No Apology for my Outrage
In more traditional leadership theory, anger isn’t deemed to be a very effective leadership characteristic. We all had those experiences of shouty leaders or people pursuing blame games to prove they are right and creating chaos and hurt in the process.
I’m coming up to my 13th year leading our amazing charity and I have worked hard over those years to develop a leadership approach that aligns to the purpose of the organisation and supports our staff and our volunteers to deliver their very best. Our values guide me;
We believe in being the best We value our history We are passionate about recovery
They help me make those big decisions and even if they are hard I know I am working to our agreed set of rules and guiding principles. Never in the last 13 years have I had the sense of burning outrage and anger that I have now. And being the reflective charity leader that I am, I have worked on owning my anger and understanding what it teaches me. And my conclusion? It is time to speak out and say what isn’t being said. Its time to say it loudly in a hope that things will change.
Why the Anger?
We are currently in consultation with our staff to close the best residential service in the country. Grace House was established in 2014 to support women who couldn’t access help anywhere else. Women leaving Holloway prison who couldn’t access accommodation because of their substance use, who couldn’t access residential treatment because of their criminal convictions, or their mental health issues; Women who found it difficult to ask for help because of the trauma they had experienced in their lives, the very trauma that led to their substance use and their criminal convictions. Women, mothers who had delayed accessing the help they needed because of the stigma they experienced anytime they tried.
Grace House is a 10-bed trauma informed Registered Care Home. Yes, we support people with substance use problems, but those women also have a myriad of other issues. Most of the women who came to us in the last year had poor mental health. Over half of the women are mothers, just under half had experienced domestic violence, had been in prison and had been homeless. As our CQC report  shows women at Grace House received ‘high quality care and support from a staff team that worked in within a strong person-centred culture. …… staff demonstrated high levels of compassion dignity and respect and provided responsive practice and emotional support’
No one left Grace House last year with nowhere to go. 64% of women completed their treatment with us, the rest went on to continue their treatment or recovery supported by another organisation. After a lot of hard work, we are really proud of what we have achieved in Grace House and were delighted to receive an Outstanding rating from the Care Quality Commission in their recent inspection. Grace House is the only third sector specialist substance use treatment Residential Rehab in the country to receive an Outstanding rating.
For that we charge £800 per week, one emergency detox in hospital costs the NHS £4,300.
So why on earth are we closing it? Because over the last 4 years we have subsided the service with £1m of charitable funds and whilst 46 local authorities referred into the service many didn’t, many would only fund weeks of treatment rather than the months of treatment required to be effective and despite our efforts there is no sign that the position would get any better.
Need, Demand and Who Pays?
We have a belief in this country that our Health and Social care system takes care of people when they are in need. We think our health system provides a safety net for people with life threatening conditions. We think that this is free and accessible to all who need it.
A National Health Service is increasingly becoming a fallacy for people in need of drug treatment.
Funding has been cut across all health and social care budgets. Within substance misuse that has meant cuts of between 25-50% in local treatment budgets. Those cuts have affected all provision. Needle exchanges, support for families as well as the wider support people need to re-establish their lives. Those cuts have also meant people needing more intensive support to address their physical and mental health needs are finding it increasing hard to get the support they need.
Residential Care Homes provide support for people who struggle to live independently and need an intensive level of support but not personal care or hospitalisation.
In the substance treatment sector residential care homes are described as residential rehab. They are recognised in the clinical guidance for drug treatment as important treatment option;
The range of therapeutic approaches employed in residential treatment makes some programmes especially suitable for those with the most complex needs and for those who “have not benefited from previous community-based psychosocial treatment” (NICE 2007). However, there will be some people who desire to go directly into residential treatment and some may benefit from doing so. Such decisions will need to rely on a best clinical judgement.
In times of limited resources and increasing levels of need we have expert guidance to support our approach in delivering evidenced based healthcare;
It seems clear that, for some people, recovery is likely to be better supported in a service that provides a safe environment, daily structure, range of psychosocial interventions, higher intensity, accessible peer support, etc – all conducive to recovery
So, with a record level of drug related deaths, a record level of people dying of drug related issues whilst homeless why are our residential care homes specifically for this group of very vulnerable people not being used?
Grace House is closing because women have been unable to get through the many hurdles put in front of them to access the service. The main hurdle they face is getting the funding they need to access the support. Decisions being made on the basis of rationing rather than clinical need. Stigmatising views forcing women in trauma to prove they deserve a share of limited resources.
And whilst the loss of Grace House will be felt so acutely due to its specialism the hurdles and rationing and stigma is something experience across the UK by many trying to get the help they need. Those are stories for another day which I will share on these pages.
The Facts That Need To Be Heard Now
- Residential care is one of many recognised clinical interventions that is particularly suited to those with the most complex needs and for those who “have not benefited from previous community-based psychosocial treatment
- Good quality residential care is available for people experiencing substance misuse issues
- Residential care provides value for money
- Decisions are being made locally that prevent people from accessing treatment for their chronic health condition
- Charities as a result do what they can and fund the NHS to the tune of millions of pounds each year
- The poorest most vulnerable and excluded in our country are suffering disproportionality from lack of health care and are dying as a result.
So, this is why I am angry and this is what needs to be heard, and I will continue to find many different ways to say it until people listen and act. Because that is what leaders should do.
And no, I don’t apologise for my outrage.
 Grace House Phoenix Futures CQC report https://www.cqc.org.uk/location/1-6531568825
 Drug Misuse UK Clinical Guidance https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/673978/clinical_guidelines_2017.pdf
 Medications in Recovery - Strang https://webarchive.nationalarchives.gov.uk/20170807160631/http://www.nta.nhs.uk/uploads/medications-in-recovery-main-report3.pdf