January 19, 2013


High hopes raised by the Drug Policy 2010 have been dashed in implementation, rehabs are closing – and commissioning is changing with localism, Public Health England, Health & Wellbeing Boards, GP commissioning, Police & Crime Commissioners, Payment by Results...
Deirdre Boyd identifies issues so you can defuse them.

AT140CoverForecasts by Nick Barton
Action on Addiction

Forecasts by Tessa Corner &
Patrick Gormley
, Streetscene

Forecasts by Laura Graham

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Deirdre BoydForecast from Deirdre Boyd, CEO of the Addiction Recovery Foundation which publishes Addiction Today, and cofounder of the Concordat of rehabs/providers of full recovery.

Survival will be the name of the game even more so than usual this year: survival of vulnerable people seeking to end their addictive behaviours, and survival of the professionals who have historically helped them into full recovery. As well as the other predictions in this article, below are some pointers to consider in your future business plans.

Turning point on workforce. Is this the most significant sign of the times? At the end of 2012, Turning Point sacked 2,393 staff then re-hired most on new contracts, to cut costs. As the largest of the “Big 4” mega-agencies in the drug- and alcohol-treatment field, Turning Point’s latest accounts showed a salary-related cost of £60million and a pensions liability of £7million. 

Volunteers: threat or help? Also towards the end of 2012 came the news that the second-largest of the “Big 4”, CRI, merged with Sova which organises 450 volunteers to run projects. This is a visible sign of similar moves elsewhere, such as “experts by experience” being used in CQC inspections. Will volunteers complement and expand service offerings or will they replace qualified staff? Will they give a low-cost competitive edge when tendering to commissioners? How will this impact workforce development advocated by Nick Barton? A trend to watch.

Cultivate your local commissioners. I am surprised by how many providers do not formally include building such pivotal relationships into their business plans or allocate specific members of staff – then complain when others get contracts for which they themselves have not even tendered. To help your relationship, update commissioners regularly on clients, without being prompted.

Fotolia_46231781_markus dehlzeitLocal authorities. Last March, we wrote that “From April 2013, councils will be given a ringfenced budget – a share of £5.2billion – and choose how they spend it. Recovery providers must start campaigning NOW to get a fair share.” Compliments for the article came even from universities, while providers who followed our advice have already reported benefits.

Fotolia_46231781_markus dehlzeitTsunami of commissioning changes. In May last year, we wrote that “the tsunami of changes in the drug and alcohol sector includes:
>> a new drug policy       ) separate documents,
>> a new alcohol policy   ) not really joined up
>> health sector reforms
>> primary care trusts and special health authorities to be abolished
>> local authorities to take over the remnant of  PCTs as public health departments.
>> Health and Well Being Boards being created
>> Public Health England created, taking on the functions of the National Treatment Agency for Substance Misuse, and other organisations
>> the National Commissioning Board to be  created, to include “Offender Health”
>> prison substance-misuse services were transferred to the NHS and local drug/alcohol action teams;  clarification is required as to whether Offender Health or local DAATs have control
>> police and crime commissioners created, taking  the Home Office element of the Dip main grant.”

Our recommendations to address these are worth reading again (Addiction Today, May 2012).

Fotolia_46231781_markus dehlzeitPartnerships and spectrum of care. Providers will need to provide a fuller spectrum of care: perhaps day programmes to attract local clients integrated into/alongside residential care, perhaps detox as a precursor to rehab, and a range of professional and grassroots support options for when clients move on from first-stage care. If providers cannot supply these, they could partner with other providers which can fill gaps – they might even tender jointly for contracts, particularly where gaps exist in requirements ranging from harm reduction to abstinence.

Fotolia_46231781_markus dehlzeitBig Society means big corporations. I wrote before about many local commissioners writing clauses in tender documents which barred smaller providers from applying. Now the Cabinet Office guide to Social Impact Bonds hardens that mindset of working with big business. However, these businesses could be revenue sources if cultivated.

NTA and Public Health England: business as usual? Despite the foregoing, NTA senior management have been telling DAATs that all will be “business as usual” as the NTA will be move almost intact into PHE. Monitor this.

Interventions. We are working hard so that rehabs get more referrals from interventionists.

Language as propaganda. Read between the lines of NTA and related documents. Enter "dossier" in the web-search box at the top of the left column for some starter examples.

AT140CoverVested interests: good drug policy, bad implementation. “Successful reform isn’t just about policy – it’s also about the resistance and inertia in the face of vested interests,” confirmed the Reform think-tank in its 2011 Scorecard, which we publicised to Addiction Today readers. It scored the DoH with a D. Add to this “wealthy peasants” and opportunists’ power struggles, such as described in the Laura Loves/Loathes column in January Addiction Today, and  you get...

The treatment field is more divided than ever. It is also – rightly, sadly – more suspicious, as betrayals have abounded. We must never abandon the message of “united we stand, divided we fall”.


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