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ago experienced and adapted to changes that are now happening in health and
social services.
Alongside his client assessments, he feels that one of the most important
parts of using his expertise is in finding pathways for clients and linking them to
colleagues and partner agencies for their health, psychological and social needs.
CREATIVE COMMISSIONING
Chris Lee, a commissioner in Lancashire and a member of the new Faculty of
Commissioning, agrees with the need to ‘create robust pathways to make sure
the skill set is there across all organisations’ – particularly as the treatment
system now has so many diverse stakeholders including CCGs, the NHS (and the
prison estate), local authorities, Collective Voice and the NHSSMPA.
While ‘the front door to treatment has changed’ and clients might enter
treatment through one of many different routes, the current challenges mean
that leading through specialisms is more important than ever, he says. ‘The
money’s going out of the system at 100 miles per hour, but the clinical guidelines
have been enhanced. So how do you do that with a population that’s got ever-
increasing complex needs?’
This, he believes, makes the case for a different and more creative brand of
commissioning. ‘If I sit down and write a specification for a tender this afternoon
that mentions an addiction psychiatrist, your bid will come back with an
addiction psychiatrist in there,’ he says. ‘But you can commission differently. You
can say, “you’ll be working with people with complex needs, people with co-
existing mental health and substance misuse concerns. You’ll be dealing with
people with long-term homelessness issues, people who are long-term
unemployed – and you need to be able to deliver both the clinical and
psychosocial model.”
‘You’re not saying that you must have a psychiatrist or a psychologist or
whatever – you’re saying, “this is the level of complexity you’ll be working with;
what team would you put out?” It’s up to the provider to come back and say
what they will give you.’
Lee sees opportunity in the need to mix cost-effectiveness with addressing
complex needs, and says ‘that’s where it gets really exciting, because you can
start playing around with different delivery options’.
Traditional ways of working are not ‘the given’ anymore, right down to the
buildings that can constitute one of a service’s biggest overheads. The new way
of working can be ‘light and agile’, he suggests – meeting in a coffee shop or a
library, using community assets, and freeing up money to spend on staff instead
of buildings.
LET’S GET DIGITAL
Service delivery might be able to incorporate digital support – a Skype call, email
contact, text support, people filling in their own assessments online, or contact
with a keyworker that can be anywhere.
‘Even people with highly complex needs could get some of their support
through digital means – you could do doctors’ appointments by Skype for
example to save travelling,’ says Lee, adding that there will always need to be a
balance between this and traditional face-to-face meetings.
His point is that ‘years ago everyone got the same broad-brush approach, but
these days you don’t do it that way. And if the money’s draining out of the
system, we can’t afford to be working in old-fashioned ways.’
Furthermore, he believes that commissioners have a responsibility to lead on
this open-minded approach: ‘If the commissioner pretends they know
everything, you’re robbing yourself of some good ideas,’ he says. ‘The good
providers out there have some really innovative ideas.’ DDN
This article has been produced with support from Camurus, which has not
influenced the content in any way.
pathways
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April 2018 | drinkanddrugsnews | 15