Drink and Drugs News DDN 1804 - Page 14

Commissioning DO MORE WITH LESS There’s much talk of developing innovative commissioning practice – prompted, in the main, by the need to ‘do more with less’. As part of the refining process, many services are letting go of the specialist posts that would have been central to operations just a few years ago. In our March issue (page 20) the alliance of NHS providers, NHSSMPA, highlighted the ‘significant decline in registered staff, including nurses, social workers, clinical psychologists and doctors’ and cautioned that some drug and alcohol services had begun relying on limited clinical expertise. Through a recent suite of documents for commissioners, providers and clinicians, Public Health England (PHE) emphasised the many and varied roles that specialist doctors, nurses and psychiatrists should play in addiction services. These highly trained professionals are, they reminded us, not just there to provide medical treatment in response to highly complex needs – although those are the elements of their roles that cannot be fulfilled effectively by lesser trained and qualified staff. PHE named many other skills that enhance quality and leadership within teams, as well as integrating many public health activities and interventions. Furthermore, they pointed out, specialists can help to coordinate resources in a way that adds cost efficiency to a system stretched to breaking point. MULTI-SKILLED VALUE The fact that nurses are such ‘a multi-skilled breed’ is without doubt why they bring such good value to drug and alcohol services, says Ishbel Straker, a clinical director and board member of the nurses’ association IntANSA. Their expertise in therapeutic engagement, assessment and care planning, health care delivery, disease prevention and prescribing works alongside their commitment to the NMC standards – ‘prioritising people, practising effectively, preserving safety and promoting professionalism and trust’. ‘We are ever evolving to meet our clients’ needs and the needs of our services,’ she says. ‘We work with harm minimisation at the forefront of our minds, while giving advice, assessing and treating through a variety of activities such as vaccinations, lung function tests, wound care, blood sugar monitoring, ECGs and sexual health – all of which are measurable outcomes.’ ‘Looking at the client from the centre of their needs’ has become the way of working at Change, Grow, Live, says Dr Arif Rahman, CGL’s consultant addiction psychiatrist. Far from dispensing with the psychiatrist’s role, CGL have put it right at the centre of their services. ‘It’s really good for the client as it gives them a specialist assessment that’s holistic. We’re medically trained, psychiatricall