Payment by results |
Pilots
LET’S S
LET’S S
The government’s PbR pilots are
now up and running.
DDN
hears
how things are going so far
12 |
drinkanddrugsnews
| May 2012
www.drinkanddrugsnews.com
Your area was chosen based on the ideas
you put forward. Could you briefly outline
what those were?
Jo Melling, director of Oxfordshire DAAT: We have
redeveloped the whole treatment system, embedded
alcohol intervention and treatment within it, and
introduced not only payment by results to the
recovery contract but incentive payment to every
contract. All services were competitively tendered.
We’ve also redesigned police custody-based inter-
ventions with Thames Valley Police and commissioned
an independent local area single assessment and
referral service (LASARS) with a 75 per cent contract
value, 25 per cent PbR element, provided by Aquarius.
There’s a harm minimisation service, with 70 per cent
contract value and 30 per cent PbR element provided
by Oxford Health in partnership with OASIS, and we’ve
also commissioned a recovery service, on a 100 per
cent outcome basis provided by Lifeline.
Jillian Hunt, DAAT manager and commissioner at
Bracknell Forest: We based our approach on
appointing a single prime provider with a contract
that is 100 per cent PbR. As a small unitary
authority we have a strong record of partnership
working to maximise resources and, about two years
ago, the police in Bracknell Forest set up a regular
operation called Ladybird, which has been
instrumental in reducing levels of crime. It adopts an
assertive outreach approach – joint visits are made
to offenders who have disengaged with services, and
it’s been successful in getting people back into
treatment. Our model extends this approach to all of
the people using drug and alcohol services.
David Gray, prolific offender and drug intervention
strategy manager at Wigan: The intention was to
look at whether financial incentives can drive
performance and help achieve the sustainable
recovery that we wanted. It’s part of a much wider
remodelling of our services.
It’s obviously still early days, but how would
you say the process is working out so far?
JH: It only went live on 2 April, however our LASAR
has been undertaking all of the assessments since
mid December and that’s working very well. Many of
the people who were in treatment already and have
been reassessed using the new recovery-focused
approach have commented favourably on the
process and said that it has made them feel more
involved in their own care.
What key lessons would you say you’ve
learned, that might be useful to other
areas?
JM: PbR is complicated in terms of ensuring that the
complex needs of clients are met, whilst setting
outcomes that can be measured and are sensible
for the client group we’re dealing with. Having
overarching outcomes seems simple, but turning
that into, one, a good quality service and, two, a
contractual payment is not an easy process.
JH: One of the major lessons is not to underestimate
the time it takes to reassess the people who are
already in treatment. Your LASAR and providers need
to work together to explain not only the benefits of
the reassessment but also that people have to have it
done. For some people that is of concern because it’s
change and they may not actually want recovery at
that point. Keeping the people in services in the loop
is crucial to ensure a smooth transition.
DG: You need to look at things from your local area
aspect – what your relationships are like, the profile
of your clients – and understand what you want to
incentivise and how you want to do it. Also, give
yourself plenty of planning time – a lot of people
might just rush into it and end up incentivising
activity rather than outcomes.
Any mistakes that people should avoid?
JM: Many! It’s been a huge learning curve in terms
on turning aspirations into reality, and I know more
about the legalities of NHS contracting than I ever
wanted to.
PbR is designed to boost value for money
and affordability. Is there any evidence so
far that it’s doing so?
JM: I think PbR is actually about improving outcomes
– it is for me. As a commissioner I think we serve
only two overarching aims – the best quality services
for the service user and the best value for money for
the taxpayer. I know that sounds very grand but when
you break it down, that’s what we need to be
achieving. It’s too early to say if PbR can improve that.
JH: Again, it’s too early to tell. However Bracknell
Forest has set its own tariffs and has developed a
client complexity profile modelling tool outside of the
national model, which takes into account all of the
domains that have impacted on a person misusing
drugs and alcohol. The tariffs have been set so that
the prime provider should have sufficient resources
to meet every individual’s needs. Early indications in
terms of the people already in service are that a
saving will be made without reducing the quality of
the service and ensuring that the financial risks to
the prime provider are minimised.
DG: With the context we’re working in – the new
funding arrangements and public health coming over
to the local authority – we need to better evidence
performance and the effectiveness of substance
misuse services. A significant question is how we
can support individuals with entrenched substance
misuse problems towards recovery, and I don’t even
know if we’ll have all the answers in a year or two’s
time, but a big part of our evaluation is to look at
whether a PbR approach could contribute to positive
outcomes for clients and for us to understand the
wider impact on services and service users.
In other areas where PbR has been
introduced – such as mental health
services – it’s taken years to develop, yet
the time frame to get the pilots up and
running was fairly tight. How did you find
the process, and of co-designing the
system with the government’s team?
A YEAR AGO, Bracknell Forest, Oxfordshire and
Wigan were among the eight areas chosen to pilot a
payment by results (PbR) approach to drug treatment
(DDN, May 2011, page 5). As the pilots only went
live last month it’s too early to assess any impact on
levels of reoffending or drug use, but some
interesting lessons are already starting to emerge.