DDN Oct_2022 Octoober 2022 | Page 13

Chris Lee is a public health specialist at Lancashire County Council and chair of ESUCG . He was part of the expert advisory group involved in developing the new Commissioning Quality Standard .
Tony Margetts is a drug and alcohol treatment commissioning consultant . He was commissioner for drug and alcohol services with East Riding of Yorkshire Council for 16 years , responsible for the range of drug and alcohol treatment services from harm reduction to community services .
‘ There ’ s thousands of vacancies in the NHS and even more in adult social care – there ’ s a massive workforce issue across the board .’
crisis is leading to intense wage pressure across all sectors – often with industrial action to go with it – simply offering more money comes with risks of its own , warns Lee . ‘ If you can earn three grand a year more as a drug worker than in the homeless hostel down the road then you ’ re going to do that – my fear is that we risk destabilising other bits of the system . That doesn ’ t help anybody , because we need a workforce plan right across that multiple and complex needs sector . So that ’ s a real concern .’
QUALITY TRAINING Capacity issues aren ’ t just limited to drug and alcohol workers themselves , however – there are very real challenges in the commissioning workforce itself . ‘ Lots of experienced commissioners went , and there isn ’ t good training for commissioners ,’ says Margetts . ‘ You ’ re tending to get people with no experience of drug and alcohol treatment , or people from drug treatment services who don ’ t necessarily know how to crack on as commissioners and work their way around local authorities , which can be a tricky process .’ While there are ‘ some fabulous people out there ’, adds Lee , ‘ a lot are choosing to work freelance or going off to do
something else . If you start losing experienced commissioners because they ’ re fed up of the pressure , then the whole thing will crumble – if commissioners don ’ t get the money out then providers can ’ t deliver the extra treatment places .’
CAPACITY ISSUES So are commissioners fully ready for this new post drug strategy landscape ? ‘ It ’ s a mixed bag ,’ states Lee . ‘ That ’ s not just based on the fact that there are those who are more experienced and therefore more ready , and those who are a little bit more new to the game and so maybe have less resilience . I know colleagues who are some of the most experienced who are effectively working on their own . You ’ re trying to do so many other things in the treatment system from a commissioner side . I ’ ve got a reasonably sized team because we ’ re a big local authority and we ’ re struggling for capacity just to service the grant methodology and everything else .’
A commissioner ’ s portfolio can be incredibly wide ranging and easily encompass sexual health , gambling , mental health , tobacco , digital health , complex needs accommodation and more alongside drugs and alcohol – with all the partnership working , meetings , admin and reviews that entails .
‘ You commission your treatment system contracts , but then you ’ ve got agendas like drugrelated deaths ,’ says Lee . ‘ So you ’ re managing all your public health grant funded stuff , and you ’ ve got all your agendas that sit on top of that , your organisational responses because you ’ ve got a transformation programme running , NHS reorganisation going on around you , and then you ’ ve got different OHID grants coming down . And that ’ s if you ’ re lucky , because it is great to be getting
the money and we genuinely appreciate that it ’ s flowing . But it ’ s not like “ here ’ s some money , deliver some outcomes ”.’
His area is one of those receiving a housing grant , for example , but putting in the bid obviously takes time and effort . ‘ We ’ re scrambling around over a massive county area in a tight window trying to get meetings with 12 district housing leads and different organisations on the ground , because it ’ s not all about your treatment system . Over the geography we ’ re working on it ’ s a massive task .’ And all of this , of course , could easily be disrupted by anything that happens in the ‘ day job ’. ‘ If there ’ s a death in a rough sleepers unit , for example , that might take half a week out ’, he says .
EXPANDING SERVICES A key challenge , therefore , will be how the money ends up being woven into the system – not only getting the experienced and qualified staff , but also expanding services to meet the needs of different groups who perhaps haven ’ t been particularly well served up to now , such as the growing cohort of people with cocaine issues , people using steroids , people experiencing problems with prescription drugs , or people with alcohol issues who aren ’ t at the dependency level . ‘ It ’ s nowhere near a comprehensive service ,’ says Margetts . ‘ We have got the money and it is an opportunity , but a lot of damage was done over a long period and it ’ s going to take a long time to get it back . Just chucking money at it over a couple of years won ’ t give you a magic fix .’
PRESSURE ON ‘ The pressure ’ s on in the commissioning world ,’ states Lee . ‘ Everybody looks at it from the outside and goes , “ It ’ s great you ’ ve got all this money flowing in – it ’ s the answer to all your dreams .”
And it is . But I ’ ve had posts vacant in my team for 12 months . We had to prioritise doing the grant work so we haven ’ t been able to do the recruitment work . Getting people into public health teams and commissioning teams is hard . There aren ’ t necessarily the people who want to do it , or the skills sets out there . So it ’ s going to take a little bit longer to get your teams together , get your training done , get your competencies up and then start getting more people through the door .’
But it ’ s obviously vital not to let the challenges obscure the fact that this a hugely exciting moment – one with enormous potential . ‘ I think the overarching position is that this is brilliant ,’ says Lee . ‘ We ’ ve all been crying out for the money and we ’ ll make sure we do the right thing and deliver as best we can . If we don ’ t , the money ’ s not going to keep flowing , is it ? It ’ s great that all the attention is coming and that there ’ s going to be partnership structures in every area , and it ’ s a real chance to change people ’ s lives for the better . I don ’ t think there ’ s anyone in the commissioning landscape who questions any of that . The mechanics is where it gets difficult .’ DDN
Commissioning Quality Standard at www . gov . uk / government / publications / commissioning-qualitystandard-alcohol-and-drug-services / commissioning-quality-standardalcohol-and-drug-treatment-andrecovery-guidance
See November ’ s DDN for part two of the series , which will explore how we go about creating genuinely effective operating partnerships .
This series has been produced with support from an educational grant provided by Camurus , which has not influenced the content in any way .