(These meeting notes have been prepared by Crisis Centre Ministries and circulated to those present. Any references to 'we' and 'us' refers to CCM, or sometimes to Bristol, and not to the people round the table. To the best of our knowledge, this is an accurate and reasonably complete record of what was said.)
More details of the background to this meeting and related documents can be found at:
Alan Goddard (CCM Drop-in Centre Manager), Paul Hazelden (CCM General Manager), Sue Bandcroft (Safer Bristol Senior Commissioning Manager), Claire Main (Safer Bristol Commissioning Projects Officer), Glenn Mower (BSDAS Senior Social Worker), Kristin Dominey (AWPT Head of Substance Misuse Services), Jane Baker (BSDAS Team Leader) and Barbara Coleman (NHS Bristol Associate Director Public Health).
(AWPT is the Avon & Wiltshire Partnership Trust.)
Implicit in the context of the meeting were two objectives:
At the start of the meeting, three others were suggested:
One part of the context for this meeting is the previous meeting with Stephen Williams MP, and the notes circulated from that meeting. Unfortunately, most of the people present had not seen these notes and did not have a copy, so any discussion of the detail in the notes was difficult.
The second part of the context, for CCM, is that in the Coffee Shop we frequently see people being 'recycled' - going into treatment in Bristol, and lapsing, over and over again.
The third part of the context are some outstanding questions from Alan:
This information is not easily available. Sue has tried to get hold of some answers to these questions, but did not succeed in time for this meeting. She promised to make it available shortly. (Post-meeting note: we have not yet received this information.)
In discussing how CCM could set about finding out what is happening in this area, several meetings were mentioned:
We were informed that minutes of all these meetings are posted on the Safer Bristol web site. (Post-meeting note: we have made several searches on the web site and asked to be told where these minutes are and, so far, failed to find them.)
People from Safer Bristol are welcome to attend the meetings of the BCAN Homeless Forum (on the second Thursday of alternate months, venues posted on the BCAN web site - www.bcan.org.uk/bhf), as are people from other statutory or funded groups.
Alcohol treatment does not have the same level of funding as drug treatment. This is essentially a political decision: it is not due to a lack of treatment options, but due to a lack of will to pay for it. However, the alcohol funding has increased recently.
When people have both drug and alcohol needs, as is frequently the case, Safer Bristol intend to provide help for both needs. The two areas have been 'brought together' to facilitate this combined approach, but it is not immediately clear what this means.
Safer Bristol have made a conscious decision to 'maximise residential rehab within Bristol' as this enables better deals to be made with the treatment providers, and so more treatment can be offered within the budget. The policy was developed with the providers - the treatment services - with the two aims of maximising the resource we have in Bristol and of encouraging people to maintain the links they have with families. "We buy block beds in advance because it is cheaper that way, so we get more treatment for the money."
While CCM accepts that Safer Bristol have chosen this approach, we are not yet convinced that it is the best one, either for the individuals being treated, or from the perspective of simple economics.
It seems obvious to us that, if you ask the treatment providers in Bristol, they will favour an approach which maximises the amount of treatment they provide, and hence the amount of money they make.
It also seems obvious that, if a person has been living in addiction for some time, then their current relationships (whether with family or friends) have been encouraging and facilitating that addiction, so it is unlikely that these same relationships will suddenly encourage a drug-free life post-treatment.
And it also seems obvious that you can maximise the quantity of treatment provided by choosing the cheapest treatment available, but this is not the same as choosing the most cost-effective method of treatment: it is at least possible that a more expensive form of treatment may prove to be more cost-effective than a cheaper form.
It is our conviction that the most ethical form of treatment (that which is most likely to produce a successful outcome: where the treatment programme is completed, and and where the individual remains drug-free for a significant length of time after treatment) is actually in the long run the most economical approach.
Sue listed the many sources from which Safer Bristol gets money to commission the services listed in the Bristol Drug Treatment Directory. Anyone in Bristol can access these services, which include the following.
All the people in these programmes should have a key worker, who would provide access to the specialist services through the Community Care Assessment Review process. The funding for this comes from the Community Care budget.
All the people in these programmes should have a care plan which identifies what they will do once the treatment is complete. However, Alan knows of two people currently in detox for whom there is no plan - or, at least, the plan is to put them back into a hostel where they are very likely to relapse. Sue thinks this should not be the case, and would like the details. Alan will ask for permission to give her the details. (Post-meeting note: Alan received permission, and supplied Safer Bristol with the details.)
When it is a question of life or death, Safer Bristol (actually, a panel consisting of Sue, Kristin Dominey and a senior social worker) will accept people in to Acer (the Acer Specialist Drug and Alcohol Inpatient Unit at Callington Road Hospital, where they provide inpatient stabilisation and detox) without a plan, but not otherwise. If clients are referred to Acer they will have a key worker, so we need to find out from the key worker why they are planning to go back to the hostel and then pass this information on to Sue.
Safer Bristol plan to do 200 Community Care Assessments each year. From these 200 assessments came 152 placements last year.
Several places that Safer Bristol has used were identified. Sue has started the process of finding out details of the people who have been placed in funded residential treatment outside Bristol, and will pass on the results to CCM as soon as she has them. (Post-meeting note: we have not yet received this information.)
(On several occasions, the meeting touched on the subject of the nature of the services being provided, but this was not explored in detail. A point which seems obvious to CCM is that there is a range of treatment provided by residential services outside Bristol which is simply not available from providers within the Bristol area. Limiting people to services within the Bristol area not only reduces the probability of success due to the social context when the treatment is complete, but it also reduces the range of treatment options, and this will also tend to lower the success rate. Different individuals respond to very different treatment strategies, styles, approaches and philosophies. The wider the range of possible options, the greater the chance of finding something which will work well for the individual concerned. This seems to us to be common sense, and it is certainly backed up by our experience.)
Several points were made to support the policy of keeping people in Bristol for drug treatment:
It was suggested that people from CCM should meet the people from Walsingham House, as Walsingham House are asking for Bristol people to come and fill their vacant places. (CCM comment: we are willing to meet these people, but don't really see the point. We accept that people who provide drug treatment services will want drug users to use their services, and will probably feel they do a good job of helping them. As a quid pro quo, maybe people from Safer Bristol could meet some of the treatment providers we use outside Bristol, and discover some of the treatment strategies which are not currently available from the treatment providers within Bristol.)
Funding for treatment at Serenity House needs to go through the Community Care Assessment. This treatment is not being offered, but neither is it being prevented. At present, nobody is going to Serenity House because nobody is asking to go.
In this context, the comment was made that 'Bristol is wall-to-wall with twelve step'.
The New Street Wet Centre is open on two days each week now.
There is now more access to alcohol treatment at the Salvation Army than there used to be. They have 6 beds for the year for alcohol treatment as a pilot project.
The preferred option is to do community based alcohol detox, but this is not suitable for many people.
There are around 70 or 80 referrals from GPs each month for alcohol treatment.
People cannot do a detox at the Salvation Army any more because alcohol detox is now funded by Safer Bristol, and therefore Safer Bristol need to make sure the 'governance' is correct and safe. If Safer Bristol fund the programme and any problems occur, Safer Bristol will be 'up in front of the coroner'.
On 26 June the Robert Smith Unit will be moving to Colston Fort.
Alan asked: how do we make sure that our clients have access to Community Care Assessments? The initial answer was that we need to make sure they have a way in to the treatment services through accessing the tier 2 services (it would probably be helpful to be clear what these are...).
The panel meets every two weeks to consider the Community Care Assessments. It would be helpful to know who is on this panel.
CCM can refer people for Community Care Assessments. We did not know this before. Alan will aim to get some completed in the near future.
How long will it take for someone to access treatment through this route? It varies according to the individual needs, but the target is 28 days to do the Community Care Assessment, and then provide treatment within 3 months. Sometimes the treatment can happen within 4 or 5 weeks.