Using names in needle exchanges

I don’t think I’m going to make many friends in some parts of the needle exchange community with today’s article.

I’m going to talk about the idea of using a full name and date of birth for needle exchange clients. You see, I think we should use peoples real names. I think there are some very good reasons why we should, and they are mostly for the benefit of the client.

Anyway read my reasons for yourself and remember, if you disagree with me I’m, as always, happy to respond to comments on the article.

So, as anyone working in UK needle exchanges probably knows it has been traditional to have needle exchange as a fully anonymous service. Different services manage this in different ways, some giving out colour coded keyrings, some assigning a number and others working from initials. The reasons for this have always been to protect client identity.

In most places I’ve worked when an attempt is made to increase the amount of information collected from clients there has been great resistance, but never from the clients. Staff resistance is great, usually with comments like “If we start asking those questions no clients will come in.” 

Reasons for using names

1. NTA Monitoring: The National Treatment Agency has recently introduced more monitoring of exchange services, although at the moment this is limited to detailing the equipment out and equipment returned. It’s no great stretch of imagination to realise that they may soon be asking for more client focused details. I’m actually hoping this happens, the more focus we get for needle exchange may even lead to better funding for the services.
2. Improved treatment journeys: While I’m all for allowing anyone to be given a needle exchange under the name Mortimer Mouse, it’s really difficult to arrange a hepatology referral for Mr. Mouse. Needle exchange as I’ve said many times is a gateway service that attracts people at earlier stages and refers into appropriate treatments, that’s one of the main arguments we have for continued funding. Using full names and dates of birth means we have the evidence of the work we do for each client.
3. Better services: If you assess people properly for their needs you can provide better more targeted services. Not something that is fully possible when they are identifying themselves through a number (every service I’ve worked in using ‘number IDs’ has had issues with people just giving a random number when they attend). Also if you keep a regular record of the work done during an exchange then you can follow up on previous advice as well as minimising repetition. (This is also a way of evidencing the work we do to commissioners)
4. The most important reason: What is the message given to the client  when the first thing we say is don’t worry you can use any initials you want, no one will know you are coming etc etc. Personally I feel we are at risk of it seeming like “don’t worry about your dirty guilty secret, you should be ashamed, no one will find out.”. It’s just not normal to use initials when talking to people, I use names when I talk to clients or anyone else, not using names separates the process out as different, unusual, clandestine. Our clients are stigmatized enough by the rest of society, we shouldn’t be adding to this. Treat your clients with respect and use their names.

Confidentiality

Of course we need to get clients to understand that services are confidential, but that can be done by having robust confidentiality systems. At first presentation you should be explaining to people in what way information is kept, why it’s kept and the limits on how confidential we can be within current UK law. You should be doing this for EVERY client you work with anyway.

Staff buy in

It’s no good just asking people to start doing robust assessments for needle exchange visitors if they don’t understand the advantages to the service and the clients. Because of this it is important that you get all staff on board with any changes you make before letting them loose on your clients.