Commissioning #Addictions #Recovery Services

Could the process for commissioning addiction services be the foundations of (sometimes) mediocre and lackluster service delivery and performance or, could the root cause be something entirely different?

The simple answer from me would be a resounding “YES” …probably!

If not the root cause, I would be obliged to cite commissioning as; the single most significant negative impact upon the whole process of providing addictions treatment and recovery support, in recent years. Especially when you add to this, the ever declining reductions in overall funding allocated and available for the delivery of those addiction support services.

Many of the issues are succinctly addressed in the article Commissioning: What’s in a Name? Published in the November 2017 edition of Drink & Drugs News, and quoted below;

Such is the cut-throat climate of retendering that treatment agencies are paring their tenders to the bone – or walking away from areas where they just can’t make the funding work… Many are angry that their winning bid helped to drive tender prices down to a dangerous new low and blame the commissioning team for exacerbating a ‘race to the bottom’ culture… (Read full article HERE)

As the article points out, the sector is “still shuddering from the recent demise of Lifeline” (see my previous blog) and many probably speculated that the commissioning process had a negative here however; in a mostly unpopular and precarious marketplace, with a constantly moving landscape, that logical supposition is mostly superfluous… right or wrong.

Yes, funding for addictions and recovery support has been in decline. We have to get over that, this particular sector of public health provision is not alone. There is absolutely nothing productive to be gained from ‘crying’ over the spilt milk of diminishing public money pots.

The sector has to shout, now more than ever before, about the life-changing needs of their service users. This can help to prevent the public (and purse-string holders) from sweeping these (unsavoury and often misunderstood) issues under the commissioner’s dusty carpets at the Borough Council offices.

  • Providers have to be proactive in marketing their services, constantly explaining the efficacy and benefits derived from support which is delivered by driven and competent professionals.
  • The importance of ‘recovery’ isn’t just for individuals, often stigmatised and mostly disconnected from our society.
  • The positive impacts of recovery has significant benefits for our society’s entire framework.
  • All work done to reduce the human and social harm caused by substance addictions has corresponding social benefits including;
    • reductions in health-care expenditure
    • mental-health improvements
    • positive impacts for crime reduction
    • Improvements in overall social cohesion and connectivity

I find it frustrating that so many can (conveniently) fail to see, let alone understand many of these issues. This is why it is incumbent upon providers to proverbially but proactively poke this type of information into the public eyes of our society! After all, action is only ever based around political whim formed from popular public opinion… isn’t it?

A simple but underlying problem for all addictions services, which was also alluded to in the above article is; “the important thing is to have commissioners who ensure that substance misuse services don’t get disproportionately affected” by reduced funding. (Sarah Hart, senior commissioner at Haringey Borough Council)

…everything in the sector, it’s about balance – and about recognising that substance misuse services really matter: ‘This isn’t about buying paper, this is about services that people value highly and they get very very frightened when those services are being changed.’ And the welfare of the sector going forward will depend on better partnership working (Sarah Hart)

In the quote (above) you will also find a key to unlock the door of problematic commissioning… ‘Effective Partnership Working’ – something that (unfortunately) is still mostly destined for more failure unless; providers and commissioners of those service can effectively and finally remove the inherent parochialism and silo-thinking displayed by many in stakeholder strategy and management.

Finally, Ms Hart passed another observation about the so-called ‘race to the bottom’ sector culture. Something that (in part) results from providers stripping a service bare, during tender ‘competitions’ by saying;

…if there’s not enough money in the tender, don’t bid for it. It’s the thing that commissioners most fear, that no one will bid for their tender – but don’t bid against each other. (Sarah Hart)

A sensible and logical stance but also problematic… Many providers are ‘between a rock and a hard place’ in real terms. Their workforce (or the employes they inherit via TUPE) are (mostly) dedicated to what they do. They realistically want to provide the best and most efficient service they can. They also want/need to keep their jobs, if only for reasons personal financial stability.

Providers (employers) hold a massive responsibility here to their workers (employees) but also, without them they couldn’t provide the service that they’re tendering for. More of the old ‘chicken & egg’ conundrum. A simplistic but wholly appropriate and now prolific phrase abounds in these difficult times.

I’ve heard it on numerous occasions and from various different parts of government and the addictions sector recently. Lately Karen Biggs (CEO, Phoenix Futures and Chair of the Collective Voice consortium) has said, at two separate 2017 Drug Strategy conferences, the sector “will require greater levels of innovative thinking” and she is right. If you consider Ms Biggs as one of the ‘experts’ within service provision you should accept that assumption.

The bottom line is also another business buzzword phrase; ‘start thinking outside the box’ because if providers don’t do that, you can rest assured that the proverbial box doesn’t contain any cash… or their thoughts…hopefully!

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