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