Dr Penny Buykx

Senior Research Fellow in Public Health

Background: Primary responsibility for commissioning alcohol services moved to Local Authorities in 2013/14 and many areas have since experienced substantial budget reductions. Aims: To investigate (1) the approaches taken by diverse Local Authorities to commissioning alcohol services in a climate of disinvestment and (2) the perceptions of key stakeholders regarding the strengths, challenges, and outcomes of these approaches. Methods: An in-depth multiple case study approach was taken of five English Local Authorities. In-depth qualitative interviews (n=32) were conducted with local commissioning stakeholders. Interviews primarily focused on the drivers, processes, and perceived outcomes of the most recent local commissioning round. Data were analysed with reference to Donabedian ‘s model for evaluating the quality of health care, including consideration of context, infrastructure, processes and outcomes. Results: The need to accommodate large budget cuts in recent commissioning rounds was common across sites and produced similar responses in several sites, including: merging of services, delegation of commissioning functions to lead providers (e.g. through sub-contracting), review of the intensity of treatment pathways, a changing role for outreach within the system and increased involvement of peer workers. Although these responses had generally been informed by stakeholder consultation and were considered to make best use of available funds, perceptions of the ensuing benefits and challenges differed within and across sites. Conclusions: In a sector characterised by budget cuts and frequent recommissioning, stakeholders are simultaneously optimistic about the opportunities this creates and cognisant of the potential risk to client outcomes. The true impact on service outcomes requires close scrutiny.

Co-Authors

Mr Andy Irving, Research Associate, University of Sheffield Dr Lucy Gavens, Specialty Registrar in Public Health, Derbyshire County Council

Conflicts of interest:

No conflict of interest