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Improving commissioning for drug treatment

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In part 2 of her Review of Drugs, Dame Carol Black argues for big changes to how we commission drug treatment.

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New Quality Standard

This is the latest in a series of blog posts I’m writing covering the detail of Dame Carol Black’s second part of her independent Review of Drugs which sets out a way forward on drug treatment and recovery for the government and which was published earlier this month (8 July 2021). In the opinion of myself and many others, the Review is the most important drugs report of the century so far. This week’s post looks at Dame Carol’s recommendations for improvements in how we commission drug treatment. You can read the full series of posts summarising both Part 1 and Part 2 of the Review of Drugs here.

Dame Carol argues that the increased funding she recommends will not improve services unless the commissioning process is strengthened. She found that many local authorities commissioning structures and processes are not sufficiently robust or effective. The capacity, experience and specialist competence of local authority commissioners have declined in recent years. As funding increases, Dame Carol is adamant local authorities must take immediate action to bolster this function and resource it properly.

Worryingly, many local authorities do not commission the full range of services required by their local population. The most significant cuts have been made to inpatient detoxification and residential rehabilitation services, outreach programmes, comprehensive recovery support, and psychosocial interventions, particularly for non-opiate drug users. The Care Quality Commission’s (CQC) regulation of services assesses the quality of only those services which are being provided, but Dame Carol wants it to go further and consider whether extended or different services are needed.

Commissioning quality standard

To address these problems, Dame Carol was the Department of Health and Social Care (DHSC)  to develop a national Commissioning Quality Standard, based on the UK clinical guidelines on drug treatment, to clarify the commissioning process that local authorities should follow and the full range of drug prevention and treatment services that should be available to their local population, for adults and young people. SHe provides a helpful Annex (see pages 38-39) which lists the 18 key issues which should be covered by the new standard.

Dame Carol says that this process will be enhanced by co-production with people with lived experience of addiction, and so the national Commissioning Quality Standard should sit comfortably alongside the quality standard for recovery support services which is currently being developed by the College of Lived Experience Recovery Organisations (LEROs).

This national Commissioning Quality Standard can and should exist alongside local leadership and innovation so that services are tailored to local needs within a strong partnership approach. Many successful treatment and recovery systems include smaller, locally led voluntary-sector organisations. These are often well placed to engage minority populations and underserved groups

Local partnerships

Dame Carol argues strongly that this national Commissioning Quality Standard should exist alongside strong local leadership, with local authorities working closely with NHS organisations and wider recovery partners. She is clear that this essential local partnership work is not happening in many places at the moment. She recommends that joint local plans should be produced across all local organisations involved in treatment and recovery. Dame Carol expects local authorities, NHS organisations, Police and Crime Commissioners and the probation and prison services all to be involved and says that funding should be contingent on proper needs assessment and commissioning plans.

Extending the recommissioning cycle

A very welcome recommendation from the Review is that commissioners should also work more collaboratively with providers and introduce longer commissioning cycles of at least 5 years, to encourage service stability and improvements to quality. Dame Carol argues that commissioning arrangements should mirror NHS practice where there is a move away from competition towards collaboration.

She also asks that government departments should require budgets to be aligned or pooled at local level, removing any barriers and “deploying incentives” where appropriate.

Many people in the drug and alcohol field feel that there has been little leadership from the Health and Wellbeing Boards currently responsible for drug and alcohol services and will hope that Dame Carol’s recommendations reinvigorate our commissioning processes.

 

Thanks to Pretty Drug Things for the images in this post. Pretty Drug Things  explores different visual aesthetics and marketing techniques used in either promoting or demonising different psychoactive substances in our society.

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