Letters and comment
DDN welcomes your letters
Please email the editor , claire @ cjwellings . com , or post them to DDN at the address on page 3 . letters may be edited for space or clarity .
‘ the pressure on management to protect ideas , assets and services doesn ’ t encourage sharing and conversation . In fact , if I was still working in the field I couldn ’ t have even sent this letter .’ |
|
|
|
Unhealthy climate
Having worked in the sector for 18 years I ’ ve been part of recommissioning numerous times , even recommissioning that was delayed for three years , and I ’ ve worked ‘ in partnership ’ with primary and mental health services as well as NOMS .
It ’ s felt to me that the service user is at risk much of the time , but good management can try to shield their workers on the ground – and therefore the service users – from much of the turmoil and politics of recommissioning . But I ’ m not convinced it ’ s the right system . There absolutely needs to be review , checks and a procedure for services to progress , but we often ended up with the same provider employing us , despite recommissioning , and it wasn ’ t credible or best for anyone . In fact it appeared to be based on friendships as much as finance .
Similarly , working in partnership is a great idea and good teams can
|
accomplish loads together through colocation and willingness to listen , but the senior management and PR departments are always thinking strategically and competitively and I don ’ t think that ’ s healthy for staff or services .
The pressure on management to protect ideas , assets and services doesn ’ t encourage sharing and conversation . In fact , if I was still working in the field I couldn ’ t have even sent this letter .
Charlotte Richards , by email
What a hypocrite
I have been on methadone maintenance more than six years . The entire time , I have not used illicit substances . I have worked full-time jobs , paid my bills , paid my taxes , and been a functional member of the community . In fact , nobody would know I ’ m on methadone unless I tell them . I find it quite offensive that someone would say I ’ m ‘ fucked ’ for being on a prescription medication
|
( DDN , October , page 10 ).
I ’ m also on an antidepressant ; would Russell Brand consider me not ‘ clean ’ for that as well ? What about people with schizophrenia who need antipsychotics ? Methadone is also an effective treatment for people with endorphine deficiency syndrome who have used opioids to self-medicate . And where is this ‘ 80-90 per cent ’ comment coming from ? I ’ m fairly certain he just made that up on the spot . I know many people in MMT who do not use on top of their prescription .
Basically , he ’ s being a self-righteous ass in order to make himself feel better , and of course , to sell books and make lots of money ( which he claims is not important to him . Whatever ). He seems to me to be a judgmental hypocrite of the highest order . It ’ s people like him that are feeding into the opioid epidemic by encouraging stigma and making people too afraid and selfconscious to seek help for their disease .
Ida Swisher , via DDN website , www . drinkanddrugsnews . com
|
LegaL LIne
On 29 November 2017 , CQC published ‘ Substance misuse services : The quality and safety of residential detoxification ’, a briefing of the 2016 / 2017 inspection cycle . The document , which is necessary reading for all within the sector , is significant for its almost exclusively negative tone .
The nine-page document contains no reference to the hard work of frontline staff ; no recognition of providers choosing to work with some of the most vulnerable in society ; and no thanks for the benefits to individuals and society .
From the 68 services analysed , CQC identified a number of general concerns , including :
• providers that did not assess risk to individual clients adequately
• services that did not follow best practice guidance
• poor management of medicines , including controlled drugs
• providers that did not provide staff with relevant training
• failure to safeguard clients by carrying out employment checks on staff
FOREWARNED IS FOREARMED !
The CQC ’ s new briefing is essential reading for the sector , says Nicole Ridgwell
Certain concerns raised within the document are those that you would likely find in an overview of any segment of the healthcare sector , such as record keeping errors . Other concerns are far more likely to be found in substance misuse services , for example , the reference to failing to provide treatment in line with the NICE guidelines .
NICE guidelines are guidelines not tramlines , and there are valid reasons why a service may choose to depart from them . We have been successful in challenging CQC by demonstrating why the service chose their particular course of treatment or medication . Inspectors often make judgements about substance misuse services based upon a misunderstanding of the client base .
Likewise , the issue of ‘ complex and varied healthcare needs ’ is referenced . As providers will be acutely aware , those experiencing long-term drug or alcohol dependence often suffer from a range of health issues , mental and physical – many of which reduce or disappear during detoxification . Providers know this and risk-assess the suitability of admission accordingly . Were one to believe this briefing , it would seem that providers regularly admit clients with health needs they cannot meet , indifferent to potential dangers to the individuals . Despite reading this in draft inspection reports , I have yet to find this to be true once the circumstances of the examples are explored .
Indeed , this briefing could be said to be reflective of a regulator which has entered a new sector and was not prepared for the practices they found . This is reflected in the statistics , which make for stark reading :
Of the 68 providers , 49 ( 72 per cent ) were required to make improvements after findings that they had breached regulations of the Health and Social Care Act and failed to meet fundamental standards of care . Forty-three providers ( 63 per cent ) were found to have breached Regulation 12 ( Safe Care and Treatment ) and eight providers ( 12 per cent ) were served with enforcement action .
In summary , this is stark but necessary reading . It provides an insight into CQC ’ s concerns , allowing providers and staff to reflect on their own practices , address any they find wanting , and ensure that they have the evidence to justify why they have chosen a particular course of treatment or medication .
It is not pleasant or encouraging reading , but it pro - vides the sector with an insight into its regulator ’ s view of it . Whether you agree or disagree with its find ings , it is always better to know ; forewarned is forearmed .
Nicole Ridgwell is solicitor at Ridouts Solicitors , www . ridout-law . com
14 | drinkanddrugsnews | December / January 2018 www . drinkanddrugsnews . com