NTA Residential Rehabilitation Event Welcome Baroness Massey of Darwen

NTA Residential Rehabilitation Event Rosanna O Connor NTA Director of Delivery

Welcome to all Key aims: to support closer relationships between residential providers and commissioners to provide an opportunity for networking to facilitate the sharing of ideas and models of delivery

The new drug strategy 2010 drug strategy sets out a clear ambition to help people recover and to overcome their dependency Companion public health white paper makes clear reducing drug use, enabling people to overcome dependency and recover fully are a key priority Improving successful completions are a component part of the success of any partnerships approach to recovery Residential rehabilitation has a key part to play in providing abstinence-based treatment and enabling people to successfully complete treatment There are also a range of residential models available, some of which we are highlighting today

NTA role in delivering the drug strategy Mandated to work with others to support the transformation of treatment systems into recovery systems Ensure integration of treatment into wider systems of recovery: Ensuring that the system links to housing, employment, education, children services, families and Mutual Aid Ensure a holistic tailor-made response to the whole needs of an individuals recovery journey Assisting partnerships to develop recovery orientated systems in prisons – bringing together the clinical and CARAT services

Transition year Transitional year as some NTA functions transfer to Public Health England New local accountability structures from April 2012 – e.g. Health & Wellbeing Boards Building Recovery in Communities to replace Models of Care

Snapshot of the 2011/12 work plan Implementation of BRiC Patient placement criteria – segmenting treatment population Support Payment by Results Secretariat to the National Skills Consortia Supporting recovery networks & champions and Mutual Aid groups

Key themes for Commissioners & Providers March 2011 Mark Gillyon Head of Delivery - North

Models of Care (3?) Building Recovery in Communities

MoC 3 Building Recovery in Communities 2007 Clinical Guidelines Integrated Drug Treatment System (IDTS) Recovery Mutual Aid, successful completions, the supportive role of families, the importance of housing and employment Support through the system User choice and responsibility Families and safeguarding Targeting the right interventions, to the right people, at the right time.

The new framework The over arching aim of the new framework is to support local areas in developing their systems and services to become recovery focused, highly ambitious and offer a real opportunity for sustainable recovery.

The sector is changing... Different models of delivery Traditional Locally commissioned and locally provided Quasi-residential

The commissioning environment is changing... Funding in 2011/12 Funding in 2012/13 Funding from 2013 onwards Outcome-based systems, Payment by Results, and the leadership of Directors of Public Health / Health & Wellbeing Boards

Other things will change... Successful completions The number of people leaving drug treatment free of their drug(s) of dependency Payment by results Model / length focus vs. specific required outcomes Data About 2/3 report to NDTMS New models / new data problems The future of PTB Within Public Health ring-fence, for Health & Wellbeing Boards

Data support NDTMS Regional Teams Data collection, support, training, analysis Rehab Online Marketing Testimonials Vacancies Evidencing outcomes and value

ClientCommissionerProvider

Future developments Colin Bradbury Residential Rehabilitation Event March 2011

Contents 1.Payment by Results 2.Case Mix Adjustment 3.Residential Rehabilitation Outcomes

Payment by Results - Background A recovery programme, not a treatment programme – aiming to attract new providers Around 6 pilot local authority areas April – Sep 2011: co-design, running Independent evaluation 4 outcomes (interim & final) identified: Leaving treatment free from drug(s) of dependency Re/Offending Employment Health & Wellbeing (interim only) Payment by Results

Opportunities and challenges Moving away from process/ front end targets Giving providers freedom and flexibility to innovate and sub-contract what they need Letting the market show what works Encouraging new providers to enter the market Developing a single point of contact model A need to avoid perverse incentives Delivering more outcomes with the same money Ensuring small/ new providers are able to compete Payment by Results

Case Mix Using outcome and re-presentation data to predict risk for new treatment entrants Push and pull factors for recovery Allowing comparisons of outcomes in similar areas and services – segmenting on the basis of probability of recovery Limited to the data we have Says something about an individuals chances, but nothing about how best to help them... Case Mix

RR outcome research a prospective outcome study of publicly funded providers of drug and alcohol residential rehabilitation expert academic and provider advisory group Peer reviewed academic journal Consult on which sort of models should be included Rehabilitatio n Outcomes

In summary... How might we further incentivise recovery, moving beyond the existing evidence base? Payment by Results How can we ensure accurate tariffs are set and there is a level playing field? Case Mix Adjustment How could we ensure people get the right treatment at the right time? Patient Placement Criteria What role can residential rehabilitation play in this? Outcomes Study