DDN June2022 June 2022 - Page 16

COMMISSIONING

ARE WE READY ?

While the new drug strategy and investment are welcome they also come with challenges , say Chris Lee , Ben Hughes and Niamh Cullen

We probably need to kick off with a big sigh and a smile acknowledging that we do now , at last , seem to be seeing some new focus and investment in the drug and alcohol treatment and recovery agenda . Following years of cuts and deprioritisation , things seem to be looking up .

The new funding announced nationally in the wake of the Dame Carol Black work offers local partnerships great opportunities to invest and rebuild local treatment systems . In line with the national drug strategy , national commissioning quality standards , national and local outcome frameworks and new partnership guidance from the Joint Combating Drugs Unit , the foundation stones are being laid for the next ten years . Local commissioning leads will shoulder a significant burden of the new development work involved , supported by colleagues in the English Substance Use Commissioners ’ Group ( ESUCG ), established in spring 2020 . Whilst the ESUCG welcomes the new developments in the sector , we feel this is an ideal time to raise some challenges that wider partners maybe able to support .
The capacity and capability to develop balanced and effective treatment systems to respond to local need has , over the years , been significantly reduced . Through the various grants that are being provided it is strongly suggested that local areas can and should strengthen their capacity to help drive and deliver the outcomes that our local populations demand . While we implore colleagues to take these steps , we are also clear
that the workforce is not waiting in the wings . It will take time to develop and train new staff to support this work , when we are at our most stretched .
The way in which the money is being made available , the processes by which the various grants are being administered and the seemingly disconnected nature of the allocations and associated planning processes also mean there is a danger that we will see these processes driving an industry created to monitor and manage grants rather than develop integrated , effective treatment and recovery systems . So , while capacity is going to be required , we also need to ensure whatever function is driving the work locally is ‘ rightsized ’ and commensurate with the need to commission effectively .
A significant proportion of the new funding will necessarily be invested in staffing across the sector to reduce caseloads and develop the treatment capacity required to increase access . Again , as with commissioning capacity , the workforce waiting to be recruited is limited , with many local areas reporting difficulties filling vacancies . Provider agencies will need real local connection and innovation to not only find , but successfully recruit , train and retain this new workforce without destabilising other sectors such as homeless units , domestic abuse services and wider third sector partners . The time it takes to build a competent and skilled workforce means expanding the capacity of the system will take longer , or risk service users getting a secondclass service .
We are , quite rightly , seeing a drive to develop effective and balanced treatment offers / systems
It ’ s an exciting time and we really do have a chance to make a significant difference to people ’ s lives . We just need to make sure we do this properly .
and priorities being identified for investment such as residential and in-patient . While wholly appropriate there is a clear risk that demand will far outstrip supply in the short term . We have already seen evidence that waiting times for in-patient provision may be increasing due to the sudden investment and there is a clear concern that if there is further , sudden increased investment across the country we will simply overwhelm provision as it stands . To prepare for this there needs to be some reality about how systems are being driven , how targets are being set and how expectations are managed .
The new grants come with significant aims to expand the system . However , working against the grain is a significant cost of living crisis and rising inflation which are eroding the value of existing investment and putting huge pressure on delivery costs . There is a real risk of the new investment merely enabling the current system to hold steady rather than significantly expand . Finally , the erosion of salaries in the sector will undoubtedly be felt . The question of investment in pay is yet to be addressed nationally and will require long term sustained investment if the workforce of tomorrow is really expected to deliver the ambitious aims we all have .
There are a number of other issues to face up to , including the impact of the new provider selection and the price of prescribed medications , and we hope to explore some of the details in future editions of DDN .
It ’ s an exciting time and we really do have a chance to make a significant difference to people ’ s lives . We just need to make sure we do this properly .
Chris Lee is a public health specialist at Lancashire County Council and chair of ESUCG . Ben Hughes is head of wellbeing and public health at Essex County Council
Niamh Cullen is a public health manager in Halifax

SO ... TO SUM UP :

• Yippee , new money !
• We need to build the capacity and capability across the workforce
• We need to manage expectations effectively – government and local communities
• We need careful , joined-up , forward planning .
16 • DRINK AND DRUGS NEWS • JUNE 2022 WWW . DRINKANDDRUGSNEWS . COM