A changing landscape for commissioning
Not only does substance misuse commissioning have to try to address the complex needs of many service users, it also has to do so within a very complex political and financial landscape, as a recent (14 April 2015) briefing from the sadly missed Drugscope makes clear.
Drug and alcohol commissioners face a number of substantial challenges:
- Having to provide quality services with substantially less resources.
- Operating within new public health, rather than dedicated substance misuse, structures.
- Adapting to almost continuous wider public service reforms.
Three main themes
The briefing was based on a roundtable discussion attended by individuals from commissioning and provider backgrounds as well as those involved in public sector reform; it highlighted three key themes:
- The different scales on which commissioning is taking place.
- A trend for drug and alcohol systems to become a vehicle for delivering other policy objectives.
- Peer recovery networks.
Many readers will have first hand experience of commissioners seeking to achieve economies of scale by integrating drug and alcohol treatment and moving to one contract for a local area with the aim of delivering a co-ordinated treatment system led by a single provider. The recent decision to allow Greater Manchester to manage its own health treatment system (see here for the formal memorandum of understanding) is an example both of devolution and of an attempt to maximise economies of scale.
However, there are also a number of examples of much smaller scale approaches which allow commissioning to be very specific in targeting local need. There are even examples of commissioning at the “lower super output area level” – the population of which is normally about 1500 people. Because drug and alcohol misuse is often linked to social determinants of health, addressing substance misuse can help to deliver unrelated agendas. The briefing includes a case study of a Place Based Pilot in Kirkholt, Rochdale which focuses on local troubled families.
Broader public health outcomes
Roundtable participants argued that drug and alcohol services should now function as vehicles for the delivery of broader public health and social outcomes.
In addition to close partnership working to support successful recovery journeys, including with partners in housing, education, training and employment, Public Health England commissioning guidance also highlights the importance of effective responses for parental substance misusers, in collaboration with adult and child social care, to strengthen families and protect children from harm.
Effective substance misuse recovery systems can also play a lead role in tackling issues such as domestic violence and abuse, the needs of women offenders or hospital admissions.
Alongside this move towards large-scale, more integrated commissioning and provision is a more grassroots recovery movement which has led to diversity of initiatives growing up within services, but outside of traditional commissioning structures.
Peer led recovery groups are slowly getting increasing attention from commissioners as an area which can make a significant contribution towards achieving positive outcomes within the context of funding cutbacks. Many readers may already be familiar with Lancashire’s Red Rose Recovery which uses a recovery coach approach to help service users develop a personalised recovery plan, based on their individual assets, and is featured as a case study within the briefing.
I am left wondering who will chart these increasingly complex changes in commissioning structures and practices through the next Parliament when, irrespective of who forms the government, there will clearly be further cuts in treatment budgets.
The closure of Drugscope through lack of funding seems to me an extremely worrying harbinger of things to come.