THE NEW COMMISSIONING
ARRANGEMENTS FOR DRUG TREATMENT
IN ENGLAND
NAT Roundtable
14/1/13
Pete Burkinshaw
Overview
• Key Policy drivers and context
• The architecture
• Opportunities and challenges
• Public Health England
Key policy drivers
• Localism
• Transparency and accountability
• Public health and health inequalities
• Recovery
• Payment by results
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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.
Recovery, integration and sense of place
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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)
Context: Suite of evidence-based clinical guidance
• In total there are 15
NICE drug and
alcohol publications
• Q1 13/14 NICE
commitment to reflect
all these in in LA PH
briefing.
The evidence ...
 ... is good that OST:
 Retains people in treatment
 Suppresses illicit use of heroin
 Reduces crime
 Reduces the risk of BBV
 Reduces risk of death.
 ... is less persuasive that OST:
 Suppresses other drug use
 Improves physical and mental health
 Improves social reintegration of marginalised heroin users
 Promotes abstinence from all drugs.
Guidance…….
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The treatment system’s achievements
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
PHE Centres
Responsible
for publishing
data and
supporting
delivery of
PHOF
CCG/NHS CB
Commissioning OF –
set by the NHS CB for
CCGs
HealthWatch
Accountability
Oversight
Links
PHE
Sets out the indicators
that the PH system &
DH understand are the
best mechanisms to
improve public health.
Up to LAs to prioritise.
Slide 16
NHS CB
PHOF
ASCOF
NHSOF
Mandate – only means of
holding the CB to account
Secretary of State for Health
Parliament
Sets out the indicators that the NHS should
seek to achieve through the Mandate objective
of continuous improvement
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Architecture
Drugs and alcohol services 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
Purpose but not how
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Timely access to substance misuse treatment is one way of reducing
health inequalities across many public health indicators; it
(1) Supports Public Health Outcomes Framework (PHOF) vision:
To improve and protect the nation’s health and wellbeing, and improve the
health of the poorest fastest.
(2) Impacts directly on both of the PHOF outcomes:
• Outcome 1: Increased life expectancy
• Outcome 2: Reduced differences in life expectancy and healthy life
expectancy between communities
(3) Contributes to many of the outcome indicators.
Substance misuse treatment contributes to over half of the PHOF outcome
indicators.
Slide 19
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Budgets
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13/14 and 14/15 Budgets released on Friday
• £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 services: 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.
The Public Health Grant
• Local authorities will need to forecast and report against the subcategories 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
More opportunities and challenges
Unintended consequences:
old
new
Balanced systems – maintaining gains
Clinical Governance
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
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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
• BBV and DRD guidance due soon
Director of Health Improvement and Population
Healthcare for Public Health England
Kevin Fenton, M.D., Ph.D., is the Director of
the National Centre for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention
(NCHHSTP) at the U.S. Centres for Disease
Control and Prevention (CDC). He joined the
CDC in 2005 as the Chief of the Syphilis
Elimination Effort, and in 2006 began his
tenure as the Director of NCHHSTP.
Prior to the CDC, Dr Fenton was the
Director of the Health Protection Agency
(HPA) HIV and Sexually Transmitted
Infections Department where he led the
development, implementation and
evaluation of numerous national and
European HIV and STD surveillance,
prevention, screening, and research
programs.
Public health - broad and diverse, so is treatment.
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