was my starting point.

The rising tide of deaths from hepatitis C, a preventable and curable virus, is a scandal. It is absolutely unacceptable that half of those living with hepatitis C are still undiagnosed and a mere 3% of those infected are treated each year. There is a clear link between hepatitis C and deprivation. Hepatitis C has been overlooked, ignored, under-prioritised and underfunded resulting in spiralling hospital admissions and deaths. This is because the majority of people living with, and dying from, the virus are from the most marginalised, vulnerable, deprived groups of society.

If the health service is to reduce health inequalities and “improve the health of the poorest, fastest”, hepatitis C must be addressed.

Many hepatitis C patients are still never assessed for liver damage or offered potentially life-saving treatment despite the fact that treatment has improved and new drugs with almost 100% cure rates and very few side effects are expected to be approved shortly. We need to ensure we test, treat, cure and eradicate hep C and drug and alcohol agencies need to do their part in finding, testing and supporting people into treatment.

I travelled home to radio 4 talking about how a new report indicated a huge jump in liver cancer and death from liver disease as a result of alcohol consumption and Hep C.

My next theme was the changing patterns of drug use bringing with it different needs. The changing pattern of drug and alcohol use continue to offer challenges to traditional service models which for many no longer meet their needs at a time when service cuts is limiting the range of services on offer.

Services will need to quickly adapt our methods of working and re-engage with a harm reduction/minimisation approach if we are to respond adequately to the risky drug and sexual behaviour in some communities. In the age of legal highs we need to teach people how to minimise the risks, in the age of older drug and alcohol users we need to develop care facilities to cope with those who continue to use illicit drugs.  We need to respond to the drug and alcohol use of all where this is problematic not just the marginalised in society.

I am concerned at the failure of commissioning structures and policy to recognise that some of the best work of drug and alcohol services is in supporting those who have yet to become drug or alcohol free to stay alive and survive and find shelter and food from day to day, along with minimising the potential risks they face.

Current developing drug use patterns in many ways remind me of the 60’s and 70’s and e-cigarettes could be the most significant change in administration routes in a generation both for good and bad.

Given that I have been raising the issue for nearly three years now my third theme was how substance misuse organisations are coping in the evolving funding and commissioning landscape.

In less than a minute to cover the ground I decided on a poetic delivery style, more for less, increased involvement of volunteers and mutual aid, adapt or die, diversify and innovate, mergers and partnerships, and for some bankruptcy.  We are seeing the extinction of the small agency and the serious threat to larger organisations as a result of tender destabilisation.

Sadly services are also operating in a much reduced voluntary sector with far fewer local organisations on the ground to share the load as a result of the bleak funding ice age for the sector which is giving every indication of getting worse.

What I was going to say about Blenheim, but had to cut when 5 minutes became 3, was the following:

“At Blenheim we have completely re-organised our approach to manage in the new commissioning world with a clear vision of who we are this involved some clear choices:

  • We chose to be a charity,
  • We chose to say focussed on the needs of those with drug and alcohol problems
  • We chose to focus on skills of our staff and delivering high quality services.
  • We chose 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 stigmatised by their drug and alcohol use.

Small and medium size organisations can survive but they have to fight and be clear about why they deserve to make a difference for the people they serve.

We have the best alcohol and drug treatment system in the world much of what is good has come from the diversity of the small.  Fight for it, and fight for the diversity of the small.”


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