Milton Keynes is a largely urban ‘new city’ with a population of 250,000 just north of London.
The right time for change
For many years in Milton Keynes substance misuse services were provided by multiple providers. Co-ordination was poor and users found the service complex and often dropped out of treatment.
This complexity and fragmentation characterises a wide range of different NHS services. For most patients navigating through the system is very difficult. For people who misuse substances this is almost impossible. This raises questions about the efficacy of any substance misuse service that is arranged around a number of different contracts.
Milton Keynes healthcare commissioners and Milton Keynes local authority jointly developed an understanding of the outcomes that they wanted from the COBIC contract. They worked with service users and partner agencies to set better outcomes, including keeping people in housing, increasing the percentage of substance misusers in employment and ensuring that the courts had access to a treatment service as an alternative to imprisonment. The COBIC contract for substance misuse was won by a single provider: a national charity called CRI. The results were dramatic. The service was transformed in weeks, providing measurably better quality and experiences than before – and with annual spend reduced by 20% in year 1.