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Drug System Change Pilot
Commissioning for Substance Misuse in a Personalised Way
Sue Wilks, DAAT Manager
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The Concept
personalised care in aself directed way usingindividual budgets viadirect payments………
Personalisation & Self Directed Support - Background
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Challenges perceptions - giving drug users money changing the way services are secured changes needed by everyone – staff,
service users, commissioners, providers balancing choice, risk, clinical safety and
flexibility market and broker development
Personalisation & Self Directed Support
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The Basics
We are not offering choice and control :in specialist prescribing medical detoxdrug of choice
Personalisation & Self Directed Support
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We have:A set of very basic and simple tools developed, Self Assessment Questionnaire (and Resource
allocation)Banding levels A – E, reflecting basic Tiers and
services currently available Personal support plan
Delay inputting of the resource until identified support to meet need from ALL resources
Personalisation & Self Directed Support
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Key points to cover
some notes to consider current picture desired picture changing the approach keeping a foundation the reality
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We already provide some interventions in a semi personalised way .e.g. spot purchases, small flexible funding allocations
Treatment system is covered by several funding streams – PCT, LA, DAAT. Range of leaders needed to be involved
There are many steps and barriers to reaching our aspirations of social enterprises, buyer groups
Some notes to consider :- Where are we ?
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Commissioning…….
how to change without destabilising the systems
joint commissioning outside of substance misuse
Consider :-
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Current Picture
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Desired Picture
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Changing the approach
Through new contracts and building in flexibility
Release funds from block contracts
Translate block contracts into individual budgets
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Changing the contracts
2 options suggested, through :
gradual reduction in contract value, releasing funding into new areas of service growth
– commissioner to develop the flexibility provider sub contracting and developing
flexible markets within their contracts
– provider to develop the flexibility
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Changing the contract
Percentage sub contracted or distributed via self directed support
Commission full service at outset
↑ ↑ ↑Start of contract 2.5 years 5 yearsSmall amount of
core commissioned services
Flexible markets and services
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Changing the approach
Release funds from block contracts Structured day Psychosocial services Residential rehab
Translate block contracts into individual budgets Create unit price Work with individuals to tailor their
package linked to current provider
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Keeping a foundation
At the point of contact – few clients want to start taking control at this point, they want support, advice, and help to deal with presenting need
Not always able to take control and make choices at key points
Opportunities can be increased using anticipatory care planning.
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Keeping a foundation
Core Commissioned service. .
Flexible Markets –
SDS options
Limited SDS Choice and control Well being, recovery and reintegration
Engagement developed
Wider reintegration & recovery community based
services
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The Reality
To date the pilot has seen: a few work through the full process / low allocations a focus on structure - college and / or training – yet to
translate into actual take up on courses request to use resources for rent / accommodation –
areas already known to be areas of unmet need in the sector.
a few disengage from the scheme. low take up concerns this is another tool in addition to others (CAT,
ITEP, PSP) - need to streamline
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Next steps:
Now increasing practitioner engagement to enable more clients to engage with the pilot as numbers remain low.
Providers are considering how to respond and engage with the changes, but as yet little demand from client group.
Positive interest from service user groups – social enterprise and buyer groups
The Reality
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Barriers & Constraints Need for hearts and minds to move – not just structural Using evidence based and registered services Commissioning boundaries – supporting people, criminal
justice Maintaining and engaging small providers to retain the
flexibilities they offer Existing commissioned services and contracts Transitional period for all areas of the system – clients,
practitioners, providers, commissioners
The Reality
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For further information :
Please Contact :
Jessica BerrySelf Directed Support Project Manager
Mob: 0776 0992311Fax: 01256 818270