and it ’ s a picture the group wants to change . ‘ Partnership involvement and relationships can be hit and miss between different areas , which doesn ’ t seem fair on people who need support ,’ says Will Haydock , senior health programme advisor at Public Health Dorset . The group is devising a workplan , but is waiting for the recommendations of Dame Carol Black ’ s review ( DDN , July / Aug , page 5 ) to avoid any duplication or inconsistency .
They are , however , certain that their plan will focus on developing best practice and workforce skills in all different areas – including tier 4 ( both detox and rehab ), criminal justice commissioning , and complex needs . Reducing drug- and alcohol-related deaths will be at the top of the agenda .
One aspect of commissioning that comes through very strongly in the ‘ best practice ’ conversation is the need for it to be a natural part of the public health agenda . The ESUCG talk about how drugs and alcohol issues should be everybody ’ s business , permeating into all areas of social care , education and all aspects of life .
Networking right across the sector is key to this , says Niamh Cullen , and making sure that substance misuse services are linked into primary care networks and local developments and are on the ‘ front foot ’ of what ’ s happening locally .
‘ Trust is key , alongside mutual respect and equality ,’ she says , ‘ and it ’ s important to include everyone , the sub-contracted smaller providers too . We need to share risks – sometimes big ones , particularly working in an environment of contract extensions .’
A strong relationship between commissioners and providers increases capacity for strategic work , says Cullen . The other essential partners are of course the service users , and the group is keen to talk about co-production rather than service user involvement to make sure it is never tokenistic . ‘ The task is ensuring that coproduction is common practice , and we should focus on how that is embedded rather than on service user involvement ,’ she says . ‘ We hope to move to a dynamic and co-produced service specification to
‘ Trust is key , alongside mutual respect and equality , and it ’ s important to include everyone , the sub-contracted smaller providers too .’
further improve outcomes .’
Commissioning of substance misuse services in Wales is the responsibility of area planning boards , and these are made up of members of the ‘ responsible authorities ’ which form the community safety partnerships in Wales . The area planning boards also have responsibility for providing strategic leadership to deliver the Welsh Government ’ s substance misuse strategy across their regions , and so commissioning decisions are made taking into account both the long-term vision of prevention , and the current needs of a region ’ s population .
Partnership decision-making is at the core of the commissioning process , and there are close relationships with Welsh Government , explains Eleri Probert , a commissioning programme manager . The benefits of this have been seen during the COVID-19 pandemic : the Welsh Government responded promptly to local clinicians seeking to expand a pilot of long-acting buprenorphine by investing in a rapid national rollout , with positive results .
The Welsh Government ’ s public health perspective requires a much
wider approach across the health , social care , housing and education sectors to meeting the needs of people using substance misuse services . ‘ We aim to design services around people ,’ she says , and this involves ‘ trying to improve the pathway for people using services through joint commissioning for outcomes and exploring looking at how best to align provision throughout the system .
‘ As commissioners we are always trying to balance the challenge of providing effective , high-quality , evidence-based , joined-up treatment and support , with the longer-term vision of prevention ,’ she says . ‘ We take a public health approach but there ’ s always more we can do … it would be really useful to discuss these challenges with commissioners from other areas of the UK to learn from each other .’
The London borough of Southwark has retained a drug and alcohol team ( DAAT ) structure , which gives the team a clear remit to commission treatment and support services related to this client group . The enormous challenge related to this is that their budget has been severely reduced .
‘ When I joined Southwark , when the PCT still existed , there were 11 people between the DAAT and the PCT , doing the functions that two of us now do ,’ says Iain Gray , a commissioner with 15 years ’ experience . Partnership working was easier with a larger team , but with only two people , partnership working is an area that has suffered .
‘ With the cuts , you look at it on paper and try to make sense of it . We have cut X , Y and Z as they ’ ve asked us to , but they still come back for more ,’ he says , knowing that it will keep getting worse . He worries particularly about the vulnerable clients who are bearing the brunt of local services being sliced away . ‘ When I started there were seven or eight detox units in London – there is now one , for the whole of London ,’ he says . ‘ That doesn ’ t mean that we don ’ t use other detoxes outside of London , but for complex clients who have poor mobility , poor motivation , is sending them on a train up to The
‘ When I joined Southwark , when the PCT still existed , there were 11 people between the DAAT and the PCT , doing the functions that two of us now do .’
Wirral easier than getting them on a bus up to City Roads ? No , it ’ s not . It ’ s so obvious .’
Despite the many challenges , connections with local treatment services are still strong and essential to putting service users first . ‘ We collaborate and consult heavily in the design of services ,’ says Gray , which influenced them to invest in a dynamic purchasing system for commissioning residential rehab and residential detox services – a flexible framework that ’ s working well to match clients to services around the country . ‘ We took on board what our local services said and their experiences previously with dynamic purchasing systems to make sure we didn ’ t make the same mistakes ,’ he says .
As with colleagues all over the country there ’ s a weary acceptance of a difficult climate but a strong will to push through to get the right result for those who will most feel the impact . As Gray says , ‘ Everything in the garden isn ’ t rosy , but we are determined to get clients ’ needs met .’ DDN
This article has been produced with support from an educational grant provided by Camurus , which has not influenced the content in any way .