Drug System Change Pilot

Commissioning for Substance Misuse in a Personalised Way

Sue Wilks, DAAT Manager

The Concept

personalised care in aself directed way usingindividual budgets viadirect payments………

Personalisation & Self Directed Support - Background

Challenges perceptions - giving drug users money changing the way services are secured changes needed by everyone – staff,

service users, commissioners, providers balancing choice, risk, clinical safety and

flexibility market and broker development

Personalisation & Self Directed Support

The Basics

We are not offering choice and control :in specialist prescribing medical detoxdrug of choice

Personalisation & Self Directed Support

We have:A set of very basic and simple tools developed, Self Assessment Questionnaire (and Resource

allocation)Banding levels A – E, reflecting basic Tiers and

services currently available Personal support plan

Delay inputting of the resource until identified support to meet need from ALL resources

Personalisation & Self Directed Support

Key points to cover

some notes to consider current picture desired picture changing the approach keeping a foundation the reality

We already provide some interventions in a semi personalised way .e.g. spot purchases, small flexible funding allocations

Treatment system is covered by several funding streams – PCT, LA, DAAT. Range of leaders needed to be involved

There are many steps and barriers to reaching our aspirations of social enterprises, buyer groups

Some notes to consider :- Where are we ?

Commissioning…….

how to change without destabilising the systems

joint commissioning outside of substance misuse

Consider :-

Current Picture

Desired Picture

Changing the approach

Through new contracts and building in flexibility

Release funds from block contracts

Translate block contracts into individual budgets

Changing the contracts

2 options suggested, through :

gradual reduction in contract value, releasing funding into new areas of service growth

– commissioner to develop the flexibility provider sub contracting and developing

flexible markets within their contracts

– provider to develop the flexibility

Changing the contract

Percentage sub contracted or distributed via self directed support

Commission full service at outset

↑ ↑ ↑Start of contract 2.5 years 5 yearsSmall amount of

core commissioned services

Flexible markets and services

Changing the approach

Release funds from block contracts Structured day Psychosocial services Residential rehab

Translate block contracts into individual budgets Create unit price Work with individuals to tailor their

package linked to current provider

Keeping a foundation

At the point of contact – few clients want to start taking control at this point, they want support, advice, and help to deal with presenting need

Not always able to take control and make choices at key points

Opportunities can be increased using anticipatory care planning.

Keeping a foundation

Core Commissioned service. .

Flexible Markets –

SDS options

Limited SDS Choice and control Well being, recovery and reintegration

Engagement developed

Wider reintegration & recovery community based

services

The Reality

To date the pilot has seen: a few work through the full process / low allocations a focus on structure - college and / or training – yet to

translate into actual take up on courses request to use resources for rent / accommodation –

areas already known to be areas of unmet need in the sector.

a few disengage from the scheme. low take up concerns this is another tool in addition to others (CAT,

ITEP, PSP) - need to streamline

Next steps:

Now increasing practitioner engagement to enable more clients to engage with the pilot as numbers remain low.

Providers are considering how to respond and engage with the changes, but as yet little demand from client group.

Positive interest from service user groups – social enterprise and buyer groups

The Reality

Barriers & Constraints Need for hearts and minds to move – not just structural Using evidence based and registered services Commissioning boundaries – supporting people, criminal

justice Maintaining and engaging small providers to retain the

flexibilities they offer Existing commissioned services and contracts Transitional period for all areas of the system – clients,

practitioners, providers, commissioners

The Reality

Thank you for your interest

Sue Wilks

sue.wilks@hants.gov.uk

For further information :

Please Contact :

Jessica BerrySelf Directed Support Project Manager

jessicaberry@nhs.net

Mob:  0776 0992311Fax:  01256 818270