Transcript System change personalisation - Sue Wilks

Sue Wilks, DAAT Manager
Drug System Change Pilot
Commissioning for Substance
Misuse in a Personalised Way
Personalisation & Self Directed
Support - Background
The Concept
 personalised
care in a
 self directed way using
 individual budgets via
 direct payments………
Personalisation & Self
Directed Support
Challenges
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perceptions - giving drug users money
changing the way services are secured
changes needed by everyone – staff,
service users, commissioners, providers
balancing choice, risk, clinical safety and
flexibility
market and broker development
Personalisation & Self
Directed Support
The Basics
We are not offering choice and control :
 in specialist prescribing
 medical detox
 drug of choice
Personalisation & Self
Directed Support
We have:
A set of very basic and simple tools developed,
 Self Assessment Questionnaire (and Resource
allocation)
 Banding levels A – E, reflecting basic Tiers
and services currently available
 Personal support plan
 Delay inputting of the resource until identified
support to meet need from ALL resources
Key points to cover
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some notes to consider
current picture
desired picture
changing the approach
keeping a foundation
the reality
Some notes to consider :Where are we ?
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We already provide some interventions in a
semi personalised way .e.g. spot purchases,
small flexible funding allocations
Treatment system is covered by several
funding streams – PCT, LA, DAAT. Range of
leaders needed to be involved
There are many steps and barriers to
reaching our aspirations of social enterprises,
buyer groups
Consider :Commissioning…….
 how
to change without destabilising
the systems
 joint commissioning outside of
substance misuse
Current Picture
Desired Picture
Changing the approach
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Through new contracts and building in
flexibility
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Release funds from block contracts
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Translate block contracts into
individual budgets
Changing the contracts
2 options suggested, through :
gradual reduction in contract value,
releasing funding into new areas of
service growth
– commissioner to develop the flexibility
 provider sub contracting and developing
flexible markets within their contracts
– provider to develop the flexibility
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Changing the contract
Flexible markets
and services
Percentage sub contracted or distributed via
self directed support
Commission full service at outset
↑
Start of contract
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2.5 years
↑
Small amount
of core
commissioned
services
5 years
Changing the approach
Release funds from block contracts
 Structured day
 Psychosocial services
 Residential rehab
Translate block contracts into individual budgets
 Create unit price
 Work with individuals to tailor their
package linked to current provider
Keeping a foundation
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At the point of contact – few clients want to start
taking control at this point, they want support,
advice, and help to deal with presenting need
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Not always able to take control and make choices
at key points
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Opportunities can be increased using anticipatory
care planning.
Keeping a foundation
Core
Commissioned
service.
.
Flexible
Markets –
SDS options
Limited SDS
Choice and control
Engagement
developed
Wider reintegration &
recovery community
based
services
Well being, recovery and reintegration
The Reality
To date the pilot has seen:
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a few work through the full process / low allocations
a focus on structure - college and / or training – yet to
translate into actual take up on courses
request to use resources for rent / accommodation –
areas already known to be areas of unmet need in the
sector.
a few disengage from the scheme.
low take up
concerns this is another tool in addition to others (CAT,
ITEP, PSP) - need to streamline
The Reality
Next steps:
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Now increasing practitioner engagement to
enable more clients to engage with the pilot as
numbers remain low.
Providers are considering how to respond and
engage with the changes, but as yet little
demand from client group.
Positive interest from service user groups –
social enterprise and buyer groups
The Reality
Barriers & Constraints
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Need for hearts and minds to move – not just structural
Using evidence based and registered services
Commissioning boundaries – supporting people, criminal
justice
Maintaining and engaging small providers to retain the
flexibilities they offer
Existing commissioned services and contracts
Transitional period for all areas of the system – clients,
practitioners, providers, commissioners
Thank you for your interest
Sue Wilks
[email protected]
For further information :
Please Contact :
Jessica Berry
Self Directed Support Project Manager
[email protected]
Mob: 0776 0992311
Fax: 01256 818270