Drug service, anyone?

Thursday, October 2nd, 2014

I have been quiet for some time, but something momentous has happened, there are things that need to be said, and again the words have started whirring..

This week, our drug services have been privatised.

I need to make a few obvious political statements, but also want to pick through what this means.

The backdrop: in this area in the late 80s and the 90s, as a result of high unemployment and entire communities lacking self-worth, heroin became rife. Intravenous amphetamine use, which had long since died out in most parts of the country, was also a firm favourite amongst the socially forgotten, given its relative cheapness compared to the city folks’ crack. Drugs services were, it has to be said, sparse and extremely poor. Methadone was virtually unobtainable, the tightly-clenched fists of a few dangling it like an ever-retreating green carrot, and healthcare was an emergency commodity.

Unsurprisingly, people died. All over the place. Bodies dumped in wheelie bins and found in skips.

Political moves meant that something had to be done. Drugs had been the Number One Priority for local Police forces for some time, but the criminal justice angle had reaped few benefits. And so the other group saddled with the problem – the healthcare providers, who until now had primarily just responded to overdoses, deep vein thromboses, septicaemia and liver failure – stepped into the void. Drugs became a health problem. Ring-fenced funding direct from Central Government arrived, and substantial NHS drug services began functioning with vigour.

The deaths ground to a halt. In the first month, burglary reportedly decreased by 80%. Methods were crude, targets were basic. But it was an intervention of unrivalled success, not only for the drug users themselves but for the communities as a whole.

I’m not implying that things were perfect. In the years that followed, it has to be said, there was a period of relative affluence under Labour when services carried some dead wood. The overarching easiness meant that, in some corners, a lazy malaise developed. And the service users’ sense of entitlement, exploiting this new enhanced status, grew way beyond empowered independence.

Yet despite this imbalance, the interventions continued to work. The previously most excluded members of the community now had health opportunities, and with that came life choices.

Things have changed. The current Government have taken away the ring-fenced budget. They have separated financial decisions from the care providers, and moved public health money across to local councils. These councils are having their funds cut constantly. Services have been put out to tender, and decisions have been made not on quality of service provision or importance of outcome, but on finance alone. And the NHS cannot compete with private companies who pay less and offer less.

Concurrently, the Government’s smear campaign of the poor – portrayed as the cause of the financial crisis rather than the victims, a voiceless scapegoat for the mistakes of those few at the top – has made the vulnerable an easy target for funding cuts. The first service to go under council cuts in our area was rape crisis counselling. Drug services were never going to be far behind. If it’s not society’s problem when someone gets raped, it definitely isn’t when someone doesn’t have enough aspiration, self-esteem or identity to “just say no” to a drug problem. If I’m honest, I’m surprised the drug services have lasted so long.

So what does it mean to move service provision to private providers? On the plus side, in the private sector there is no room for dead wood. And there is no bureaucracy, so decisions will not take six months to make and a further six to implement.

However, no-one would want G4S running the police force. There is a reason why these services are so much cheaper to operate. Managed at arm’s length, lacking in local knowledge, paying less than an experienced, qualified professional is prepared to work for – my experience is that these organisations are inferior. And they are not healthcare providers. They are narrow, isolated ventures. So they do not have practice nurses on hand to dress wounds; they do not share a building with health visitors and school nurses to keep tabs on troubled families; they can’t run symptoms past a GP or psychiatrist to see if someone needs admitting; they have no way of providing integrated, holistic healthcare by sharing service provision with associated professionals for no extra cost.

They provide the required statistics and meet specific targets. And as anyone who has worked in healthcare knows, meeting targets is easy. Anyone can fiddle stats and ‘reinterpret criteria’ to appear splendid. Providing good care is much more complicated than that.

I worked for a similar organisation a while ago. They were never fully-staffed, because they employed inexperienced (cheap) staff who subsequently moved on as soon as they had good enough CVs to apply for other jobs. That won’t be an option for these guys – there is nowhere else for anyone to go now – but I am confident that the same attention to finance and not quality of care will rule supreme.

Recent investigations into private care homes has shown us what happens when we pay poorly and devalue care. When we treat staff like dispensable cattle, it will be those receiving the care that suffer the most. Especially when those receiving the care are once again the brunt of society and once again voiceless.

Given the bumper Afghani crop and the rate of novel psychoactives arriving, it doesn’t bode well. And whose problem will it be when drug services struggle to address the need? Not a Government organisation, that’s for sure.

2 comments on “Drug service, anyone?

  1. carlton from the fresh prince says:

    Interesting perspective and insightful interpretation, which I think sums up the atitude which appears so clearly to be ‘if the powers that be can find a way to devalue members of society and inturn afford them less ,thats good for the economy” -whos economy ,who’s is this economy we readily now serve…i thought the economy should serve us as a society,rather than the other way around!
    Unfortunately locality Trusts hightened thier specialism to increase thier wage and the provision became a medical specialism which often was far away from the social and practical health outcomes that the general subs user needed for stability and as a foundation to move on….Sure there is scope for counselling,CBT and a plethora of therapies ,but often the “treatment” required was basic help ,in the first instance,engaging with a ‘proffessional’ and constructive friend that sat outside of the sump of a drug using community…Unfortunately healthcare proffessionals began to entitle themselves as specialists and increasingly spoke a language that was far removed from the user ,adopted targets which were cruedely managed by carreerist managers and further disngaged the bulk of ‘problematic’ users from understanding treatment as a viable option but rather a process of targets that irrespective of thier needs being met, would be the primary focus.. Importantly missed in the general cultural deficiet between user and carer is that substance use is on the whole symptomatic of a number of underlying ills based on structural divisons often prior to birth…

    • I take your point – it’s not only quality that costs but also specialism, and although the level of specialism was not always required it was still being paid for under the NHS system. It was that period of affluence that bred greed in the NHS. I do think, though, that the system needed tweaking, not selling,

      And I fully agree with your point about the economy – who is slave and who is master?! But maybe we should replace the word ‘economy’ with ‘wealth’, then the dynamic is clearer..

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