’ s individual needs are individual – and unique ,’ said Dr Prun Bijral , medical director at Change Grow Live . ‘ It ’ s about the balance of getting that dose right for them . In a nutshell , we ’ re trying to help people stay comfortable and get some stability in their lives .’

People entering treatment services were often at a very low point , so it was vital to build relationships that were based on trust and honesty in a supportive environment , said Peter Yarwood , founder of Red Rose Recovery and in

‘ What I will always say to people is , “ it ’ s your treatment ”. It ’ s for us to serve and make that treatment as accessible , practical and useful as possible .’

DR PRUN BIJRAL

long-term recovery himself . ‘ You ’ ve got people at different stages , who might not know what ’ s right for them – that ’ s got to be a process , it can ’ t be fixed in one visit .’

TREATMENT QUALITY Ultimately , whether people felt they were able to speak honestly came down the quality of the treatment , Bijral told the session . ‘ As a doctor I ’ m not going to be able to do my job if I don ’ t know what the real issue is . What I will always say to people is , “ it ’ s your treatment ”. It ’ s for us to serve and make that treatment as accessible , practical and useful as possible .’ Clinicians had to recognise that entering treatment was very often a ‘ make or break ’ situation for people , and it was vital that they did everything they could to make them feel comfortable and informed . ‘ You have to be there for them , rather than have some agenda of “ I ’ m going to get you on this or that ”.’

It all came down to the quality of the relationship , added Yarwood . ‘ Everybody wants to help people improve their wellbeing and get to their destination , but that ’ s not to say we might not get it wrong . But if we do we need to be mature enough to open up a space to explore that without taking it as a personal criticism .’

Bringing about culture change across the sector and addressing sub-optimal treatment depended on education , said Bijral . ‘ Demystifying treatment – it ’ s not rocket science . Get the dose that helps that person feel comfortable .’ Change Grow Live had made the guidance more accessible to its frontline staff , modified its training and , crucially , showed services what their treatment looked like . ‘ Those same issues persisted , people were underdosed , were using when they didn ’ t want to – we weren ’ t providing the treatment

for the need , it was as simple as that . But when you start showing people that , they automatically start to change and have different conversations .’

Stigma remained a significant issue , however . ‘ The solution is broader than a clinical one , it ’ s a social one ,’ said Yarwood . ‘ There ’ s work that needs to be done to educate the community , and then highlight the support available .’ People were now able to put their own stories out on other platforms without needing to go via news outlets , however – ‘ we can counterbalance the negative voices .’

OPPORTUNITY FOR CHANGE The Carol Black report was a crucial opportunity for change when it came to the central role of peers – ‘ it ’ s not about hearing that voice , it ’ s about enabling people to take control of things like commissioning , of policy ,’ said Bijral . This had been one of the few silver linings of the pandemic , he added . ‘ We can ’ t just go , “ Yeah , we ’ re hearing you ” now ’ – the people most affected by the system and change needed to be the ones shaping it . ‘ Then you ’ re going to have a better system and a better service . It ’ s not going to be easy , it ’ s complex – without question – but you ’ ve got to start at the principles .’

Postcode lotteries remained a recurrent issue , but providers had to make sure their practice was in line with the evidence-based guidance , stressed Bijral . ‘ That ’ s key – not just , “ I fancy providing this dose because that ’ s how I woke up this morning .” Our services aren ’ t about fancy machines , they ’ re about people , so you ’ re going to get differences . But it comes down to awareness and shining a light on the treatment that ’ s being provided . We ’ ve got to move more towards a focus on quality

‘ Everybody wants to help people improve their wellbeing and get to their destination , but that ’ s not to say we might not get it wrong . But if we do we need to be mature enough to open up a space to explore that without taking it as a personal criticism .’

PETER YARWOOD

and what people deserve , and view it from people ’ s perspective – not a provider perspective , or a commissioner perspective . It ’ s got to be about the person .’ DDN