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concerned that they may be seen as ‘extras’ and risk losing their funding. It is
essential that a clear funding pathway is identified for services working with
children and families affected by parental alcohol and drug as currently neither
children’s services or adult substance misuse services see themselves as
responsible for funding these crucial services. Investment to save the enormous
human and financial cost of taking children into care makes sense.
*****
Then there are issues of bureaucracy and paperwork.
Over the years the amount
involved with our work has increased dramatically. We fully support the use of
thorough assessment and care planning, national frameworks and guidelines but the
level of detail that is specified by our national framework,
Models of care for alcohol
misuse
, and its local implementation has resulted in staff and clients being required to
complete at least ten forms, some of them lengthy, before a client starts structured
alcohol treatment. Six of these forms need to be signed by the client, and we also
need to enter every contact with a client onto an electronic database.
This is extremely time consuming and we would prefer that the paperwork was
streamlined so we could spend more time with the clients – the activity that is key
to understanding their needs and supporting them to meet their goals. Often
clients present in great distress and/or are very unsure about engaging in
treatment, an completing and signing multiple forms can be counter-productive to
engaging some people at this stage.
As experienced alcohol workers we feel that outcomes for clients would be
improved if we were able to exercise our professional judgement and if paperwork
were streamlined. At a broader level, the amount of bureaucracy involved in
commissioning and procurement of services places a huge burden on the capacity of
services, effectively excluding smaller local services from the process. During the
tendering process, members of the commissioning and procurement teams and
managers of services spend many days carrying out their respective roles and clients
and staff experience long periods of uncertainty about the future of the service.
When services are restructured and/or change hands there is a great deal of
change to manage and adjustment required from clients and staff. We are fortunate
to have a three-year contract that can be extended for a further two years. Often
this commissioning process is repeated every three years. We aim to provide
stability and structure for our clients but this is difficult amidst constant upheaval.
Longer contracts would help to reduce this upheaval. We also think clients
would benefit if the commissioning process was streamlined and some of the
resources spent on the commissioning, procurement, monitoring and restructuring
of services diverted to direct service provision which is so desperately needed.
Hazel Jordan is area manager for Islington Community Alcohol Service, Blenheim CDP
November 2012 |
drinkanddrugsnews
| 9
www.drinkanddrugsnews.com
Cover story |
Frontline alcohol services
require additional support such as interpreting services.
Our role as alcohol workers is to coordinate treatment plans to address the full
range of needs our clients bring. Alcohol use cannot be tackled in isolation.
Pathways and joint working between different sectors, for example between
mental health and alcohol services, can be difficult to establish and maintain and
clients with both mental health needs and alcohol problems can easily fall through
the net. In a climate of public expenditure cuts, we are finding coordination
increasingly difficult as partner services are reduced. This in turn puts further
strain on our capacity and stress on staff. The most vulnerable clients with the
highest needs are losing out.
Strategic planning is needed at senior levels within the different sectors to ensure
that joint working is possible at service delivery level. The alcohol strategy and NICE
guidelines include such principles as ‘one size does not fit all’ and ‘person-centred’
care, and NICE guidelines also recommend a 12-week limit for alcohol interventions.
The guidelines refer to a ‘more intensive community intervention’ and this fits better
for clients with complex needs. They can and do recover from addiction, but this often
takes time. In the context of stretched resources, however, the 12-week limit is often
taken as the guideline for commissioning services and this risks failing to meet the
needs of some of the most vulnerable members of society.
We are very concerned that, in the current climate, these most vulnerable people
may be at risk of losing their services if payment by results (PbR) is introduced without
specific safeguards. If PbR only focuses on final results –
ie
full recovery – services may
be tempted to cherry pick those clients who are more likely to make progress quickly.
Furthermore, some of the work we do with these vulnerable clients who are not ready
to stop drinking is about minimising harm. This work directly contributes to
Department of Health priorities of reducing alcohol related deaths and hospital
admissions but there would be no results demonstrating recovery. It is absolutely vital
that services that mitigate harm to the most vulnerable people, and their families and
communities, are preserved if PbR is introduced.
Both adult family members and children can be profoundly affected by the
drinking of a family member, and we are fortunate in Islington to receive funding
to run a service for adult family members. There is clear evidence that involvement
of adult family members in treatment can improve outcomes for alcohol and drug
users. We also receive funding towards our family service for children, young
people and families affected by parental alcohol and drug use via the Safer
Islington Partnership. Parental alcohol and drug misuse is one of the three major
causes of children being accorded child protection status, and young people
affected by parental alcohol use have higher levels of alcohol problems and other
mental health problems themselves.
Despite the evidence that services for families lead to better outcomes, we are
ming
the
TIDE