Drug and Alcohol Treatment

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1 CABINET Drug and Alcohol Treatment Report of Executive Director, People, Communities and Society Portfolio Holder: Cllr Phil Harrison; Adult Social Service and Health 27 February 2012 Officer Contact: Janet Sewart, Head of the Drug and Alcohol Commissioning Team Ext: 8749 Purpose of Report To provide information about the current commissioning arrangements for drug and alcohol treatment and consider extending Service Level Agreements for the commissioned treatment providers for alcohol and drug treatment, prior to a full review and re-commission in Executive Summary Not applicable. Recommendations - To extend the Service Level Agreements up to the end of March 2013 for the existing providers of drug and alcohol treatment funded from the existing Adult Pooled Treatment Budget and DIP (Drug Intervention Programme) Main Grant for drug treatment for offenders. - For officers to undertake a comprehensive review of the drug and alcohol treatment system jointly with NHS Oldham and commission a new treatment system for , with effect from 1 April 2013.

2 Cabinet Drug and Alcohol Treatment 1 Background 1.1 The DAAT (Drug and Alcohol Action Team) commissions drug treatment and some alcohol treatment where alcohol is a poly substance (in other words, where a client uses alcohol in addition to other drugs). Primary alcohol treatment is commissioned by NHS Oldham. The DAAT was previously based in Positive Steps Oldham and exercised its commissioning responsibility within that organisation s framework. Monies for commissioning drug and alcohol treatment come from the Department of Health and the Home Office via the National Treatment Agency (based in the Department of Health). The spend on these budgets is scrutinized by the National Treatment Agency as is performance. The DAAT moved into the Council on 1 November Current Position 2.1 The Adult Pooled Treatment budget and the Drug Intervention Programme Main Grant currently fund commissioned activity. Service Level Agreements exist for all commissioned treatment activity. The allocations for have now been received and both have been subject to a percentage decrease. In addition, these budgets contribute to the Primary Care Trust core treatment provision, the DAAT team, corporate costs, service user support (including Oldham Boxing), IT support for bespoke database, Best Bar None contribution, Integrated Offender Management contribution, spot-purchasing abstinence-based in-patient detoxification, training support, on-line support for clients and drug testing (Concateno contract). 2.2 The reductions to the budget allocations for will be met through an overall reduction of the same percentage with regard to commissioning arrangements and provider services are aware of this. These reductions will also reflect performance, with a smaller reduction for those aspects of delivery which have delivered required (or surpassed required) outcomes and a larger reduction for those aspects of delivery which have not delivered required outcomes. In addition, Payment by Results is being introduced in shadow form on 1 April The forecast is that efficiencies Page 2 of 5 Drug and Alcohol Treatment

3 will be identified from 2013 onwards with a view to realising 23% cost savings over a three year period. 2.3 The intention is to re-commission a recovery focused treatment system from April 2013, based on a prime-vendor model, responsible for co-ordinating recovery plans for all clients throughout their treatment journey and for that provider to sub-contract other necessary and appropriate providers to ensure a rich mix of evidence-based treatment provision for the benefit of adult service users in Oldham. Harm reduction and community prescribing will continue to have an important role to play but within an integrated treatment system that has the recovery and social inclusion of users at its heart. Key service elements are: open access; assessment, engagement and preparation; recovery based treatment; re-integration and on-going recovery support. Services will be fully integrated into the wider partnership to ensure a whole systems approach towards service users and their families. There will be full engagement with key partners across children s and adult services, criminal justice agencies, mental health services, supported living and the voluntary sector. 3 Options/Alternatives 3.1 To continue with existing providers, with new Service Level Agreements for (agreed between the DAAT and providers) based on a Payment by Results model to improve the current performance, up to the end of March 2013 when the whole treatment system will be revised and re-commissioned. The advantage of this option is that it provides stability within the treatment system and time to conduct a thorough review and agree a new commissioning model. 3.2 To review individual Service Level Agreements against performance with a view to de-commissioning some providers, prior to 1 April The disadvantage of this is that it will be very difficult to find a suitable replacement within the time frame. The NHS contract for alcohol treatment does not expire until the end of March Preferred Option 4.1 To continue with existing providers, with new Service Level Agreements for (agreed between the DAAT and providers) based on a Payment by Results model to improve the current performance, up to the end of March 2013 when the whole treatment system will be revised and re-commissioned. The advantage of this option is that it provides stability within the treatment system and time to conduct a thorough review and agree a new commissioning model. 5 Consultation 5.1 A 3 year commissioning strategy has been produced and thoroughly consulted on. This provides the detail of the proposed new treatment system Page 3 of 5 Drug and Alcohol Treatment

4 and a mandate to review and re-commission. Consultation has included all provider service managers, Council commissioners, the Police, Probation Service, NHS, National Treatment Agency, Voluntary Action Oldham, GPs, service users, and elected members. 6 Financial Implications 6.1 The report proposes to extend a number of the current commissioned treatment contracts for 1 additional year. 6.2 Costs will be met from the payments to contractors section of the DAAT budget which is fully funded from the externally sourced Adult Pooled Treatment Budget (Department of Health) and Drug Intervention Programme Main Grant (Home Office). 6.3 The remaining budget available within the payments to contractor s budget line will be used to fund smaller commissioned services which fall below tender thresholds, on an ad hoc basis, during the review period of existing services. 6.4 Confirmation of 2012/13 funding has been received in finance and the above proposals fall within the approved allocations. (Neil Stott) 7 Legal Services Comments 7.1 This proposal is to maintain the current position with a view to a full procurement of services being carried out in the forthcoming financial year in order to start a Commissioner / Provider arrangement to take effect from the beginning of the financial year 2013/14. Such procurement will of course need to comply with all the internal and external regulatory and policy requirements. David Swallow 8 Human Resources Comments 8.1 Not applicable 9 Risk Assessments 9.1 Failure to extend the Service Level Agreements to the end of March 2013 will have the following risk implications: 9.2 Service users will be left without treatment provision. This will damage the recovery prospects of both individuals and the wider community. This is particularly pertinent for those on prescribed medication such as methadone. 9.3 Police, Probation and other criminal justice agencies will incur more work and greater costs as a direct result of this untreated drug using and offending population. Page 4 of 5 Drug and Alcohol Treatment

5 9.4 Providers will require a notice period of 6 months before termination of the service contract. In the event of termination there will be a number of contractual, staffing and human resource issues to deal with and all costs associated with these measures. 10 IT Implications 10.1 Not applicable 11 Property Implications 11.1 Not applicable 12 Procurement Implications 12.1 Procurement agree to option 3.1. DAAT have recently moved under the remit of OMBC from Positive Steps. To continue with current arrangements until 31 st March 2013, to allow for a full review of services to be undertaken, which will inform and reflect commissioning requirements for the future. This meets the requirement for exemption under the Contract procedure rules (DN). 13 Environmental and Health & Safety Implications 13.1 Not applicable 14 Equality, community cohesion and crime implications 14.1 Effective treatment helps to build resilience in communities, tackle health inequalities and significantly reduce crime. 15 Equality Impact Assessment Completed? 15.1 Yes 16 Key Decision 16.1 Yes 17 Forward Plan Reference 17.1 PCS Background Papers 18.1 Background papers, including Service Level Agreements, are available from the Drug and Alcohol Commissioning Team, level 6, Civic Centre. 19 Appendices 19.1 None Page 5 of 5 Drug and Alcohol Treatment

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