HOSC Report Integrated community drugs and alcohol service retendering options beyond April 2016 Meeting Date Sponsor Report author Purpose of report (summary) 12 th May 2015 Margaret Willcox Steve O Neill To inform the Gloucestershire Health and Care Scrutiny Committee of current and future commissioning arrangements and intentions for adults drug and alcohol services. 1. BACKGROUND/CONTEXT 1.1 Gloucestershire County Council (GCC) holds the responsibility for commissioning drug and alcohol misuse services. The community drugs and alcohol recovery service has an annual contract value of 5.97m. It forms part of a wider programme of activity to reduce drug and alcohol related harm, and accounts for 24% of the ring fenced PH grant. GCC s total investment into drugs and alcohol related services is 7.73m per annum. Before the transfer of Public Health to GCC on 1 st April 2013 the service was jointly commissioned by the then NHS Gloucestershire Primary Care Trust (NHSGPCT) and GCC. It is now commissioned and funded solely by GCC but with contribution of 65,000 from the Police and Crime Commissioner. 1.2 The service is provided by Turning Point, following a retendering exercise in 2012. As part of this exercise the service model was radically transformed to deliver a more recovery-focused offer. The number of providers was reduced from six to a single provider. The current contract period is for three years from 1 st April 2013 to 31 st March 2016. This tender was led by NHSGPCT as was, with involvement from key organisations i.e. Police, GCC and District Councils. Service users were involved in the evaluation of bids. 1.3 The local delivery model and level of investment in this provision per head of the population are broadly in line with other comparable Local Authorities. Performance on high level metrics requires improvement and targets need to be reset with assistance from Public health England (PHE).
1.4 Nationally the estimated return on investment for drugs and alcohol treatment services is around 2.50 per 1 invested, with beneficial impacts on service users and families, the criminal justice system, health and social care system and the wider economy. 1.5 Stakeholder and service user feedback about the current model is positive. 2. WHERE ARE WE NOW? 2.1 Summary of local need 2.1.1 There are estimated to be approximately 2,500 opiate (largely heroin) and /or crack users in Gloucestershire, and approximately 35,000 higher risk drinkers (regularly drinking > 50 units per week for men and > 35 units a week for women). Around 13,000 of these higher risk drinkers have a degree of dependence on alcohol and approximately 3,000 have a moderate or severe dependence. 2.1.2 In the current treatment year there are 1500 individuals in treatment for illicit drugs, and 700 individuals in treatment for alcohol. 2.1.3 The impact of substance misuse on family members and demand on children s social care is a significant concern. Between October 2013 and September 2014 there were 5,578 initial assessments undertaken by Children s Social Care in Gloucestershire. Of these 9.3% (518) identified parental alcohol misuse as a concerning factor and 7.2% (403) identified parental drug misuse as a concerning factor. 830 (circa 60%) current users of the drugs treatment service and 358 (circa 50%) users of the alcohol treatment service have either parental responsibility or are living with in household with children. 2.2 Current service provision 2.2.1 The community drugs and alcohol recovery service broadly provides: Advice and information to the public, service users and their families and carers Training for external stakeholders and front-line professionals Early interventions for those starting to experience problems with drugs or alcohol Harm reduction support for those who are not ready for treatment Elements of community Housing related support delivered as integrated model Cross county recovery-focused drug and alcohol treatment services (includes psychosocial and clinical interventions including substitute prescribing for drug and alcohol dependence) A range of criminal justice interventions including, Drug and Alcohol related court orders together with Police and probation Peer support and user led groups to support to sustain recovery e.g. housing- and employment-related support.
2.2.2 The service contributes to the following GCC population outcomes: PO1: Children, young people and adults are safe from harm PO2: People live healthy lives as free as possible from disability of limiting long term illness PO8: Gloucestershire and its communities are attractive places to live, work and invest PO9: Good value for money for local citizens. 2.2.3 The service is offered universally to alcohol and drug users (adults) and also forms an important part of the targeted offer for families by children s social services. 2.2.4 Performance against the Public Health Outcomes Framework (PHOF) indicator for recovery among opiate and crack users is below the expected level and commissioning staff are in constant discussion with the provider to address this. The target is currently under review with support from Public Health England. The presentation accompanying this paper, which will be bought to HOSC on 12 th May, will demonstrate broader aspects of performance. 2.2.5 In addition to the community recovery service, the following drugs and alcohol related services and functions are commissioned by GCC. Family drugs and alcohol court (FDAC) - specialist staff and drugs and alcohol testing Gloucester City social work Pods workers Family focus (family therapy for families where parental drug or alcohol misuse is an issue) Substance misuse midwife Substance misuse health visitor Young people s drugs and alcohol service Out of county residential rehabilitation budget Supervised methadone consumption in pharmacies Independent advocacy Hepatitis C and blood borne viruses nurse Alcohol hospital liaison service Alcohol arrest referral scheme (co-commissioned with the Police and Crime Commissioner) Drugs arrest referral scheme (co-commissioned with the Police and Crime Commissioner). 2.2.5 There is scope for further integration of some of these functions, which will be explored in developing the business case for the retender of the community drug and alcohol recovery service.
3 DIRECTION OF TRAVEL (MODEL AND PRIORITIES FOR DEVELOPMENT) 3.1Progression of drug and alcohol service(s) model Pre-2013 Jointly commissioned and funded (NHSGOCT, GCC and Police and Crime Commissioner Six providers of community and inpatient drug and alcohol treatment services Range of separately contracted health and criminal justice services Fragmented provision, difficult to navigate by service users and professionals. 2013 to 2016 (current service) Radically remodelled service Single provider of tier interventions Recovery focused model including housing and employment related support Separately contracted health and criminal justice services Some joint working with children s services Hub-based model of provision. 2016 onwards (where do we want to get to? Stronger integration with GCC children and families family related work (Family Focus and Family Drug and Alcohol Court) Increased focus on improving outcomes for families via integration with family services in areas of high need e.g. Drug and Alcohol workers co-located in children s social care in areas of high need Further integration of alcohol and drugs into wider systems i.e. safeguarding and domestic abuse multi agency meetings. Assimilation of some of the separately contracted criminal justice interventions Stronger community based capacity building and enabling functions, particularly for alcohol (aligned with wider health behaviours review) Increased presence and flexibility of staff in communities ( hub and spoke model with more assertive outreach) Continued benchmarking and adjustment in contract value via a contract with the flexibility to incentivise providers to improve performance, and to reduce contract value through sharing in efficiency savings. 4. HOW DO WE INTEND TO PROGRESS? 4.1The current suite of services will be retendered pending a review of performance and finance. The proposed future tender presents the following opportunities to improve efficiency and outcomes, which will be worked up as part of the full business case: Better alignment of resources to local need Reviewed balance of investment into drugs versus alcohol elements of the service, with more resource for alcohol
Reviewed investment into housing related support, which we believe exceeds the level of need Reviewed balance of hub-based versus outreach activity, strengthening outreach services for the vulnerable and hard to reach, including street drinkers. Improved outcomes for service users and their families Strengthened family focused support and safeguarding functions in partnership with children s commissioners, including: - Increasing the scope of the service to build on learning from work with children and families - Strengthening linkages with interventions and services for domestic abuse - Strengthening linkages with mental health interventions and services with particular reference to the mental health concordat Improved efficiency / value for money Improved performance (recovery outcomes) through the introduction of financially incentivised performance measures Strengthened performance monitoring so that we are better informed about the return on our investment, including the introduction of more sensitive measures of impact on service users Strengthened the use of community assets in supporting recovery Modelled impact of different levels of investment on overall Council costs (i.e. public health and children s services) and make recommendations on the best balance of investment. Evaluation of the social return on investment of this service, and use the Social Value Act (2012) as a mechanism to maximise the return Scope to integrate arrest referral schemes and alcohol emergency department worker into the new service specification reviewed (pending consultation with co-commissioners (Police and Crime Commissioner) and current providers. Manage or reduce demand for social care Given the high frequency of parental drug and / or alcohol use as a factor in driving demand for children s social care there is a need to model the potential impact of different levels of investment into the drugs and alcohol recovery service, including family support elements, on helping to achieve savings within children s social care, and elsewhere in the system. 4.2 Further development of the service model and specification will be informed by further exploration of key interdependencies including those with: Children s social care Families First programme Domestic abuse strategy and plans Mental health and wellbeing strategy and plans, and services.
4.3 Governance arrangements 4.3.1 Internal governance for the retender is via a project board including representatives from Gloucestershire Clinical Commissioning Group Public Health England. Police and Crime Commissioner (Co-commissioner). 4.3.2 A wider stakeholder reference group includes representatives from: Voluntary sector alliance National Probation Service and Community Rehab company District Councils Housing Children and Young people commissioners and services. 4.4 Next steps Further modelling on service model and specification Work with local stakeholders including service users, on need and service model Cabinet decision on future procurement in June 2015.