Substance misuse commissioning in the new landscape DrugScope conference November 6th 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 Lancashire experience Key questions 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 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 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 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. 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 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? 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! 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 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?