The shadow of ‘More for less!’ – What are the implications for drug and alcohol treatment?

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The shadow of ‘More for less!’ – What are the implications for drug and alcohol treatment?

In an era of cuts, and the legacy of ‘More for less!’, where does that leave services?  Policy makers have to strive toward creating a strategy that is meaningful, while at the same time recognise that resources are slim.  Commissioners have to pay for services that cater to the service user while at the same time recognising the requirements of the worker, of teams, who need to be supported in doing the best job possible.  The workers engaging the client – head on – have to be able to manage challenging case loads, ever increasing paper work and the constantly changing landscape of alcohol and other substance use.  And the simple question is – whether or not it is possible to juggle these components that represent ‘treatment’.    In reality how are the commissioners, how are the workers, how are the clients – and with ‘client’ I am referring to the full diversity of clients including those in the criminal justice system, those from socially excluded groups, the young person using substances etc.   I have to ask how well are we doing with regard to the diversity of requirements mentioned above.

Whether you/we are policy makers, strategists, commissioners, service delivery organisations or ground floor/frontline staff, operating in a planned or considered way or are we operating in a reactionary way.   Is it possible to get ‘More for less!’, or has it simply become a market place whereby – we can keep on asking for more, and everyone is so anxious that they simply say ‘ok!’, we can do it!  Of course you can get ‘More for less!’, however there has to be some serious thinking as to how you actually accomplish this.   And I presume – simply asking for more is not ‘serious thinking!’.

Hence, in order to get ‘More for less’ you may have to create a kind of ground zero, that is to say:

  • Step back and re-evaluate everything that you have done before
  • Be brave and be honest with regards to what has worked and what has not worked
  • Be clear about what success is – and success can not be overly woolly
  • Consider, in this case, the nature of the client you are dealing with – what is that nature?
  • Create synergy between the above, and the components that should be at the heart of commissioning for this client group, that is to say: Policy, Strategy, Implementation, Service Delivery and The actual client.  Note:  I refer to the ‘actual’ client because the client should be accountable – not to waste funds, hence there should be expectations regarding the client
  • Be sure not to view ‘cheap’, with ‘More for less’, that is to say, service user representation, peer mentors and volunteers are valuable, however they are not in their entirety a representation of the work force.  They should not be viewed as a replacement work force, but peer led added value.  Of course people will say that is how ‘I/we’ view and use them! I would simply say: Is that the case? And what will be the direction of traffic regarding this particular workforce, say, ten years from now?
  • The above would need to be driven from the top, yet how can you really get ‘More for less’ without looking at what we did; what we are doing and what we need to do!  And in order to get to that place of scrapping and getting rid of what did not work; exploring the training required to achieve synergy, and training in a more universal approach to treatment and finally re-configuring provision to reflect this new environment – then there may well have to be alittle extra spending.  So in order to get ‘More for less’, you may initially have to spend more!
  • A struggling business may be advised to invest appropriately in order to succeed.  Does the same rule belong to the treatment and recovery sector?  Of course you may say: ‘I do that already!’.   I would ask – Do you?  Of course I have not presented commissioning language, and sometimes that is not a bad thing!

So – are we working like hamsters on the wheel or are we working in a ‘smart’ way!  Hopefully this blog over time will allow us some thought provoking discussion on this ever more challenging area of work.


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