Commissioning
THE RIGHT FOCUS
An effective review of commissioning will need input and inspir a tion from everyone involved – practitioners , commissioners , and especially those using services . DDN reports
There have been many calls for a review of commissioning practice as budget cuts have sliced through services and severely curtailed treatment capacity . So the newly formed Expert Faculty on Commissioning ’ s consultation ( page 10 ) is certainly timely . ‘ The financial squeeze on drug and alcohol services will seriously undermine the quality and effectiveness of services ,’ says Annette Dale-Perera , chair of the ACMD Recovery Committee , which at the end of last year announced that the commissioning structure needed an overhaul ( DDN , November , page 7 ).
The faculty ’ s review offers key questions for commissioning , asking how we can ensure skilled staff are providing high quality support , incorporate innovative thinking , make sure that services are well integrated with partner support services , and consider whether we are using the right outcome measures .
The question of staff skills and training is being addressed by the Federation of Drug Alcohol Practitioners ( FDAP ), which is now administrated by SMMGP . Interim executive director Kate Halliday explains that FDAP has been developing an apprenticeship for the sector to drive up standards . A ‘ trailblazer group ’, including major employers in the field , is putting forward a proposal to the Institute of Apprenticeships for a Drug and Alcohol Practitioner Apprenticeship level four qualification .
The standardisation of training for drug and alcohol practitioners represents an exciting time for workforce development in the sector , says Halliday : ‘ We can hope to see an improvement in the provision of services , the retention of staff and the encouragement of new talent to the field .’ FDAP hopes that the first apprenticeship courses will be ready for roll-out in 2019 .
The question of adopting more innovative commissioning practice depends on ‘ a fluid dialogue between commissioners and those at the front delivering the services ,’ believes Yasmin Batliwala , chair of WDP – whose organisation , alongside Blenheim and Addaction , supports the Drugs , Alcohol and Justice Cross-Parliamentary Group . The group ’ s recent Charter for Change called for the creation of a national commissioning ombudsman to address failures in commissioning practice .
‘ By establishing firmly this culture of transparency , the often-byzantine process of allocating funding is made that little bit simpler ,’ she says . On the one hand commissioners are put at ease , safe in the knowledge that the money is going to dedicated experts and professionals , and on the other , it instils confidence in the providers on the front line , ensuring that they remain valued and supported .
Blenheim ’ s interim chief executive , Deborah Jenkins , acknowledges that innovation is difficult when commissioners are under such huge pressure to do
the best they can , with continuing levels of disinvestment against a rising number of service users . She sums up the ‘ lose-lose situation for commissioners , providers and most importantly service users ’, as ‘ tenders are issued where it is just not possible for even the leanest organisation to deliver ’.
‘ Commissioners are facing extremely difficult choices about where to cut back ,’ she points out . ‘ Do they cut back on needle exchanges , which are perhaps an easy choice but which would lead to wider public health risk of an increase in blood-borne viruses such as HIV and hepatitis C ? Do they try to commission innovative digital services which , while largely unproven , are cheaper than faceto-face services and don ’ t require the overheads of premises ? Do they decommission the wrap-around employment , training and education programmes that are designed to help people integrate back into society , sealing that final step on the recovery journey , and without which relapse is highly likely ? Or do they cut back on children and young people ’ s services , where the interventions have the greatest possible lifelong impact for service users and their families ?’
There is no easy answer , she acknowledges , as all these services are crucial in providing highly effective drug and alcohol support services . But her suggestion is that commissioners think laterally , focusing on the return on investment to the wider economy . And yes , she believes there is scope for a more innovative approach .
We need to ask ourselves whether there are better ways of commissioning drug and alcohol services , she says , such as ‘ commissioning jointly with CCGs who are responsible for mental health , with police for prevention of drug and alcohol-related crime , and with housing departments .
‘ The same vulnerable and high-risk cohort of people appear in the pathways across all these organisations , so let ’ s take a people-centric approach and a joined-up view of how to address the problem and complexity surrounding substance misuse .’
The question of integrating services has to take service user involvement as its starting point , believes Tim Sampey , founder and chief executive of the peer-run service user charity Build on Belief . A lot has changed in service user involvement in the past decade , with peer-led initiatives springing up all over the country – ‘ Build on Belief and the FIRM in London , Red Rose Recovery and the Recovery Republic in the north of England , SUIT in the Midlands , to name but a very few ,’ he says .
‘ In the past couple of months , the importance of these service user initiatives
14 | drinkanddrugsnews | February 2018 www . drinkanddrugsnews . com