This was an excellent blog written by John Jolly, CEO of Blenheim in November looking at the negative impact of the commissioning and procurement of drug and alcohol sector services. I shan’t republish in it’s entirety but feature the sections that resonated with me and you can read the whole piece here.
At Blenheim we have serious concerns about the commissioning, procurement, tendering, payment terms and the application of payment by results in the drug and alcohol sector. We also have great sympathy for the impossible funding environment that Local Authorities have been placed in by Central Government. This is not helped by the latest 6.2% cut in Public Health England (PHE) funding to Local Authorities, a £200 million in year cut. We share the growing concern that cutting £800 million from the PHE budget over the next four years will only be the tip of the iceberg, with some expecting the PHE budget to be decimated by the spending review in November or in subsequent years. Given that drug and alcohol treatment and indeed all PHE services provided by Local Authorities are subject to the NHS constitution it is outrageous that PHE spending, which is mainly invested in services for stigmatised and vulnerable groups is under attack.
It is right that local authorities now responsible for the provision of community based drug and alcohol treatment in England have a process for retendering the work provided to them by organisations such as Blenheim, however there needs to be a level playing field for charities of varying sizes, large private sector companies, NHS and local authorities. More importantly any recommissioning needs to be aware of the impact on service users.
Poor and frequent commissioning and procurement has a number of serious consequences not least of which is the cost. An exercise done by a provider to quantify the costs of tendering services over 10 years ago came up with a figure of £300,000 as the cost expended by all bidders and the commissioning authority per tender. Unintended impacts include deteriorating service provision, poor staff morale, and more importantly the fact that transitions between providers along with early exits from treatment are known factors in drug and alcohol related deaths. For example 1 in 200 injecting heroin users released from prison die within a month of release.
Increasingly charities like Blenheim seem to be in the business of tendering rather than in the business of caring for people in desperate need. In the last two years nearly 100% of drug and alcohol services have been through retendering processes according to a Drugscope survey.
A report, ‘Review of Alcohol Treatment Services’ published in August 2015 by the Recovery Partnership funded by the Department of Health into the state of alcohol services raises serious concerns about the impact of the current commissioning environment as did the ‘State of the Sector’ report, by Drugscope in 2014 into drugs and alcohol services.
The blog then goes on to look in detail at:
- Transfer of Financial Risks
- Payment by Results (PbR)
- Procurement, tendering and contracts
- Minimum Turnover Requirements
- Tendering Processes
If we want a thriving drug and alcohol sector we need to create a funding and commissioning environment where it can survive. Otherwise we face the risk of a choice of four or five mega charities as all but the largest go the way of the corner shop and the local butcher. Like banks and NHS Trusts these large charities maybe too big to let fail, but get into financial difficulty some will in the not to distant future as cuts in funding and huge public sector liabilities catch up with them.
I agree with everything he writes and worry about the future of this sector and more importantly the people, like you and me, that they serve.
PS I also listened to this yesterday: www.bbc.co.uk/programmes/p03fc82k
David Yelland, former editor of The Sun and recovering alcoholic, and Adrian Anthony Gill, whose recent memoir Pour Me tackles his own problems with alcohol, talk frankly with John Humphrys about their relationships with drink. They appear on Channel 5’s documentary My Name Is… And I’m an Alcoholic airing on 13 January 2016. I watched it & would really recommend. As soon as a Youtube link goes up I’ll share it for my global friends. Those in the UK might be able to catch it on C5 catch-up 🙂
Edited to add: thank you to the lovely Paul over at Alcoholics Guide to Alcoholism for sharing the link to the show mentioned above. Here it is! 🙂