Addiction to Medicines

28/02/13

Mark Gillyon

ADDICTION TO MEDICINES:COMMISSIONING IN THE NEW PUBLIC

HEALTH LANDSCAPE

Overview

• Key Policy drivers and context

• The architecture

• Public Health England

• local Health & Wellbeing Boards and Clinical Commissioning Groups

• Opportunities and challenges

3

Key policy drivers

• National Drug Strategy 2010

• Health & Social Care Act 2012•Localism

•Transparency and accountability

• Public health and health inequalities•Recovery

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.

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The new health and care system

Slide 11

Local people and communities

Health and Well-being Board

Parliament

Secretary of State for Health

PHE NHS CB

HealthWatch

PHE Centres

Local Authorities

CCG/NHS CB

Responsible for

publishing data and

supporting delivery of

PHOF

PHOF NHSOF

Police and Crime Commissioners could have

a seat. Up to each LA

Undertake JSNA & develop HWB Strategies setting out

local priorities

Mandate – only means of holding the CB to

account

Commissioning OF – set by the NHS

CB for CCGs

ASCOF

Sets out the indicators that the PH system & DH

understand are the best mechanisms to

improve public health. Up to LAs to

prioritise.

Sets out the indicators that the NHS should seek to achieve through the

Mandate objective of continuous improvement

The evidence in this presentation can inform

the JSNA and HWB Strategies.

Accountability

Oversight

Links

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Architecture

Specialist drugs and alcohol services (inc. Addiction to Medicines) commissioned by local authorities, through Directors of Public HealthSupported 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 2013Public 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

16

Public Health Budgets

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 sub-categories 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

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More opportunities and challenges

Balanced systems – maintaining gainsPriorities competing for scarce resourcesCommissioning skills: making the case for investment and developing alliancesComplexity, dual diagnosis and healthMedicines and new drugs and patterns of useCreativity – ABCD, social enterprises, recovery communitiesEngage PCCs, local Police and the crime reduction agenda

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