Drug addiction isn"t going away so why are treatment centres being slashed?

You may not know that your local authority is responsible for funding drug and alcohol treatment. And unless you, a friend or family member have been personally touched by addiction you might not think that these services should be a funding priority for cash-strapped councils.

We’re left to manage a host of intractable problems that we’re not qualified or able to deal with.

I work in a community drug and alcohol treatment centre and my job is to support people to overcome their addiction and support their recovery. When I arrive at work in the morning there is usually a queue of people outside wanting to get help.

They’re vulnerable people with complex needs and demand for our support is increasing. Yet we’ve seen our funding slashed by 42% since 2010. The situation is the same across the country.

I see fewer heroin users nowadays but far more people dependent on alcohol and people getting into problems with so-called party drugs such as methamphetamine and ketamine. The heroin users might be fewer in number, but they require more of our attention as they get older and sicker. They often have hepatitis C and smoke tobacco and succumb to liver and lung diseases as a consequence.

Addiction sits at the centre of a cluster of physical, psychological and social difficulties. Our service users need help and support in all these domains if they are to stand a chance of recovery. Our caseloads have got bigger because we have had to cut posts and as pressures elsewhere in the health and social care system builds, the complexity of the problems we are presented with has increased, too.

Even when there are clear mental health problems, mental health services don’t want to treat people who also use drugs or drink, so they send them to us. The same applies to the general hospitals – with access to liver treatments being rationed. I know they are also under pressure, with ever-expanding waiting lists, but as a consequence we are left to manage a host of intractable problems that we are not qualified or able to deal with.

Some of our clients lead chaotic lives and come to us in desperation with a whole host of difficulties that go far beyond addiction. They might be embroiled in the criminal justice system and need advice, they might have housing problems or be struggling with trauma; it is not uncommon for me to treat clients who used to be in care and have survived institutional abuse. We used to have psychologists in our team who could provide treatment for complex trauma related to sexual abuse but their posts were cut last year.

I have two clients who are so physically unwell that the local residential detox provider does not think they can safely manage them. The NHS-run unit we used to refer to because it had the necessary medical cover has been closed due to the cuts. If they don’t die beforehand, the only hope for my clients is that they will get a detox if they are admitted in an emergency with a physical health crisis to a general hospital.

With diminished resources we have had to prioritise treatments such as opiate substitute medications and needle exchange, which we know can keep people alive. But how are these actually helping people overcome their addiction?

Addictions services are often retendered with contracts being awarded to the cheapest bidder. I work with people who have had their service retendered and employer changed multiple times. This is a massively stressful process and I have friends who have left the sector feeling demoralised and burnt out.

We are judged on figures like the number of people leaving treatment drug-free, and treatment centres know that this can be used against them. The worst-kept secret in our sector is the gaming of this so-called “performance data”.

If a client drops out of treatment it will have a negative impact on our figures. One way to manage this is not to start the most chaotic people in treatment in the first place. People aren’t refused treatment but they are asked to jump through hoops before structured treatment is commenced.

A homeless, mentally unwell heroin user is going to find it difficult to attend a “treatment induction group”, but the consequence is that they never start on the medication that might actually help them.

Some facts are impossible to hide: drug-related deaths are increasing and new drugs and associated problems are causing problems in prisons and emergency departments. Even the shadow health secretary, Jonathan Ashworth, whose father was an alcoholic, has called for greater recognition of the damage done by excessive drinking.

Drug and alcohol use and addiction isn’t going to go away. I try to do the best I can for the people I work with. I try to close my ears to the negative and stigmatising language. Instead I keep my ears open to my clients and I try to find a connection and build a relationship that may help them in their recovery.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

Talk to us on Twitter via @Guardianpublic and sign up for your free weekly Guardian Public Leaders newsletter with news and analysis sent direct to you every Thursday.

Drug addiction isn"t going away so why are treatment centres being slashed?

​Ukraine"s medicine bill slashed by 25% after UK firm brought in to handle procurement

A British company hired to buy medicines for Ukraine’s health ministry has succeeded in cutting prices by up to a quarter, in a rare success for anti-corruption efforts.

Last year, under pressure from activists demanding action against graft, the health ministry brought in Crown Agents, a not-for-profit development company that specialises in the procurement of medicines, and two UN agencies, in the hope this would both lower prices and drive corrupt intermediaries out of business.

Public anger over corruption was a major cause of Ukraine’s 2014 revolution. Shady middlemen dominated state procurement, using offshore companies to syphon cash to insiders, while inflating prices the government paid for crucial goods.

On the eve of the uprising, Transparency International rated Ukraine alongside Nigeria and Iran on its Corruption Perceptions Index.

Christine Jackson, the senior procurement expert who signed Crown Agents’ contract last November, said: “In the main, I think progress has gone very well.”

The British team is supplying Ukrainian doctors with cancer medicines, while the UN agencies are procuring HIV/Aids medicines and vaccines. Jackson said preliminary figures suggested a saving of 20% to 25%.

However, although Crown Agents succeeded in negotiating lower prices than their Ukrainian predecessors, they have struggled to actually get many drugs to the people who need them. Officials have either failed to sign off on documents, or actively obstructed shipments, meaning the final deliveries arenot due until November, some 11 months late.

Members of Ukraine’s parliament have demanded Crown Agents lose its contract for next year as a result – something that Jackson said she found extremely frustrating. She cannot buy drugs until the health ministry gives final approval, which it has been increasingly reluctant to do. One letter had not been replied to for 139 days and counting, she said, while drugs worth $ 6m (£4.6m) were still held up at customs.

The SBU, Ukraine’s equivalent of the FBI in the US, said it wanted to check all of Crown Agents’ correspondence.

Service on the 30th anniversary of the Chernobyl disaster in April. The disaster has contributed to Ukraine’s high cancer rate. Photograph: Sean Gallup/Getty Images

“It’s incompetence, corruption, or just not the will to make a decision,” Jackson said. “From my experience this is quite extreme, so much pushback from so many quarters. You expect it maybe from some of the Ukraine distributors, suppliers having to share the market … we don’t usually have the same from the client who’s actually contracted with us, so that’s been a real difficulty.”

Healthcare failures

Ukraine’s government is nominally committed to fighting corruption, but has failed to jail any senior figures from the previous regime, and what little progress there is has been largely driven by Ukrainian activists and foreign diplomats, rather than ministers or officials.

At present, prosecutors and anti-corruption investigators are locked in a turf war over who exactly has the right to conduct surveillance, which is threatening to paralyse much of their work.

Cancer is Ukraine’s second-biggest cause of death, with rates driven by widespread smoking and – at least in part – residual radiation from the Chernobyl disaster. Corruption has long blocked effective treatment, starving hospitals of medicines, and keeping doctors’ salaries low. By 2014, the country’s leading oncological centre, the Cancer Institute, had become a post-revolution symbol of how bad things had got, with its doctors in open revolt against its management.

Doctors described having to ask patients for money just to afford spare parts for diagnostic machinery, while patients’ organisations had to arrange black market shipments of drugs to make up for the hospital’s failure to provide them.

Following a Guardian investigation into the institute, its workforce elected a new director, Dr Olena Kolesnyk. By staging transparent tenders for supplies, she too has succeeded in driving down prices. She said that inpatients had started getting meat with their meals for the first time in at least eight years, with new contractors knocking 40% off the institute’s food bill. “Previously, they just had buckwheat porridge, or some pasta maybe,” she said.

She hoped to finally fulfil a long-delayed building project to expand the institute, and to start cooperating with major western centres to make up some of the research ground lost over the years, but was facing exactly the same problems as Crown Agents. Officials at the health ministry were failing to reply to letters, or to make basic decisions – such as about the registration of new medicines – paralysing any hopes of progress.

“Crown Agents didn’t know what they were dealing with,” she said. “But we can’t go back to the past, people won’t allow it. People have changed, their worldview has changed, I don’t think they’ll allow these old schemes to come back.”

Ukraine is now on its fourth health minister since 2014’s revolution, with the appointment of Ulana Suprun last month. She said that she signed about 5,000 documents within two weeks of taking office, just to try to remove the blockages that had built up under the previous administration, and to get the drugs procurement process moving again.

“It’s a steep learning curve but I think we are tackling it. The important thing is to identify the problem and mistakes, and to fix them so it’s smoother,” she said. “This has cut out a lot of corruption, but these forces that caused the corruption in the past are the ones that don’t want us to move forward, and they have a lot of money and a lot of strength.”

She said Ukraine hoped to have its own independent procurement agency by 2019, but would continue to employ international agencies until then.

This story was supported by the Pulitzer Center on Crisis Reporting

​Ukraine"s medicine bill slashed by 25% after UK firm brought in to handle procurement

Public hospital bed ratio ‘slashed by 43% over past twenty years’, report reveals

A new public hospital report card exhibits the quantity of beds, measured towards the size of the population in excess of the age of 65, has declined by 43% over the previous twenty years.

Medical professionals have raised fresh considerations about well being spending amounts and the adequacy of hospital beds as the population ages.

The Australian Health-related Association’s (AMA’s) yearly summary of public hospital statistics also displays the national median waiting time for elective surgery has “substantially deteriorated” more than the previous decade, with no improvement in the past 3 many years.

The group has used the release of the report on Friday to phone for higher federal funding to assist struggling public hospitals meet patient demand and Council of Australian Governments (Coag) functionality targets.

The AMA stated its analysis showed the midyear economic and fiscal outlook, launched by the Abbott government in December, showed about $ 400m much less in public hospital investing more than the next 3 years in contrast with amounts projected in the earlier midyear update.

The former Gillard government attracted controversy in late 2012 when it recalculated expected payments to the states and territories primarily based on lower than anticipated population figures.

The new, reduce payments have been incorporated in the November 2012 midyear update. The AMA has utilised these revised figures as the baseline for its comparisons with anticipated public hospital investing over the following three years, saying the amounts outlined in the Abbott government’s midyear update are $ 398m decrease over the period 2013-14 to 2015-sixteen.

The president of the AMA, Steve Hambleton, said this was “very disturbing” due to the fact the National Wellness Reform Agreement signed in 2011 offered a commonwealth ensure that “no state will be worse off in the brief- or extended-phrase, simply because they will continue to receive at least the amount of funding they would have acquired below the former National Healthcare SPP”.

Hambleton called on the Abbott government to restore federal funding to at least the initially committed ranges “to aid public hospitals all around the country to meet their overall performance targets and give timely and high quality care for the community”.

“Now’s not the time to consider income away from public hospitals,” Hambleton said.

According to the midyear update in December, the government will give an added $ 66.3m to states and territories to “increase money flow certainty” this economic yr, prior to total implementation of activity-primarily based hospital funding from July 2014. Exercise-based mostly funding backlinks payments to the actual quantity and nature of individuals taken care of.

The overall health minister, Peter Dutton, will front the media in Brisbane on Friday afternoon to discuss the situation, but the prime minister, Tony Abbott, blamed the former government for cuts.

“I explained at the time I’d like to reverse them but it was dependent on the budget predicament. I do not think it is reasonable at this point in time to reverse them,” Abbott mentioned in the course of an interview with Fairfax Radio.

The opposition leader, Bill Shorten, said the prime minister have to maintain his guarantee not to reduce overall health funding.

The AMA’s public hospital report card says it can be useful to measure hospital beds against the size of the population aged more than 65 years, due to the fact older people have far more hospital episodes than youthful individuals.

On this measure, the quantity of public hospital beds “has been slashed by nearly 43% over the past 20 years”. There have been 18.six hospital beds for each and every 1000 individuals older than 65 many years in 2011-twelve.

In raw numbers, 648 beds had been additional in 2011-twelve, but the variety of public hospital beds per 1000 of the complete population remained at 2.6, a ratio that has not changed considering that 2009-10.

“Public hospital capability is just trying to keep speed with population development and is not increasing to meet the developing demand for providers,” the AMA report says.

It says only 68% of emergency division individuals classified as urgent in 2012-13 were witnessed within the recommended thirty minutes – failing to meet the 80% target for 2012-13 that was set out in the National Partnership Agreement on Hospital and Wellness Workforce Reform in 2009. There was, even so, a small improvement in efficiency in excess of the past number of many years.

The AMA says that in 2012-13, about two thirds of all emergency department visits have been finished in 4 hours or less, reflecting a important gap to be bridged to meet the 90% target to be accomplished by the finish of 2015.

The national median waiting time for elective surgical treatment remained unchanged at 36 days in 2012-13, in contrast with 28 days a decade earlier. Following a period of development in the waiting time, the national figure has stabilised in the previous 3 years.

Hambleton mentioned he was concerned the ageing population would enhance stress on hospitals, and the extended-term decline in bed numbers as a ratio of more than-65s was regarding.

“Unless we’ve received the capacity we’re going to run into difficulty,” Hambleton mentioned.

Abbott acknowledged the overall health system was under strain, saying that “there wouldn’t be a public hospital in the country that is not below spending budget pressure”.

In pushing for national well being reform, the former prime minister, Kevin Rudd, declared that the buck would stop with him. But Abbott said public hospitals were, in the first instance, the duty of local managers in the 2nd instance, the responsibility of the state government and “sometimes it is the federal government”.

“I suppose it depends on the distinct situation in which the certain buck stops,” Abbott explained.

Public hospital bed ratio ‘slashed by 43% over past twenty years’, report reveals