Birmingham City Council: moving from 19 providers to one integrated service

Birmingham City Council has created an integrated substance misuse service after concern its previous approach was too fragmented.

The new service is achieving results, helping people recover from their problems, while also helping with everything from employment to housing and benefits.

The challenges

Birmingham City Council runs the biggest substance misuse service in Europe, providing support to nearly 7,000 people. Evidence shows those with substance misuse problems have a range of problems.

This was reflected by the fact that until three years ago the service was split across 27 different contracts run by 19 different providers. But the council, concerned the service was fragmented, decided to change the commissioning approach. The merit of this was also confirmed in a consultation of services users and staff.

An overwhelming majority said they wanted a greater focus on recovery and the needs of families, such as finding a job or re-building past relationships.

Max Vaughan, the council’s Head of Service for Universal and Prevention Services, said it was clear things had to change. “Both service users and professionals were very confused as to which substance misuse service was most appropriate for a specific need. Furthermore, the service that an individual first entered into was the service they tended to remain with, despite the nature of their substance misuse problems. There were also concerns that the relatively high number of contracts all required separate building, management, IT and administration costs.”

The solution

The decision was made to bring all the services together in one integrated contract. Change Grow Live won the tender for the five year contract, which started in 2015.

Its programme, Reach Out Recovery, provides people with substance misuse problems a full range of support.

Once someone is referred on to the programme they are given a recovery coordinator who organises all aspects of their wider support from help with employment and training to housing and benefits.

The clinical side of treatment is carried out through the consultant-led team, which includes doctors and nurses.

They work from five locations across the city, although the recovery coordinators work from over 200 different locations, including libraries, fire stations and community venues.

Head of service Sian Warmer said: “The idea has been to base the service around the individual, out in the community. We have residential and in-patient services, but the day-to-day support is based close to where people live. The role of the coordinator is to arrange a package of support to reintegrate the client into mainstream life. It can involve anything from gym membership to employment and training opportunities as well as housing and debt support.”

A major emphasis is also placed on involving the client’s family. They are encouraged to come along to the appointments with the coordinator.

Ms Warmer said: “Often people with substance misuse problems have lost contact with family and loved ones. By re-connecting them with these people you are helping with their recovery. But we also provide them with peer support. We have volunteers who have been through the programme and are there to help them and talk to them. It is really making a difference to the people we help.”

The impact

The service is undoubtedly getting results – in fact its contract with the city council is structured so that the provider gets 10 per cent of the value of the contract for achieving certain thresholds. Since going live over 3,000 people complete their treatment having beaten their dependence on drugs or alcohol or both, giving the service a success rate that puts it in the top quartile of performance on three of the four national performance measures.

It is also achieving its target in the other three areas that are measured:

  • getting clients into employment – one in three complete the programme with at least 10 days of work under their belt
  • involving family in the recovery programme – over half of clients do this
  • ensuring court treatment orders are completed – these can last three, six or 12 months with success rates currently running at over 80 per cent.

One of the many people who has been helped is Carl. He was a heroin addict for 17 years before he was referred to the service. He said the holistic support is essential. “Being an addict is never as simple as just picking up drugs and using, there’s always something else going on beneath the surface.”

Lessons learned

Ms Warmer said it is important to recognise that you need to tailor your approach to different populations. “You can’t have a one-size fits all approach. You need to take into account the differences that exist. For example, drug and alcohol problems can be viewed as quite a taboo subject in Asian communities. “It means people can be very reticent about coming forward for help so we have subcontracted the service to another provider in one area where we have a very high BAME population.”

The service is provided by KIKIT, which is staffed by people from Black, Asian and Minority Ethnic (BAME) communities to ensure culturally sensitive and multi-lingual services are provided.

How the approach is being sustained

The service is in the fourth year of a five-year contract, although there is an option for it to be extended for another two years. A decision on that is due to be taken during 2018. In the meantime, the service has continued to look at new ways of working. During the second-half of last year, staff joined a new initiative to help homeless people. A street intervention team, a multi-agency group involving housing, primary care, the substance misuse service and civil enforcement officers, was set up to provide rapid outreach support to homeless people. Alongside finding them accommodation, homeless people are given support for substance misuse as well as being given health checks and treatment for chronic conditions and illnesses.

Contact details

Max Vaughan
Head of Service for Universal and Prevention Services, Birmingham City Council