The latest ‘State of the Sector’ report has been published (see pdf report here) and it makes for some worrying reading…
It quantifies many common anecdotal comments which abound in the addiction treatment sector across England but also, it paints an ugly picture for future sustainability of effective service delivery.
Some might see the whole issue as irrelevant and of no concern to them after all, much of what ‘we’ know about substance use problems comes from our media… “it’s a crime and morality issue, drug users made that choice, lock them up!”
Some might even see the report as ‘scaremongering’ designed to preserve jobs but for the benefit of our society, we all need to look way beyond these mistaken perceptions.
Commissioners and service providers will continue to develop new delivery models to respond to the multiple pressures being faced. However, the on-going, annual reductions in Public Health Grant and the lack of protection by funding mechanisms afforded to local authority budgets for such services are, taken together, of serious concern. (State of the Sector 2017)
This will undoubtedly “result in a significant loss” of the support available for service users. But it’s also sadly indicative of the cutbacks, in so many of today’s public services.
- The potential of the sector to absorb funding cuts through efficiency savings has been exhausted
- Service capacity continues to be eroded
- Only central government intervention will protect the sector from further cuts
- Service models must continue to evolve
- Commissioning capacity and practices remain of great interest and concern
Irrespective of the reason(s), it’s also worrying there is an apparent “loss of specific substance misuse knowledge in commissioning teams.”
If so, how do they hope to incorporate emerging evidence, good practice and delivery models into contract specifications?
A new but often negative impact for service delivery is the sub-contracting of commissioned service elements.
Finances now dictate that many organisations can no longer provide all the support they would like to deliver, at least not from the money being paid to them.
By necessity ‘out of the box’ thinking is now creating new (some would say innovative) service models. This ‘visionary’ service provision, under the current financial constraints is laudable. But only when developed from service user need, as opposed to financial factors alone.
The parallel development of sub-contracted service models can bring benefits in local and specialist knowledge to commissioned services however, the actual or perceived ‘value’ of these smaller organisations varies.
Opinion also varies as to whether this encourages or stifles specialist services, peer-led models, co-production with service users and innovation generally. (State of the Sector 2017)
Sometimes detailed conversations around budgetary responsibility aren’t taking place in sub-contractor negotiations.
Providers looking to ‘offload’ commissioned but less (profitable) easily funded services often look to do so at minimal expense.
The sub-contractors, who are often very small voluntary CIC type organisations, can and do get blinded by money.
They see what to them can be a substantial payment but often miss what they are being ‘hoodwinked’ into delivering.
Importantly, the sums covering how much it will actually cost them to deliver haven’t been done. These sums might only cover small amounts of money, but ‘small’ is relative.
How can either party know who’s budget the money will come from if they haven’t had that specific conversation in the first place?
The sector has passed the point at which efficiencies and service remodelling can continually compensate for the loss of funding and moved into a period where choices about service configuration have become much harder. Decisions will be required as to what elements of service are retained or withdrawn. (State of the Sector 2017)
So what about the original ‘point of no return’ question?
Well, as I’ve already mentioned, addictions treatment services aren’t the only social care service experiencing problems.
All health and care services are at full stretch; the complexity of demand for health care and social care in England is in the ascendant.
When you consider the increasing demand for these services, set against a backdrop of ever decreasing funding, the answer would have to be a resounding Yes!
Health and care staff, and the services they work for, are under huge pressure. The combination of greater demand and unfilled vacancies means that staff are working ever harder to deliver the quality of care that people have a right to expect. However, there is a limit to their resilience. (State of Care – CQC)
There is only so much that any willing body of capable caring and empathic people can do, especially when they’re mostly undervalued and unsupported by their government.