Tuesday, 26 November 2013

Headspace: Not sorted for E’s or whizz

While the forensic information has yet to be made public, the tragic death of Nick Bonnie at the Warehouse Project in Manchester (28 September) appears to be the latest in a series of deaths linked either to strong ecstasy or the PMA-ecstasy combination. Up until 2011, PMA had only been implicated in two deaths in the previous 18 years. That figure leapt to 20 in 2012, while the BBC File on Four programme (29 October, listen here) claimed that figure had already been exceeded for 2013.

From a public health perspective, why this is happening now is almost beside the point; the question is ‘what more can be done to warn club goers of the dangers of using ecstasy?’ And then you have to throw into the mix the numerous anecdotal reports of serious outcomes for users of some of the new compounds, especially synthetic cannabinoids. There are no official statistics on the prevalence of use of substances like Black Mamba, Annihilation and Exodus Damnation – and nobody should be helping the more scurrilous end of the media, by unduly ramping up concerns. But even if the names are just a marketing ploy to encourage sales, the percussive effects of these drugs are all too real.

We could do worse than reinvigorate some of the harm reduction initiatives from the 1990s, when rave culture was at its height. Not that this was exactly free from controversy. The first materials on safer dancing appeared in Liverpool in 1992 published by the Merseyside Regional Drug Training Unit (now HIT). After hearing about the rising tide of MDMA-related A&E admissions to local hospitals, they produced the ‘Chill Out’ leaflet, setting out what has now become standard information about not getting overheated, staying hydrated and so on.

The tabloid response was swift and brutal, with one paper going so far as to suggest that parents go round to the unit’s offices and chuck the director Pat O’Hare in the River Mersey.  It didn’t take too long for that information to appear in medical articles, in materials from organisations like DrugScope (then ISDD) and Release and, significantly, in government literature. The government also backed the London Safer Dancing Campaign; ISDD launched the London Study Safely Campaign aimed at students and there were other similar initiatives around the country. The more responsible venues began supplying free water, chill out areas and allowing drugs workers onto the premises to offer advice and support. Did people still die from taking drugs? Sadly they did, but few club goers could have said that they had no idea about the possible ways they could reduce potential risks.

It is true that for a decade now, most drug use, be it problematic or recreational has been in decline. And we don’t know how much of a health problem we really have with the new drugs – except there seems to be a lot of them about. But there is sufficient anecdotal evidence coupled with the jump in MDMA-related deaths to warrant a step change in thinking about information provision – not least because, as well as traditional indoor venues, the last decade has seen an explosion in outdoor festivals where drug-related fatalities and casualties have also occurred.

Unfortunately, proactive information underlining risk reduction is looking pretty scarce right now. The government would point to the FRANK website as a reliable source of information – which it is. But, as reported in this issue, a survey of school students in Nottingham showed that while FRANK has high brand recognition, virtually none of the students would use it a source of information. This will sound quite Luddite, but whatever new technology can deliver, I would argue there is still a significant role for shoving a leaflet in somebody’s hand, putting up posters and providing other tangible objects of social marketing.

DrugScope continues to get regular calls from a whole range of professionals looking for just this – and we can’t help, because there are no funds for free print distribution these days. And due to financial cutbacks, government funds for similar communications activities have also dried up.

It is impossible to say if more readily available information would have saved those who have recently died; but it has to be worth making sure people are properly informed. After all, when Leah Betts died in 1995, one of the most widely publicised drug deaths of all time, few of the current casualties would even have been born.

Harry Shapiro

Wednesday, 20 November 2013

The state we’re in

Paul Anders, Senior Policy Officer, DrugScope

Everybody is aware of the pressure that the voluntary and public sector have been under for the last few years. Most areas of public spending have been squeezed to a greater or lesser extent, and some sectors have seen provision and capacity substantially affected. While the drug and alcohol treatment sector has not got off scot-free, the presence of the NTA and the somewhat protected funding structure provided for in the Pooled Treatment Budget (PTB) had sheltered the sector to some extent from the pressures elsewhere.

In April 2013, all that changed. Commissioning responsibilities moved to local authorities accompanied by funding previously indicated for drug and alcohol services, which now forms a substantial part of the local public health allocations. What should be noted here is that while the amount of funding nominally allocated to drug and alcohol services hasn’t gone down, there is (currently) no sign of effective protection or ring-fence for the sector and its clients.

Turning to the Public Health Outcomes Framework, which local authorities will be measured against, we can see that relatively few indicators relate directly to the work of the sector – arguably three out of a total of 66 outcome indicators. While well-prepared providers are already working to demonstrate the way their work supports improvement of other key indicators, there is the risk that local authorities under increasing financial pressure may think that a third of the money delivering a twentieth of the outcomes is not a great deal. Public Health England has a role to play in all of this, although it’s not yet entirely clear what that role may comprise of.

In terms of partnerships with the criminal justice sector, another change has taken place. From April 2013, elected Police and Crime Commissioners (and their staff) have replaced Police Authorities. While they, in effect, take control over their budgets in two stages (in April 2013 itself and then 2014), they will be key players – for example through commissioning Drug Interventions Programme (DIP) successors, or through commissioning outreach or – ultimately – whatever sort of provision they feel would work best locally, which could include none at all, at a time when core police budgets are also under pressure.

Clearly, 2013 could turn out to be a crucial year for the sector –a year zero for two hugely important funding and commissioning reforms. However, it was always unlikely to be a ‘big bang’ year – there are contracts with time remaining, and there was a reasonable assumption that at least some of these new structures would take time to familiarise themselves with their new responsibilities and bed themselves in. However, with around 150 local authorities making decisions about spending on public health, and over 40 Police and Crime Commissioners (PCCs) in charge of community safety and crime reduction, understanding the sector has suddenly become more difficult.

The State of the Sector research, conducted for the Recovery Partnership, is an attempt to address that, and will also provide a useful resource for DrugScope in other activities. The research comprised a large online questionnaire, interviews with services in 9 areas that had been identified as particularly interesting, interviews with a number of chief executives and through Freedom of Information Act requests to every PCC in England and Wales. In London, DrugScope, along with the London Drug and Alcohol Policy Forum, contacted every local authority to learn more about their commissioning structures.

The results so far have, to an extent, been in line with expectations – for the reasons above, it always seemed unlikely that there would have been rapid and significant changes by the end of October 2013 but knowing where the sector has come from will help us to identify the direction of travel more accurately. DrugScope and the Recovery Partnership will be publishing a full State of the Sector report later this year, but produced an interim report for its annual conference in November, focussing on key parts only of the responses to the online questionnaire.

These included:
  • 36% of services reported a decrease in funding, of which around a third was due to losing services as a result of recommissioning.
  •  41% had been through a retendering or recommissioning exercise in the last 12 months, with 64% expecting to in the coming 12 months.
  •  44% reported a decrease in front-line staff numbers, and 63% an increase in the use of volunteers.
  •  43% said they were not engaged with their Health and Wellbeing Board, including no involvement in any Joint Strategic Needs Assessment Consultation.
  • Around 4 in 10 had had involvement with their Police and Crime Commissioner, but only around 1 in 10 was involved via the Police and Crime Plan consultation.
  • 9 out of 10 respondents reported that welfare reform had had a negative impact on their clients.
  • No respondents were receiving funding from Jobcentre Plus’s Flexible Support Fund.
  • Most respondents identified funding and recommissioning as the biggest single challenges facing their own service.
  • The most significant gaps in local provision were (in order) access to housing, partnership / support for clients with complex needs, and education, training and employment opportunities.
The responses to the survey and the interviews carried out with service managers and chief executives paint a nuanced picture of a sector that clearly faces challenges, but is innovating and showing resilience. There are several causes for concern, not least in the external environment, but the outlook is far from bleak – for now.

If you would like to discuss the State of the Sector research, please contact Paul Anders – paul.anders@drugscope.org.uk or 020 7234 9799