At a recent conference I was asked to speak on what the biggest changes to the public sector for a generation felt like at the coal face for an organisation like Blenheim.
These changes include;
- Re-organisation of the NHS
- Establishment of Public Health England and the transfer of public health funding and responsibilities to local authorities
- Death of the National Treatment Agency as it is swallowed by Public Health England
- Localism agenda
- Police and crime commissioners
- More procurement lead commissioning structures
- Payment by Results
- Increasing role of CQC in our work
I took a straw poll of staff at head office on what the changes felt, looked and smelt like and the consensus answer was uncertainty, the unknown and a leap into the dark.
Uncertainty is the mother of anxiety and this certainly describes how it has felt over the last year as we worried about whether some Hitchcock like Politician with a knife would make cuts in services and funding without rational thought about the consequences for our service users.
I spent much of the last year campaigning with others to ensure that money was not disinvested from our sector and against the evils of the Works Programme and Payment by Results.
There remains huge uncertainty about what the changes will look like going forward, in the end I have decided to keep calm and pretend I know what Blenheim is doing and what the changes will mean for us as we approach April 2013, which feels like the great millennium bug fears of 2000. As I speak to managers, commissioners, CEO’s, Politician’s and senior civil servants it is clear they are all doing the same.
The good news is that central government allocations to local authorities for public health seem to be generous, particularly in the age of austerity. For now everyone is getting to grips with new structures, roles and relationships and I see little appetite or capacity for major change in 2013/14. However over time we will start to see some real changes in what is commissioned as we move to local agenda’s and a whole population rather than a complex need focus, with the needs of the many outweighing the needs of a few. We must embrace these changes with open arms whilst continuing to advocate for the needs of those with whom we work.
We have the greatest treatment system in the world but if we are to keep it we need to fight for it, love it, protect it; and embracing change, innovation and new priorities; develop it.
Perhaps the biggest threats are competitive tendering processes and the culture of competition it forces on agencies, who otherwise, would work together collaboratively in the interests of service users. There is little evidence that current commissioning and procurement processes improve service delivery and lots of evidence that they do the opposite.
The drug and alcohol treatment sector has in my view a clear mission to end dependency by enabling people to change and along the way we also have a duty to help people improve their health, quality of life and reduce their involvement in risky behaviour and criminal activity.
Excellent services and staff work tirelessly up and down the country making a positive impact that not only improves the health of the individual’s drug and alcohol users but has a positive impact on their families and friends. People using our services are not just people with drug and alcohol problems they are partners, fathers, grandmothers, children, brothers, sisters, friends, work colleagues and carers. Helping them beat dependency helps put the joy back in so many lives. The ripples of the work undertaken by staff and agencies up and down the country spread out across every community. It’s worth every penny of the £billion that is spent on it and its worth fighting for.
It is time for us to collaborate and come together as a sector to fight for what we believe is important ending dependency, enabling recovery, hope, and better lives for those with whom we work. It’s time to challenge the damaging commissioning and procurement culture imposed on us by European procurement rules which is damaging our capacity to do this. Of course commissioners should have the right to re-tender and re-commission services but this should not be arbitrary process and should be needs lead. There is a need to develop and explore concepts of co-production between local authorities and the third sector.