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The pain of losing a service?

Posted in: Alcohol, Core Values, Delphi tribe, Drugs by on 5 July 2013
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I've been reading a lot this week about the state of the NHS on it's 65th birthday and finding it particularly poignant. This week we handed over our oldest contracts in North Lancashire to a new provider, and I find myself edged out of the local clinical drug and alcohol work that has been so much a part of what I've done for the last 5 years. I'm losing colleagues, have fears for the type of clinical support the new service will deliver, and regret the passing of the deep  relationship and trust that service users have placed in us over the years. In many ways our journey as a clinical provider mirrors the same journey the NHS is on, and carries with it some warning lessons for where we are headed.

John Richmond and I come from a GP background with strong interest in treatment of addictions. We found ourselves working together in our local Lancaster services for a large mental health trust and unable to put into effect some of the innovative ideas we had for treatment. Finding ourselves in the midst of retendering of our services we decided that being an independent clinical voice was where our future lay and Delphi Medical was born.

2007 saw our first contracts to provide services with Addaction, first providing Young Persons Substance Misuse Treatment and then Criminal Justice Treatment across Lancashire. We developed substance misuse treatment across Lancashire prisons and in 2009 were contracted to provide drug and alcohol treatment first at HMP Lancaster Castle, HMP Kirkham and then HMP Lancaster Farms in our own right. Becoming the community drug and alcohol treatment provider with DISC as part of the partnership forming J2R completed the picture.  As a natural progression, Delphi Medical became the clinical 'hub', integrating community and prison drug and alcohol treatment services.

Being such a local agency has, I think, given us an edge in terms of local knowledge and commitment. Whenever it has been in the interests of clients we have had fantastic staff willing to work whatever long hours it took to ensure that treatment was available and continuous. Knowing the area means we could accurately assess the risks within our communities, and manage them in such a way that services could be flexible to the needs of our clients.  

We have gradually grown and trained a dedicated team (even a 'Delphi Tribe' as we like to think of ourselves) whose skills at providing top class recovery orientated treatment have grown as our collective experience has developed. We have worked with, and learnt from, great partners. We can stand alongside national providers and provide equal or better levels of service delivery than our competition. Our work continues in all of our projects, and we continue to look for new opportunities to bring our ethos and values to.

Nonetheless it will be with great regret that I walk past our old clinics to go to our head office. Our GP and pharmacy colleagues are mystified as to why they can no longer draw on our experience and support. Worker colleagues, some of whom taught me a great deal of what I know in this subject, are now working as our 'competitors'. Service users have expressed their regret that we can no longer provide their treatment. We miss them all already, and suspect they'll miss our input too. Our noble cause was to try and raise the standard of substance misuse treatment and we feel that we have achieved this goal locally.

My fear is that whilst early commissioning could favour smaller local agencies who could provide the benefits of local knowledge, experience and a vigorous support for their community we are now entering a time of larger and larger agencies competing for healthcare work without the vital connection that local clinicians bring. Are we going to see similar changes with GP's and Clinical Commissioning Groups? They may be local for now, but will the coming waves of primary care commissioning end up replacing your local doctors with remote, inflexible agencies with little regard for what your area needs?

Suffice it to say that although we are forced to hand over some of the great improvements to service we have helped make in drugs and alcohol treatment in Lancashire we do not intend to leave it to others. We remain committed to work in our county and if we can find new innovative ways of providing treatment in the changing landscape of the NHS (working with GPs, Public Health and charities) we will explore every possibility to return to Lancashire as soon as we can.

 Dr Ian Guinan