Drink and Drugs News DDN 1804 - Page 15

More on commissioning at www.drinkanddrugsnews.com ago experienced and adapted to changes that are now happening in health and social services. Alongside his client assessments, he feels that one of the most important parts of using his expertise is in finding pathways for clients and linking them to colleagues and partner agencies for their health, psychological and social needs. CREATIVE COMMISSIONING Chris Lee, a commissioner in Lancashire and a member of the new Faculty of Commissioning, agrees with the need to ‘create robust pathways to make sure the skill set is there across all organisations’ – particularly as the treatment system now has so many diverse stakeholders including CCGs, the NHS (and the prison estate), local authorities, Collective Voice and the NHSSMPA. While ‘the front door to treatment has changed’ and clients might enter treatment through one of many different routes, the current challenges mean that leading through specialisms is more important than ever, he says. ‘The money’s going out of the system at 100 miles per hour, but the clinical guidelines have been enhanced. So how do you do that with a population that’s got ever- increasing complex needs?’ This, he believes, makes the case for a different and more creative brand of commissioning. ‘If I sit down and write a specification for a tender this afternoon that mentions an addiction psychiatrist, your bid will come back with an addiction psychiatrist in there,’ he says. ‘But you can commission differently. You can say, “you’ll be working with people with complex needs, people with co- existing mental health and substance misuse concerns. You’ll be dealing with people with long-term homelessness issues, people who are long-term unemployed – and you need to be able to deliver both the clinical and psychosocial model.” ‘You’re not saying that you must have a psychiatrist or a psychologist or whatever – you’re saying, “this is the level of complexity you’ll be working with; what team would you put out?” It’s up to the provider to come back and say what they will give you.’ Lee sees opportunity in the need to mix cost-effectiveness with addressing complex needs, and says ‘that’s where it gets really exciting, because you can start playing around with different delivery options’. Traditional ways of working are not ‘the given’ anymore, right down to the buildings that can constitute one of a service’s biggest overheads. The new way of working can be ‘light and agile’, he suggests – meeting in a coffee shop or a library, using community assets, and freeing up money to spend on staff instead of buildings. LET’S GET DIGITAL Service delivery might be able to incorporate digital support – a Skype call, email contact, text support, people filling in their own assessments online, or contact with a keyworker that can be anywhere. ‘Even people with highly complex needs could get some of their support through digital means – you could do doctors’ appointments by Skype for example to save travelling,’ says Lee, adding that there will always need to be a balance between this and traditional face-to-face meetings. His point is that ‘years ago everyone got the same broad-brush approach, but these days you don’t do it that way. And if the money’s draining out of the system, we can’t afford to be working in old-fashioned ways.’ Furthermore, he believes that commissioners have a responsibility to lead on this open-minded approach: ‘If the commissioner pretends they know everything, you’re robbing yourself of some good ideas,’ he says. ‘The good providers out there have some really innovative ideas.’ DDN This article has been produced with support from Camurus, which has not influenced the content in any way. pathways www.drinkanddrugsnews.com April 2018 | drinkanddrugsnews | 15