Archived decisions

Agenda Item 2

HAMPSHIRE COUNTY COUNCIL

Decision Report :

EXECUTIVE SUMMARY

1) Summary of Decision Area:

1.1. Effective substance misuse services play a significant part in supporting the corporate priorities:

· Hampshire safer and more secure for all - by promoting treatment services and encouraging users (including known offenders) to take up treatment options there is a known correlation between numbers entering treatment and a reduction in acquisitive crime rates.

· Maximising wellbeing - treatment and harm minimisation services have a significant impact on the health and wellbeing of individuals, their families, carers and communities.

1.2 This report seeks permission to formally consult on future delivery and commissioning arrangements for substance misuse services in Hampshire. The consultation will be based upon the information contained in a Strategic Review Information Pack.

1.3 The findings from the consultation will inform the production of a 3/5 year commissioning strategy for drug and alcohol services which will ensure that the best possible configuration of drug and alcohol services are effectively commissioned, properly contracted and monitored to meet needs and targets, and are affordable within the available budget.

1.4 The adoption of this approach is required to address the forthcoming reduction in the central allocation of funding for drug services. (Adult Pooled Treatment Budget).

1.5 This is likely to result in a programme of service de-commissioning, re-commissioning and tendering to achieve the desired outcome.

2) Issues Covered in Report:

2.1 Reduction over 3 years (2008/9 - 2010/11) in the centrally funded Adult Pooled Treatment Budget (PTB) requiring review of Hampshire drug treatment service.

2.2 Need for review and possible restructuring of current separate commissioning arrangements for drug and alcohol services across main commissioning agencies (Hampshire DAAT, Hampshire PCT, Adult Services)

3) Recommendations:

3.1 That approval is given to formally consult on future delivery and commissioning arrangements for substance misuse services in Hampshire. Consultation will be based upon the information contained within a Strategic Review Information Pack.

3.2 That following the 12 week formal consultation period the development plan and implementation plan, that together will form the commissioning strategy for substance misuse services, are brought to the Executive Member for further decision.

MAIN REPORT

1) Purpose of the Report:

1.1 This report seeks permission to formally consult on future delivery and commissioning arrangements for substance misuse services in Hampshire. Consultation will be based upon the information contained in a Strategic Review Information Pack.

2) Contextual Information

2.1 The requirement to undertake this review has been prompted by the following key issues:

· a significant reduction in the central allocation of ring fenced funding for drugs services over the next 3 years

· in order to rationalise current commissioning arrangements

· to provide a robust commissioning strategy for both drugs and alcohol

2.2 The recent scrutiny review, looking at access to services for people with alcohol problems, conducted by the County Council, Safe and Healthy Select Committee wished to ensure that joint commissioning opportunities were prioritised and have drawn to the attention of the Department of Health and the Home Office, the local inequities in access to drug and alcohol services associated with ring fenced fundingstreams and levels of funding.

2.3 The aim of the strategic review is to have in place, the best possible configuration of effectively commissioned, properly contracted and monitored drug and alcohol services, which meet identified needs and targets and are affordable within the available budget by 1 April 2010.

3) Key Issues:

3.1 Drug and alcohol treatment services are currently commissioned via a number of separate commissioning processes by various statutory agencies - principally, Hampshire DAAT, Hampshire PCT and Adult Services.

3.2 As a result of the recent announcement by the National Treatment Agency regarding the centrally funded, 3-year Adult Pooled Treatment allocation to the DAAT for 2008/09 to 2010/11), Hampshire DAAT is required to reduce its annual spending by 16.5% (£995,535) by 2010/11 against 2007/8 planned in-year expenditure levels.

3.3 The review may result in a substantial or significant change in service provision or delivery. It is, therefore, deemed necessary to seek full stakeholder involvement in the review process

4) The Strategic Review Process

4.1 The strategic review will follow a three stage process :

· Stage 1 - Strategic Review Information Pack (SRIP)

· Stage 2 - Formal Consultation leading to Development Plan

· Stage 3 - Implementation Plan leading to operational service delivery

4.2 Stakeholders in this Strategic Review include :

· Hampshire County Council Adult Services Department (including relevant staff)

· Hampshire Primary Care Trust

· Police

· Probation

· Local Pharmaceutical Committee and Local Medical Council

· Local Criminal Justice Board

· Community Safety Partnerships

· Elected Members

· District Councils

· Voluntary sector organizations which represent and support those with substance misuse problems

· Service providers of substance misuse services

· Adult users of drug and alcohol treatment services and their carers

All of these stakeholders are likely to affected by the outcome of the review to a greater or lesser degree.

4.3 Stage 1 will comprise of a period of information gathering which leads to the production of a final Strategic Review Information Pack (SRIP). The final SRIP provides:

· an analysis of the drug and alcohol services delivered in Hampshire

· a baseline position for the review

· verified and enhanced by stakeholders, users and carers.

4.4 Stage 2 is the development phase and comprises of :

· formal consultation with stakeholders, users and carers in order to develop proposals for the future which best meet evidenced need and budget constraints

· culminates in the production of a Development Plan to shape future provision.

4.5 Stage 3 is the implementation phase and comprises of :

· service level Implementation Plan to `operationalise' the commissioning intentions set out in the Development Plan.

· it may involve a reconfiguration of services, which may be commissioned, re-commissioned, de-commissioned or remodeled.

4.6 The timetable for this work is as follows:

· Stage 1 - Information - Jul to Sep 2008

· Stage 2 - Development - Oct to Dec 2008

· Stage 3 - Implementation - Jan 2009 to Mar 2010

4.7 The draft version of the Strategic Review Information Pack (SRIP) is now available on the DAAT website www.hampshiredaat.org.uk and all stakeholders (listed above) are invited to read, consider, comment upon and contribute to a final SRIP. The final SRIP will form the basis for the formal consultation, copies of this will also be available in the Members rooms.

5) Formal Consultation Process

5.1 The formal consultation process will be carried out in line with the One Compact (the framework for the working relationship between Hampshire County Council and the Voluntary and Community Sector), corporate and departmental procedural requirements. Research governance requirements and procedures are being followed.

5.2 Officers from within the DAAT Support Team and Wellbeing and Partnerships Section will lead and manage the consultation process.

5.3 A communications strategy will ensure effective consultation and communications processes are in place. Communications with Members will include the provision of information via HAT Coordinators. The consultation will be undertaken using a variety of methods:

· utilising the strategic and partnership meeting structure already in place in relation to drug & alcohol issues and this includes service user groups. See Appendix 3

· attendance at additional meetings upon request by stakeholders/ possible focus groups

· use of questionnaires

· use of the DAAT website to publicise consultation material and encourage use of feedback form

· DAAT newsletter

5.4 The consultation will specifically include service users and carers. The Chair of Hampshire Working Group (drug service users) has been part of the project team for the review. Hampshire Working Group, Hampshire Alcohol Advisory Group and Hampshire Carers Forum will be formally consulted and asked to participate in the development of service user and carer questionnaires, which will be made available in provider agencies.

5.5 Preliminary discussion has taken place with the Equality, Diversity and Inclusion Manager to explore how best to consult with marginalised groups. Community Action Hampshire may be commissioned to undertake this work.

5.6 The integration of the Personalisation agenda will also be considered as part of the review.

6. Impact and Implications

6.1 Legal

6.1.1 Powers available under Section 75 of National Health Service Act (2006) ("Health Act Flexibilities") may be applicable in relation to the rationalisation of commissioning arrangements and the possibilities of aligning or pooling existing commissioning budgets.

6.1.2 A meeting to discuss with HCC legal services has been arranged in September 2008.

6.2 Financial

6.2.1 The strategic priorities identified in the Adult Drug Treatment Plan for 2008/09 include the delivery of a financially sustainable treatment system.

6.2.2 As a result of the recently announced 3-year Adult Pooled Treatment Allocation (2008/09 to 2010/11), Hampshire DAAT is required by 2010/11 to reduce its annual spending by 16.5% (£995,535) against 2007/8 planned in-year expenditure levels by 2010/11.

6.2.3 The reduction in total annual funding available is 18.4% (£1,152,885) compared to 2007/8 levels. This results from a phased 17% reduction in the annual centrally-funded Pooled Treatment Budget (PTB) and the loss of non-recurrent funding opportunities.

6.2.4 The reduction in funding has arisen due a change in the funding formula which is now based on levels of delivery and an analysis of unit costs for specialist treatment, undertaken by the Audit Commission. As a large predominantly rural county, Hampshire's costs per case are above average and the redistribution of central funding under the new formula will move funding to those DAAT areas who have previously received below average funding per case.

6.2.5 A reduction in funding of this magnitude cannot be delivered through imposed efficiency targets alone. The strategic review process will, therefore, seek to reprioritise planned developments and identify opportunities for decommissioning.

6.3 Personnel Implications

6.3.1 TUPE may apply to providers staff where there are changes to commissioned services.

6.4 Impact Assessment

6.4.1 In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. The Hampshire DAAT diversity statement states that it is committed to securing genuine equality of opportunity, recognising the many differences between people and avoiding or overcoming discrimination, whether required by law or not, in all aspects of its activity by positively valuing different perspectives and skills.

6.4.2 The Hampshire DAAT ensures through its contracting and contract review processes that all service providers demonstrate equality of access to, and quality of treatment across all groups of potential service users and that all services shall respond positively to the needs of diverse drug users, including cultural, religious, language, gender, sexuality, disability, age and communication need.

7) Outline of Options:

a) Option 1:

i. Undertake strategic review of drug and alcohol treatment system and commissioning processes ensuring full, formal consultation with all key stakeholders.

ii. Outcomes of the review to inform the development of a 3 to 5 year strategic joint-commissioning strategy.

b) Option 2:

i. Seek to maintain existing treatment system.

ii. Necessary reductions in expenditure to be delivered through opportunistic savings and negotiated efficiency programmes.

8) Option Analysis / Comparison:

a. Option 1:

i. Meets national and local requirements and expectations in respect to stakeholder consultation and service user involvement.

ii. Provides opportunity for consolidation of commissioning processes thereby supporting cohesive strategic commissioning direction and integrated commissioning practice.

iii. Provides opportunity for whole-system redesign maximising benefits to clients through delivery of complimentary services and integrated care pathways.

iv. Maximises potential for management of commissioning within known financial constraints.

v. Managed impact on service quality due to scope for proactive service planning.

b. Option 2:

i. Does not meet national and local requirements and expectations in respect to stakeholder consultation and service user involvement.

ii. Provides opportunity for consolidation of commissioning processes thereby supporting cohesive strategic commissioning direction and integrated commissioning practice.

iii. Does not provide opportunity for whole-system redesign, hence failing to maximise benefits to clients through delivery of complimentary services and integrated care pathways.

iv. Limits opportunities for proactive commissioning and financial management. Risk of in-year overspend due to reactive nature savings.

v. Significant impact on service quality due to reliance on opportunistic savings and extremely challenging efficiency targets.

10. Conclusions:

10.1 A strategic review of the drug and alcohol treatment system and related commissioning processes is necessary to ensure the sustainable and equitable delivery of high quality services that are:

i. affordable within known funding constraints;

ii. appropriate to the needs of Hampshire clients;

iii. meet the requirements of both the national Drug and Alcohol strategies.

10.2 The review may result in a substantial or significant change in service provision or delivery. It is, therefore, deemed necessary to seek full stakeholder involvement in the review process.

11. Summary Recommendations

11.1 That approval is given to formally consult on future delivery of substance misuse services in Hampshire. Consultation will be based upon the information contained within a Strategic Review Information Pack.

11.2 That following the 12 week formal consultation period the development plan and implementation plan, that together will form the commissioning strategy for substance misuse services, are brought to the Executive Member for further approval.

CORPORATE OR LEGAL INFORMATION: