Commissioning practices

Joining it up: Maximising the Liaison and Diversion potential by integrating with other local services

January 2019

The Avon and Somerset Liaison and Diversion (L&D) service has integrated with the Arrest Referral service run by the Office of the Police and Crime Commissioner (OPCC). The Arrest Referral service served people with substance misuse issues in Avon and Somerset. In bringing these two services together, the OPCC and NHS England have undertaken innovative collaborative commissioning arrangements.

In the early days of adopting the national L&D service specification, providers were asked to work more collaboratively to ensure a consistent approach across police force areas, often with two or more health providers.  This worked well in Avon and Somerset.

The L&D partnership board strove to achieve optimum membership from relevant stakeholders and the OPCC became an important player at these meetings. Early on, the board identified potential duplication between the NHS England commissioned L&D service and the Arrest Referral service commissioned by the OPCC. The decision was therefore made to integrate the overlapping aspects of the two services.

An agreement was reached in January 2017 to commission for this newly designed integrated service. By January 2018, the contract had been awarded to the successful provider, Avon and Wiltshire Partnership Trust, after an incredibly robust procurement process. The economies of scale involved allowed for innovation. Plus, it enabled the building of an infrastructure that allowed commissioners to be agile with other emerging initiatives such as Community Sentence Treatment Requirements.

It was felt that improving pathways for women as well as having a defined Peer Support function was a very important aspect of the integrated service, and these are both now contractually defined and have accompanying ‘CQUINS’ (Commissioning for Quality and Innovation).

An exciting opportunity encompassed within the new service was that of the Drug Education Programme (DEP). The DEP is a group programme delivered by trained people and those with lived experience for low level drug offences.  Those that engage can avoid the offence going on their criminal record.  Whilst the DEP was already established it only served the Bristol area of Avon and Somerset.  Integration of the services has allowed for this to be delivered across the whole force area.

We are looking forward to 2019 and beyond with this new service. We have a response for all vulnerabilities and people will have greater choice, especially women who are notoriously poorly served in criminal justice environments. We have a service that can avoid criminalisation for what are often psychological problems, i.e. substance misuse, and we have a service with the service user at its core.

From 2018, 100% of people who are assessed by the service have been informed of the opportunity to come back and help us after their contact with services is over in the form of peer support.  This is built on the concept of reciprocity to improve engagement. For some of our service users there is a stigma attached to accepting help but if it can be framed into “borrowing a bit of help,” we often see engagement improve.

Cliff Hoyle, Health and Justice Commissioner, (South-West), notes: ‘Whilst we enter this exciting partnership we cannot avoid the challenges. As with any change, when people see their place of safety and sense of belonging challenged it can be unsettling, especially when there’s a change to employment terms. This has led to a period of storming whilst people become familiar with the new structures and service aims. I would like to say this is just applicable to the staff but as commissioners we had been susceptible ourselves. While establishing appropriate communication with the provider and a shared vision for the service we found ourselves having some strong feelings about the right way to deliver a service. Reflection allowed for us to see how we were “storming” which has actually helped the relationship but not before some unfounded misgivings about the venture.’

The service launched on 1 July 2018 and goes by the name of Advice and Support for Custody and Courts (ASCC pronounced ‘ask’), as was chosen by our lived experience focus group.

Article by: Cliff Hoyle- Commissioner, NHS England Health and Justice (South-West)