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Optimising our work in an uncertain time

how treatment systems can respond more effectively to the needs of people who use opiates

On the 14th June I had the privilege to speak on a webinar at the Expert Faculty Academy on how treatment systems can respond more effectively to the needs of people who use opiates within the context of the current challenges we face; so that we can continue to modify our approaches based on what we know works and making full use of the new medications becoming available.

Put simply, I believe that we badly need stable funding and commissioning so that we can provide much more effective interventions to the people who need our services.

A critical part of this process requires us to properly articulate how the challenges we experience affect the communities we serve; once this shared understanding has been reached, we can transparently agree and prioritise what we can deliver to as many people as we can.

In recent years, Humankind have managed multiple integrated drug and alcohol systems. There are some areas where we have been working for a long time and other areas where we have come in as a new provider. Often implementing significant changes to the services being delivered at a time of considerable reductions in funding. In real terms, we have been working with 25 to 50% reductions in funding for our services, but as importantly are the similar cuts being imposed upon other essential health and social care services. It’s generally agreed by most people of any political persuasion, whether they are the general public or in decision-making roles, that the reductions have gone too far, and, furthermore that we desperately need to facilitate our communities and service providers to be able to work differently to have a much greater impact.

Scale and context of the issues we face

The areas that we support and their needs are changing rapidly and continuously. An example of this is from Humankind’s largest treatment system in Leeds which we mobilised in 2015 – our bid was designed and priced based on 2300 people accessing the service, however we received a further 10% cut to our budget in the first year of our delivery. Forward Leeds now has 3234 active clients as opposed to 2300, with 6450 clients being seen in 2018/2019. Locally, there is still a significant number of people injecting and not in touch with treatment or services, and Forward Leeds attracts approximately 300 people into our services, with 300 people also leaving Forward Leeds each month.

The places and populations we work with, given their rapid changes are also not straightforward to predict; the culture and context of England is unique and on a different scale to most other countries. Given this context, most treatment systems simply cannot meet the current demands that they face and there is a need to prioritise the populations served.

There are, in my opinion, two main factors which have contributed to our current position:

  •  There has been little or no fixed or settled position on investment and what works. A level of chaos and change can be positive, but not at our current pace and level of instability. The users and their loved ones are those experiencing the greatest consequences.
  • Cuts have coincided with increased complexity and demand both in the needs of service users but also the range of services in the specifications for contracts.

Despite these challenges, our services and staff are passionate about treating as many people as we can despite the pressures that we face, rather than sticking rigidly to our specifications and contracts, and we remain keen to continue to adapt our services. A clear example of new innovations in the treatment of people who use opiates is buprenorphine depot injections; these provide an opportunity to better meet the needs of the people that use our services and they want them.

The people that use our services need stability, access, choice and effective evidence-based interventions.  However, all too often they receive:

  • The wrong interventions at the wrong time
  • Inadequately embedded segmentation which fails to implement our established evidence base and the range of options available
  • People simply not being able to get what they need, when they need it most

This is often a direct result of a chaotic and unstable commissioning environment, and the subsequent changing expectations on what services should be delivering. As our figures demonstrate, many people receive effective interventions, but both when accessing and over the course of their treatment people can easily become distanced from what they want or need.

As a sector, we have proven that with stability and the willingness of all people involved we have the potential to transform our delivery nationally, starting with system changes in our localities that make the most of the resources we have.

Of course, there are areas which we also need to address as a sector; some of our current resources are inefficiently deployed and ultimately not being expended on what people who use our services want and need. These can include unnecessary bureaucratic processes, and managing tasks and interventions that our service user group simply does not want. We can improve the choice and range of interventions, whether pharmacological or psychosocial, and better target them to users who benefit from them. An example is that new medical interventions can be of particular use to people using opiates who are:

  • Struggling or not engaging with treatment – this also has an impact on providers’ resources as well as requiring people to re-engage
  • At risk or presenting risk which can include rough sleeping and injecting in public places
  • Employed and only requiring light touch treatment
  • On lower levels of substitute treatment. There are still a lot of people who would benefit and want different support packages.

The impact

Stable funding and service delivery would provide us with the space to develop greater choice and more timely interventions, as well as offering delivery to many more people with the resources that are made available to us. Critically, it would allow us to target and expand upon:

  • Delivery for those at highest risk or with the most complex needs; staff would be able to have smaller caseloads and provide more intensive packages of care
  • Providing skills and support to access safe housing and meaningful activity. Services do not consistently have the resources or permission within contracts to deliver the sustained life changing outcomes needed
  • Proactively engaging drug and alcohol users not currently in touch with treatment by offering early prevention and more user-friendly approaches
  • Engaging underrepresented groups and communities not adequately in touch with treatment

These challenging times provide an important opportunity to cement the evidence base of what our service users and our communities need, but to achieve this we will need stable funding and commissioning.


Paul Townsley, Humankind Chief Executive