General Managers / Chairpersons AGM Reports – November 2018

General Managers Report 

The DHDP seeks to maintain itself and build in the lower North Island as a peer-based community service organization which;

The importance of a peer based organisation cannot be overstated. It’s an intrinsic part of the founding document, the Ottawa Charter that also sits alongside the Treaty of Waitangi. Peers pass knowledge onto our community; (allowing them to make better health choices), they connect with pharmacies, doctors and other primary health care organisations. They are the strength and backbone of our organisation. It’s not always easy to find suitable staff, but patience is a virtue and if we wait long enough the right person does come along. 60% of our staff are on the Methadone program and the rest of the staff have injecting backgrounds or drug use that has led to some form of addiction or drug abuse or mental health background.

It’s been a hard year for DHDP with the passing away of two staff members and the departure of manager and another shift worker, and illness of staff has led to a very busy year with me feeling like my car was more like my office for a few months this year. It is wonderful to report that as we come to the end of the year, all is back to normal and we are fully staffed once again.

Whanganui – Is running very smoothly, the manager has had a few health issues through the year but is on fine form currently with two very supportive staff. Working well with local DHB and it is looking like they will run a HepC once a week clinic at the exchange.

Palmerston North – The new manager is settling in brilliantly, she has created a safe and calm environment for the staff who are responding well to her leadership. I have spent a lot of time in this branch over the last 6 months and it is really nice to be stepping back and allowing the new manager to take control.

Napier – The new manager is doing a brilliant job here and is working very closely and in sync with the new shift worker. I spent a lot of time at this branch at the end of 2017 and for the first 3 months of this year but once again it has been brilliant to step back and let the staff step up. Of course I am fully supporting both Napier and PN in their learning curve.

Masterton – The manager had a big health scare earlier this year which has required a complete change in lifestyle. This has been hard and it has been a bumpy year here but we are lucky the shift worker has stepped up and really taken the pressure off the manager. Things are improving for the manager’s health but it really is a 1 step forward and two back and I continue to monitor the situation.

Wellington – Is doing really well even with the loss of 2 staff members. Staff here have really stepped up and filling the void left by 2 staff leaving. I have spent much less time in Wellington this year but we have such a confident team here and all has run smoothly.

Through all the changes and upheaval this year I have been completely supported by staff and the community we serve. People have gone beyond the call of duty and I feel very blessed to have Glenn and Rachel do lots of work in PN when there was no manager there.

Secures the best possible health, welfare and freedom from coercion for people who inject drugs;


Criminalisation helps create the stigma our community face on a daily basis making best possible health outcomes incredibly difficult to achieve. Society has a negative view of those who inject drugs and PWIDs are constantly coerced to accept second best from health services. OST and other health care services often discriminate and stigmatise our community which leads them to be dishonest about their health problems, this causes both physical and psychological harm. Peers are often apprehensive to talk to GP’s who often don’t ask questions about drug use and HepC is regularly overlooked.  This can often leave people feeling vulnerable to blackmail, and typically involves disapproval and rejection; - this can also come from peers too.

To help achieve the best possible health, welfare and freedom from coercion, we provide a non-judgmental and understanding service that welcomes diversity and uniqueness and provides a unique space for people to engage with peers. We have a thorough list of agencies that we can refer people onto. The close ties that we have developed with these agencies means we know our clients will receive a fair and non-judgmental service. We have also found a couple of agencies who will advocate and support our clients if they feel disadvantaged by a primary health care organisation. Community Law and Health Disability Commission are both committed to support our clients should they feel they are being badly treated at OTS or their pharmacy. (We receive the most complaints for poor service from these two.)

Evidence:

We are in the process of putting a fact sheet together for all staff to use which is titled “10 reasons NZ needs drug law reform” and this is help staff with quick accurate responses to people when the topic is brought up. Helen Cark and Ruth Dreifuss have been touring New Zealand to promote the Global Commission on Drug Policy report that states the best way forward is “Regulation – The Responsible Control of Drugs”. Conversations have started and will get more intense as we get closer to a cannabis referendum. When discussions on cannabis arise we must encourage people to look beyond cannabis and promote the decriminalisation of all drugs.

Presentations to OST, Police, Compass Health, Community Nursing, AOD, Hospice staff, Like-Minded organisations and Support groups which are all opportunities to reinforce our message that people who inject drugs deserve the best possible health outcomes, welfare and freedom from coercion. We always use these opportunities to re-inforce that people who inject drugs should have good quality access to health and social services free of stigma and discrimination.

Our mobile service feeds into this aim as we see people in their own environment which creates an ease in which to have conversations about their general health and wellbeing. As we develop national consistency we are hoping that mobile services will be rolled out across the country.

Reduces to the minimum the harms associated with injecting drug use, particularly

2.1.     Deaths by overdose

Naloxone has featured quite predominantly for DHDP over the last few years. The board have fed into the NZDF policy document that has been presented to Government.  It has been established that Naloxone should be distributed to people who inject drugs via the NZNEP. Work is being done to facilitate this outcome.

We have a Memorial Tree for International Overdose Day and this year we combined this day with our 30 years celebration at Southern Cross bar. A lovely evening that was attended by over 30 people from peers to MoH officials. A more worrying trend is that we have seen the first signs of Fentanyl use in NZ, vials have been seen in Christchurch and Hamilton and we have had queries on how to get the opioids out of Fentanyl patches and NZNEP have developed a resource so staff can give accurate information on doing this.

Evidence:

The reclassification means that we will be able to provide Naloxone over the counter (after we have provided training) to our clients in the future, but we are seeing many hurdles in getting this achieved especially who will pay for the Naloxone. Currently this is a barrier as it costs $50 per script at present. It has been proven that extensive distribution of Naloxone does decrease the chances of dying from an overdose by a large percent.

 2.2.     The spread of blood borne infections (including HIV and Hepatitis)

To stop the spread of BBV’s is the backbone of our work, clean fits and equipment, education, support, advice given all in a safe environment free of judgement or stigma allowing people to speak honestly and ask questions they might not ask of anyone else. This year we have worked well with Compass Health to establish a half day once a month HepC clinic at each exchange. Our HepC nurse Sheryl Gibbs has made inroads into the community and is having initial conversations but, as predicted, it has been a slow process. I think there will be greater uptake once rapid testing is introduced early in 2018. A targeted testing project carried out by Geoff Noller has recommended the greater use of rapid testing within the NZNEP. Currently policy and procedure protocols are at the MoH to get approval for peer rapid testing at an exchange.

I am representing NZNEP on a national group that is looking into chemsex in NZ among gay men. This group is made up of NZAF, NZDF, Body Positive and Odyssey House. The focus is on gay men but hopefully we can gather some facts and maybe address this issue happening in our community, we have been made aware that chemsex is a part of the film making industry here in Wellington. I have also attended the HIV forum representing NZNEP and am the NZNEP rep for a HIV Stigma Index research project that is a joint project with all HIV groups around the country.

 Evidence:

I’m a participant on the NZ HepC working group that has been set up by NEST and we are looking at all the approaches being used across the country to get people into treatment. Having met with Pharmac it is felt that the uptake of HepC treatment is very slow and there is a lot of work to do if we are to eradicate HepC by 2030. Rapid testing will definitely help and it astounds me that health professionals don’t understand the barrier of drawing blood from PWIDs.

We have made submissions to Pharmac on the need for HEPC treatment to be fully funded and have stipulated the need for a pan-genic treatment for all geno-types and we are hoping this will get approval early in 2019.

The NZNEP has to take major credit for having such low percentage of HIV within the community - 0.2%. This is a global low and we are often used as an example of good outcomes due to having the longest running state funded NEP in the world.


Educates about safer drug-use practices

The Senior Management Group has supported the development of a national website with individual trust portals. This will mean that the latest news, ideas and practices would be loaded by a centrally dedicated person. Trusts will maintain their own page consisting of times, events and services, this is still a work in progress project.

NZNEP are working on revamping all our published material with current and accurate information included in this will be a pamphlet about steroids.

Evidence:

We are regularly educating people who inject drugs on safer injecting practices. We are constantly looking to improve our product range and the new maxi steri-cups are getting good feedback. We continue to subsidise wheel filters to the tune of $8K per year as we believe this a very important harm reduction product.

NZNEP is working on a best practice guidelines for injecting and are collaborating with all Trusts in this process and Rachel sits on the Practice Working Group who have reviewed all the new resources.

The establishment of a National Users Advisory Group has given us an opportunity to discuss and road test material directly with a peer group and this group has fed back on new resources, website and has fed in to national pricing.

Our front of house TV monitors educate by televising relevant articles. It has proven a popular way for clients to engage and learn. Clients will see something interesting and want to talk or just turn the sound up and tune in. Our Facebook page continues to grow

 Advocates for improved access to, and quality of, health and social services for people who inject drugs

This we do at any opportunity. We have built a large base of connections to a wide range of organisations.  When giving a presentation we get an opportunity to re-iterate that HONESTY is the only way to build client relationships. I feel that through our networking and connections we provide a human face for the organisation and the community we serve. There is no doubt we are all very passionate and advocate loudly for the human rights for our community and we are very aware of the stigma and discrimination that confronts all within this community. 

Evidence:

Our Harm Reduction Conference celebrating 30 years of NEP in New Zealand was a huge success and DHDP was well represented with 10 staff and board members attending. One piece of feedback I got was what a refreshing, honest and real conference – best I’ve been to.

All managers have been visiting organisations on their referral lists to discuss the unique health needs of our stakeholders and build strong ties. The Compass Health initiative to provide a long term HepC nurse at our branches can only help improve health outcomes for those with HepC.

DHDP is part of the newly formed Wellington Community Addiction Network that includes organisations such as PACT, CareNZ, Atareira, Problem Gambling, Salvation Army Bridge programme, Matua Raki and CART and we have hosted this group and given information on how and why we do what we do.

 We feel that we need to advocate strongly to anyone who will listen but especially the Ministry of Health, Pharmac, PHO’s, medical professionals and other organisations who work in the field of prevention of HEP C, to eliminate Hep C in New Zealand by 2030. 

 We hope to increase the number of services we provide to PWID's including a health clinic, the distribution of Naloxone, rapid testing and fast pathways to new Hep C treatments as well as advocating for drug reform.

We also need to advocate for drug law reform if we are to be able to tackle stigma and discrimination in a positive way.

 

Carl Greenwood

General Manager
Drugs and Health Development Project

 

Chair’s Report for the year 2017-2018

 Twenty-nine years ago we were founded as WIDE,  Wellington Intravenous Drug Education, to serve the interests of People who Inject Drugs, particularly by supplying clean needles. Later we became the Drugs, Health and Development Project, or the Drugs Project, and we expanded to do harm reduction work for People who Inject Drugs in the lower North Island. We are thoroughly committed to the principles of harm reduction.

 Our core business is running the Needle Exchange Programme under contract to the Ministry of Health, with needle exchanges in Whanganui, Palmerston North, Napier, Masterton and Wellington and a mobile needle exchange service.

 The Trust Board has formal and legal authority over the organisation, and we assert the moral ownership of the organisation by People who Inject Drugs. Members of the Board accept that moral ownership, and many of them are themselves peers. As with many government-funded health providers, the constraints of our contract give us only limited independence, and in the recent past we have been required to work as the local providers of a nationally consistent programme under the leadership of NEST, the Needle Exchange Services Trust, of which we are a constituent part. The Ministry wants a Needle Exchange Programme run as a unitary national service, and we hope to use what influence we can have to ensure that service will be peer run and peer led.

 Local issues

 While much Board attention, and much of my own attention, has been focussed on national issues, the work of the DHDP has continued, and continued at a high level. There have been crises, but they have been been crises imposed on us rather than crises created by us – death of one exchange manager, the illnesses of two others and the departure of a fourth. Inevitably these have been distressing and difficult, but they have been handled competently and with humanity under the leadership of our General Manager, Carl Greenwood.

 It has otherwise been a straightforward year in which our management has been able to maintain our services and address necessary urgent developments within a budget which has in real terms been slowly shrinking. There are, as there always have been, gaps in the services we can offer, and we are particularly aware of those among tangata whenua, steroid users and in Kapiti-Horowhenua, the Porirua Basin and the Hutt Valley. It is not that there is no coverage in these areas, but that due to resource constraints our coverage is unfortunately not what it should be. Our funders tell us that these gaps can be met only through a redistribution of resources on a national basis.

 Our audit and control functions have revealed no anomalies. There was one unfortunate disciplinary matter dealt with in an extremely patient and highly professional manner by our senior management, seeking advice when appropriate, but with this exception there appear to have been no significant disputes.

 With much of our work moving from the regions to the national arena, Carl, who normally does a lot of travel within the region, has been travelling more outside it, especially to Christchurch, which is where NEST is headquartered. He has taken up various national responsibilities, especially in the professional development programme.

 The future

 The Ministry of Health have made it clear that when our contract expires at the end of June next year they intend to replace it, and the other regional contracts together with the contract of NEST, with a single national contract. They seek to run the Needle Exchange Programme as a single national service under a consistent philosophy according to sound national standards. They have been unambiguous in this, and although they have not put it all in writing, they gave NEST the opportunity to reorganise the needle exchange organisations to meet the Ministry’s requirements. This unfortunately allowed some trusts to hope for more continued regional autonomy than will in fact be possible.

 While it is true that in principle there could be a single coherent service under a single contract run by employees of multiple trusts, in practice that would be very difficult. It would require a history of close cooperation and philosophical harmony, and might in any case be expensive to maintain. Besides, such a history of cooperation and philosophical harmony is sadly wanting.

 The DHDP has accepted that one national contract, one standard and one service as required by our funder implies one primary organisation. And we have decided that we will proactively seek to create that one organisation. We accept this necessity with regret. Our relatively localised form of organisation has conditioned a higher degree of peer involvement at every level of the organisation than almost anywhere else in the country. The current arrangements have suited us. We are proud of what we have achieved.

 But it is not enough that things go well here in the lower North Island. Even from a parochial Wellington-first point of view, problems around the country will eventually cause waves that hurt us here. And besides, there are things that can be done nationally that cannot be done locally. We have a short list of urgent requirements: we need naloxone wherever there are users, we need a decent hepatitus C service; we need drug checking in at least the Wellington exchange (and Auckland and Christchurch); we need an expanded mobile outreach service. Actually most of the gear we sell should be free. There is a good business case to be made for all these things, but we need a strong national organisation to prepare that case, and the clout to make sure it is heard. No local organisation will cut it, and anyway the Ministry has made it very clear that it won’t fund any expansion of services except via national initiatives.

 There’s a good case for a consumption room and drug education centre on K Road. It’s my personal view that the whole community of New Zealand people who inject drugs need that facility, because what happens there reverberates around the country. But they need it run by peers responsible to a New Zealand peer-led organisation. And only a national organisation of that kind will have the authority to make it happen.

 So DHDP seek a national organisation to negotiate a national contract, and to be the ongoing unitary organisation tying together harm reduction among people who inject drugs.

 I am the DHDP’s representative on the NEST Board of Trustees, and over a year ago I was elected chair of the NEST Board. It has not been a happy job. Although in principle all trustees have all at one point or another said they are agreed that the five regional trusts should merge with NEST, in practice Auckland Drug Information Organisation (ADIO) Trust and the (Waikato/Bay of Plenty) Midlands Needle Exchange Trust have resisted taking any actual steps toward merger, with constant delaying tactics and expensive legal correspondence. The Board itself is tied on all votes in important matters, and on this a decision would have to be unanimous.

 Currently NEST is not a functioning organization. Its management and staff do a great job in extraordinary circumstances, but its governance is not functioning. Together with the Deputy Chair I try to keep an eye on the finances and play a supervisory role over operations, but this cannot substitute for a functioning Board.

 It is rather clear that unless there is some unexpected change NEST will not be able to either negotiate a contract with the Ministry of Health or become an ongoing organisation tying together harm reduction among people who inject drugs around the country. It therefore seems more or less inescapable at this point that the Ministry of Health will seek tenders for the contract in the marketplace, and we are in very great danger of losing everything we have built. The whole idea of a peer-run, peer-led harm reduction service may be lost.

 Our best defence against that will be to be ready with a new national organisation which can itself put in a tender for the national contract. We are seeking partners for a new national trust to negotiate the national contract. Willing regional trusts would merge into that.

 By being in on the ground floor we hope to play some role in setting some of the basics, including that a majority of trustees will be peers.

 We would expect to win the national contract and move very quickly to set up needle exchanges in those parts of the country where we did not have a base.

 Membership of the DHDP Board

 The Board of Trustees elected at our last AGM was the following:

 Bill Logan (chair), counsellor, with various previous governance experience (Council of Victoria University of Wellington, Aids Foundation Trust Board). This was my tenth year as chair of the DHDP.

 James Heslop (deputy chair), Chartered Accountant and Senior Lecturer in Accountancy at Massey University, experienced in the not-for-profit sector and governance.

 Brent Stone, peer and doctoral student in criminology

 Catherine Healy, central founder and Coordinator of the New Zealand Prostitutes Collective, associated with the movement for community-based harm reduction programmes among PWIDs from the beginning. (Became Dame Catherine Healy in the Queen’s Birthday honours.)

 Dana de Milo, long-time peer counsellor in public health programmes with governance experience. (Died in February.)

 Kate Kerrisk, trained youth worker, mother, former PWID and holds a Diploma in Trauma Management.

 Nick Hall, a peer and longtime shift worker with the Drugs Project, with previous governance experience.

 Zap Haenga, mental health and addictions worker and former manager at Atareira Trust, and former peer with street experience

 Our kaumatua is Rangimoana Taylor.

 Our approach to governance

 The Board has two main functions.

1    To set policy

2    To ensure that the policy decided on is adhered to.

 We operate according to the Carver policy model of governance, on the basis of an evolving policy document which acts as a manual for us in our work, and for the General Manager. That document sets out:

 

(i.)                            our mode of governance,

(ii.)                           the ways we delegate authority and monitor performance,

(iii.)                         the various limitations on the means available to the General Manager, and

(iv.)                         ends which we require the General Manager to achieve.

 Thus the Board requires certain regular reports on aspects of the organization from the General Manager and the Finance Manager, and also from the auditor, and we may additionally require special reports from time to time. We also (as a Board and individually) seek to keep informed on the life of the organization, taking an interest in how the organization runs—asking questions, talking to shift workers, clients and potential clients, and so on.

 Conclusion

 Two rather contrasting members of our whanau died of cancer within a few weeks of one another early in the year who we all sady miss. Sandy Wakeman, our manager in Napier for so many years, and Dana De Milo a stalwart shift worker in Wellington and member of the Trust Board. Sandy was quiet, firm, a steadying voice. Dana was flamboyant, insightful and wicked. Both were women of passion and integrity. We will remember them, and our ongoing work is in part a tribute to their contributions.

 As always, it is a privilege and a pleasure to chair this organisation, and I want to thank, both personally and on behalf of the organisation, my fellow trustees, the staff and volunteers, and particularly the Branch Managers, the Finance Manager and the General Manager, for their work and for their support. We are lucky to have a very fine team indeed.

 Bill Logan
 Chair

Drugs, Health and Development Project Trust Board

 Wednesday 14 November 2018