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Has commissioning lost its way –
or are there opportunities to be grasped? DDN reports
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
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’.
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
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