Pennine Care Substance Misuse Services

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Pennine Care Substance Misuse Services
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Current PositionCommissioning Arrangements

• Commissioned in a mixed economy
• Funding routes are via
• ? Drug and Alcohol Action Teams (DAATs)
  including Adult Pooled Budget (APB) Health and
  Drug Intervention Project (DIP) Home Office
• ? Pennine Care (Block)
• ? Local Authority (Social Services)
• ? PCT Direct
• ? Targeted Funds (NDC, Sure Start etc.)
• Different in amounts and proportions in each
  Borough
• Operated as part of a Borough wide treatment
  system alongside voluntary sector
• Very competative and volatile market

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Current PositionCommissioned Services

• Provide Substance Misuse Service in all 5
  Boroughs
• Provide Tier 3 Prescribing Services in all 5
  Boroughs
• Provide Alcohol Services in 4 of the 5 Boroughs
  (Not Rochdale)
• Provide some Criminal Justice Services in each
  Borough
• Provide Social Care Day Services (formally) in
  one Borough (Bury)
• Provide Harm Reduction and Needle Exchange
  Services in all 5 Boroughs

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Current PositionClient Group

• Substantively dependent and/or problematic opiate
  users
• Also dependent and problematic alcohol users
  (where services commissioned)
• Rising proportion of other substance users
• ? Crack Cocaine
• ? Cocaine HCL
• ? Amphetamines
• ? Cannabis
• ? Steroids and Performance/Image enhancing
  drugs
• ? Prescribed substances
• ? Poly Drug Users
• Around 3000 at any one time in care planned,
  structured treatment
• Possibly same again in Low Threshold (some
  overlap)

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Current PositionClient Group (continued)

• Approx 70 Male
• 30 Female
• Ageing Population 30 years
• Predominantly White British but increasing BME
  presence
• Characterised by socio-economic disadvantage
• Concurrent health problems
• ? Mental Health
• ? Physical Health

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Current PositionPerformance

• Retention Rates
• ? Four of 5 Boroughs achieving target.
• (Other Borough has a rising performance with
  an action plan in place. Should achieve
  target within the time scale)
• Trust retention rate of 86 currently achieved.
• Waiting times being met for all modalities.
• Numbers in treatment short of stretch targets.
  This is however, the National picture.
• Harm Reduction Services falling short in some
  areas.
• Health Care Assessments on target.
• Care planning on target (some data collection
  issues)

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Performance (continued)

• Health Care Commission 07-08 Harm Reduction
  Services
• Bury 13/16 3
  Good
• Rochdale 11/16 3 Good
• Oldham 15/16 4
  Excellent
• Tameside 14/16 4
  Excellent
• Stockport 12/16 3
  Good
• Oldham achieve joint 2nd highest score
  Nationally for service delivery
• Health Care Commission 06-07 Care
  Co-ordination and Prescribing
• Trust achieved a score of 3 - Good

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Developments andChallenges08/09 onwards
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Developments

• Organisational
• Commercial
• Clinical

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Organisational

• Moving from Borough based to Directorate
  Structure with Divisional Lead
• Opportunities
• ? More focused clear strategic direction
• ? More commercially mobile/responsive
• ? Economies of scale
• ? Clear clinical standards
• Risks
• ? Too removed from Borough structures and
  developments

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Commercial

• Secure existing business
• Growth and new business opportunities
• ? Improved contracting arrangement
• ? Clarity about what commissioners buy
• New business opportunities local
• - DIP contracts
• - Day care-social reintegration programmes
• - Alcohol
• - Emerging client group (ACCE)
• New business regional
• - Prescribing and Harm Reduction contracts

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Clinical

• Standardisation and development of services
• ? Benchmarking against clinical guidelines
• ? Nice technical appraisals
• ? Alcohol Service
• ? ACCE Client Profile
• ? Dual Diagnosis
• ? Social Reintegration Programmes
• ? Harm Reduction Services
• ? Health Care Commission Review (Tier 4
  and Diversity)
• ? Treatment outcomes agenda
• ? Service use and carer involvement

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Challenges

• Substance Misuse Service Economy
• Wider Economic Changes
• Clinical/Substance Use Changes

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Challenges

• Very competitive, volatile economy
• ? Trusts
• ? Voluntary sector
• ? Private companies
• Uncertain and personality based commissioning
• Shrinking/slowing down economy
• Potentially changing funding streams
  (particularly re alcohol)
• Payment by activity and results (Individualised
  budgets)
• Changing patterns of substance use

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Summary

• Provide Prescribing, Care Co-ordination, Harm
  Reduction and Support Services
• Service structure and commissioning routes differ
  Borough to Borough
• Competitive and volatile market
• Rapidly changing commercial and clinical profile

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However ..

• Objective measures show Pennine Care to be a high
  performing organisation
• . Good Health Care Commission Results
• . Good performance against targets
• . Improving financial profile
• . Unit cost exercise show Pennine as very
  competitive/cost effective
• . Highly skilled and motivated workforce (low
  sickness and staff turnover)
• . Growing positive reputation in the region
  to build on (very different from 3-4 years ago)
• Liz McCoy

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AnyQuestions?