PbR Full Proposal - 015
PILOTING PAYMENT BY RESULTS FOR DRUGS RECOVERY
FULL PROPOSAL - 015
PROPOSAL/DESCRIPTION OF MODEL
1. Please outline the PbR model that the partnership intends to develop, including
the improvements you expect to deliver, and how these will better meet the needs of
current & potential drug/alcohol users in your local population. Please indicate
whether the model you intend to pilot will cover alcohol as well as drug recovery
1.1 We are seeking to develop a recovery-orientated Payment by Results (PbR) model
that puts the individual at the heart of the drug treatment system and commissions a range of
services at a local level to provide tailored packages of care and support, including housing
and employment services. The ultimate goal is to enable individuals to become free from
their dependence - supporting people to live a drug-free life is at the heart of our recovery
ambition. To achieve this, we recognise the need for an information infrastructure and the
necessary workforce development that supports systemic integration alongside the highest
standards of information governance.
1.2 The pilot we propose is based on developing a single referral and assessment
pathway into our already integrated treatment and recovery services, which will reduce
bureaucracy and improve information sharing, by using staff from existing service providers in
a multi-disciplinary Local Area Single Assessment and Referral System (LASARS) workforce.
We will develop a local approach that will enable LASAR to be delivered by existing providers
and that supports the principle benefits of a PbR approach to commissioning and ensures the
critical functions of the LASAR - standardised assessment using evidence-based
methodologies, delivered by trained and supervised staff, undertaken in a consistent and
auditable manner. The LASAR workforce will also track an individual’s progress across all
relevant outcome domains including physical and mental wellbeing, social, criminal justice
and addictive behaviours. The LASAR will involve recovered service users who will lead on
the introduction of asset-based assessments.
1.3 We will take a whole systems approach and the focus and priorities for our PbR pilot
are based on the findings of a robust needs assessment (see Annex A), which clearly outlines
the needs and circumstance of our local area, specifically:
There needs to be a shift away from the focus on numbers in effective treatment
(although this is important) to a greater and measurable focus on treatment outcomes
and successful planned treatment exits in line with the recovery agenda and the new
national drug strategy.
Assess the needs of service users in relation to the demand for residential and structured
Improve pathways between criminal justice substance misuse services and courts and
between community criminal justice agencies and prisons to maximise treatment
outcomes for drug using offenders.
1.4 In order to deliver this challenging agenda, we will focus on how service users exit
treatment either through community-based structured day services or via residential
rehabilitation services. Building on our annual needs assessments and service-user reviews,
planned exits and recovery opportunities will be key building blocks in our model. We will
build links to mutual aid groups into all local systems, ensuring that all individual services
have pathways to mutual aid groups and will identify recovery champions at both a strategic
and service level, which will assist in retaining the focus of all parties on the recovery agenda.
Recovery champions play an important role in articulating ambition, championing routes to
recovery and challenging partnerships and services to retain a recovery focus.
1.5 The overall aims of the model are to:
Build on existing commissioning systems to improve/re-design and re-focus service
Develop recovery network and communities;
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Involve service users to uncover previously “hidden skills and assets of our service users”
and signpost through to entrepreneurial community development schemes that assist
people back into work or other areas, such as citizenship;
Provide opportunities at all stages of the criminal justice system, including prisons;
Develop a flexible and more proactive workforce;
Make better use of generic and specialist resources for drug users;
Aligned teams of practitioners around assessment, referral and information systems;
Develop a more dynamic risk assessment process to ensure the right choices are being
made, prevent people falling through the gaps, and to create efficiencies and cost
Map treatment journeys and create effective packages of care, particularly for people with
1.6 The three key elements of this model are the development of a multi-disciplinary
LASARS workforce, an Outcomes framework and a Tariff system. This will be framed by a
commitment to ongoing workforce development, which will be transformational in some areas
of the treatment system, including a commitment to IT modernisation and systems integration.
It is our intention to use 100% of our community budgets to pay providers for the outcomes
We have been using an outcomes-focused system for the past two years and so we are able
to identify and outline metrics that will make a measurable difference and we believe our
existing outcomes framework can be quickly adapted to our proposed PbR model. These key
elements and metrics are described in detail below under section 2.
1.7 Our providers fully support this proposal and the move towards a PbR model as they
have already been delivering to an outcome-focused model and can see the positive results.
Evidence demonstrates that our current outcomes approach has resulted in:
28% increase in treatment exits (from 334 to 427);
Number of onward referrals trebled from 39 to 122;
Proportion of both planned exits (28% to 22%) and unplanned exits (60% to 50%)
Drug-related arrests decreased by 22% over the last 3 years;
There has been a decrease in drug tests in custody in 2009/10, however the
proportion testing positive remains stable (31%).
1.8 However, we recognise that more needs to be done to create a user-led recovery
system. Developing a PbR model provides an opportunity to build on our current systems, to
test new approaches where money will follow success, and to challenge/re-design weak
elements and gaps in our treatment system to deliver the ambitious practice necessary for
sustained recovery and to further develop competitively driven markets.
1.9 We will include alcohol in this pilot. We are piloting the DH Alcohol PBR clustering
tool for tiers 3 and 4 (Models of Care for Alcohol) and are putting the validated screening tools
onto the local clinical system. This will ensure that appropriate links are made between both
pilots to avoid duplication of payment. We will weave in what we believe will be the
anticipated outcome data mapped to the recent NICE guidance, specifically:
Increasing the proportion of people in the local population with alcohol dependence who
enter and complete treatment in a setting appropriate to their need;
Increasing the proportion of dependent drinkers who achieve their treatment goals,
including a reduction in alcohol consumption to moderate levels or abstinence;
Preventing unnecessary hospital admissions or re-admissions because of acute alcohol
withdrawal or other alcohol-related physical complications;
Reducing complications arising from unplanned acute alcohol withdrawal;
Reducing length of hospital or inpatient stay for medically assisted alcohol withdrawal;
Preventing the development, and subsequently reducing the numbers of people
diagnosed with alcohol-related physical complications such Wernicke-Korsakoff
syndrome, alcohol-related liver disease and pancreatitis;
Reducing rates of relapse to heavy drinking.
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1.10 We are also delivering Integrated Drug Treatment System services to two local
prisons and, in line with our local priorities, we are keen to extend our community outcomes
framework to encompass substance misuse outcomes for offenders and would consider how
this can best be done during the co-design phase.
2. Please describe your approach to assessment, referral and tariff setting and
how you will ensure that the needs of all individuals (CJ and community/self referrals)
can be met.
2.1 A partnership meeting was held on the 7 January, to consider the benefits (and
challenges) of a PbR system. A commitment was secured from all partners and agreement
reached on an embryonic PbR model that included three elements: a LASARS that could
effectively place users into the treatment system; a revision of our existing outcomes
framework; and a tariff setting model with incentives. These are outlined in detail below.
Local Area Single Assessment and Referral System (LASARS)
2.2 We currently have a range of services that provide single points of access/referral
and assessment for drug users within criminal justice, community and primary care GP
clinical services. There is no doubt that this creates duplication and inefficiencies in our
current system. Therefore, our aim is to make better use of existing resources by establishing
a streamlined, multi-disciplinary, integrated referral, assessment and information team - from
the point of entry to the point of exit. Although, the LASARS team will not be co-located, we
will re-design current practices to ensure that there is a clear specification around the role of
the individual LASARS and that they have the appropriate skills, training, leadership and
supervision to ensure that they are able to meet the needs of all individuals.
2.3 The commissioners, working closely with providers, will be responsible for setting up
and overseeing the work of LASARS so that they can act independently of their organisations
whilst being integral to the treatment system. Commissioners will establish a Memorandum of
Understanding (MOU) with each of the individual organisations. The MOU will specify terms
of engagement throughout the life of the pilot, its leadership and governance, and define the
critical functions and tools to be used that will ensure consistency of professional practice,
standards and outputs.
2.4 In order to monitor and reliably evidence the work and independence of the LASARS,
we will commission an innovative specialist team who will be responsible for producing a
replicable and transferable quality assurance audit tool to review how the individual LASARS
assess users, set tariffs, and track individual users to ensure outcomes are achieved. The
end product of this audit will be the development of an audit and assurance ‘tracking tool’ that
can be used by commissioners to continue to monitor the work and provide assurance of
independence of the LASARS once the initial design audit is completed and independently
2.5 Two years ago members of our Integrated Care Organisation in substance misuse
developed our local outcomes framework, a balanced scorecard approach, to meet the
expectations of commissioners; the ambitions of the service providers; and the needs of the
service users. Our goal was to establish clear measurable outcomes by which to appraise
the quality of developing services in four key areas:
Service User Experience
Health and Wellbeing
2.6 The individual metrics and some of the results of the outcomes system are detailed in
Annex B. While these outcomes have been a success, we have become aware of the need
to re-design our outcomes in line with our revised focus on recovery. For example, one of the
best predictors of recovery being sustained is an individual’s ‘recovery capital’ – the resources
necessary to start and sustain recovery from drug and alcohol dependence.
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2.7 Therefore, we intend re-design our outcomes system to take into account the
Social capital - the resource a person has from their relationships (e.g. family, partners,
children, friends and peers). This includes both support received, and commitment and
obligations resulting from relationships;
Physical capital - such as money and a safe place to live;
Human capital – skills, mental and physical health, and a job; and
Cultural capital –values, beliefs and attitudes held by the individual.
2.8 We will now work towards re-designing our outcomes system to incorporate the PbR
outcomes as laid out in the PbR bid specification and the individual’s recovery capital.
2.9 The tariff programme requires the development and implementation of an agreed set
of pricing and currencies for integrated substance misuse services to be paid by the SMCG to
community providers. We propose a two-pronged approach to costing out the proposed
pricing and currencies for community substance misuse services: a top-down review of actual
cost per contacts and a bottom-up Patient-Level Information and Costing System level
pathway pricing approach. The bottom up approach involves detailed pathway pricings
developed with inputs from the provider services and reference to best practice and other
sources. We anticipate being able to access benchmarks mapped to pathway bundles of
care and to outline of each recovery oriented pathway profile/bundle based on best practice.
2.10 Our aim is to establish an effective ‘cap and partial collar’ approach to tariff setting
that will balance commissioner and provider risk during the initial introduction of PbR, whilst
still having 100% payment by outcomes. Examples of how we might initially utilise the tariff
setting approach to limit provider and commissioner risk in the early stages of the pilot are laid
2.11 In terms of a Health and Wellbeing outcome, a potential interim payment could be
based on the annual number of users supported and provided key work alongside substitute
prescribing - the interim outcome is that people are maintained and so drug related deaths
are reduced, freedom from illicit drug use is reinforced and associated offending reduced,
thus supporting service users to develop individual recovery capital. The interim outcome
could be based on current contract at 90-98% divided by the number of service users
annually supported, thus forming the interim tariff.
Current contract of a provider at £1,000,000 90% = £900,000
1000 service user provided with key work support for substitute prescribing in previous
£900,000 / 1000 = £900 tariff for each service user
In line with existing resources, the above could be capped at 1000 service users
Could have a collar element at minimum payment of 900 service users
The remaining 10% (£100,000) could form the other outcome payments
2.12 In terms of setting a tariff around the Free from Clinical Dependency Outcome, we
present the following examples below:
Example 2 - Drug Free Tariff and Targets (interim):
50 service users leaving drug free in the year
Target of 60 service users leaving drug free
£30,000 allocated to outcomes
£30,000/60 = £500 tariff per individual outcome
Target capped at 70 meaning total income cannot exceed= £35,000
Example 3 - Drug Free Tariff and Targets (final):
20 service users leaving treatment and not representing for 12 months
Target set at 25 service users
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£20,000/25 = £800 tariff per individual outcome
Target capped at 31 meaning total income cannot exceed= £24,800.
2.13 We believe that this approach is achievable within our current Pooled Treatment
Budget (PTB) and demonstrate this in the example below:
Example 4 - Total impact on PTB planning
Total PTB set aside = £59,800 with a potential outcome range of £50,000 and £59,800
Tariff Matrix example:
Target Tariff Cap Maximum
Outcome 1: Free from clinical 1000 £900 1000 £900,000
Outcome 2: Offending 60 £500 70 £35,000
Outcome 3: Employment 25 £800 31 £24,800
Outcome 4: Health & Wellbeing 80 £402 100 £40,200
2.14 The above example is given as an illustrative example only and we would envisage
developing the tariff model to include other health and wellbeing outcomes and variations in
tariffs to reflect complexity. Over the course of the pilot we will vary the tariff framework to
incentivise and direct activity to achieve the right balance in outcomes according to our local
needs assessment and strategic planning.
2.15 The cap element has to be applied to support responsible commissioning and ensure
that the parameters of payment are clear to providers. It will also help to prevent adverse
effects of the financial incentives i.e. if there was no cap on the interim substitute prescribing
then providers could be incentivised to keep people in treatment unnecessarily. Existing
providers and the current financial footprint is inevitably at risk here as there is no additional
funds for the delivery of incentivised outcomes. Consequently, there needs to be a
consideration of a stepped approach to risks for providers and/or freedoms to restructure their
model to maximise their delivery outcomes. We will also segment the current treatment
population and develop key clusters, which will vary payment dependent on complexity of
needs and recognise the challenge in delivering positive outcomes. These clusters and their
tariffs will be closely monitored and benchmarked to ensure that the financial incentives
associated with these groups does not lead to adverse ‘parking’ and ‘cherry picking’.
3. Please describe the governance arrangements for the proposed PbR pilot, and
how you will ensure that adequate leadership, drive and focus is provided to progress
3.1 We recognise the need for strong and consistent leadership to champion this
challenging programme and we have an established and functional local governance model
that would seamlessly be able to provide this leadership.
3.2 A PbR Project Team will be established – the current Integrated Care Organisation
(ICO) Board (which oversees the Department of Health ICO Pilot) will become the PbR
Project Team. The ICO has been in place for two years and includes representatives from
treatment, reintegration, offender and user organisations (for full membership see point 5.1).
The oversight of the PbR Project Team and the pilot will be with the existing Substance
Misuse Commissioning Group (SMCG) (previously the DAT). This group is accountable to
Community Safety Partnership - one of 5 co-ordination and delivery groups – and is chaired
by a member of the Local Services Board (LSB). The LSB is an overarching group made up
of chief executives from the key partner organisations (e.g. PCT, local authority, police,
probation) and is chaired by the leader of the council (see governance map below).
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Local Services Board
Substance Misuse Commissioning Group
PbR Project Board
Integrated Care Organisation
PbR Project Team
3.3 This simple governance structure guarantees that there is sufficiently senior
leadership at all levels to ensure appropriate and timely decisions are made and to have the
support of the Chief Executives in the LSB. The SMCG will provide leadership, drive and
focus by setting up agreed terms of reference (ToR) for the pilot. The primary focus of the
SMCG will be to ensure the timely achievement of the deliverables and that any lessons
learnt during the pilots are effectively captured. This governance structure is also able to
provide the pilot with strong financial governance especially in regard to the development of
the tariff framework to ensure that neither commissioners nor providers take on adverse
financial risks in the early stages of PbR development. The governance arrangements are
flexible enough to take account of further developments that may emerge as the pilot
progresses. All key stakeholders and partners, including providers, users and reintegration
services (housing and employment) have helped to develop this proposal.
4. Are there any barriers that you have already identified to the governance
arrangements proposed and how these might be tackled locally/regionally/nationally?
4.1 The SMCG governance arrangements have been successfully in place for ten years
so many of the barriers around drugs issues have been addressed, and key support services
such as housing and employment are fully engaged and part of this governance structure.
There are, however, some gaps in regards to alcohol and links, for example, need to be
established with the Acute Trust – these are being explored at present.
COMMISSIONING AND DELIVERY
5. Please describe your current Joint Commissioning systems
5.1 The SMCG has developed an outcome-focused commissioning and delivery system
and includes high-level representation from the following partnerships organisations:
Metropolitan District Council
HM Prison Service
Service User and Carer Representation
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5.2 The SMCG have a robust approach to commissioning built on a shared
understanding of the local needs for drug treatment. The SMCG developed their drug
treatment plans in line with the local needs assessment and the Models of Care update 2006,
and have improved the effectiveness of local drug systems by focusing on:
Best practice in handling public money, contracting with providers and monitoring service
Improving performance management of local systems of drug treatment by using data
and key performance indicators in partnership with local strategic partners and plans;
Ensuring the SMCG are “fit for purpose”, having involvement from key stakeholders at an
appropriate level of seniority and ensuring commissioners are competent against national
quality standards and other relevant professional frameworks.
5.3 The work of the SMCG was recognised by Affinity Healthcare who awarded the team
with the Excellence in Commissioning Award for engaging and involving stakeholders in
decisions; having excellent financial management skills; and, ensuring the highest quality
experience and care for patients.
6. Have your current commissioning systems had a direct impact on the delivery
of improved outcomes for service users? How can you evidence this?
6.1 The SMCG have had clear targets to perform against set at a national level, but also
through our outcomes system, the Balanced Scorecard. The evidence shows that our
delivery against these outcomes and targets are very good (see point 1.7) and this can be
contributed to the robust processes in place of quarterly contract management meetings with
all providers, standardised reporting and paperwork, accurate and timely financial reports and
regular NDTMS and local data reviews (quarterly position, year to date and forecast out turn).
During the quarterly contract monitoring meetings commissioners and providers work together
to resolve problems or any areas that are under achieving. We also facilitate training days,
innovation workshops, distance from target meetings and away days to ensure
commissioners and providers work together to achieve the target together for the benefit of
the service user. In this way, we ensure that there are robust performance monitoring and
performance support arrangements in place.
7. Please describe briefly your existing treatment/recovery systems and how you
will manage the transition from your current to your proposed commissioning and
delivery systems. Broadly outline any incremental stages, with dates, to the changes
you are proposing. Inclusion of a Gantt chart or similar project timeline would be
helpful to illustrate this.
7.1 We have made significant progress in streamlining and coordinating commissioning
services for people with drug problems. A strong, inclusive SMCG has brought together
planning and monitoring of services and, through this, has increased the number of people
who receive the services that they need and the quality and appropriateness of those
services. Our current local drug treatment system, in line with the Models of Care, is centred
around an outcomes system that focuses on reducing harm to individuals and communities,
improving clients’ journeys through treatment, including providing more support services such
as housing and employment, predicting client flow through local systems and improving the
quality and effectiveness of local drug systems. We have also published a Recovery Strategy
that outlines actions to support the achievement of a truly recovery-orientated system.
7.2 While our commissioning is currently coordinated, it is not fully integrated, with
different funding streams working to different grant conditions and accountabilities.
Therefore, while we have had some success with creating better continuity of care and
reintegration for our drug users, the effect of these ‘silos’ is to fragment services provision for
drug users, particularly for those who want to exit treatment. We believe more needs to be
done and, in line with the new Drug Strategy, had already begun to re-design our treatment
systems to focus on recovery. We are aiming at a model in which all the public services that
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have a significant effect on the recovery and reintegration of drug users (e.g. housing and
employment services), can be commissioned and performance managed through a truly
integrated commissioning and governance process that is person-centred and promotes
improvement and innovation. We believe that being part of the PbR pilot will enable us to
build on our current successes and make a step change away from the focus on numbers in
effective treatment to a focus on more effective treatment outcomes and successful planned
treatment exits. A transition programme is already being developed and our early thinking
and proposed outline/timetable can be found in Annex C. This table shows the majority of
tasks, deliverables and review activities that will make up the pilot, plotted across the first year
of the pilot period. This will be developed into a measurable, owned and time bound delivery
plan covering the two years of the pilot as a key priority, during the co-design phase, if we are
successful in this bid.
7.3 Through the development of our outcomes system, we already have an information
sharing protocol/system SharePoint, a web-based portal that reports shared performance
metrics. We believe that this information sharing system can be easily adapted to be used in
this pilot and have found the benefits of our ‘systemic integration’ through SharePoint to be
A place to access shared documents –guidelines, protocols, audits
Collate and share evidence of quality improvement e.g. (CQC)
Report on minimum data sets e.g. NDTMS
Analyse and report our own Balanced Scorecard KPIs
Populate client evaluation and organisation assessment forms
Set up discussion forums (staff and service user and carers)
8. Do you have contact with provider(s) who are interested in responding to the
challenges posed by developing a PbR model? In particular, does your proposed
model have scope to attract new PBR providers to the market?
8.1 We already have a number of providers that helped to develop this proposal and are
interested in working with us to create this PbR model. We also believe that our proposal
does have the scope to attract not only new PbR providers to the market, but to create new
models of working together and to attract new funding sources. For example, our statutory
health provider and key voluntary sector provider have already joined together to form a new
Social Enterprise - Spectrum Community Health CIC and they have opened a dialogue with
the Social Enterprise Investment Fund about innovative social impact bonds linked to return
on investment modelling. This is the type of provider/finance models we believe that the PbR
pilot will positively allow us to build upon.
8.2 The largest provider in our area has also expressed a desire to develop local
partnerships and explore subcontract arrangements for the delivery of positive outcomes. As
a national provider they have experience of managing and delivering subcontracted services
across a range of health and social care sectors working alongside private, statutory and third
sector providers. They also bring substantial experience of delivering outcome-based
payment models within employment brokerage services.
9. Please provide copies of this year’s (2010/11) treatment budget ( including all
funding streams currently used to commission and detailing income & expected year
end expenditure) alongside an overview of next year’s proposed PbR budget.
9.1 Please find attached in Annex D a copy of this year’s (2010/11) treatment budget.
As stated in point 1.7, it is our intention to use our community budgets to pay providers for the
outcomes achieved (for details see section 1). Our proposal will align and/or pool, where
appropriate, the range of funding resources managed by SMCG partners, including drug and
non-drug specific budgets, in order to use these resources to more flexibly meet the pilot
outcomes. The SMCG are committed to ensuring that the current levels of investments will
be maintained, wherever possible, and will seek to lever in further resources and explore
funding opportunities such as social finance models e.g. Social Impact Bonds (SIB) - their
potential to improve social outcomes are currently being considered as an innovative way of
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attracting new investment. There are a range of risks to be considered in developing this
proposal including the risks related to the transition of budgets to local government as
proposed in the White Paper ‘Healthy Lives, Healthy People’, both financial and non-financial,
and these are outlined below in section 11 on Risk Management.
10. What are the cost implications of changes to existing contracts?
10.1 An assessment of the costs of any changes to existing contracts has been made and
there is a risk that major costs could be incurred to changes in some contracts, which could
delay the start of the pilots. Therefore, to mitigate this risk, it has been decided that it would
be more effective to introduce variations into contracts at this stage rather than making major
changes. This has been discussed with the major providers and it has been agreed that this
is an appropriate and acceptable way forward in light of the potentially tight timescales to get
the pilots underway and to develop a robust PbR system that delivers positive outcomes.
There is potential in this proposal for efficiencies and economies of scale, including:
Improving the quality and consistency of referral and assessment services though the
development of LASARS to ensure those most in need, and the most vulnerable are able
to access appropriate provision, more rapidly e.g. drugs users with mental health
Ensuring more efficient use of resources by improvements in service quality, choice and
outcomes for the individual, their families and the community, resulting in less people
being retained in treatment and more in exits from treatments.
Create efficiencies and streamline systems by considering joint commissioning and
performance arrangements with partners where appropriate. This would enable a more
coherent integrated approach to be developed that could include greater information
sharing, increase our ability to plan based on need and reduce the bureaucratic burdens
11. What are the top-level potential risks and the possible actions to mitigate
these? Inclusion of a risk register and Equality Impact Assessment with your
submission is recommended.
11.1 A risk register has been completed (see Annex E) identifying a series of risks at a
strategic, management/operational and project level. One of the most significant risks is
related to ensuring that once high-level commitment is gained for the pilot from key strategic
partners that this is maintained during times of major economic pressures and the transition of
budgets to local government. There is a need to balance the financial risks between
commissioners and local providers, and to consider the risks to smaller local providers. There
is also the risk of negative impact to drug users through the development of perverse
incentives such as ‘cherry-picking’ of clients by providers, which must be avoided. Other
additional areas of risk are related to workforce development, finance and information
management and sharing. A mitigation process is outlined in the risk register and will need to
be further developed during the co-design phase. Moreover, as the key measures of success
for the pilot are dependant on the achievement of improved outcomes, the reliance on robust
partnership arrangements with housing, employment, education, training and health cannot
11.2 A pro-active approach to planning and maintaining effective communications
throughout the two year pilot programme will be vital – it ensures that links are maintained
with pilot partnerships and key stakeholders; prevents negative rumours and speculation
about activities; and enables information to be tailored to the needs of a variety of
stakeholders and interested parties. Therefore, a Communications Plan will be developed
to promote the objectives of the pilot, to highlight the progress and outcomes as they develop,
and to ensure that any emerging findings or learning is shared. The Communications Plan
will focuses on a broad audience including the local drug treatment sector and key
stakeholders, the wider recovery system, local media, and the general public.
11.3 Equity and equality issues are an integral part of the commissioning and provider
process, so we will take into account all relevant requirements of the new Equality Act 2010.
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As standard, all reconfigured or newly commissioned contracts have these requirements
within the contractual arrangements. The SMCG, who will be responsible for overseeing this
pilot will monitor whether the services, strategies, policies, programmes relevant to this pilot:
Promote equality of opportunity;
Promote good relations between and positive attitudes towards different population
Ensure under represented groups to participate in public life;
Eliminate unlawful discrimination; and,
Whether the service change, policy, programme is likely to have any adverse effects on
11.4 The pilot is aiming to achieve positive effects on equality in particular by:
Improving accessibility to mainstream services for this client group;
Improving peer support and mentoring to achieve empowerment of client group i.e.
greater confidence, ability to take on responsibility and make important decisions and
Enhancing the ability of LASARS staff to be able to better address diverse and individual
support needs of clients.
11.5 There is a risk that the pilot has unintended, adverse effects on equality. Annex F
summarises the initial findings of an Equality Impact Assessment. This is the start of a
longer process, and while we are able to identify potential impacts at a high level, we will
conduct more detailed assessments of the impact of the pilot through Equality Impact
Assessment exercises and will develop mitigation to counteract any potential adverse effects.
The pilot will also be able to draw on the published outputs of a Multiagency Equality and
Diversity event held in September 2010, which demonstrated a cross-agency commitment to
tackling inequality. The event was attended by over 60 delegates representing all ICO
members and culminated in the identification of three high level Equality Objectives. The ICO
are committed to taking this work forward and will report on progress against these objectives:
The ICO has an improved understanding of the substance misuse and offending
population’s inequalities across the eight strands
Communities and service users perceive and evaluate staff working in the ICO as having
a high standard of competence in cultural awareness, equality and diversity
ICO workforce adequately reflects the 8 strands of the E&D strategy groups that we serve
including service users
12. What support and opportunities for shared learning would you like during the
12.1 During the co-design period, it would be useful to have the opportunity to share with
other pilot areas their plans around the development of LASARS, outcomes and tariff setting.
We would particularly welcome the opportunity to discuss issues around tariff setting and to
gain an insight into what models other pilots intend to develop, as this is one of the most
complex areas in establishing this pilot. We would like access to learning achieved in other
areas of healthcare to assist us in the development of our own local bottom up currency and
pathways pricing methodologies to be used alongside top down benchmarking. We would
welcome the opportunity to hear about other PbR schemes from other sectors such as mental
health and the criminal justice system to see what lessons have been learnt.
13. What can you offer other areas who may wish to learn from your pilot?
13.1 We believe that our current outcomes framework, information sharing
procedures/governance and steps to achieve systemic integration through investment in a fit
for purpose infrastructure may be of interest to other areas and we would be happy to share
lessons both positive and negative around developing and implementing a local outcomes