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Substance misuse commissioning in the new landscape DrugScope conference November 6 th 2013 Tom Woodcock and Chris Lee

Substance misuse commissioning in the new landscape DrugScope conference November 6 th 2013 Tom Woodcock and Chris Lee. Presentation overview. The commissioning function, theory and practice What does the new landscape look like Key themes, success factors, risks, challenges

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Substance misuse commissioning in the new landscape DrugScope conference November 6 th 2013 Tom Woodcock and Chris Lee

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  1. Substance misuse commissioning in the new landscape DrugScope conference November 6th 2013 Tom Woodcock and Chris Lee

  2. Presentation overview • The commissioning function, theory and practice • What does the new landscape look like • Key themes, success factors, risks, challenges • Lancashire experience • Key questions

  3. Back to basics. • A commissioner can be lots of things: • a change agent, a catalyst, a leader, a broker, a pivot, a linchpin, an enabler, an architect, a politician, a fixer • Or: a nuisance, a martinet, a petty bureaucrat, a frustrated service provider, a pushover, an ATM • Commissioners are few in number and dedicated substance misuse commissioners are increasingly rare. • Commissioning is directing resources wisely and generating a culture of improvement and change. • Commissioning is a great responsibility, full of potential and possibilities. Poor commissioning wastes resources and creates disharmony

  4. Foundations, values, and competencies • Expertise and knowledge: substance misuse experience helps but isn’t essential. Understand value for money. • Good communications: being able to build and develop relationships and networks. • Be open, visible, and accessible. • Be committed, resilient, and patient: stick to the plan and take a long view. • Be systematic: personalities are good but systems are better. • Be a leader: Have a vision, and share it. • Be honest and fair in decision making • Be creative and allow for innovation

  5. Changing landscape and policy drivers • National strategies and commissioning guidance: 15 years of direction • Health and Social Care Act: LA Public Health, CCGs, NHS England, PHE, Health and Well-being boards • Police and Crime Commissioners, Transforming Justice/Rehab • Social value, localism, community asset building • Austerity: PbR and outcomes

  6. Implications • Increased competition for resources • Commissioners must be pro-active around system change • Substance misuse sector must evolve or will start to wither • Integration, not disintegration. Systems not lots • Providers must develop products and solutions • Engage and mobilise the recovery community • Must focus on outcomes • The need for flexibility.

  7. Themes • Leadership: change management, political, Political, vision, consistency, guidance, motivation, knowledge • Relationship management • Competition: delivers change, let the market lead – commissioners letting go • Understand the product • Inclusion: real involvement and inclusion of SU’s and recovery community/families • Recovery: treatment wide, ABCD, devolved commissioning (BRIC)…… • Culture: attitudes and ambition • Identity: Commissioners, providers (branding), service users, recovery community • Communication

  8. Success, risks, and challenges • Recovery communities engaging with providers • Diverse treatment opportunities with flexible providers • Peer mentors, recovery activists, volunteers, social enterprise development….. • Prison and communities engaged together • Austerity, the ring fence and political opinion • Buy in from other ‘professionals’ • Challenges to traditional worker roles • NPS – how to keep abreast of developments; alcohol and rising demand, the return of heroin?

  9. Lancashire case study • History: Numerous providers and contracts, lack of design, poor equality of provision • Process: Whole system modernisation between 2008 - 2013 • Outcomes: 3 locality adult contracts, prime provider model, booming recovery communities • Improved outcomes: hospital admissions and treatment completions • Lessons: Leadership, Relationship management, Competition, Understand the product, Inclusion, Recovery, Culture, Identity and Communication!

  10. Summary • Understand commissioning • See the bigger picture: integration • Plan effectively and stick to the plan • Build consensus and be inclusive • Relationships not transactions • Shared values: commissioner/provider/service user/recovery community

  11. Key questions • Is substance misuse a sector on its own? • Can Substance misuse service reduce demand elsewhere in the system? • How do we use competition to improve delivery? • What do we mean by a whole system? • Recovery communities – what can be commissioned? • Can providers play a role in improving commissioning?

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