‘There’s a great deal of potential for the sector to start to see ourselves as less of an isolated world of “we only do substance misuse interventions”, and much more as a part of an overall health and wellbeing public service,’ says Ryan Campbell, who took over as chief executive of KCA in April.
KCA provides mental health and troubled families services alongside its drug and alcohol work, and he believes there’s enormous potential for organisations to make more of their skills and capabilities – against, of course, the backdrop of financial uncertainty. ‘Most organisations in the sector are going through a process of change to adapt to the new commissioning arrangements and the new contract formats, and KCA, like everybody else, is working out where we fit into that new environment.’
The same features that made the KCA role attractive to him will, he hopes, make the organisation attractive to commissioners and communities, and KCA has been working on its new three-year strategy, which goes live next April. In the meantime, priorities are to work in partnership with other providers to meet ‘more public health needs’, as well as to support the professional and personal development of its own staff. ‘One of the by-products of the contracting and retendering culture, mixed with financial constraints and uncertainty about the future, is that organisations have been under pressure to minimise their cost base, and that can sometimes threaten the amount of support and development they’re able to give staff. But to support the health and wellbeing of our service users we need to be committed to the health and wellbeing of our own staff.’
The organisation remains unusual in providing both substance use and mental health services, and he’s also chair of mental health charity Mind. Does he think there’s enough support for people with a dual diagnosis? ‘No I don’t, and I actually take issue with the term “dual diagnosis”,’ he states. ‘It’s another form of compartmentalising people. Very few people fall into the technical definition of dual diagnosis – you tend to have to have very severe and entrenched needs in both substance misuse and mental health, and of course if you have entrenched needs in both of those areas the chances are you’ll have some quite considerable needs in other areas too. So to parcel up a small number of people under the label “dual diagnosis” I find quite problematic.’
Is it limiting people’s access to support? ‘I think it certainly is,’ he says. ‘The other thing that limits access is that dual diagnosis tends to operate on the basis of different kinds of organisations coming together, so it’s unusual for most mental health services to be delivered by a substance misuse provider, and vice versa. That means that a client who’s got a range of needs – and they’re not different facets of your situation – has to get those interventions from different organisations in what’s often quite a complex series of pathways and protocols and strategic meetings. It isn’t the best experience for the client or the most efficient way of delivering a service.’
The recent Brighton and Hove drug commission recommended that adult and young peoples services be kept separate, so that young people get age-specific care and aren’t in contact with older service users (DDN, May, page 5). As KCA does both, what’s his take on that?
‘At the moment [the services] are quite separate, although there’s quite a considerable hinterland between the two,’ he says. ‘If we’ve got someone who’s been in young persons’ substance misuse services, to just say on their 16th or 18th or 24th birthday or whatever that they have to enter an adult service can be quite difficult, so we try to make sure there’s access into both so they get the service that’s most appropriate. I don’t see any reason why those services can’t be delivered under the same umbrella, but overall I’m very supportive of the idea that working with young people is a distinct specialism.’
One reason is that adults and young people tend to present at different stages, he says. ‘Not many young people think of themselves – or should be thought of – as entrenched, serious drug users and to try to put a young person through a typical adult pathway just isn’t appropriate. It’s more about how they manage the risks in their lives and their own behaviour, and how they manage their substance use within that. That’s quite a distinct specialism.’
He’s been in the voluntary sector for more than 16 years and came to KCA after five years at RAPt, which he joined from Age Concern. But he also has personal experience of both mental health and addiction issues. ‘I think it’s quite important that people in recovery are open about being in recovery,’ he says. ‘It’s part of the agenda for tackling the stigma around both substance misuse and mental health. The general population often get messages about substance misuse and mental health which are purely around chaos, harm caused to self and others, and which really don’t focus on the recovery aspect. There are a lot more people in some form of recovery than there are in those chaotic phases, and I think it’s really important that that’s visible. I’ve always been very open about my own recovery status.’
KCA has doubled in size in the last five years to employ around 450 people, and one of his ambitions is to be able to broaden the support it offers. ‘I think we’re missing a lot of opportunities to help people to the fuller path of recovery, so I’d like KCA to be seen as part of a health and wellbeing approach where we support people and families into full recovery, which isn’t just isolated into 12 weeks of treatment and a little bit of aftercare.’
Another ambition is to continue to develop in ‘what is quite a difficult environment with additional risks – as well as opportunities – around payment by results and all those sorts of things,’ he states. He’s previously said that one of the downsides of PbR was a growing culture of secretiveness – is that still the case? ‘I think people are starting to open up a bit more but I think it’s still a risk, and not just around payment by results – it’s around the commercial confidentiality that enshrouds contract tendering in general,’ he says. ‘But it can be particularly prevalent in payment by results contracts.
‘I’ve always worked in the voluntary sector, so I can remember in my days with Age Concern there was rivalry and competition for grant funding, but I would take it as a point of pride that if my organisation was doing something really well I wanted every other organisation to do it. Yes, I wanted us to get some credit for it, but I wanted everyone else to do it. Now my fear is that we’ve got this atmosphere where if your organisation is doing something well you keep how you do that very closely guarded secret so that you can take someone else’s contract off them in the next couple of years. That does worry me – that we’ve got a way of working that limits the dissemination of ideas, which has always been a strong feature of the voluntary sector.’
Signs of improvement
So is the risk that things will become even more cutthroat? ‘I’m a born optimist, and I think things will get better,’ he says. ‘That’s partly because no one wants to work in a system that’s inefficient or unpleasant to work in, and where it has happened I believe it’s been accidental.’
There are already signs of improvement, he feels. ‘There was a time around three or four years ago, for instance, when no provider or commissioner would have an open discussion about whether wholesale re-tendering of services did or didn’t add value, whereas that now seems to be a feature of discussion at conferences and policy forums and the like – people are actually examining what we’re doing and asking whether it’s good or bad.’
There’s also a sense of regret in the sector about smaller organisations going under, he says. ‘Sometimes that’s the way of the world, but if it happens as a by-product of a system then it’s a tragic shame because it’s difficult to build something like that back up. So we’re now having open discussions around how we can protect the real jewels of the voluntary sector, who are sometimes quite small and unable to compete in a massive contract, payment by results world. I can really feel a movement to make sure that doesn’t happen, and make sure we have a well-functioning system that puts the needs of our clients above the needs of our individual organisations.’
It’s even possible that financial constraints could make that more likely, he believes. ‘One big area of growth in the voluntary sector was in the 1970s when charities started to not be run in that parochial, slightly patronising hangover from the Victorian, “worthy poor” type way, and instead became more organised, grassroots organisations. That happened at a similar time of political uncertainty, severe financial uncertainty and poor outlook. There’s something about a financial crisis or recession that brings out in the voluntary sector, and people as a whole, their will to work together and make the absolute best of the limited resources they’ve got.’