LETTERS AND COMMENT
of dealing with them . Whenever I saw a patient , I would usually know almost within a minute what the outcome of my assessment would be , even if I was in with them for an hour and a half .
There ’ s stuff going on in mental health that isn ’ t right , and if this is taking place in a major hospital it ’ s likely to be happening elsewhere . The community services are in pieces and some
‘ They talk about being better across the board , but all they ’ ve done is stifle the expertise at the heart of patient care . The only thing in the NHS that ’ s across the board is the logo .’
of them are still working from home since COVID – face-to-face doesn ’ t happen very often and constant meetings have turned 9am-5pm services to 10.30am- 4pm with no flexibility beyond that and certainly no options for weekends .
So if you ’ ve got depression and it ’ s getting worse and warrants community team input , they write to you , and if you don ’ t respond they write to you again , and then discharge you when you can ’ t respond . That ’ s not patient centred at all .
Of course there are some successes , but we ’ re missing out on years of experience and expertise – and in our case it was a really good group of people who made it work . We ’ d identify problems and do things differently , because we were all experienced enough in the job to be able to say what would work better .
TOP-DOWN CHANGES The NHS is constantly being given the money to change things , but these changes are coming from above . It happens in commissioning too – a few bright sparks get together and decide on a better structure without it being informed by the people it affects . We don ’ t all need to be run on a corporate level , to make a profit . How can you do things that benefit the patient if you ’ re not getting their opinion or their clinician ’ s input ?
This lack of inclusivity has triggered an exodus of staff . Nurses like me don ’ t want to complicate life , we want to do what we ’ re really good at . You go into nursing expecting a tough job and a lot of issues – but not this fundamental lack of respect .
Our team was cost-effective , we were good and we got things sorted . We rarely needed to go to the coroners but in the last two years this happened four or five times . People are not even getting triaged properly and the followups aren ’ t happening either .
LAYERS OF KNOWLEDGE There are layers of knowledge that should inform practice . A new nurse in A & E might not understand that taking away a patient ’ s super-strength lager while they wait for ages can lead to severe withdrawal , or that a short fast emergency detox doesn ’ t work .
Alongside a massive loss of expertise there ’ s so much lost opportunity – people are just switching off . You don ’ t go into nursing because of the money . If you see something that can be changed for the better , you ’ ll say something – but now you ’ re not heard .
I loved my job and I wanted to be true to my patients , but eventually I went to my manager and said ‘ I can ’ t do it . I ’ m broken .’ I was met with a blank look . Upset and frustrated , I applied for a new job in a different part of the NHS . Three other team members piggybacked onto my leaving do and the four of us left together . Now nobody wants to work in the team – and the people who do leave within a year .
They talk about being better across the board , but all they ’ ve done is stifle the expertise at the heart of patient care . The only thing in the NHS that ’ s across the board is the logo .
I and my colleagues at Forward Trust are big fans of DDN , and learn a lot from the articles , but I do need to register a couple of clarifications on how some of the contents of my speech at the recent Drugs , Alcohol , Justice parliamentary group were described ( DDN , April , p18 ).
First , the ‘ Morgan et al ’ report I referred to was not the 1991 report you referenced , but Home Office research report 79 , authored by Nick Morgan in 2014 . It is the official report that , amongst other things , credits the investments in substance misuse treatment through the 2000s for making a contribution to declining crime rates in that decade .
My reference to the development of a ‘ quantity not quality ’ system was not specific to the delivery of ‘ CARAT ’ s ’ ( the acronym for prison substance misuse advice and guidance services from the late 1990s to the early 2020s ), but has been the tension across the whole system ever since treatment budgets were created . My point was that prioritising lowintensity interventions for tens of thousands of prisoners who have high levels of dependence and complex needs is not the most effective strategy .
And finally , my reference to ‘ years of neglect ’ needs context – it is not a comment on the great , often heroic , work of prison-based drug workers around the country , but is lamenting the loss of momentum in strategy , research , service improvement , and recovery offers to prisoners during a decade in which the pressure on them to engage in wing-based drug markets has intensified .
We have been losing the battle with the dealers on prison wings , but hopefully the new policy attention , and some new money , will start to turn that around . Mike Trace , CEO , Forward Trust
I am in total agreement on what you say about stigma and how it affects the discussion of the drug issue in the UK . Powerholders are putting criminalisation ahead of public health , or so it seems . Within the same context there is an obvious cohort that is almost always forgotten about : those on the supply side of the equation – the so-called drug dealers .
As you say , there are many reasons as to why people develop serious drug problems , such as childhood trauma , mental health issues and post-traumatic stress disorder . These same reasons are attributed to why ‘ dealers ’ get involved in the illicit drug market in the first place , and I think a bridge needs to be made . There is a litany of service providers for those who misuse drugs but none for those who deal , other than punitive action , which is largely ineffective .
I have created an intervention programme , designed around the unique experiences of those who commit county lines offending behaviour . It is a six-week programme built on a foundation of lived experience and cultural competence . It addresses all aspects of county lines behaviour – and unpacks the mental and physical behaviours that lead to county lines involvement , in which I am well versed due to my past chapters of life .
The new improved me would like to give back by helping those in my previous world of illicit drug dealing to exit that career , by giving them empowerment – the tools to succeed .
Is there anyone or any organisation that might be able to help me to move my intention forward ? Serving prisoner , name and address supplied . If you can help , please email the editor .
DDN welcomes all your comments . Please email the editor , claire @ cjwellings . com , join any of the conversations on our Facebook page , or send letters to DDN , CJ Wellings Ltd , Romney House , School Road , Ashford , Kent TN27 0LT . Longer comments and letters may be edited for space or clarity .
/ ddnmagazine @ ddnmagazine www . drinkanddrugsnews . com
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