AN INITIATIVE BLUNTED

For years, the Bristol needle exchange has been funded by the local
NHS. Then Whitehall accountants decided to impose "special measures"
on the new primary care trust because it had inherited debts from the
old Avon health authority.

As a result, the trust announced in February that it could no longer
afford the UKP35,000 for the needle exchange. Drugs workers were horrified.

However, Richard Elliott could see a solution. There was spare money
in another funding stream, the pooled treatment budget, which is the
largest single source of DAT funding, pro vided by the new national
treatment agency (NTA). But they would not let him have it, because
their rules forbid their money being switched to projects being funded
from elsewhere.

Elliott saw another solution. In January, the home secretary, David
Blunkett, had announced two new funding streams, either of which could
afford UKP35,000. But they wouldn't let him have any of that either:
one stream was reserved for offenders, the other for new schemes. In
March, the needle exchange workers were issued with protective
redundancy notices and drug users were warned that the service was on
the edge of extinction. The NTA responded by insisting that, as a
matter of policy, even if there was no money for it, the exchange must
not be closed.

Elliott met a middle-level civil servant from the regional government
for a drink and together they came up with a plan. The NTA had so many
rules that, even if one rule trapped them, another might set them
free. They could ignore the rule which forbade the funding of a
project which was already receiving money elsewhere and apply the rule
which supported efficiency savings. They would pretend that they were
setting up a new needle exchange as a more efficient substitute for an
old one. It was not true but it would look all right on paper, and it
would release UKP35,000 from the NTA's pooled treatment budget. The
trouble was that the NTA would know it was not true.

It took weeks of discussion, involving nine different local government
agencies, new audit trails, new fully-costed service level agreements,
the threat of political embarrassment as local MPs and reporters
started asking questions, but finally the NTA agreed to blindfold
itself with its own red tape.