Post on 28-Mar-2015
transcript
Cornwall & Isles of Scilly DAAT
Tier 4 Interventions
Commissioning to Meet Needs and Deliver Outcomes
Square Pegs, Round HolesKim Hager
Promoting recovery
What is Commissioning?
Strategic activity of
• Assessing needs
• Assessing resources and services
• Developing a strategy to make best use of available resources to meet identified needs.
Commissioning Cycle
Needs Assessment Priorities & Outcomes
Operational Plan
Purchasing Activities
Monitor & Review
‘In-patient’
• Assessment• Observed titration• Supervised interventions• Stabilisation• Withdrawal
• Up to 6 weeks• Free
CIOS Tier 4 Needs Assessment
Engaged in effective treatment
• 1,886 ADUs
• 1,265 PDUs
• 1,615 Severe & dependent drinkers
• 10% require ‘in-patient’
Evidence & Outcomes
• Better outcomes
• Cheaper
• Effects of T4 ‘cumulative’
CIOS ‘Stepped Approach to Detox’
• DIY
• Supported DIY
• Community ‘Home & Dry’ LES
• Community Nurse supported
• Community Hospital
• General Hospital
• Residential Independent Sector
Assess, Stabilise, DetoxYear Estimated
NeedActual Capacity
Gap
08/09 262 82 180
09/10 266 113 153
10/11 268 141 127
12/13 270 181 89
Why not just buy more places?
• Care Co-ordinator capacity• Skills development• Preparation capacity• Contingency capacity• Aftercare capacity• Rehab budget and capacity• Financial assessment process• We were building a residential assess,
stabilisation and detox unit
Residential Rehab Services• Estimate 5% of treatment population
(131)• Actual 60• Gap 71
• Average cost of a 12 week placement£7,000
£497,000
• Adult Social Care payments and processes
• Managing the impact of means testing
• VACs and Community Care
• Reform of Adult Social Care
• ‘Putting People First’
• Personalisation
Adult Social Care
• Diverse and innovative provision • Services tailored to people’s needs &
aspirations • Focused on outcomes
Enable people to • exercise choice and control over the
types of services they want • directly shape the services that are
commissioned on their behalf
‘Putting People First’
What Have we done to improve? System Re-design
• Pathways
• T4 options at Assessment, Care Plan & Reviews
• Unblocked the bottleneck
• Stopped rationing people out
• Raised awareness of evidence base and Standard item on all commissioning & treatment tasking meetings
Criteria• Preparation A process, not an activityPreparation & Engagement ChecklistPreparation groups are not compulsoryPreparation for Change ManualVisits encouraged & supported
• Unplanned discharge/contingency plan• Clinical plan agreed by both RMOs• Aftercare Plan• Care Co-ordinator remains up to 3 months
• Alcohol & Drugs T4 Panel
• Once funding agreed, can go/return within 3 months
• Made requirements/requests of T4 Providers
Local providers
Boswyns Broadreach
Chy Colom Bosence Farm
• Commissioning is a Partnership • Worked hard to change and better meet
needs• Constant evolution of practice• Service characteristics have greater impact
on success than client motivation
Why did you leave early?
The plan changed
They took me off my anti-depressants
too
It wasn’t what I
expected
My family couldn’t manage
I was the only druggie Drugs got in
I couldn’t think straight and there was no one to
talk to at nightThey wouldn’t let you have music in your room or
tapes to listen to at night.
I couldn’t sleep
I went a little crazy
Not allowed to watch tv when
you want
Why residential?Peer support
All under one roof
A safe and supportive environment
Time to look at issues and
work on them intensively
Spending a lot of time with people who have
similar issues
Being able to deal with the
feelings underneath My keyworker coming to
visit
Family interventions
away from home
Never managed it in the
community
Time out, distance
Challenges• Finding the Tier 4 services to meet the
needs
• Adapting services to meet needs
• Homelessness
• Bridging the Gap – reintegration needs
Specific needs• Co-morbid mental health problems• Co-existing alcohol problems• Clients with dependent children (31%)• Couples• Stimulant users• Young adults• People with disabilities• People with learning difficulties• Unassessed/undiagnosed problems• Respite
Different approaches required
• Treatment naïve (50%+)
• 0-6 months
• 6 months – 2 years
• 2-4 years
• 4 years+ (21%)