Established 2005 Registered Charity No. 1110656

Scottish Charity Register No. SC043760

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What treatment\'s available if you\'re from Eastern Europe?

September 25 2009
Many boroughs are reluctant to work with A8 clients because of the political and financial implications of providing them with services Nearly half the homeless agencies working with A8 nationals show that their clients had alcohol as a support need, according to a report produced by Homeless Link last year. A number of people were recently arrested in Hammersmith and Fulham and tested positive for drugs in custody. However, because they have no access to public funds, their entitlement to treatment is in question. This situation may end up being replicated across London and the whole of England. With no formal policies and procedures to resolve this matter, what will happen to these people? Many boroughs are reluctant to work with A8 clients because of the political and financial implications of providing them with services, as I discovered when I contacted a number of boroughs and spoke to the DAAT (Drug and Alcohol Action Team), the primary care trust (PCT) and frontline services. However, even those boroughs deemed to be 'hard nosed' will provide a service to A8 homeless nationals, albeit to a lesser or a greater degree. It is still, though, a postcode lottery. According to a briefing paper produced this May for the Hammersmith & Fulham (H&F) DAAT, only Westminster has a written policy. It states that treatment providers can only provide needle exchange and basic advice and information to A8s. The other boroughs had no policy. Camden will not publish a policy until the NTA produces guidance and asks treatment providers to make a decision on a case by case basis. Islington has offered detox and does know of cases where specialist prescribing has been provided". Under the Workers Registration Scheme (WRS), individuals coming to the UK from the A8 countries should be in a position to take up work within six months of arrival. Once employed, they must register on the WRS within one month. When they have been working continuously for 12 months, they become eligible for public funds and services. This means that an A8 national (homeless or not) who is on the WRS scheme, whether or not currently working, can register - and is entitled to - with a GP. However, even if they are homeless and not registered with the WRS, they should still be able to register and access primary care, which includes detox, via a GP. I was advised that if an A8 homeless client was refused access to GP services, the PCT should be informed and a GP would be allocated. The H&F briefing also states that "registration appears to be at the discretion of the GP". It was unclear whether or not this applied in Hammersmith & Fulham only, or in other boroughs as well. So it is possible for clients with alcohol dependency to get a detox through the primary care route via their GP. The difficulty for illicit heroin users (who may or may not be using high doses) in accessing detox is that they need to be stabilised on methadone before admission, and many GPs and drug teams are still reluctant to prescribe to this client group. In my discussions with some of the boroughs, there was an emphasis on community rather than in-patient detox. This is, in my opinion, counterproductive. Research shows that nearly 80per cent of all out-patient (drug) detoxes fail. It also stands to reason that if "alcohol is a drug", the failure rates for detoxing alcohol clients in the community will be just as high. The clincher to this scenario is, even if they do get a detox, inpatient or otherwise, they still won't get access to rehab or supported housing. So after leaving/finishing detox, they will be in the same position as they were before they started: homeless, on the streets and with no access to public funds. The Homeless Link report stated that "400,000 A8 nationals contributed an estimated ?î???240 million to the economy in the first eight months of arriving here in 2004". We can extrapolate from this that the current population of A8s has doubled since 2004, and that the revenue generated by this group will be running into the thousands of million pounds. So, with this in mind, shouldn't we be considering using part of the revenue generated by A8 nationals to provide drug and alcohol services, proper safeguards and policies appropriate to their needs? Because - like it or not - there will always be a proportion of A8 people living here affected with substance misuse problems, in the same way that these problems affect us.
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