1. Drug System Change Pilot Commissioning for Substance Misuse in a Personalised Way Sue Wilks, DAAT Manager

2. The Concept personalised care in a self directed way using individual budgets via direct payments……… Personalisation & Self Directed Support - Background

3. Challenges 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

4. The Basics We are not offering choice and control : in specialist prescribing medical detox drug of choice Personalisation & Self Directed Support

5. 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 Personalisation & Self Directed Support

6. Key points to cover some notes to consider current picture desired picture changing the approach keeping a foundation the reality

7. 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 Some notes to consider :- Where are we ?

8. Commissioning……. how to change without destabilising the systems joint commissioning outside of substance misuse Consider :-

9. Current Picture

10. Desired Picture

11. Changing the approach Through new contracts and building in flexibility Release funds from block contracts Translate block contracts into individual budgets

12. 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

13. Changing the contract Percentage sub contracted or distributed via self directed support Commission full service at outset Start of contract 2.5 years 5 years Small amount of core commissioned services Flexible markets and services

14. 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

15. Keeping a foundation 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 Not always able to take control and make choices at key points Opportunities can be increased using anticipatory care planning.

16. Keeping a foundation Core Commissioned service.. Flexible Markets – SDS options Limited SDS Choice and control Well being, recovery and reintegration Engagement developed Wider reintegration & recovery community based services

17. The Reality To date the pilot has seen: 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

18. Next steps: 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

19. Barriers & Constraints 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 The Reality

20. Thank you for your interest Sue Wilks sue.wilks@hants.gov.uk

21. For further information : Please Contact : Jessica Berry Self Directed Support Project Manager jessicaberry@nhs.net Mob: 0776 0992311 Fax: 01256 818270