I was recently sent a classic cartoon strip from Scott Adam’s Dilbert series, which documents the indignities and inanities of office life. This strip is set at a meeting where an intern has been invited to introduce himself to new colleagues. ‘I am Asok the intern’, he begins, ‘I report to you. But I also report to Alice on a dotted line. And I report to Carol on a fuzzy thin line. I have a blinking irregular line to Wally, and a wavy brown line to Dilbert’, at which point Alice buries her head in her hands and says ‘please make this stop’.
This strip may strike a chord with DrugScope members who are adapting to a wide range of new structures, which relate to each other in a variety of ways. These include Directors of Public Health, Clinical Commissioning Groups, Health and Wellbeing Boards, Healthwatch (both nationally and through its 152 local centres), Public Health England (nationally and through 15 regional centres), NHS England and elected Police and Crime Commissioners.
There is clear potential in so much simultaneous system change for a proliferation of dotted, fuzzy, blinking, irregular and wavy lines – particularly as different initiatives have been developed by different government departments, and may not always have been exhaustively choreographed.
Take, for example, Public Health England (PHE). At national level, strategic leadership for substance misuse sits with the PHE’s Directorate for Health Improvement and Population Health. But there is no direct line from this directorate to the 15 PHE regional centres (and their substance misuse teams), which are overseen by PHE’s Operations Directorate. The ‘line’ from PHE to local public health budget holders is also of the dotted variety. The recent PHE document ‘Our priorities for 2014-15’ explains that ‘PHE will not performance manage local authorities’, with public health ‘led locally by elected members’. (It was reported at a recent meeting attended by DrugScope that PHE Regional Directors may have autonomy to set their own local priorities independently of PHE nationally – raising intriguing questions, if true, about the scope and force of PHE’s national priorities and strategy within the wider organisation.)
To take another example, DrugScope recently met with the drug and alcohol team within the London Mayor’s Office for Policing and Crime (MOPAC). MOPAC is responsible for discharging the Police and Crime Commissioner role in London, and has identified ‘developing smarter solutions to drug and alcohol crime’ as a strategic priority in the London Police and Crime Plan, but it has limited say in the design and development of treatment services for offenders. The MOPAC team is therefore busy forging connections with decision-makers in the 33 London Boroughs – for example, Health and Wellbeing Boards. They are also working with the PHE London regional team, and thinking about how their work might eventually link up with the Ministry of Justice’s Transforming Rehabilitation reforms.
It was in Howard’s End, that the novelist E M Forster wrote ‘Only connect! That was the whole of her sermon. Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height.’ That might somewhat overstate the benefit for us, but certainly ‘connecting’ will be critical for the future of drug and alcohol services. On a positive note the ‘fuzziness’ and ‘waviness’ of some of the lines could be viewed as a welcome indication of ‘flex’ and fluidity and an opportunity for creative inter-agency work. A lot will then depend on pro-active local work to ‘join the dots’ and ‘build recovery in communities’.
On a practical level, creating robust local forums and getting the right people to attend them is critical (think, for example, of the history of Drug Action Teams). It’s also important that busy people are supported to prioritise the activity that is needed to build relationships and effectively link up with others (for example, at a basic level, in job descriptions and work plans). Organisations like DrugScope have an important role to play in catalysing these processes and supporting members to engage effectively. In the autumn, for example, we are hosting a series of regional events on ‘building recovery’ in this new environment on behalf of the Recovery Partnership, and will be in touch as this – and other related work – develops.
DrugScope is currently monitoring, for the Recovery Partnership, developments for drug and alcohol services in light of the significant changes for the sector and related services. Find out more and tell us about any concerns in your local area at http://www.drugscope.org.uk/partnersandprojects/RecoveryWatch
Director of Policy