Transcript competences of the recovery orientated workforce

ADDICTION TO MEDICINES:
COMMISSIONING IN THE NEW PUBLIC
HEALTH LANDSCAPE
Addiction to Medicines
28/02/13
Mark Gillyon
Overview
• Key Policy drivers and context
• The architecture
• Public Health England
• local Health & Wellbeing Boards and Clinical Commissioning
Groups
• Opportunities and challenges
Key policy drivers
• National Drug Strategy 2010
• Health & Social Care Act 2012
• Localism
• Transparency and accountability
• Public health and health inequalities
• Recovery
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2010 drug strategy: ‘…all services are commissioned
with the following best practice outcomes in mind’
• Freedom from dependence on drugs or alcohol;
• Prevention of drug related deaths and blood
borne viruses;
• A reduction in crime and re-offending;
• Sustained employment;
• The ability to access and sustain suitable
accommodation;
• Improvement in mental and physical health and
wellbeing;
• Improved relationships with family members,
partners and friends; and
• The capacity to be an effective and caring
parent.
Health & Social Care Act 2012
• Clinicians at the centre of commissioning
• Provider innovation
• Empowering patients
• New focus on Public Health
• Patient voice - Healthwatch
This shift will provide a platform for
a more integrated approach to improving public health
outcomes. This approach addresses the root causes
and wider determinants of drug dependence and alcohol
misuse, and the harm and impact they have on
communities and troubled families (such as mental
health, employment, education, crime and housing). It
also delivers the greatest gains for individuals and the
community. (NTA/DH 2012)
The Framework for Commissioning
Context: Suite of evidence-based clinical guidance
• In total there are 15
NICE drug and
alcohol publications
• Q1 13/14 NICE
commitment to reflect
all these in in LA PH
briefing.
The new health and care system
Local people and communities
Police and Crime
Commissioners could have a
seat. Up to each LA
Undertake JSNA & develop
HWB Strategies setting out
local priorities
The evidence in this
presentation can inform the
JSNA and HWB Strategies.
Health and Well-being Board
Local Authorities
PHE Centres
Responsible
for publishing
data and
supporting
delivery of
PHOF
CCG/NHS CB
Commissioning OF –
set by the NHS CB for
CCGs
HealthWatch
Accountability
Oversight
Links
PHE
Sets out the indicators
that the PH system &
DH understand are the
best mechanisms to
improve public health.
Up to LAs to prioritise.
Slide 11
NHS CB
PHOF
ASCOF
NHSOF
Mandate – only means of
holding the CB to account
Secretary of State for Health
Parliament
Sets out the indicators that the NHS should
seek to achieve through the Mandate objective
of continuous improvement
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Architecture
Specialist drugs and alcohol services (inc. Addiction to
Medicines) commissioned by local authorities, through
Directors of Public Health
Supported by and coordinated through Health &
Wellbeing Boards
Joint Strategic Needs Assessments (JSNAs) and Joint
Health and Wellbeing Strategies (JHWSs)
Ring fenced public health budget
From DH & Public Health England (PHE)
NTA functions transferred to PHE –April 2013
Public health outcome indicators
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Clinical Commissioning Groups
“Clinical commissioners have a crucial role to play in
ensuring that care is integrated and delivered in the
community, with maximum input of local people and patients.
Also, by working to overcome the barriers between the NHS
and social care, they will be able to provide patients with
better, seamless and more accessible care.” Dr Michael
Dixon, Chairman of the NHS Alliance (18 June 2011).
Clinical Commissioning Groups
• NHS Commissioning Board
• Guidance & tools, evidence
• Commissioning of core, general medical care
• NHS services commissioned by groups of GPs
• CCGs are responsible for care, and commissioning
enhanced care
• Continuous improvements in quality
• Reducing inequalities
• Choice & patient involvement
• Innovation & research
• Collaboration with Health & Wellbeing Boards
• Focus on outcomes
• Universal system
• All practices involved
Public Health Budgets
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13/14 and 14/15 Budgets released
£2.66 billion and £2.79 billion to LAs to spend on public
health services for their local populations. Average growth
of 5.5% in 2013-14 and 5.0% in 2014-15
‘Currently, on average, about one third of spending is
connected to mandated services, leaving a significant
opportunity to commission services that meet the needs of
your population. Services not currently covered by the
mandating regulations include obesity, smoking cessation
and substance misuse.’
Mandated: sexual health services; duty to ensure there are
plans in place to protect the health of the population; public
health advice to NHS commissioners; National Child
Measurement Programme; NHS Health Check.
The Public Health Grant
• Local authorities will need to forecast and report against the subcategories of spend in returns to Public Health England who will
review them on behalf of the Department of Health.
• ‘Pace of change’ to a target budget position (12/13 PTB formula
will affect target position within pace of change parameters)
• Substance misuse component includes: PTB; DH DIP; YP; local
drug and alcohol spend
• Prison treatment to NHS Commissioning Board
• HO DIP funding (£35M) to Police and Crime Comissioners
More opportunities and challenges
Balanced systems – maintaining gains
Priorities competing for scarce resources
Commissioning skills: making the case for investment and
developing alliances
Complexity, dual diagnosis and health
Medicines and new drugs and patterns of use
Creativity – ABCD, social enterprises, recovery communities
Engage PCCs, local Police and the crime reduction agenda
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Public Health England
Substance misuse personnel in:
• Operations Directorate (PHE Centres)
• Health and Wellbeing Directorate
• Knowledge and Intelligence (NDTMS)
• Drugs, Alcohol, ATMs and prevention
• Evidence
• Transparency
• Support and mirror