Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report :

EXECUTIVE SUMMARY

1) Summary of Decision Area:

1.1. This report outlines proposals relating to the future delivery and commissioning arrangements for substance misuse services in Hampshire, following a period of formal consultation.

2) Issues Covered in Report:

2.1 Background and contextual information about the substance misuse strategic review process.

2.2 The emerging themes arising from the formal consultation undertaken from 2 October 2008 to 2 January 2009 and a summary of the consultation responses in line with departmental protocol and the requirements of the One Compact for Hampshire.

2.3 Proposals for the future delivery and commissioning arrangements for substance misuse services (drugs and alcohol) in Hampshire.

3) Recommendations:

3.1 That the Executive Member for Adult Social Care accepts the outcome of the consultation and emerging themes as the basis for future service delivery and commissioning arrangements.

3.2 That the Executive Member for Adult Social Care accepts the financial forecast and approves the strategic direction and proposals for future service delivery and commissioning arrangements for substance misuse services in Hampshire as outlined in the Development Plan.

3.3 That, following work to pursue any potential National Health Service Act flexibilities (Section 75 Partnership Arrangements or Section 256 Grant Arrangements, National Health Service Act 2006), any formalised proposals will be brought to the Executive Member for further decision.

3.4 That a further report will be brought to the Executive Member on completion of the Implementation Plan, seeking authority to tender for the new treatment system.

MAIN REPORT

1) Purpose of the Report:

1.1 To provide feedback on the substance misuse strategic review process, following the period of formal consultation, in line with the Departmental consultation protocol and the One Compact for Hampshire.

1.2 To seek approval from the Executive Member for Adult Social Care, regarding the strategic direction and proposals for future service delivery and commissioning arrangements for substance misuse services in Hampshire.

2) Contextual Information

2.1 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 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.

2.2 A countywide strategic review of substance misuse services was launched during July 2008 and a formal consultation process, based upon a strategic review information pack took place between 2 October 2008 and 2 January 2009.

2.3 The review does not consider the commissioning or service delivery arrangements for children and young people under 18 (or up to 19 for those already engaged in the young people's treatment system). It does however take account of the transitional needs of children and young people and the needs of children and families or households affected by an adults substance misuse and future service delivery will have clear links to Children's Services, family work and young carers.

2.4 The desired outcome of the review process is to deliver the best possible configuration of drug and alcohol services in the county. These services will be effectively commissioned, properly contracted and monitored to meet needs and targets, and will be affordable within the available budget.

2.5 The need to undertake a substance misuse strategic review was 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

2.6 The strategic review has followed 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

3) Key Issues for Consideration:

3.1 Reduction over 3 years (2008/9 - 2010/11) in the centrally funded Adult Pooled Treatment Budget.

3.2 The performance issues in respect of National Indicator (NI) 40 - Number of Drug Users in Effective Treatment, which has a direct influence on future allocations of the DAAT Pooled Treatment Budget.

3.3 The need to deliver the alcohol flagship 10 Point Plan as part of the work programme for the Local Area Agreement (see Appendix C).

3.4 Proposals for the future delivery and commissioning arrangements for substance misuse services in Hampshire.

4. Information relating to the Formal Consultation Stage:

4.1 The formal consultation process has generated:

· 32 service user and 6 carer responses

· Of the 32 service user responses, 18 were drug clients, 4 were alcohol clients, 7 used both drugs and alcohol and 3 were no longer in treatment

· 19 partnership/agency/ organisation responses

· Of these 3 were from key strategic partners; 7 from commissioned providers, 1 from a non commissioned (tier 1) provider, 5 from district-based partnership groups and 3 from voluntary sector/user led groups

4.2 Emerging issues from the consultation

· Good access and clear referral pathways

· One stop shop model, including hub and spoke arrangements

· More alcohol service provision and greater parity between drugs and alcohol

· Community reintegration

· Adequate detoxification and rehabilitation including community based provision

· Integrated commissioning across drugs and alcohol and all partners

· Holistic assessment and interventions

· Family /Carer Services

· Flexible, low threshold, rapid prescribing

· Emphasis on recovery

· Blood Bourne Virus testing and harm reduction

· Equity across the county

· Carer/Service User involvement

· Improved waiting times

· Outcome focused commissioning and service delivery

· Personalisation

4.3 The following issues were also raised by a number of respondents; longer contracts to provide stability, better dual diagnosis provision, attention to retention and drop out, shared care, early intervention and prevention, improved publicity and promotion of services

4.4 The existing system was considered during the consultation and positive comments have been recognised in Questions 1, 3 and 8 (See Appendix 1). Many of the key priorities and objectives identified by respondents are already underway or aspired to within the existing treatment model; these include areas like improving waiting times, clear referral pathways, effective outcome-based treatments and shared care.

4.5 The response to the question `what do you consider to be working well' highlights positive elements that can be found within the existing treatment system which should be retained and built upon, for example:

· Trying to provide equality across the county

· Clear referral pathways, good inter-agency working between open access services and community substance misuse teams

· Relationships and communication between agencies is professional

· Waiting times low for drug clients

· Open access shop front services successful in providing well located access points

· The current geographic focus and service models seem to be working well

· Process and provision in place and routes into treatment

· Skilled committed professionals with willingness to improve

· Joint working at a strategic level regarding domestic abuse and drug and alcohol issues

4.6 The current model is well thought out and has increased provision and opportunities for treatment; this should not be overlooked.

4.7 Respondents identified a number of issues that were not working well or were gaps within the existing system in questions 1, 3, 5 and 10:

· The need to provide additional provision for alcohol service users and to remove post code inequalities is a recurring theme. The weight of this argument should not be underestimated and it is developed by a number of respondents who mention specific services and geographical areas that need to be included.

· Dual Diagnosis and closer links with Community Mental Health Teams is an issue that needs to be better addressed.

· The care co-ordination model is not perfect, clients do not want to attend two or three different services and this has implications for CARE counselling / structured day services. If they were followed by the same service then this would benefit service users.

· The Common Assessment Tool is mentioned as needing to be reworked.

· Contracts need to be longer in order to promote stability, with a 4 year +1 year model favoured.

4.8 Respondents began to develop new ideas for delivery, questions 1, 3, 5 and 6:

· Integrated criminal justice intervention, integrated commissioning for drugs and alcohol and a combined service where possible.

· The DAAT taking on responsibility for premises to allow for more seamless transition between services and greater influence of service location. However, the cost implications of this approach may make this idea untenable.

· The personalisation agenda will need to be accounted for, however services are configured and Hampshire is currently bidding to become a pilot site for personalisation as part of the National Treatment Agency (NTA) Drug System chance pilots.

· Dependant drinkers who are referred by a GP should be able to directly access Tier three services.

· The One Stop Shop model, possibly supported by a hub and spoke arrangement of satellite provision was advocated by a number respondents and the benefits of this model would seem to address a number of the gaps in current provision. These include:

o Services not working in silos

o Providing a more holistic approach

o Allowing for specialist workers

o Improved care pathways

o Reduced drop out rates

o Reduced building overheads costs

4.9 All of these considerations, together with any new national and local drivers have been taken into account in the development of the service delivery model for the Hampshire Treatment System.

5) Next Steps

5.1 The formal consultation phase formed a part of the ongoing substance misuse strategic review process and it is important to note that certain elements of the review will be subject to the emerging outcomes of the community safety strategic review, which will report to the County Co-ordinating Group for Community Safety in September 2009 and further discussion will also take place with strategic partners.

5.2 Further work has been undertaken to:

· develop the service delivery model for the Hampshire treatment system, clarify care pathways and describe the treatment journey.

· progress the proposals for joint commissioning and the appropriate administrative, governance and accountability arrangements to support these processes

6) Proposals for Future Service Delivery and Commissioning

6.1 A `working draft' of the Substance Misuse Strategic Review Development Plan is attached for information at Appendix D. This document provides information on the `direction of travel' in terms of the strategic commissioning intentions which will support the planning and delivery of services within the treatment system.

7) Impact and Implications

7.1 Legal

7.1.1 In preparation for the review, existing contracts that were due to expire during the period of the review were extended and those that extended beyond the period of the review have received notice, to facilitate a process of commissioning to implement the findings of the review.

7.1.2 Advice and guidance will be sought from Hampshire's Legal Department during the preparation of the tender paperwork, tender timetable and evaluation criteria.

7.1.3 An open tender process will be conducted for each new contract to be let and the award recommendations will be submitted for approval, in preparation for the contract awards by Legal Services.

7.1.4 The Transfer of Undertakings (Protection of Employment) Regulations 2006 (SI 2006/246) are designed to protect the rights of employees in a transfer situation enabling them to enjoy the same terms and conditions, with continuity of employment, as formerly. These are likely to apply in most cases relating to non Hampshire County Council staff who are delivering services within existing contracts arising from the tender process and the letting of new contracts.

7.1.5 Whilst not anticipated, if there are any changes in employment relating to the Hampshire County Council Social Work staff, the Transfer of Undertakings (Protection of Employment) Regulations 2006 (SI 2006/246) may apply.

7.1.6 Advice and guidance will be sought from Hampshire's Legal Department with respect to the progression of any Health Act flexibilities (Section 75 Partnership Arrangements or Section 256 Grant Arrangements, National Health Service Act 2006) and the development of any legal agreements pertaining to the above.

7.2 Financial

7.2.1 The table below provides the current profile for income and expenditure

7.2.2 The current profile for income and expenditure indicates that without the re-tendering exercise and support from Adult Services to offset possible pressures there would be an expected overspend of £414,575 in 2010/11.

7.2.3 In order to manage the funding deficit over the three year period, steps were taken to maximise the amount of managed under spend carried forward from 2008/09. As a result the DAAT was able to carry forward £750,527 from 2008/09 into 2009/10.

7.2.4 There are two key points relating to financial impact and implications:

· re-tendering / re-commissioning exercise will deliver the required efficiencies to ensure a balanced budget position by 2010/11

· the carry forward of non-recurring funding across years has been approved by the partnership and by the National Treatment Agency

7.3 Impact Assessment

7.3.1 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.

7.3.2 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.

7.4 Human Resources

7.4.1 There are five full time equivalent Social Care staff, employed by Adult Services and supported by funding from the Hampshire DAAT Pooled Treatment Budget. These staff, together with a further seven social work posts funded by Adult Services are part of the current multidisciplinary community based substance misuse teams currently providing structured treatment services.

7.4.2 The future delivery of structured treatment services will form part of the open tender process which will be put in place during 2009/10 and will therefore have implications for all 12 FTE staff employed by Adult Services.

7.4.3 Whilst not anticipated, if there are any changes in employment relating to the Social Work staff, the Transfer of Undertakings (Protection of Employment) Regulations 2006 (SI 2006/246) may apply.

7.4.4 These staff have been closely involved with the consultation process and are also involved in ongoing work to clarify and redefine the social work role within the new treatment system.

8. Summary Recommendations

8.1 That the Executive Member for Adult Social Care accepts the outcome of the consultation and emerging themes as the basis for future service delivery and commissioning arrangements.

8.2 That the Executive Member for Adult Social Care accepts the financial forecast and approves the strategic direction and proposals for future service delivery and commissioning arrangements for substance misuse services in Hampshire as outlined in the Development Plan.

8.3 That following work to pursue any potential National Health Service Act flexibilities (Section 75 Partnership Arrangements or Section 256 Grant Arrangements, National Health Service Act 2006) any formalised proposals will be brought to the Executive Member for further decision.

8.4 That a further report will be brought to the Executive Member on completion of the Implementation Plan, seeking authority to tender for the new treatment system.

Appendix A

CORPORATE OR LEGAL INFORMATION:

Appendix B

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

A comprehensive Equalities Impact Assessment has been carried out.

The Substance Misuse Strategic Review process and the development of a new treatment system in Hampshire will build upon the current knowledge base, data evidence and activity in place (as described within the assessment), to improve access and engagement with the drug treatment system by groups of individuals who may be marginalised by virtue of a wide range of presenting needs.

The 2009/10 Adult Treatment Plan specifically prioritises BME; substance misusing parents; crack users; problematic drug users (PDU's) aged under 24, however, all groups should expect an improvement in the way their needs are met in a more holistic and integrated way.

It is proposed to undertake a regular review and update the Equalities Impact Assessment on an annual basis. Progress will be evidenced by an improvement in the knowledge base relating to marginalised groups, the available data evidence and documented activities in place.

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.

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.

2. Impact on Crime and Disorder:

The County Council has a legal obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all decisions it makes on the prevention of crime.

The proposal in this report aims to improve the safety of vulnerable Hampshire residents and reduce the risk of crime occurring.

There are elements of the substance misuse treatment system that interface directly and indirectly with the criminal justice system and impact upon community safety across the county. In carrying out this strategic review we have been mindful of these links and have ensured that we have an overview of both the substance misuse strategic review and the community safety strategic review and have been involved in the development and detail of both reviews.

The strategic commissioning of an integrated drug and alcohol treatment system will contribute directly to the delivery of National Indicators NI15 - 18, 20, 30, 38, 41 & 42.

3. Climate Change:

a) How does what is being proposed impact on our carbon footprint / energy consumption?

The re-commissioned treatment system will have regard to the accessibility of services to the client and will include the physical accessibility, i.e. proximity to public transport and the use of satellite provision to take the service into localities to reduce the burden of travel placed upon service users. An increase in local purchasing due to personalisation may also reduce carbon footprint through reduced travel.

b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

As the procurement process develops, a requirement to consider the need to adapt to climate change, and be resilient to its longer term impacts will be taken into account in the detailed planning and development of the Invitation to Tender (ITT). Prospective service providers will be required to demonstrate that they have considered climate change in developing their service delivery model.

Alcohol Flagship/ 10-Point Plan

Summary of 10-Point Plan - by Functional Area/ Objective