Commissioning
Strategy for
survival
W
Challenging times
mean smaller
organisations must
embrace new ways
of thinking, says
Caroline Cole
16 | drinkanddrugsnews | November 2017
e operate in difficult financial times,
and for charities delivering addiction
services in England the landscape is
particularly challenging. As interim
CEO of an exemplary residential abstinence-based 12-
step treatment centre, and observing similar charities
closing while private ventures open up, I have been
pondering the feasibility of our charity and designing
plans for our survival in this difficult world.
There are two key questions. First, can we free
ourselves from the fierce statutory commissioning
environment in which we work, and on which we
have for a long time been dependent, while
remaining true to our altruistic vision and mission?
And second, can we use learning from the profit-
driven corporate world to inform our strategy?
I am primarily concerned with how rehabs that
are charities rather than businesses can position
ourselves and borrow from corporate strategy to
support sustainability. Things are not getting easier
– investment in abstinence-based treatment is not
on the political agenda, and the stigma of addiction
prevails so public understanding and support for our
services is at best limited and at worst dismissive.
Broadway Lodge in Weston-super-Mare is the
oldest 12-step addiction rehab in the UK, having
been operating for 43 years. Throughout this time
we have supported well over 13,000 people to
rebuild their lives and we have a huge cohort of
alumni, some with decades of recovery. As pioneers
in the 1970s and 1980s we functioned as a
consultancy for other 12-step treatment centres
that followed this highly successful model – people
who found recovery asked us how to do it, we told
them and they set up more treatment centres.
In these early days there was sufficient statutory
support for people to be treated without knowing
who was paying, and these people were treated
alongside people who were paying privately – duke
or dustman, we mucked in together. Treatment
then was based on a public service and charitable
ethos rather than a profit-grabbing corporate ethos.
Since then, statutory funding for treatment has
gone from abundance to austerity and a place of
uncertainty and peril. In the 2000s drug money
was ring-fenced for many political reasons, not
least the emphasis on crime reduction and public
health, and although it was sensibly targeted
mainly at harm reduction services there remained
a small niche that offered abstinence. Clients
therefore still had some choice of the treatment
modalities they were offered.
The change of government in 2010 brought hope
that the new PM, a strong supporter of 12-step
recovery, would occasion a revival of treatment
centres by insisting on a more evenly balanced
provision between harm reduction and abstinence-
based recovery. Sadly, this aim never percolated
through to commissioners and when ring-fencing
was lifted and budgets reduced throughout 2014-15
and 2105-16, 12-step and other abstinence rehabs
were the main casualties.
Add to this the focus on fewer but larger
contracts to drive down costs and the sector has
seen integrity give way to greed and the pursuit of
profits, with small/medium charities squeezed twice
– at commissioning level with the cuts in overall
funding, and as a potential sub-contractor to larger
organisations for whom it is easier to provide the
service themselves and retain the revenue. In this
model, clients lose choice.
Bargaining powers are limited for charities such
as ours. Because of our position in the supply chain,
our suppliers (of referrals) are also our customers
and this creates a dual difficulty. We as providers are
both buyers and sellers but we lose any buying
advantage in our need to sell. Statutory services
have to be delivered in accordance with the
expectations of the commissioners and all contracts
or spot purchases are a trade-off between what we,
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