Good commissioning goes beyond purchasing, hears DDN.
A robust discussion on commissioning was the focus of the year’s final meeting of the Drugs, Alcohol and Justice Cross-Party Parliamentary Group.
‘The focus has been on austerity and shrinking funding, but the demand for our services has certainly not decreased,’ said WDP chair Yasmin Batliwala, who gave a provider’s perspective. Doing more with less meant that providers had to be innovative and ‘think outside the box’. In turn, commissioners ‘must give providers the best chance of success’ by addressing inconsistency and subjectivity in tenders, she said.
Commissioning varied enormously from area to area, and a commissioning ombudsman (as proposed in the recent Charter for Change) would help to encourage standardisation, including minimum-term contracts, and ‘eliminate questionable decision-making’.
All too frequently immediate cost savings were not taking into account longer-term investment, such as provision for youth services and healthy-living interventions. ‘Since the NTA went, we assumed more wellbeing would be added to contracts, but this hasn’t been the case,’ she said.
Mark Gilman had worked in the sector for 35 years before setting up the Expert Faculty of Commissioning with colleagues, as ‘we were concerned we were losing the memory of commissioning and wanted to keep a repository of expert knowledge’. The faculty already works with around half of local authorities that commission drug services and aims to promote best practice.
‘Too often commissioning falls to purchasing, but it’s a design job,’ he said. ‘It’s about having the vision to say, “What’s the problem, who’s in pain, and what should we do about it?”’
The most important thing was to get those who were not in treatment into treatment – ‘and you get this if you give them a free opioid. Until sanity breaks in the war on drugs, give them OST… they want to get, as quickly as possible, a drug that keeps them alive.’ The rise in polydrug use and the increase in drug-related deaths intensified the need for commissioners to understand this.
Anthony Bullock, drug and alcohol commissioner from Staffordshire, had been working with the faculty to share good practice. Among his recommendations were to make sure the narrative was much clearer: ‘There are so many nuances to addiction and recovery – what is it we want to achieve?’ Alongside this, we needed to shift the mindset ‘from funding to investing’ and ‘be able to demonstrate the value of what we do’.
Treatment meant different things to different people and it was important to recognise that different elements were needed, including peer support. ‘Our job as commissioners is to collaborate and coordinate,’ he said. ‘We need to support services to work together and have support around them.’
In the discussion that followed, Pete Burkinshaw, PHE’s alcohol and drug treatment and recovery lead, commented that it was important not to generalise in associating bad practice with all commissioning, and that we needed to be ‘careful, nuanced and precise.’