A view from West Kent’s Recovery Service provider
The CRI West Kent Recovery Services has a real focus on positive sustained outcomes for all of those using the service. It was designed to deliver services holistically and acknowledging that “treatment” as we understand it is a small part of sustained recovery.
The introduction of this service and mindset has been assisted by the fact the service has been commissioned through a “payment by results” (PbR) contract, and that payment is based on identifying and reducing risks not just around substance misuse, but other risk factors that affect the individuals, the people around them and the wider community incorporating education, training and employment, mental health, housing, safeguarding issues and criminal activities.
This should be seen as a positive from an end user point of view as it makes it fundamental that the service provision addresses all aspects of a client’s life in order to achieve payment for the provider. This has created challenges for the service without a doubt. Other agency’s agendas, resources and policies are not always aligned exclusively to our provision.
We have acknowledged and welcomed the challenge in a more assertive and collaborative way to ensure that financial risks are reduced. The PbR has clearly focused our attention on detail around the wider issues of substance misuse and sustained recovery, taking a less passive approach to reducing barriers, ensuring collaborative/joint working with other agencies where substance misuse is not their sole focus, and I have to say they have all responded and supported our delivery in a positive way for example social services, JCP’s, mental health teams and health advisors to mention just a few.
Internally the whole team have embraced a significant amount change through the TUPE process, moving to a single treatment system (which has created more efficient delivery and experience for the end user), up skilling into all areas of drug and alcohol treatment, and sustained recovery. We have always been very good in achieving positive outcomes and supporting positive change for our client group, but the challenge has been for the team to understand PbR and how to achieve and agree evidence of an outcome for payment to an independent assessor team (LASARS), which is typically new for practitioners in this field.
There have been some anomalies with PbR, for example alcohol treatment orders, drug rehabilitation orders, and how alcohol users who achieve controlled drinking within safe limits have their positive outcomes for reflected. We enjoy close collaboration with the LASARS team and commissioners and we are nearly there on intertwining PbR and treatment delivery which impacts positively for those accessing the service.
This change brings newer, greater aspiration and opportunities, for the provider and commissioners to reduce financial risks we would advise a “bedding in” period as significant culture/process/system change requires time to implement which undoubtedly has to be acknowledged.
Lee Ashmore is the Services Manager at CRI in West Kent