Drink and Drugs News DDN Nov2017 - Page 16

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, www.drinkanddrugsnews.com