Drink and Drugs News DDN Nov2017 - Page 7

More on procurement at: www.drinkanddrugsnews.com What’s the name of the game? Has commissioning lost its way – or are there opportunities to be grasped? DDN reports T he commissioning structure needs an overhaul, according to the ACMD Recovery Committee, which recently advised government of the drastic effects of funding cuts (DDN, October, page 4). Since commissioning was moved to public health structures in local authorities in 2013, there have been dramatic reductions in local funding that ‘are the single biggest threat to drug misuse treatment recovery outcomes’, says their report, Commissioning impact on drug treatment. The stark truth for the treatment sector, ACMD Recovery Committee, service user representatives and many commissioners themselves is that the level of disinvestment is causing drug-related deaths. ‘The loss of funding is resulting in drug-related deaths, blood-borne viruses, crime and human misery,’ the committee’s chair, Annette Dale-Perera told the Drugs, Alcohol and Justice Cross- Party Parliamentary Group. Gathering evidence for the report brought strong evidence of an overall reduction in funding of around 12 per cent, she added. ‘There was a definite decrease when money went over to local authorities. But many commissioners and providers told of cuts that were more severe than shown.’ DDN is hearing of cuts of up to 30 per cent in some areas. The situation is no surprise. Blenheim chief executive John Jolly said at the latest meeting of the parliamentary group, ‘I take no joy in arriving where I said we’d be five years ago, when everyone said I was shroud waving.’ The difference now is that it’s being felt all over the country and the effects are critical – on service users’ lives and on the skillset of a sector whose workforce are voting with their feet at having their wages cut and their roles merged and changed beyond recognition. Current commissioning practice is taking much of the blame for the disastrous slide into chaos being felt by the sector. Such is the cut-throat climate of retendering that treatment agencies are paring their tenders to the bone – or walking away from areas where they just can’t make the funding work. Bristol City Council received no bids from service providers when attempting to retender drug and alcohol support services recently, with feedback that the money offered was just too low. Those that have ‘gone for it’ at any price find themselves tethered to uneconomic contracts with the risk of harsh ‘payment by results’ penalties and financial liabilities that come with TUPE arrangements for transferring staff. The sector is still shuddering from the recent demise of Lifeline and speculating on a toxic mix of contributing factors. Many are angry that their winning bid helped to drive tender prices down to a dangerous new low and blame the commissioning team for exacerbating a ‘race to the bottom’ culture. Jolly is among the providers who recognise that local authorities are ‘between a rock and a hard place’, with dwindling budgets and some difficult choices to make: ‘do you spend on substance misuse, or do you spend on social care for the elderly? They’re in a difficult space.’ Blenheim is on the commissioning rollercoaster with everyone else, having to remodel services to try and fit new specifications. The www.drinkanddrugsnews.com experience of working for decades in a neighbourhood suddenly counts for very little against shaving a third off the contract price. There’s no getting away from the fact you have to do much more with fewer resources. The loss of expertise is one of the many things that bothers him. Gone are the days of specialist services for different substances. Everything – including alcohol, cocaine and stimulants, which would have had specific services a short time ago – is combined into the same service, which ‘can be a problem if people don’t see that it’s for people like them’. Young people’s drug services are no longer standalone, but combined with sexual health services. This contraction of services has meant a cut in the skilled workforce, which does not match well with a depressed economic climate and emergence of new drug trends – young people are returning to opiate use after a generation away, and the growing threat of more fentanyl deaths looms. Drug and alcohol use accompanies deprivation all too readily, and street homelessness is commonplace. ‘In every major city now, you’re seeing street homelessness in a way that we’ve not seen for a decade, maybe 20 years,’ says Jolly. Furthermore, the cuts mean people who use services are often couch surfing, in hostels, or living rough, he explains, and ‘m any of them are returning to opiate use because they’ve got absolutely nothing to lose’. B ill (not his real name) is a drugs worker who is being transferred from one service provider to another, as part of retendering. He blames the last round of tendering for bringing an assortment of providers together to create a system that did not work. ‘By the end of the process, what you’ve got is a complete history of poor key-working, inappropriate allocation, poor assessment and a situation where the top staff, who had come over from the NHS or previous places, had been replaced by kids without any real experience or qualification,’ he says. He describes how it felt to be caught in the middle of the process. ‘Since the tendering process began, there was an exaggerated bonhomie about the success of partnership working, which was unrealistic,’ he said. ‘There was some fairly desperate grabbing of intellectual property, which was grubby, and there was a real sense of isolation for the individuals involved in the process. And for people in active recovery, people in the community, there was a sudden loss of the security they’d built up in those five years.’ Most disturbingly, ‘in the six months after we announced the contract was lost, we had about a 40 per cent relapse rate among service users and a huge drop in engagement,’ he says. ‘So it’s been devastating on the community and devastating on individuals.’ He believes that the cost-cutting led to cutting corners with staff training and development and a dismissive attitude towards peer support. Assessments of new clients were conducted through a deficit-based approach – ‘when did you last commit acquisitive crime?’, ‘when were you last a sex worker?’, rather than an November 2017 | drinkanddrugsnews | 7