1. Commissioning Update – Specifications, Performance and Funding Ben Seale January 2012

2. 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

3. Original Proposed Model Assessment, Care Planning, Case Management, Assertive outreach, Peer Support Successful Treatment Completion Reduced Offending Employment Improved Health and Wellbeing Residential Rehabilitation Psychosocial Interventions Community Integration /ETE Detoxification – Community or Inpatient Substitute Prescribing Detoxification – Community or Inpatient Self Referral Harm Reduction DIP Hospital Professional referrals Family Interventions

4. Revised Model Lead Provider Self Referral DIP Hospital Professional referrals RECOVERY OUTCOMES Interim - Reduced substance misuse / Abstinence Improved H&WB -Injecting -- Housing -BBV Successful Treatment Completion Sustained - Reduced re-presentation Reduced Offending Psychosocial Interventions Clinical Interventions Specialist Harm Reduction e.g. Housing e.g. Employment

5. Information Model – Single Reporting System to be managed by lead Referral Discharge Early diagnostic indicators e.g. Care plans etc. Clinical modalities Psychosocial Modalities Outcome measures (1) Outcome measures (2…) Multiple Episodes (re-presentation)

6. 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

7. 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%)

8. 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%)

9. 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%)

10. Proposed Payment Structure Operating Year Main Payment Interim Outcomes Payment Sustained Outcomes Payment 2013/1480%20%0% 2014/1570%20%10% 2015/1660%20% Block Payment Planned Discharges H&WB Reduced substance misuse Abstinence Reduced re-presentation Reduced Re-Offending

11. 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

12. 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

13. Discussion - Validity of revised model - Chosen High Level Payment Structure