Commissioners and Providers must work together to find innovative solutions: Richard Roberts on key points from #EXCO2018.


Richard Rodgers, NHS SMPA representative and Strategic Lead for Greater Manchester Mental Health NHS Foundation Trust, attended the Expert Faculty on Commissioning’s first congress (#EXCO2018) last week. Here’s his round up of the event:

Last Friday I attended the first integrated meeting for commissioners and other experts in the substance misuse field to debate the future of services for Opiate Use Disorder (OUD). 

Rosanna O’Connor (Public Health England) acknowledged the pressures facing the treatment system (an ageing population, the rise in drug-related deaths and a reduction in resources), all pointing to the need for commissioners and providers to work together to find innovative solutions. 

The needs of long-term heroin users are increasingly complex. Additionally, trends showing a rise in the prevalence of crack, the use of new Psychoactive Substances (NPS) (particularly in the prison and homelessness populations), and the threat of Fentanyl provide significant challenges for commissioners. It is crucial that in future, commissioners procure services that are able to respond effectively.

Rosanna reported that the cut in budgets across substance misuse, as demonstrated by the local authority financial accounts, was around 7% across the country. She called on commissioners (who often tell her anecdotally of far greater cuts to their budgets) to ensure the accuracy of the figures through their respective councils. 

Rosanna also called on commissioners to use levers with other departments within the council to demonstrate the cross-cutting benefits of continued investment in the drug and alcohol sector. Example departments include: child protection, adult social care and crime reduction. 

Mark Gilman estimated that as many as 100,000 people who use drugs (PWUD) are not in treatment and asked how we make our services attractive to them while minimising the risks of their drug use. 

It was great to see a genuine appetite for collaboration between commissioners and a recognition that working with providers (rather than in opposition to them) has to be the way forward - ‘there is no innovation without collaboration’ seemed to be one of the key themes of the day - but of course the market has created these tensions. It would be unrealistic to deny that this represents a huge elephant in the room. 

The afternoon panels were lively where the importance of harm reduction, of shared care across rural areas, and the impact of Adverse Childhood Experiences (ACE) were discussed. 

There was recognition that in order to provide stability for innovation there was a need for longer contracts, which is supported in the drug strategy. However, the commissioners on the panel described this being unsupported by the commercial and legal departments within the council. 

The workshop I attended had an interesting debate about choice and how far we can realistically expect services that have experienced significant reductions in their budgets to offer a wide range of alternatives to service users. Digital solutions clearly have potential but are they really a substitute for talking to a person face to face, and can it be done ‘at scale’?

Throughout the day (particularly in the afternoon workshops) the desire to share information between commissioners about local initiatives that are making a difference was palpable. 

The starting point for the Faculty is the drawing up of a manifesto – watch this space!

At the NHS SMPA, we’re keen to share examples of best practice so they inspire other service providers and can be replicated in other areas. Has your service been working with Commissioners in an innovative way to develop better outcomes for service users? We’d love to hear from you! Please get in touch.