Skills for the future a look into the crystal ballDr Emily Finch, Clinical Director, Addictions, South London and Maudsley NHS Trust

What did it use to look like?Strong emphasis on opiates, focus on numbers in treatment Alcohol services less prominentJoint commissioning influenced by health and criminal justiceFinancial growth in the sector, ring fenced budgetsStrong national control from the National Treatment Agency Strong political interest

Workforce

Long careers in one organisationProfessional groups assured of careers in addictionDANOS, University MSc courses

The people we treat?Opiate use decliningAgeing treatment population prematurely agedIncreasing physical health needsIncreasing mental health needsIncreasingly socially disadvantagedPolydrug use increasing

Addiction to medicines associated with other physical and psychiatric comorbiditiesNPS range of problems some complex some not

Alcohol is different?Vast amount of unmet needBroader range of interventions and needsHarmful and hazardous drinkers need evidence based brief interventionsTreatment in non-treatment and non specialist situationsPatients in different environments e.g acute hospitals

Dependent drinkers requiring evidence based psychological and pharmacological treatment interventionsMost severe drinkers require a full range of harm reduction and social interventions

How are we organised?Commissioning moved to local authorities with strong influence from public healthNTA moved into Public Health EnglandCreation of PHE Tobacco, Alcohol and Drugs

Escalation of competition in the sector, regular retendering of servicesStrong emphasis on local political decision making Many innovative models emerging e.g. integrated care, focus on well being, parity of esteem unsure of impact on substance misuseLess political attentionRole of Francis. Drive to quality in health

Fewer but larger non-statutory organisations, less role of the NHS

The MoneyRemoval of ring fenced moneyPart of public health grantCompeting with other public health prioritiesUse of retendering to remodel services and to reduce costs.

What is public health?Focus on health of the whole populationBenefits for large groups not individualsReducing inequalities Obesity, tobacco, exercisePrevention and wellbeing

Alcohol but generally at a population levelInfectious diseases e.g. HCV

Important benefits for our clients but little emphasis on more intensive treatments. This may disadvantage our treatment population

Gaining the skillsMost training internal within large organisations. But risk of TUPEUniversities need to adapt and find ways to provide specialist educationBroader range of skills needed e.g. smoking and brief interventionsProfessional groups are responding e.g. SMMGP. Role of Health Education England (HEE)? ButChange expected populations less predictable and systems less predictable. Innovation necessaryNeed a long term view retaining managers and leaders through uncertainty is difficultNeed system leaders Maintaining a high quality motivated workforce a priority.

Focusing on outcomes and using the evidenceSkills in evidence based interventions e.g RP, MI, 12 step facilitation, recovery skillsTransferable skillsNew pharmacologies e.g. for tobacco and alcoholHealth interventions e.g. for HCVMental health interventions e.g. CBTNew populations e.g. in the acute hospital and in primary careNICE and other evidenced based and recommended interventions

Recovery and beyondBroader range of skills to support clients full recoveryMay not need all skills in one person Embedding former service users into the workforce and supporting them properlySkills in working in partnership

Who is the workforce?Generalists e.g. in acute hospitals and primary care. Substance misuse skills may be one of manyNew specialities e.g. pain clinics, liver clinicsThose with careers in substance misuse need to adapt with core skills embedded. Ex-service usersProfessionals who are specialists.

Doctors, nurses, psychologistsSpecialist training still remains e.g. RCPsych and RCGPBut rapidly decreasing placement and training opportunitiesSector is less attractive due to uncertainly and disruptionPsychology and nursing fewer speciality placementsBut more interest in generalist training e.g. for medical and nursing students

The role of addiction specialist doctors in recovery orientated treatment systems A resource for commissioners, providers and clinicians

Outlines contribution of doctorsSet out standards for training and supervision for commissionersExpectations of contractsOutlines ways of providing training for doctors

SolutionsSpecialists and generalists need different solutions. Clarity of who does what and who needs which skills.Preserve standard of training for specialists and professionals Use all opportunities to set standards Encourage universities and other training organisations to provide sustainable specialist training. Opportunities for generalists to train in SM both undergraduate and post graduate.

Its a bit fuzzy butMoney is likely to be the biggest problem but..

Keep supporting and motivating staffAcquire new skills where neededBuilding high standards in contracts at all opportunitiesAllow opportunities for creativity and innovation. New career paths in recovery

Use every opportunity to create careers in the sector

And what is different?*I was told I was part of the public health workforce really not sure what that meantMany positives, many synergies with behaviour change we already do.

But risky we need skills to provide real treatment and support for individuals with entrenched addiction problems. They may be disadvantaged. *Primary care under real pressure*On example of standard setting. RCPsych and RCGP got together to set standards for training for addiction specialists. PHE have turned this into guidance for commissioners attempt to embed high standards into contracts. *