DHDP ANNUAL REPORTS

Drugs Health and Development Project Trust Board

Chair’s Annual Report

2015-2016

 

The DHDP or Drugs Project started life 27 years ago as Wellington Intravenous Drug Education (WIDE), to focus on harm reduction initiatives among People Who Inject Drugs (PWIDs) in the lower North Island, centrally through the Needle Exchange Programme for which it is under contract to the Ministry of Health. We assert the moral ownership of the organisation by PWIDs, and we run needle exchanges in Whanganui, Palmerston North, Napier, Masterton and Wellington and a mobile needle exchange service.

 Membership of the DHDP Board

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

 Bill Logan, counsellor, supervisor and celebrant, and with various previous governance experience in health promotion and other fields. This was my seventh year as chair of the DHDP.

 Catherine Healy, central founder and Coordinator of the New Zealand Prostitutes Collective, associated with the movement for community-based harm reduction programs among PWIDs from the beginning.

 Dana de Milo, long-time peer counsellor in public health programs with governance experience.

 James Heslop, Chartered Accountant and Senior Lecturer in Accountancy, experienced in the not-for-profit sector and governance.

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

 Kate Kerrisk, trained youth worker, mother, former PWID and Diploma in Trauma Studies.

 Our kaumatua is Rangimoana Taylor.

 The Board is a diverse group which has lively discussions and works well as a team, but it is hoped to strengthen the Board with the election of two new trustees at this AGM.

 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.

 We lead the organization by way 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 Chief Financial Officer, 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.

 The year’s work

 It has been a year of steady unspectacular work, 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 over a number of years.

 Our usual audit and control functions have revealed no anomalies, and there appear to have been no serious conflicts.

  The National Consolidation of the Needle Exchange Movement

 The Needle Exchange Programme in New Zealand was started on the initiative of PWIDs, and originally run on the whole by them, and for that reason it has been more effective than such programmes elsewhere. Decision-making in many matters was local. The people distributing needles were listened to by the people using them.

 Over the years there have been incremental modifications to the national framework, including the addition of new products and services but little increase in funding. In the early years most needle exchanges were administered by a separate trust, each of which included considerable peer representation. Over time the number of needle exchanges has grown, but the number of trusts reduced, and the number of peer representatives on trusts has reduced even more. There are now 21 dedicated needle exchanges in New Zealand administered by five trusts. These processes also increase the felt distance between PWIDs and the needle exchanges.

 Other processes have pressured the five trusts to find mechanisms to hand over their decision-making power to the Needle Exchange Services Trust under the rubric of “national consistency”. Furthermore, currently all regional and national contracts with the Ministry of Health relating to the needle exchange movement are being renegotiated in a process coordinated by the Needle Exchange Services Trust (NEST) and that will inevitably lead to further centralisation of decision-making.

Within limits national consistency and the centralisation of certain kinds of decisions may be valuable.

 One benefit that we should see early on is a new and superior integrated Point of Sales and inventory management recording system.

 But national centralisation can also contribute to the sense of alienation of PWIDs from the organisations that they ought to feel ownership over. 

 Naloxone

 In accord with the DHDP’s general strategy of harm reduction for people who use drugs, we have had some focus on seeking to modify the policy environment to allow the supply of Naloxone through needle exchanges. When administered by a bystander, Naloxone acts as an antidote which can save lives after an opioid overdose.

 We were not terribly successful in getting the support of the Needle Exchange Services Trust (NEST) but used the occasion of the opening of the new clinic in Masterton to pitch the issue directly to the responsible minister (the Hon Peter Dunne), and in that we were successful. The necessary decisions have now been made and although the wheels of bureaucracy are inordinately slow, we will get there.

 In practice making Naloxone available will require some staff training and involve interacting in new ways with people who come to the counter. It will be a challenge for the organisation to make the best use of the opportunities provided for new kinds of harm reduction conversations.

 

We can be proud of the success we have had on this issue, against quite extraordinary inertia. We should particularly record our thanks to Kate for her role in this, and also Catherine.

 However, this success was possible only because the DHDP had the right to speak independently, ie, because we were allowed to advocate on behalf of our moral owners. We must make sure that as the new contracts are negotiated that we retain the right to speak our mind.

 The future

 We have maintained funding from the Ministry of Health pending the renegotiation of regional and national contracts for a three-year period, which will require some adjustments to the organisation as we implement the national standardisation required by the ministry, and as we make a wider range of products and services available to PWIDs.

 There is a tendency for the voice of PWIDs themselves to get lost in the process of serving their health needs. It remains key to be mindful of the Ottawa Charter which sees health arising through strong, confident, self-organised communities. The Drugs Project, as the moral property of PWIDs has a responsibility to speak up for them, but we cannot pretend represent PWIDs in all matters, and should not seek to do so. Our role is narrow. We should always be alert to opportunities to support initiatives for independent PWID organisation.

 Conclusion

 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 management, the staff and volunteers, and particularly the General Manager, for their work and for their support.

 Bill Logan

Chair

Drugs, Health and Development Project Trust Board

 Wednesday 14 September 2016

 

 

General Managers AGM Report – September 2016

 

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

 Needle Exchange operates in a unique environment remaining low key but giving the very marginalised and isolated PWID (People Who Inject Drugs) community an access point for discussing their health needs.  Over the previous 12 months we have had over 1400 conversations where we gave out important health advice. We are a solid, consolidated organisation that operates five comprehensive static exchanges and three mobile exchanges that are growing in area covered and distribution of equipment.


 
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 and expand our mobile services.

 

From here on Itallics represent policy quotes from our policy document.

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


Criminalisation creates the stigma our stakeholders face on a daily basis making best possible health outcomes incredibly difficult. Society has a negative view of those who inject drugs and PWIDs are constantly coerced to accept second best. OST and other health care services often discriminate and stigmatise our stakeholders which leads them to be dishonest about their health problems,  this causes both physical and psychological harm. 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-judgemental 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, and with the close ties that we have developed with these agencies we know our clients will receive a fair and non-judgemental 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 have both committed to support our clients should they feel they are being badly treated at OTS or a pharmacy. (These two lead the field in complaints we receive regarding poor service.)

Evidence:

We are participating in “Valuing Communities” at the Police College for cadet training and have attended eight training sessions in the last year.  We are pleased to say that cadets are being taught that possession of needle and syringes is legal, we think due to our involvement.  We are still seeing the odd charge sheet with these charges and we support the individual as best we can.

Presentations to OST, Pharmacy Guild, Compass Health, Community Corrections, AOD and Hospice staff are all opportunities to reinforce our message that people who inject drugs should have the best possible health, welfare and freedom from coercion.

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.

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 couple of years. The board have fed into the NZDF policy document that has been presented to Government.  Two board members are on a steering committee for Naloxone and we are happy to announce that Naloxone has been re-classified. It has been established that Naloxone should be distributed to PWID’s via the NEP and there is a lot of research and evaluation done to support this model. We had a Memorial Tree for International Overdose Day and a drop in day that was well received creating awareness and discussion.

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 very near future. This in itself could decrease the chances of 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 all in a safe environment free of judgement or stigma allowing people to speak honestly and ask questions they wouldn’t ask of anyone else.

 Evidence:

DHDP provided a couple of submissions to Pharmac regarding HepC treatment options and it has been wonderful to have a new treatment option that is fully funded, Viekira Pak  is available for anyone who has genotype 1. Harvoni has also been approved but with strict criteria access, there is still work to do here but this is good start.

We are also working with Compass Health to provide a half a day a month HepC clinic which would involve testing, scans, information and access to a nurse in each of our branches in 2017

Educates about safer drug-use practices

The Hub Leadership Group has all supported the development of a national website with individual trust portals. This would mean that the latest news, ideas and practices would be loaded by a centrally dedicated person, within this each Trust will maintain its own page consisting of times, events and services.

Evidence:

This is a constant as we are regularly educating PWID’s on safer injecting practises and handed out over 1400 pieces of advice in the last year. 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 $10K per year as we believe this a very important harm reduction product.

Our front of house TV monitors with education and relevant articles being showed 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 is growing with a number of new admin people feeding into the information being disseminated.

 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 other organisations.  When giving a presentation we get an opportunity to re-iterate that HONESTY is the only way to build client relationships and how can someone have best possible health outcomes if treatment is built on lies. I feel that our networking and connections 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:

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.

We are also in discussion with Geoff Noller to be part of a research project that is focussed on the efficacy of rapid testing in the NEP setting, another benefit for our people.

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

 

Carl Greenwood

General Manager

Drugs and Health Development Project

Wedsnesday 14 September 2016