July 2012 |
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Family matters
They’re the experts, and with themwe’ve been able to shape services. If we only have
the third sector and general practice we won’t do anything.’
She also praises
DDN
columnist and GP Chris Ford (who retires this month –
see column, page 22) as ‘one of the unsung heroines’ of the substance misuse
movement. ‘She really helped to galvanise it all with her force of personality.
We’ve had our big arguments over the years – even though we’re both on the
same side – but I just think she’s someone who’s done incredible work.’
*****
Gerada spent most of the early part of this year immersed in campaigning around
the Health and Social Care Bill – or Act as it now is – but she feels it’s now time to
concentrate on stabilising the NHS and having a proper discussion about its
future. ‘I think the focus needs to be on having a national debate about what the
NHS should provide, led by government, because it’s a government issue – how
much of our GDP should go to fund the NHS,
how
it should be funded, and how
we should tackle the big issues.’
There also needs to be a focus on provider reform, she stresses. ‘I think with
commissioning we’re looking at the wrong end of the telescope. We’re the only
country that does commissioning. How we should be looking at it is: there’s resource
allocation, and then there’s provider reform. And then let’s get on with what doctors
and nurses and everybody else is best at, which is sorting out how best to work
together. I’m also concerned about rationing – not that we shouldn’t have rationing,
because in every publically-funded health service you have to have it – but rationing
that’s limiting what’s provided once it’s been decided that it
should
be provided. I
don’t think that should be done by GPs – it should be done by elected politicians who
can be held accountable. We can help them, but I don’t think it’s our role.’
This is already an issue in the substance misuse sector, she stresses. ‘A lot of drug
users don’t have access to psychological treatment – talking therapies – for example.’
On that subject, she established the RCGP’s practitioner health programme for
doctors who are experiencing addiction or mental health issues themselves. How
big an issue is that in the profession – is it still a real taboo? ‘I use the line that
doctors have as poor access to mental health care as homeless patients,’ she says.
‘It’s different, but it’s the same sort of issues. It is a huge stigma, and people tend
to present very late because they’re worried about losing their livelihoods. But
once they’re in treatment they do remarkably well, with 80 per cent abstinence
from alcohol at three years and 90 per cent abstinence from drugs at three years.’
*****
On top of all of her work with the RCGP, she’s also still a practising GP – how does
she manage to juggle her time? ‘Oh, I’m just tired,’ she laughs. ‘I work hard, as a
lot of people do. I don’t do as much as I used to, but I still do a fair whack of
normal general practice and doctor stuff.’
Given all the changes she’s witnessed, how would she hope to see the sector
develop now? ‘We’ve come a long way in 20 years, but I’m seriously concerned
about counting drug users as if they were commodities which you then have
funding for. It takes a long time for drug users to get better and there should be
shared care between all the different parts that are not in competition with each
other. I’m worried that once you’ve got a tariff on a drug user’s head you’ll start to
lose the integrated services that many of us have fought for.
‘I think abstinence is what every drug user would want, but for many of them
it’s a long journey. I’ve been seeing some patients for 24 years, and their lives are
really just starting to sort out.’
www.rcgp.org.uk
Xxxxxxxx
xxxxxxx
xxxxx
Joss Smith is director of policy and regional
development at Adfam. www.adfam.org.uk
FAMILY MATTERS
DEFINING THE PROBLEM
Struggling with disadvantage shouldn’t qualify
‘troubled’ families who need support as
‘troublesome’, says Joss Smith
THE TROUBLED FAMILIES PROGRAMME
was first
discussed by David Cameron in December 2011,
when he stated that ‘Our heart tells us we can’t
just stand by while people live these lives and
cause others so much misery. Our head tells us we
can’t afford to keep footing the monumental bills
for social failure. So we have got to take action to
turn troubled families around.’
The figure of 120,000 families has been much
talked about in the media and the significant cost
alleged to be involved in ‘dealing’ with these
families is extremely high, with estimates of £9bn
a year. In March 2012 the Department for Communities and Local Government
(DCLG)’s
The troubled families programme: financial framework for the
payment-by-results scheme for local authorities
defined troubled families as
those households which: are involved with crime and anti-social behaviour
(ASB), have children not in school, have an adult on out-of-work benefits and
cause high costs to the public purse. Although families affected by drugs and
alcohol are not explicitly defined as included, the programme allows local
authorities the flexibility to bring this issue in at a local level under the ‘high
cost to the public purse’ indicator.
The figure of 120,000 has been widely used by government within the
programme. However, its validity has been questioned in relation to the current
agenda, having been calculated by the Cabinet Office’s social exclusion task
force using 2005 data from the
Families and children study
(FACS). The 2005
study sought to identify families ‘troubled’ by multiple disadvantages, such as
living in poor and overcrowded accommodation, or where the mother has
mental health problems or an inability to afford a number of food and clothing
items. Some may argue that many of these criteria, which have seen families
included within the initial 120,000 figure, may be out of the families’ control and
may also be indicators of poverty – more so than a condition of being ‘troubled’.
What is concerning some commentators is the short leap that current
rhetoric is making from those families who are troubled by multiple
disadvantages to ‘troublesome families’ who are disruptive and harmful to
local communities. The conflation of the two encourages placement of blame
and accusation on some families who continue to struggle to cope with their
multiple problems without being ‘troublesome’. Often these families have
lived through many definitions… complex, chaotic, multiply disadvantaged,
troubled or troublesome. However one constant is that their situation hasn’t
changed. They are still stuck. On top of dealing with their lived situation, they
also cope with the pervasive and insidious effect of stigma that these labels
convey, when many may not be causing any more harm or chaos than some of
their unlabelled neighbours.
The troubled families programme heralds a real opportunity for local
authorities to take a more systemic approach and focus on improving training
and awareness, multi-agency working practices, less bureaucracy and
management support and supervision. However in order to ensure that this focus
and political will is capitalised on, there is an urgent need to clarify who we are
talking about and how we might best support them to make positive changes.
Joss Smith is director of policy and regional development at Adfam.
www.adfam.org.uk
The Adfam/Drugscope troubled families briefing can be found at
www.adfam.org.uk/news
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