Almost a year ago when we wrote about the proposed changes to South Island free needle exchange services, we were concerned the loss of longstanding DISC Trust providers could have negative repercussions.
As we said then, decisions about health services which have an impact on vulnerable people must always consider much more than the immediate bottom line.
The reduction in funding was supposedly due to the implementation of a new population model, but we would expect such services to be dependent on need rather than some sort of arbitrary head count.
From October, the Dunedin Intravenous Organisation (DIVO), Southland Harm Reduction Programme, the Timaru Needle Exchange Trust, and Nelson Injecting Community Health Enterprise, which had trusted programmes which had run for decades, were replaced by the South Island-wide health collective Te Waipounamu.
Nothing that has happened since then has lessened our scepticism about the change.
In April we learned from research by University of Otago research fellow Dr Geoff Noller the change to the new provider had led to a rise in needle reuse in Dunedin’s drug community.
He reported clientele had advised the new provider had not initially supplied enough equipment to meet the demand which had led to the re-use of needles.
One person he interviewed said ‘‘nearly everyone is using at the moment’’ while another described entering the new premises was like ‘‘doing a walk of shame’’.
There was also concern from some clientele the new provider had an overriding focus on abstinence, something not consistent with a client-centred harm reduction model.
Dr Noller was disappointed his report which was designed to offer a warts and all look at the changes, was dismissed by HNZ.
The best HNZ could do in response was say it was mindful that inaccurate or incomplete information about the new provider was affecting confidence in the service.
It later clarified the misinformation was coming through the community, not from Dr Noller’s report, and that it was exploring ways to counter misinformation, build awareness of the service, and ways to access free injecting equipment and harm reduction advice and support.
Such a response reeks of a patronising attitude to what clients think. How dare they not like what HNZ thinks is best for them?
This week’s news the HNZ contract with the only general practitioner in Dunedin and the South Island specialising in drug harm reduction will end this month does nothing to alleviate our concerns about the changes.
Advocate Gilbert May has drawn attention to the lack of consultation with the users of the DIVO GP Clinic or the wider community over this decision which he said would directly and detrimentally affect their health and wellbeing.
He put it bluntly when he said drug users had come to expect poor treatment and stigma in health and other settings, but now the GP providing the service was being treated with the same dismissive and cavalier attitude.
Interim HNZ funding for the clinic after the changes last year runs out this month.
But there does not yet seem to be a proper plan to replace this service.
HNZ saying that Ngā Kete, the lead provider in Dunedin (part of Te Waipounamu Collective) is actively exploring options to provide and continue a GP clinic service for clients is a statement so vague it is meaningless.
It has had months to sort this out.
That it has not done so is another illustration of how poorly the service change has been handled.
The health agency has previously said it does not have concerns the new service will lead to an increase in needle sharing/reuse, in blood-borne diseases or needle-use injuries among people who inject drugs but will continue to monitor the situation closely.
If that monitoring shows it is wrong, it must start listening to those who think it is on the wrong track.
