In a follow-up to last year’s commissioning series, we look at how the elements of a strong partnership can fit together.
Last year we ran a three-part series looking at what’s next for commissioning in the wake of Dame Carol Black’s Independent review of drugs, the drugs strategy and the new money that followed it (DDN, October 2022, p12; November, p12, and December-January, p14).
Commissioning had become fragmented, said the Black review, with deteriorating partnerships between local authorities, housing and criminal justice agencies, among others. The government’s Commissioning Quality Standard (CQS) then set out what it thinks good commissioning should look like, with a vision of a person-centred treatment system and integrated approach – a document that was broadly welcomed by commissioning staff. So when it comes to commissioning, what does a strong partnership look like?
Connect Wiltshire is a new service that integrates drug and alcohol treatment from Turning Point and the Nelson Trust with homelessness charity Julian House and DHI (Developing Health and Independence). The latter, which was originally set up to help bridge the gap between substance misuse and housing services, operates its own social lettings agency, as well as offering supported housing, while the Nelson Trust has a strong focus on women’s services.
The service launched on 1 April this year, so it’s ‘still in its infancy’, public health principal for building resilience at Wiltshire Council, Kelly Fry, tells DDN. ‘There’s been a lot of scoping, a lot of stakeholder engagement. We’ve co-produced the specification based on local need and prevalence, but also being mindful of the Dame Carol Black review recommendations, so for us it’s been an amalgamation of various different strands that have come together into that one specification.’
Turning Point is lead provider, and has sub-contracted arrangements with Julian House, DHI and Nelson Trust. ‘That was because we felt there would be better collaboration, better resilience, better working practice, and we’re already seeing evidence of that even though we’re in those early stages,’ says Fry. ‘We wanted more of an inclusive life-course model rather than having silos for young people and adult services.’ One key aim was to address the potential for people to fall through the cracks when they turned 18, she says, ‘so we’ve factored in an 18-25 service as well which should help keep people in treatment and support when they need it. The idea is that it’s based on need, so they’d move with their key worker throughout their journey.’
‘I’m pleased with how the service is working,’ adds senior operations manager at Turning Point, Tina Roberts. ‘We’ve worked previously with our partner agencies Julian House, DHI and Nelson Trust but now we’re working as an integrated, collaborative service. Even though it’s only been a few months, I would encourage other commissioned services to combine and work together. We’re taking a holistic life-course model where there’s support for adults, young people, and supported housing to ensure continuation of care – the clients don’t have to retell their story by going from one service to another.’
When it comes to those vital housing links, Julian House has a wide client base after working in Wiltshire for a number of years, so there’s a full journey ‘in terms of early intervention, support, prevention, harm reduction advice, right the way through to supported accommodation and recovery’, says Fry. ‘We’ve also given Connect our prescribing, supervised consumption and pharmacy elements as well – again, we just felt that it made sense as they’re the clinical leads. We can oversee it as commissioners, but they know what’s working well and what isn’t.’
At the moment the partners are still meeting every two weeks, which is a ‘really important as part of mobilisation’, Fry stresses. ‘We’re really keen to keep the momentum going, making sure we’re all on the same page.’ There will be at least monthly meetings, as well as the regular meetings around grants, meaning ‘constant discussion with the key partners’, she says.
One concern about re-commissioning was the potential for a dip in service provision, Fry says, ‘so we really want people to invest in Connect.’ This has meant a keen focus on getting the message out about new identity and culture, and so far the partnership arrangements have been bedding in well, she says. One example is the supported accommodation element from Julian House – while previously there were voids, since the organisation has been a sub-contractor for Turning Point ‘we’ve been full, which is phenomenal. It just shows that developing those relationships has really paid off.’
Although it’s still early days for the service itself, what’s in place is the result of an intense 18-month period of work and planning. Aside from the usual processes and legalities of a project like this, it was also about ‘collating evidence, hearing from service users about what’s working, what isn’t, how we can improve local delivery,’ Fry stresses. ‘We co-produced specifications, so while public health are the lead commissioner we co-commission it alongside the Office of the Police and Crime Commissioner (OPCC) and we also sought support from internal services’ including children’s services, adult social care and housing. So it really did feel very collaborative.’
Wiltshire is a rural county, making travel to community hubs difficult for some people – how much of an influence did this have on shaping the service? ‘It’s something that we’re really mindful of,’ says Fry. Money from the supplementary substance misuse grant and rough sleeper drug and alcohol treatment grant enabled the service to provide outreach buses, and Connect is also looking at much more collaborative working with GPs. This additional funding for rough sleepers ‘enables us to have a team of people that are able to go out and access a different cohort of clients that may struggle to access treatment’, says Roberts. ‘We’re able to take treatment to them.’
There’s also a strong criminal justice element to the service, with workers funded through the supplementary substance misuse treatment and recovery grant. ‘We also have the money through from the OPCC so we’ve got really good continuity of care from the prisons – we really hone in on that pathway,’ says Fry.
A clear outcomes framework has been developed for the joint combating drugs partnership, meanwhile, as ‘it’s an area that touches on so many different organisations as well as our lead providers – it’s about what data can you bring,’ Fry continues. ‘What’s happening with county lines, drug arrests, A&E admissions – are those pathways working? We’re very data-driven, and everything’s shared at the combating drugs partnerships so we’re clear about whether we’re doing well or if we have to potentially support to improve that performance – or just hold partners to account.’
Peer mentors and service user reps also attend the joint combating drugs partnership meetings, while commissioners attend the service user council, so there’s constant feedback. ‘The service users are very frank, they’re very open – if it’s not working they’ll say,’ she states.
While there were some initial worries around what would change and if people would keep the same keyworker, the service was determined to communicate clearly from the start. ‘What we didn’t want to do was start losing people from treatment,’ says Fry. ‘It’s just having that continuity and discussions with service users and staff and partner agencies. The feedback is we’re getting more referrals from the 18-25s which we really wanted to see, and just the fact that we’ve got more people going through that supported accommodation pathway is testament to the fact that service users are feeling happy, feeling supported.’ To ensure that clients were aware they’d ‘still be receiving the same level of service under the Connect Wiltshire umbrella, we sent out information via email, letters, leaflets as well as speaking to clients face-to-face and updating our stakeholders in strategic meetings,’ adds Roberts.
One holistic model
So in the time since the Carol Black report said that partnerships were deteriorating, is there a sense that things are improving on a national level? ‘I think so,’ Fry says. ‘There’s a lot more governance, a lot more scrutiny, a lot more accountability now. There are national commissioners’ calls, regional commissioner meetings, SRA (senior responsible officer) meetings and more to share learning. A great deal has been put into it.’
And when it comes to lessons learned, what advice would she have for other areas trying to do similar things? ‘I think the lead-in time is really important, but now it’s about making sure that we have that life-course approach and one joined up, holistic model. I think that takes time to embed, and it can be a culture change from the way partners may have worked in the past. For example, we’re now calling them Connect rather than Turning Point and DHI. So while you’re employed by that agency, the service is called Connect. They’re their own providers with their own cultures, but for us it was about joining up so we really did create that ethos of that one service approach. It’s about letting people we know that we haven’t removed a service, we’re creating a more inclusive service for everyone – a new service based on real need.’
This series has been produced with support from an educational grant provided by Camurus, which has not influenced the content in any way.