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.

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.

It’s time to stand and fight

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

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