DDN February 2022 February 2022 | Page 7


• A welcoming place with basic comforts provided .
• A full range of equipment , with people encouraged to take what they need .
• Close links to healthcare , drug treatment and other relevant services .
• Peer leadership embedded in development and design of the service .
• A ‘ leadership steering committee ’ with commissioners , providers , police and other services .
• Volunteer or paid roles open to those who are still injecting drugs , to give them a clear role and responsibility .
• Possible outreach services – for example vans , or allowing people to deliver clean works to friends .
• Data monitoring , so we know what supplies people need and how well the service is working .
• A three to five year initial funding commitment for stability and a ‘ pan-London ’ approach that works across borough lines .
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work peers from The Hepatitis C Trust do generally . ‘ Having individuals trained who are actually present on the ground in the communities can overcome a lot of the barriers that they feel are presented to them in terms of from discrimination from some pharmacists and feeling that what they ’ re doing is problematic ,’ said Archie .
Nathan Motherwell , a Hepatitis C Trust peer who organises needle exchange services in Kent , finds the issues the London focus groups raised are commonplace . ‘ I think the problems with needle exchange are across the board very similar . If people are going into a pharmacy needle exchange , sometimes there ’ s shame and fear and stigma attached to it – sometimes they ’ re not treated very well . Another barrier is people often get their methadone scripts from places where they would be going for exchange , and they worry they ’ ll be asked “ are you using on top ?”’
A peer-based exchange could offer a way to upend this model . ‘ Peers working with peers don ’ t present the same sort of barriers to the community who use injection drugs ’, Archie argued . ‘ Because of the way society looks at them , they sometimes feel like they ’ re a burden . You don ’ t have that if it ’ s members of the community providing the service . There ’ s no judgement , no being condescending . You have an opportunity to do something different where the ownership of the service delivery is from the peers . You are taking a different approach of encouraging development , giving people responsibilities . They feel responsible , they grow esteem .’
ACCESSIBILITY There was emphasis in the groups on openness , Archie reported , as well as links to other services : ‘ It should be community-based , easy access , no limitations on the amount people can receive .
A holistic approach to the whole person and services that are provided . At the very least , the needle exchange , if it was mobile , could signpost to a community service user hub where there ’ s access to more care , more opportunity and more support .’ There could be an important role for such a hub in supporting people who leave prison with accessing a wide range of holistic services .
Peers , service users and commissioners offered different perspectives on how much data to collect about service users , but it was acknowledged that this should be light-touch to avoid discouraging people . Nathan suggested that , ‘ if you want to increase the uptake , the fewer details you take the better because we want them to have clean equipment ’, but ‘ a very basic bit of info doesn ’ t really damage it ’, such as their initials and date of birth – ‘ the ideal needle exchange is just making it more available ’.
WIDER PROSPECTS The work has already led to some changes on the ground and if it works , it is hoped there could be scope to widen the approach . ‘ We ’ ve seen that some things that have been mentioned in this process have led to changes from Hackney , and we ’ re talking about maybe a pan-London approach ’, Archie said . ‘ If we get the goodwill and the buy-in from the commissioners and the local health and justice services , and we look at treating this as a community and public health concern , we can make meaningful changes .’ This builds on existing work in New Zealand , Australia and elsewhere , he noted – ‘ The report had lots of good examples of it working internationally .’
For more information please see www . ljwg . org . uk or email info @ ljwg . org . uk .
Elliot Bidgood is a policy adviser with the London Joint Working Group on Substance Use and Hepatitis C ( LJWG ).