Oxfordshire Drug and Alcohol Treatment System

Oxfordshire Drug and Alcohol Treatment System

Overarching Principles Two overarching principles driving the change in drug and alcohol commissioning The best value for money for the tax payer. The best outcomes for the service user. Outcomes versus Activity Better performance management paying for success

National Drug Recovery Outcomes DEPENDENCY Initial 1.1 1.2 Drug and/or alcohol use reliably improved (i.e. reduced their consumption by statistically significant levels) for all presenting substances at any two Treatment Outcomes Profile (TOP) review within the last 12 months Abstinent from all presenting substances at any two TOP reviews where this was in the last 12 months 1.3 Final 1.4 Planned exit from the treatment component of the recovery journey, free from drug(s) including alcohol of dependence (including abstinence from heroin and crack cocaine) Discharged from treatment successfully (free of drug(s) of dependence) and do not re-present in either the treatment system or taken into the DIP caseload in the following 12 months

National Drug Recovery Outcomes HEALTH AND WELLBEING Initial Injecting NFA / Housing problem Hep B Vac Health and Wellbeing Of those injecting at the start of treatment, those who reported 0 days injecting on any two review TOPs within the last 12 months Of those NFA or with a housing problem at the start of treatment, those who no longer had any housing problem on any two review TOP, where this was in the last 12 months or at their exit TOP ('no' to both housing questions on TOP i.e. no longer NFA or with a housing problem) Of those eligible, those that had completed appropriately a course of Hepatitis B vaccinations within the previous 12 months. Client achieves a normative quality of life score in any two TOP reviews where this was in the last 12 months. The normative quality of life score will be that which clients that successfully complete treatment achieve on average at the point of leaving structured treatment (14)

National Drug Recovery Outcomes OFFENDING Both 2.3 Early Payment Approach Interim and Final combined Reduction in average offending of cohort compared against baseline, calculated and paid quarterly. Cohort to be made up of those individuals in and recently discharged from treatment (details to be determined with pilot areas).

Case Mix Complexity -Drugs Variables that increase risk Opiate use (daily) Opiate use (1-27 days) Problematic opiate use citation Higher crack use (5-28 days) Injecting (1-27 days) Criminal justice referral Unplanned previous episodes (3+) Low crack use (1-4 days) Hazardous drinking (F>140/m, M>200/m) Injecting (daily) Unplanned previous episodes (1-2) No fixed abode Amphetamine use (1-28 days) Problematic crack use citation Previous Treatment Journey (1+) Male Cocaine use (1-28 days) Variables that decrease risk Cannabis use (17-28 days) Education Physical health (14-20) Quality of life (14-20) Working Pregnant Psychological health (13-20) Complexity group is decided by their total score across the range of variables:- Low (score of 0 10); Medium (score of 11 18); High (score of 19 +)

Finance Modelling - Checks and Balances Simplicity of modelling = some payments being too high (i.e. higher for low than high) so allocations adjusted; Where no outcomes were achieved no payment was given; Our model = option for Harm Min or Recovery, but PbR only applies to Recovery, meaning:- Outcomes increased as expected to achieved in-line with national upper quartiles; Completions increased as modelling data is based on 40% of wholesystem, and so 40% of the completions recovery treatment will be all detox. based; Increase in non-representations expected, as this is a percentage of the number who completion which will be higher (as described above); Financial sustainability checks = higher engagement fees in yearone to ensure sufficient funds for development of the new service.

Oxfordshire Modelling Data Drugs YEAR 1 Outcome Allocated Budget Complexity Projected Levels Outcomes Low 477 Attachment (50%) Medium 624 High 681 Low 150 Abstinence (15%) Medium 405 High 301 Low 34 Reliable Change (1.5%) Medium 43 High 77 Low 30 Housing (3%) Medium 51 High 160 Hep B Vaccination (3%) Not set 773 Low 0 Injecting (0.5%) Medium 9 High 35 Low 196 Quality Of Life (12%) Medium 400 High 350 Low 234 Completion (15%) Medium 148 High 107 Low Non 0 Medium Re-presentation High 0

Oxfordshire Modelling Data Drugs YEAR 2 Outcome Allocated Budget Complexity Projected Levels Outcomes Low 477 Attachment (40%) Medium 624 High 681 Low 150 Abstinence (15%) Medium 405 High 301 Low 34 Reliable Change (1.5%) Medium 43 High 77 Low 30 Housing (3%) Medium 51 High 160 Hep B Vaccination (3%) Not set 773 Low 0 Injecting (0.5%) Medium 9 High 35 Low 196 Quality Of Life (12%) Medium 400 High 350 Low 234 Completion (15%) Medium 148 High 107 Low 106 Non (10%) Medium 43 Re-presentation High 23

Offending Outcome The measure attempts to compare PbR services with treatment services pre-pbr, by predicting the number of offences that would have been committed by a cohort of individuals in treatment previously, and comparing their actual offences while at, and 6 months after leaving, the PbR Recovery service. Payment: The Provider will be paid a set amount for equalling the predicted proven offences level, of the previous treatment system, plus a set price on top for every offence saved compared to the predicted proven offences (the baseline). Example: Total offending outcome budget 60,000 per annum Payment for equalling baseline level 20,000 per annum Payment per offence saved compared to previous 1,000 up to a maximum of 40,000 Quarterly predicted proven offences expected for cohort 95 (baseline) Quarterly actual proven offences expected for cohort 86 (10% reduction) Offences saved 9 Payment for equalling baseline level 1/4 of 20,000 = 5,000 Payment for offences saved 9 x 1,000 = 9,000 Total payment for quarter 14,000

Offending Outcome Challenges for Oxfordshire 1. Complete reliance on NTA, or equivalent body, to provide the data; 2. Time lag in data currently expected to be 1-year due to the way the measure is calculated, meaning the provider may not get a payment in year 1; 3. No data specifically for Recovery Service is available, so all baseline data will be based on whole treatment system pre-pbr (includes those not ready for recovery); 4. The baseline will not be calculated until the cohort in treatment is known so will not be available until approximately April 2013, making planning andmodelling impossible; 5. Potential need (Contractually) to pay the provider after the contract ends as in arrears; 6. Potential need to clawback money if performance dips in year; 7. Paying for noise as expected variation from the baseline over the year is +/-55 offences.

Alcohol Outcomes 679,000 per annum for alcohol treatment (35% of non CJ outcomes budget) Agreed the following outcomes for alcohol only service users with the Provider: - Outcome Attachment Completion Measure Each time a service user starts a new treatment episode with the Provider, paid once in 12 months Planned exit from the treatment component of the recovery journey, free from alcohol Allocated Budget Year 1 Year 2 Projected Outcomes Allocated Budget Projected Outcomes (50%) 500 (34%) 500 (50%) 300 (33%) 300 Non Representation Discharged from treatment successfully (free from alcohol) and do not represent in the treatment system or DIP caseload in the following 12 months 0 - (33%) 210

Challenges throughout Transition Contract Templates; TUPE; Clinical Transition; GP Practices; Residential Assessment Handover to LASARS;