Addiction to medicines: commissioning in the new public health landscape

1. Addiction to medicines:commissioning in the new public health landscape Addiction to Medicines 28/02/13 Mark Gillyon

2. Overview • Key Policy drivers and context • The architecture • Public Health England • local Health & Wellbeing Boards and Clinical Commissioning Groups • Opportunities and challenges

3. Key policy drivers • National Drug Strategy 2010 • Health & Social Care Act 2012 • Localism • Transparency and accountability • Public health and health inequalities • Recovery 3

4. 2010 drug strategy: ‘…all services are commissioned with the following best practice outcomes in mind’ • • Freedom from dependence on drugs or alcohol; • • Prevention of drug related deaths and blood borne viruses; • • A reduction in crime and re-offending; • • Sustained employment; • • The ability to access and sustain suitable accommodation; • • Improvement in mental and physical health and wellbeing; • • Improved relationships with family members, partners and friends; and • • The capacity to be an effective and caring parent.

5. Health & Social Care Act 2012 • Clinicians at the centre of commissioning • Provider innovation • Empowering patients • New focus on Public Health • Patient voice - Healthwatch

6. This shift will provide a platform for • a more integrated approach to improving public health outcomes. This approach addresses the root causes and wider determinants of drug dependence and alcohol misuse, and the harm and impact they have on communities and troubled families (such as mental health, employment, education, crime and housing). It also delivers the greatest gains for individuals and the community. (NTA/DH 2012)

7. The Framework for Commissioning

8. Context: Suite of evidence-based clinical guidance

9. In total there are 15 NICE drug and alcohol publications • Q1 13/14 NICE commitment to reflect all these in in LA PH briefing.

11. The new health and care system Local people and communities Police and Crime Commissioners could have a seat. Up to each LA Undertake JSNA & develop HWB Strategies setting out local priorities The evidence in this presentation can inform the JSNA and HWB Strategies. Health and Well-being Board Local Authorities CCG/NHS CB PHE Centres Responsible for publishing data and supporting delivery of PHOF Commissioning OF – set by the NHS CB for CCGs Accountability HealthWatch Oversight Links PHE NHS CB ASCOF Mandate – only means of holding the CB to account NHSOF PHOF Sets out the indicators that the PH system & DH understand are the best mechanisms to improve public health. Up to LAs to prioritise. Secretary of State for Health Parliament Sets out the indicators that the NHS should seek to achieve through the Mandate objective of continuous improvement 11

12. Architecture • Specialist drugs and alcohol services (inc. Addiction to Medicines) commissioned by local authorities, through Directors of Public Health • Supported by and coordinated through Health & Wellbeing Boards • Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) • Ring fenced public health budget • From DH & Public Health England (PHE) • NTA functions transferred to PHE –April 2013 • Public health outcome indicators 12

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14. Clinical Commissioning Groups “Clinical commissioners have a crucial role to play in ensuring that care is integrated and delivered in the community, with maximum input of local people and patients. Also, by working to overcome the barriers between the NHS and social care, they will be able to provide patients with better, seamless and more accessible care.” Dr Michael Dixon, Chairman of the NHS Alliance (18 June 2011).

15. Clinical Commissioning Groups • NHS Commissioning Board • Guidance & tools, evidence • Commissioning of core, general medical care • NHS services commissioned by groups of GPs • CCGs are responsible for care, and commissioning enhanced care • Continuous improvements in quality • Reducing inequalities • Choice & patient involvement • Innovation & research • Collaboration with Health & Wellbeing Boards • Focus on outcomes • Universal system • All practices involved

16. Public Health Budgets 16

17. 13/14 and 14/15 Budgets released • £2.66 billion and £2.79 billion to LAs to spend on public health services for their local populations. Average growth of 5.5% in 2013-14 and 5.0% in 2014-15 • ‘Currently, on average, about one third of spending is connected to mandated services, leaving a significant opportunity to commission services that meet the needs of your population. Services not currently covered by the mandating regulations include obesity, smoking cessation and substance misuse.’ • Mandated: sexual health services; duty to ensure there are plans in place to protect the health of the population; public health advice to NHS commissioners; National Child Measurement Programme; NHS Health Check.

18. The Public Health Grant • Local authorities will need to forecast and report against the sub-categories of spend in returns to Public Health England who will review them on behalf of the Department of Health. • ‘Pace of change’ to a target budget position (12/13 PTB formula will affect target position within pace of change parameters) • Substance misuse component includes: PTB; DH DIP; YP; local drug and alcohol spend • Prison treatment to NHS Commissioning Board • HO DIP funding (£35M) to Police and Crime Comissioners

19. More opportunities and challenges • Balanced systems – maintaining gains • Priorities competing for scarce resources • Commissioning skills: making the case for investment and developing alliances • Complexity, dual diagnosis and health • Medicines and new drugs and patterns of use • Creativity – ABCD, social enterprises, recovery communities • Engage PCCs, local Police and the crime reduction agenda 19

20. Public Health England • Substance misuse personnel in: • Operations Directorate (PHE Centres) • Health and Wellbeing Directorate • Knowledge and Intelligence (NDTMS) • Drugs, Alcohol, ATMs and prevention • Evidence • Transparency • Support and mirror