In Cornwall, a well-established partnership model, notably within the Community Safety Partnership, has flourished over several years, significantly expanding its membership. This case study forms part of the publication, Two years on: a progress review of ‘From harm to hope: A 10-year drugs plan to cut crime and save lives’.
Introduction
When orchestrating the rollout of the 10-year drug strategy, there was no necessity to establish new governance structures, as the initiative seamlessly integrated into a Combating Drugs Partnership (CDP) within the existing partnership model.
Governance
Board members of the Community Safety Partnership (CSP) have been assembled to foster their ownership of the strategy during the transition to a CDP and facilitate the exchange of ideas, thus bolstering support for the strategy's priorities. Among the members are the independent chairs of the safeguarding board for adults and children, representatives from health and wellbeing, the director of public health, OHID representation, and leads from the Integrated Care Board (ICB), Probation and the Police. Having these crucial relationships in place prior to the implementation of the strategy, laid a solid foundation for collaborative action.
Without established governance structures, the risk of redundancy and bureaucratic inefficiencies would have loomed large, as numerous members would have found themselves seated on multiple boards addressing identical issues. Embracing an open governance approach acknowledges the potential benefit of imbuing decision-making processes with more authoritative influence.
Recruitment, rough sleeping and caseloads
Staff recruitment has proved enormously challenging, in both recruiting people to the sector and retaining them due to a number of factors including the overall renumeration package and cost of living and lack of affordable housing availability. There has been some success in the hiring of recovery workers who operate directly in the field. However, it's crucial to recognise the stark contrast in the challenges faced when recruiting qualified medical personnel. This process demands significant resources and poses a distinct challenge. Balancing the allocation of funding is paramount, as there exists an interdependency between staff recruitment and the delivery of treatments. Unfortunately, the constraints of one-year funding cycles present obstacles to effectively utilising resources for both recruitment and enhancing service quality within the stipulated time frame.
Rough sleeping numbers in contact with services continue to increase, attributed in part to the health-focused nature of the funding, which lacks specificity in addressing broader social issues and interdependencies.
Overall, it is apparent that the available funding falls short of sustainably increasing treatment numbers and reducing caseloads. This trend has been observed since approximately 2012, highlighting the persistent challenge of resource allocation in meeting the evolving needs within the community. This trend also shows that after a long-term decline in budgets, reimplemented strategies take years to show long term positive results.
Additional grants and KPIs
Cornwall benefits from various grants, including those for rough sleepers, housing, and inpatient services, in addition to the funding allocated for the drug strategy. While these grants enrich the overall funding landscape and enhance the holistic nature of the strategy, navigating the distinct application processes for each grant adds complexity and demands significant resources. Moreover, managing different reporting requirements for each grant further complicates the process, although the reporting process for the 10-year drug strategy is perceived as neither more nor less complex than that of the grants.
There are also concerns regarding the tight timeframes imposed by the national strategy for addressing key performance indicators (KPIs). Achieving meaningful reductions in drug-related deaths and implementing improvements in technical prescribing processes require time and involve adherence to regulations and thorough consultations within local systems. These factors underscore the need for realistic timelines and flexibility in achieving the desired outcomes of the drug strategy.
The differing emphasis between the public health outcomes framework and the Local Outcomes Framework, could be more helpfully aligned to support partnership working and clarity of focus.
System working, partnerships and synthetic drugs
In Cornwall, there is a strong emphasis on collaborative system working and leveraging multiple grant funding streams to maximise outcomes. However, Cornwall seeks greater autonomy in developing targets set at the national level, enabling customisation of implementation to align with the specific needs and demographics of their local system.
This approach would maintain the ethos of local leadership demonstrated at the national level while fostering more robust engagement with local mental health transformation plans, for example.
Overall, joint partnerships in combating drug-related issues are viewed positively, highlighting the importance of collaborative efforts in addressing complex challenges and promoting holistic solutions tailored to local contexts.
Cornwall, like many other regions, expresses a need to secure engagement on a number of supra partnership issues such as increased engagement with regional ambulance services. While there have been some instances of collaboration in the past, such interactions are not yet part of routine practice.
A critical risk for the partnership relates to synthetic drugs and drug related deaths. The lack of robust national co-ordination, intelligence, surveillance, testing and response to local requests to assist impacts negatively.
Continuity of care
Continuity of care within the justice system presents a challenge for Cornwall, given the absence of prisons within the area. Consequently, challenges arise when individuals relocate back to Cornwall post-release and require ongoing treatment. However, the presence of strong local connections with the justice system and police helps mitigate some of these risks, facilitating smoother transitions and ensuring individuals receive the necessary support upon their return to the community.