Review of Drug and Alcohol Commissioning

Earlier this month (October 2014) Public Health England and the Association of Directors of Public Health published a joint review of drug and alcohol commissioning in England and Wales. This Department of Health funded review was based on a series of interviews with Directors of Public Health (94% of the 152 Upper Tier authorities participated) and Drugscope and looked at current and future commissioning plans for drug and alcohol treatment.

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Investment in services down

A very varied picture of commissioning and funding intentions emerged from the review, although it is clear that the substance misuse treatment sector is no longer immune from the public expenditure cuts. Here’s the key table from the report: As you can see, when we ignore the areas where data were not available or a decision had not been made, 31% areas were expecting a decrease in services for the current financial year – against 11% intending to increase their investment. The picture is bleaker still for 2015/16 with 34% expecting to make cuts and 7% expecting to fund more services (although it should be noted that only half areas were able to comment at the time of the review).

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Other findings

Other key findings from the review included several planned realignments of resources between alcohol and drug services – with an acknowledgement that alcohol treatment remains disproportionately under-funded. In addition to integrating drug and alcohol services, many areas were exploring a broader integration with services such as housing, younger people services, criminal justice, and local health delivery. There was also a general focus on improving outcomes, continuing the move to a recovery model. Interestingly, the review contained not a single mention of payment by results despite the Department of Health recent substance misuse PbR pilots.

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Tinkering

In its response to the review, DrugScope, representing service providers,  expressed a concern about the current volatility of funding. Drugscope highlighted  the continuous drive to reassess and retender services, and the need for commissioners to understand the impact frequent tendering processes have on providers (see this post for an alternative model). A similar set of concerns was also raised by Public Health teams who admitted that one of the biggest challenges they face is ensuring the sustainability of drug and alcohol services. This manifested in a number of issues:

• Uncertainties over future funding;
• The potential impact of removing the public health ring-fenced grant;
• Commissioning efficient and effective services to give better value to taxpayers; and
• The impact of short commissioning cycles on creating a sustainable service.

I’d be very interested to hear readers’ experiences of local changes to drug and alcohol funding.

• Is your area cutting or raising investment?
• How frequent is your local (re-)commissioning cycle?

Please use the comments section below.