Commissioning Update – Specifications, Performance and

Funding

Ben Seale

January 2012

Current Position

• Draft specification for lead provider component has been completed – structure to be tested today by JCG and reported to SSP at end of month

• Ancillary specifications (e.g. Psychosocial Interventions, Medical Interventions) to be completed

• Proposed PBR structure – also to be considered by JCG and SSP

• Overall model simplified slightly• Finalised model to be tested via consultation with

stakeholders including service users, carer and providers during February for advertisement in late February / Early March

Original Proposed Model

Assessment, Care Planning, Case Management,Assertive outreach, Peer Support

Successful Treatment Completion

ReducedOffending

Employment

ImprovedHealth and Wellbeing

Residential Rehabilitation

PsychosocialInterventions

CommunityIntegration /ETE

Detoxification –Community or

Inpatient

SubstitutePrescribing

Detoxification –Community or

Inpatient

SelfReferral

HarmReduction

DIP

Hospital

Professionalreferrals

Family Interventions

Revised Model

Lead ProviderSelfReferral

DIP

Hospital

Professionalreferrals

RECOVERYOUTCOMES

Interim -

Reduced substance misuse /

Abstinence

Improved H&WB-Injecting-- Housing

-BBV

Successful Treatment Completion

Sustained -

Reducedre-presentation

ReducedOffending

PsychosocialInterventions

ClinicalInterventions

Specialist Harm Reduction

e.g. Housing

e.g. Employment

Information Model – Single Reporting System to be managed

by lead

Referral Discharge

Early diagnostic indicatorse.g. Care plans etc.

Clinical modalities

Psychosocial Modalities

Outcome measures (1)

Outcome measures (2…)Multiple Episodes (re-presentation)

Lead Provider - Responsibilities• All interventions to be delivered in line with NICE Guidelines• Initial and comprehensive assessment – including setting Intervention

Package / Tariff and Clustering• Recovery focused care planning (encompassing both stabilisation and

abstinence pathways)• Pro-active case management / case conferencing• Access to residential placements• Hidden Harm / Safeguarding• Hospital In-Reach• Dual Diagnosis• Harm Reduction (A+I / Referral)• Peer Support and Mentoring• Assertive outreach and re-engagement• Access to mutual aid organisations• Specialist housing support for substance misusers• Community Integration and ETE• Specialist Family Support for Whole Family Approach• Ownership and Management of information system including outcome

measures

Clinical Provision - Responsibilities• All interventions to be delivered in line with NICE

Guidelines• Substitute prescribing• Detoxification – community and inpatient• General Healthcare Assessment and

Interventions• Communicable disease interventions – BBV

screening / immunisation• Expectations – rapid access (1 week) / HCA

(100%) / Reduction (90%) / Abstinence (90%) / Planned Exit (80%)

Psychosocial Provision - Responsibilities

• All interventions to be delivered in line with NICE Guidelines

• A range of evidence based interventions that can be utilised on a needs-led basis– Cognitive Behavioural Therapy– Motivational Enhancement Therapy– Social Network and Environment Based Therapies– Behavioural Couples Therapy– Structured Day Programmes

• Expectations – rapid access (1 week) / H&WB improvement (?%) / Planned Exit (80%)

Specialist Harm Reduction - Responsibilities

• All interventions to be delivered in line with NICE Guidelines

• Open Access – drugs / alcohol / PIEDs• Referral to treatment where appropriate• Advice and information• BBV screening and immunisation• Coordination of pharmacy needle exchanges• Collection of relevant data – e.g. for HPA• Expectations – rapid access (open access /

extended hours) / BBV uptake (?%) / Equipment Return Rate (80%)

Proposed Payment Structure

Operating Year

Main Payment

Interim Outcomes Payment

Sustained Outcomes Payment

2013/14 80% 20% 0%

2014/15 70% 20% 10%

2015/16 60% 20% 20%

Block Payment Planned DischargesH&WB

Reduced substance misuseAbstinence

Reduced re-presentationReduced Re-Offending

Financial considerations

• DIP budget has been reduced by 4% overall. However, the reduction is contained within the Home Office component of the budget – actual reduction equates to £20,183, leaving a total of £232,100

• The Department of Health will continue to pay their element of DIP funding as part of the Pooled Treatment Budget in 2012-13 – there is no anticipated change in this component

• Notification letter states “there will be a need to have regard for the incoming PCC when commissioning services and/or when entering into contractual agreements for 2012-13 and beyond”

• As such, commissioning plans may need to anticipate that the Home Office component will not be available

Financial considerations (2)

• Currently PTB allocations have not been published for 2012/13

• However, it is not currently anticipated that it will change

• Also, indicative public health budget for 2013 and beyond is not yet available

Discussion

- Validity of revised model- Chosen High Level Payment

Structure