Guidance

Part 3: how to develop systems of care that support recovery

Updated 10 October 2024

Applies to England

Local partnership support for recovery support services and lived experience initiatives

Local alcohol and drug treatment and recovery partnerships should support the growth of recovery support services (RSS) and lived experience initiatives. Stigma, risk aversion and competition can inhibit their development.

Lived experience initiatives typically start with a few enthusiastic volunteers piloting a project to support people in treatment or recovery. Some grow into fully-fledged lived experience recovery organisations (LEROs) that:

• employ staff
• manage grants
• deliver services for local authorities

Partnerships should support lived experience initiatives in a way that is appropriate to their stage of development (see the ‘Standards for LEROs’ section for how to identify the stage of development of a LERO). So, while it might be appropriate for a treatment provider to help support and manage a peer-delivered project when it starts, all stakeholders should help these projects to become independent.

There is no set way to develop lived experience initiatives and RSS in a recovery-oriented system of care (ROSC) (see definition of recovery-oriented system of care in the glossary - part 4). Work to develop these initiatives could be co-designed with people with lived and living experience or developed independently by people with lived experience. However, for such initiatives to flourish, partnerships must ensure that:

• the ethos and culture of the partnership recognises that there are many pathways into support and recovery
• all system partners are treated and respected equally for playing their part in providing opportunities for people to be safe and get well

Questions to help develop recovery support services and lived experience initiatives

When an alcohol and drug treatment and recovery partnership wants to develop and support RSS and lived experience initiatives (including LEROs), the following questions will guide their approach:

1. Are people with lived experience and lived experience initiatives respected and autonomous members of our partnership?
2. What services that support recovery already exist locally? How well are these services connected to each other and where are the gaps in support?
3. Does our treatment and recovery service commissioning and planning comprehensively build and integrate recovery support services and lived experience initiatives?
4. How are we as a partnership ensuring that lived experience initiatives are safe and effective?
5. What is our role in the funding and growth of lived experience initiatives and recovery support services?

The rest of this chapter offers guidance on how you can develop your local approach by answering these questions.

Lived experience in local partnerships

The question that the partnership will need to explore is whether people with lived experience and lived experience initiatives are respected and autonomous members of our partnership.

The value of co-production

Services and institutions are often experts in processes and setting up infrastructure. But they can struggle to understand or solve community problems, like how to tackle anti-social behaviour or help people access services, without the input of community members. Local grassroots organisations are often better placed to understand the local context and its assets (people, places and things) that can help to promote and sustain recovery.

Co-production involves institutions like local government or treatment services working in equal partnership with local communities to make decisions, design and deliver public services or projects. Co-production means that the partners will have mutual respect and use an inclusive approach that values difference.

It is not enough to only consult and engage people who access treatment and recovery services. The experiences of people who are not currently accessing services and those who have never accessed services, and their families or carers, are equally valuable when developing services and projects. Their input is especially helpful when partnerships want to:

• ensure equity of access
• reach into specific communities
• develop early intervention, harm reduction and recovery support services

LEROs often engage people who have never engaged in treatment or have only engaged intermittently. So, they are in a unique position to speak about the needs of a wide range of people affected by problem alcohol and drug use.

Partnerships can also seek the views of people who are not in treatment through joint work with other agencies such as local homelessness and housing services, employment agencies and needle exchange services. This can be facilitated by local outreach teams or posts focused on involvement and co-production.

Lived experience and learned experience are both needed in an effective system of care and both these experiences should be valued equally. Partnerships should work with lived and learned experience partners, by encouraging:

• shared decision-making
• networking
• collaboration
• connection

Partnerships should not take on a ‘rescuer’ role towards lived experience initiatives. This is when partnerships can think they are helping or ‘saving’ the initiative, like taking on responsibilities or making decisions for them. This can encourage the initiative to depend on the partnership. Instead, partnerships should support initiatives’ growth and respect their autonomy without trying to manage or control them. Partnerships can do this by providing anti-stigma training to all partnership members. This can help create an environment that welcomes voices of lived and living experience and enables planning and development to build a ROSC.

Co-production: working with people with lived and living experience

People with lived and living experience must be involved in the co-production of treatment and recovery support services. This means that commissioners and service providers must make sure that they meaningfully involve a wide range of people with lived and living experience of alcohol and drugs in:

• strategic local and operational decisions
• needs assessments
• commissioning
• service design
• service delivery
• service review

The Commissioning quality standard: alcohol and drug treatment and recovery guidance outlines how partnerships should encourage hope and ambition for everybody who enters treatment to recover and live a life independent of services. System-wide partnerships should involve:

• people with lived experience, including LEROs
• local authority officials such as public health and housing
• crime and justice partners, like police and probation
• voluntary sector and other services working with target populations
• education and employment agencies
• other health partners, such as primary care and mental health treatment providers

Involving people with lived and living experience is not just a nice thing to have – it’s fundamental to ensuring your local system meets the needs of the people it is designed to support, and builds on their strengths.

Local authority commissioners and the services they commission should have existing policies and procedures on how to involve people who access services. These should outline how people must be trained, supported and recognised, including reimbursing expenses. There is guidance for alcohol and drug commissioners and providers on good practice in engaging people who use treatment and recovery services.

Co-production: a model of participation

As a first step, partnerships should reflect on whether people with lived and living experience are currently meaningfully engaged in local decision-making. Sherry Arnstein’s ladder of citizen participation maps out the extent to which citizens can participate in plans or programmes in the form of a ladder pattern. In Arnstein’s ladder, there are 3 levels of control:

• non-participation
• citizen participation
• citizen power

We have adapted Arnstein’s ladder below to give examples of how much control people in treatment and recovery have over service planning and delivery in different scenarios. You could use this version of the ladder to review what level of peer participation is currently happening in your services and partnership. You could review this with:

• strategic partnership groups
• service providers
• lived experience initiatives
• groups of people in treatment

Peer power

Where people with lived experience lead initiatives and make decisions, we call this ‘peer power’. It has 3 levels:

• independent leadership: at this level, peer-led initiatives would be directly commissioned by the local authority or operate independently and autonomously (like mutual aid groups and established LEROs)
• delegated leadership: at this level, peer-led initiatives could be sub-contracted by a treatment provider, or work in an ‘alliance contract’ model alongside a treatment provider (see definition of an alliance contract in the glossary - part 4)
• partnership: this level could involve people with lived experience, like LERO leaders, having equal status in decision-making, for example in committees

Peer participation

Where people with lived and living experience are involved and informed, we call this ‘peer participation’. It has 3 levels:

• participation: at this level, people with lived and living experience could be actively involved in planning their own treatment or could be asked to advise on service commissioning, planning and delivery - for example, being involved in procurement decisions or providing feedback to the partnership about their experiences of accessing support
• consultation: at this level, people with lived and living experience could be surveyed in writing or in focus groups
• information: at this level, people are informed of changes to treatment and recovery services and programmes in writing and verbally

Non-participation

Where people with lived and living experience receive only passive or directive support, we call this ‘non-participation’: It has 2 levels:

• directive support: at this level, a person has limited understanding of the available treatment and support options and their support plan is largely directed by staff
• passive support: at this level, a person has the least control as they have no understanding of the available treatment and support options and their support plan is developed for them by staff following a standardised approach

Asset mapping, connections and gaps

The questions that the partnership will need to explore here is what services that support recovery (including recovery support services and lived experience initiatives) already exist locally, how well they are connected and where the gaps in support are.

Asset-based community development

Most communities are rich with resources that can help a person to build their recovery capital, and support them to sustain their recovery and stay healthy.

Asset-based community development is fundamental to creating and supporting a high-quality ROSC. It involves identifying (asset mapping) and accessing and building local resources (assets) (see definition of asset-based community development in the glossary - part 4). Research suggests that this approach improves a person’s connectedness, which then supports their recovery and strengthens the community (Collinson and Best, 2019).

Partnerships can test how their local system of care supports recovery by doing the following:

1. Reviewing and mapping the recovery support services, lived experience initiatives and other relevant services and support available locally. Staff or peer volunteers can map what is available locally by speaking to:

• local service providers
• people not accessing treatment
• people in treatment
• lived experience leaders (see definition of ‘lived experience leader’ in the glossary - part 4)
• local and regional mutual aid representatives, including public information liaison officers for 12-step groups and SMART Recovery co-ordinators
• other system partners

2. Testing how strong the pathways (‘linkage’) between local support options are. Partnerships can test these pathways by contacting some randomly-selected support groups and services to see if they can provide information (including referral information) about other randomly-selected support groups and services (Ashford, 2018).

LERO map and number

The College of Lived Experience Recovery Organisations (CLERO) has developed a national map of LEROs across the UK and Ireland. We are aware of over 50 LEROs in England working in over 70 local authorities, which is less than half of all local authorities in England.

Asset-based community engagement approach

Building on asset-based community development, researchers have developed an asset-based community engagement approach led by ‘community connectors’ who support people to connect to their community (Collinson and Best, 2019). In this model, there are distinct roles for:

• recovery navigators
• community connectors

While these roles are distinct, they can be done by a single worker.

Recovery navigators work with people to understand how engaged they are with their community and to support them to engage with services and support.

Community connectors work with people to:

• map which community resources the person is already engaged with
• explore their personal interests and the barriers they face to engaging with community resources
• link them to community resources matched to their interests
• support their engagement with these resources

Recovery navigator and community connector roles can be undertaken by treatment staff as part of treatment and recovery care planning, or by people working or volunteering for lived experience initiatives (see definition of treatment and recovery care planning in the glossary - part 4).

Building and integrating diverse assets

The question that the partnership will need to explore here is: does local planning comprehensively build and integrate recovery support services, lived experience initiatives and other local resources?

Funding and support to help lived experience initiatives grow

Some local support groups and services are not formally commissioned by the local authority. This means that it can take time and energy to map, grow and connect all existing resources in a ROSC.

Partnerships should promote and create sustainable, accessible funding and other opportunities for lived experience initiatives. This could include:

• promoting local or national funding opportunities
• offering seed funding for small projects
• creating capacity-building funding opportunities

Established local or regional services, especially those that are peer-led, can help fledgling lived experience initiatives by:

• managing small grants
• providing training opportunities
• helping them develop their organisational structures
• mentoring new lived experience leaders
• supporting elements of their administration, governance and infrastructure

Recognising local lived experience initiatives

Partnerships should actively raise the profile of lived experience initiatives by giving them a platform. This can be done through:

• features in council and other local publications
• celebratory events, such as recovery walks and awards ceremonies
• nominations for local or national awards

Partnerships should recognise lived experience initiatives and those involved in delivering and leading them, because it:

• builds their confidence and pride, and rewards the commitment and passion of people who are giving back to their community
• strengthens the wider community by making recovery visible and celebrating people in recovery as positive role models
• can help these projects make the case for funding or in-kind support from local businesses

Safe and effective lived experience initiatives

The question that the partnership will need to explore here is how they are ensuring that lived experience initiatives are safe and effective.

Making lived experience initiatives safe and effective

When services and initiatives are partially or completely outside of local authority commissioning, it can make it more difficult to assess their safety and effectiveness.

Contracting LEROs could be new to some local authorities. While some LEROs are well established, some are emerging projects working to formalise their organisation. New projects of any type are likely to have less well-developed organisational structures and policies than more established ones.

However, just because these projects are new and developing, does not mean that they’re unsafe or ineffective. If there are local concerns about the safety and effectiveness of lived experience initiatives, that could be due to stigmatised views of people who use alcohol and drugs problematically and those in recovery.

There are many ways to seek assurance and build confidence in projects and support groups in a ROSC that are arguably more meaningful than those covered by contractual agreements. All projects, initiatives and support groups will become safer and more effective if partnerships:

• build reciprocal relationships based on honesty and transparency
• work together to a shared purpose
• create a mutually supportive environment

Standards for LEROs

CLERO’s National LERO standards identify 3 types of LERO from informal LERO community groups with no formal organisational structure to incorporated and regulated LERO community providers. Standards on culture and values and the support on offer apply to all types of LERO, while standards on staff and volunteers and operations and management apply only to those that have a recognised formal organisational structure. These standards can help LEROs to develop and sustain their model, including identifying areas for improvement. The standards can also help local partners to identify ways to support a LERO matched to their current organisational structure.

You can read more about the LERO standards in the section ‘CLERO: network, map and standards’ in part 1.

Guidance for contracting lived experience initiatives

We have developed the guidance below for peer-delivered projects, LEROs and commissioners. This is designed to be used alongside the LERO standards.

Commissioners and their local partners should use this guidance when contracting any treatment and recovery services, including those that are peer-delivered and LEROs.

Services have a responsibility to ensure that their workforce is:

• appropriately vetted
• comprehensively inducted
• trained (including statutory and mandatory training)
• clear about the role and value of peer support workers and volunteers
• supported and supervised

Services have a responsibility to ensure that their organisation is:

• appropriately governed and led
• following health and safety legislation
• following consent and confidentiality good practice and legislation
• following equality and diversity legislation and best practice and is inclusive

We provide guidance for all of these areas below.

Vetting employees and volunteers

Most roles in health and social care involve working directly with children or vulnerable adults. This is known as ‘regulated activity’. Where an employee or volunteer is undertaking regulated activities unsupervised, intensely or overnight, employers must do an enhanced Disclosure and Barring Service (DBS) check (for more information, see the DBS - About us webpage).

All potential employees and volunteers must be given the opportunity to disclose criminal records during the recruitment process. Employers across health and social care widely employ people with criminal records. In some cases, a person’s offending history means that they are barred from working with a specific group.

In all other circumstances, the employer can use their discretion when making recruitment decisions. This involves making decisions on a case-by-case basis by weighing a risk assessment of the role against the person’s:

• skills
• qualifications
• experience
• conviction circumstances

You can read advice from Nacro about employing someone with a criminal record.

Members of adult peer support groups such as Alcoholics Anonymous or other mutual aid groups are not categorised by the Department of Health and Social Care (DHSC) as ‘regulated activity’, even if the group is directed or supervised by a healthcare professional. Regulated activity is defined as “the activities provided to any adult which, if any adult requires them, will mean that the adult will be considered vulnerable at that particular time”. This means that individual members of peer support groups providing peer-to-peer support to each other are not required to have DBS checks.

You can find more information about regulated activity in the DHSC guidance New disclosure and barring services.

Inducting new employees and volunteers

A well-planned and supportive induction helps employees and volunteers fit into their role and the organisation comfortably and safely. All inductions should include:

• orientation to the service, building, team, role and partner agencies
• familiarisation with policies and procedures
• information about the need to maintain clear boundaries between people working or volunteering for the organisation and those they support
• information about the importance of practicing self-care
• an introduction to line management and supervision
• completion of any essential training

Good inductions also often include shadowing existing team members, and peer support through shadowing of, and mentoring by, more experienced staff and volunteers.

Training staff and volunteers

All volunteers and staff should complete training required by law (statutory) and required by the employer (mandatory) on a regular basis, in some cases annually.

The UK Core Skills Training Framework (CSTF) sets out 11 statutory and mandatory training topics for all staff working in health and social care settings. These serve as a minimum standard.

Statutory training includes:

• fire safety
• health and safety at work
• manual handling

Mandatory training includes:

• information governance and data security, including on the UK General Data Protection Regulation
• equality, diversity and inclusion
• conflict resolution
• safeguarding children and adults

There is e-learning covering all health and social care training considered statutory and mandatory in the CSTF available from NHS England. All organisations should keep their training records up to date. Most drug and alcohol specialist organisations also mandate other essential or desirable training for people working in the sector. What is mandated will depend on the support being offered by the organisation.

The role and value of peer support workers and volunteers

People with lived experience bring a range of skills and experience from their personal and professional lives. Where peer support roles are ill-defined, or the people in them are not well supported, people in these roles can face significant challenges. These challenges include:

• undefined responsibilities
• vulnerability, including triggers to return to problem drug and alcohol use
• overwork, burnout and compassion fatigue
• lack of clarity about a peer support worker’s or volunteer’s role
• being integrated into the team
• stigma
• maintaining boundaries
• not being recognised for their work

Research has shown that there are benefits for people taking on peer support roles (Du Plessis and others, 2019). These include:

• increased confidence, stability and structure
• the opportunity to gain workplace skills and experience

These benefits all support strengthened wellbeing and recovery.

Role clarity is important for any employee or volunteer but especially for people in peer support roles. The role of peer support workers and volunteers should be clear to the people in those roles and also clear to the wider team and partner agencies.

The forthcoming drug and alcohol treatment and recovery capability framework will define the capabilities of peer support workers. This will help providers to develop effective peer support worker role descriptions.

Services often use peer volunteers to work in administrative roles. These roles can be useful for the volunteers to get employment. However, organisations should make sure that all volunteering roles recognise people’s strengths and offer them meaningful opportunities to develop their skills.

Supporting and supervising staff and volunteers

Good organisational support and supervision is vital to any employee or volunteer’s workplace wellbeing and effectiveness.

Research has found evidence that the supervision of peer support workers and volunteers is sometimes inadequate (Stack and others, 2022). Without the right support, people in peer roles can experience compassion fatigue and burnout. Peer support workers and volunteers (especially those offering one-to-one support to individuals) need regular supervision from a trained supervisor.

Any organisation employing peers as workers or volunteers should train managers, team leaders and volunteer co-ordinators in how to manage and supervise people with lived experience. This training could be planned and delivered with input from peers themselves. Support services should ideally also offer regular reflective practice sessions and group supervision to support staff and volunteers. This will help them to collectively process the work they are doing and develop their practice through professional and peer-to-peer learning.

LEROs promote a culture of ‘bringing your whole self to work’. This means that they dedicate regular time for staff and volunteers in the team to share about how they are, reflect on their own recovery and ensure they feel supported to support others.

In any project or service that includes volunteers, all staff and volunteers must be inducted into volunteering policies and procedures, and volunteers must have named supervisors. Volunteer co-ordinator roles can help to recruit, train, supervise and support volunteers. Co-ordinator roles are especially important where services or projects have large volunteer teams.

A recent survey of peer volunteers in the UK found that peer volunteers in alcohol and drug, criminal justice and homelessness services typically volunteer 25 hours per month and are reimbursed travel and subsistence at cost or set day rates. However, in some organisations, bureaucratic delays mean that volunteers can wait for a while to get reimbursed expenses. Services should make sure that their reimbursement processes are as easy to follow as possible and support volunteers to follow them.

Treatment providers and LEROs should consider achieving the Investors in Volunteers quality standard, to help ensure good practice and fair treatment of volunteers.

There is guidance on supporting peer volunteers on the Peer Volunteers resource site. The National Council for Voluntary Organisations also has general guidance on supporting and managing volunteers.

Governance and leadership of LEROs

When LEROs become more established and start to do things like employing staff and managing significant funds, most will decide to formalise their legal and organisational structure. This usually means they become a constituted group or a regulated organisation, like a charity or an incorporated company. Charities have an additional layer of independent governance, because charity trustees take ultimate responsibility for governing how the organisation is managed and run.

Established LEROs, like any established organisation, should have all the necessary policies, procedures and structures in place. The expectations of commissioners and fellow service providers should depend on the maturity of the LERO. So, for example it might be appropriate for a treatment provider or an established LERO to manage grant money on behalf of a new LERO without a bank account. But it would be inappropriate to do this for an established LERO.

The CLERO standards for LEROs outline 3 types of LERO mapped against the 3 types of organisational structure that can be adopted. MyCommunity guidance Choosing the right organisational structure for your group provides information about the 3 different organisational structures. The LERO standards also outline what governance is required with each organisational structure. For example, an informal LERO community group has no formal organisational structure, also known as a ‘small group’. It may have core written principles and ways of working. Alternatively, an incorporated and regulated LERO community provider has a formal regulated legal structure such as company or charity. This requires a governing document such as articles of association and a governing body such as trustees or directors.

Protecting the health and safety of employees or members of the public

All employers must comply with health and safety legislation. This includes:

• assessing risk
• taking measures to prevent risk and protect people
• having a written health and safety policy in place, where an organisation employs 5 or more people
• reporting incidents and accidents

All employers are legally required to report incidents and accidents at work, using the Health and Safety Executive’s (HSE) RIDDOR system (based on the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013). The HSE also has guidance on reporting requirements for health and social care services.

The NHS serious incident framework describes the process and procedures to help ensure serious incidents are identified correctly, investigated thoroughly and learned from.

The Charity Commission has guidance for charity trustees to help them spot and report serious incidents.

Where an organisation is directly commissioned by a local authority or sub-contracted to another organisation, they are contractually obliged to report incidents to the local authority or lead provider within specified time frames.

These incident reporting frameworks help ensure serious incidents are identified, investigated and prevented.

HSE provides guidance for employers on protecting the health and safety of employees and the public.

Consent and confidentiality

By law, anyone processing personal data must take reasonable steps to protect it and explain why they need to collect it. This includes privacy notices (which often take the form of consent and confidentiality forms) to help people make informed choices about sharing their data. The Information Commissioner’s Office (ICO) provides guidance on how to make your own privacy notice.

Building trusting and supportive relationships is a vital part of peer support worker and volunteer roles. Peer support groups tend to operate using the ‘Chatham House Rule’, which means that information from the group can be shared, but the identity of people involved should not be revealed.

Like anyone in a support role, peer support workers and volunteers should be trained to:

• get informed consent
• protect personally identifiable information
• know when and how to break confidentiality if anyone is at risk of serious harm

‘New disclosure and barring services’ guidance clarified that individual members of peer support groups providing peer-to-peer support to each other are not required to have DBS checks. See ‘Vetting employees and volunteers’ above for further information.

The ICO provides guidance on protecting data, with specific advice for small organisations about data protection.

Equality, diversity and inclusion

All employers and service providers have a duty to:

• eliminate discrimination, harassment and victimisation
• advance equality of opportunity
• help develop good relations between different parts of the community

The Government Equalities Office has published information and guidance on the Equality Act 2010.

Staff and volunteer teams should be diverse and broadly representative of the local community.

Staff and volunteers should be inducted into the organisation’s equality and diversity policy, and complete equality, diversity and inclusion training.

Services should ensure that the organisation and its workforce provide culturally appropriate support. For example, this includes taking account of religious requirements and festivals. Cultural competence training for staff and volunteers can help to tailor service provision. Services should recognise the impact of discrimination on a person’s wellbeing, problem alcohol and drug use and recovery (see definition of cultural competence in the glossary - part 4).

However, it is important that staff and volunteers do not make assumptions based on people’s ethnicity, faith or other protected characteristics. They should tailor support to meet the person’s unique needs, values and perspectives.

Workplaces should value difference and allow all staff and volunteers to contribute and feel part of the organisation.

People with protected characteristics and socially excluded groups experience barriers to accessing support. This includes:

• ethnic minority groups
• LGBTQ+ groups
• women
• older people
• people with learning disabilities
• inclusion health groups

Lived experience initiatives should:

• be accessible to people who could benefit from them
• meet the needs and build on the strengths of diverse groups of people and communities
• promote and tailor their support offer to diverse groups of people and communities, including reducing barriers and making reasonable adjustments to support access

Lived experience initiatives should engage people and communities in flexible ways, including but not limited to:

• partnerships with local community groups and organisations, including faith groups
• community outreach
• home visits
• promotional and harm reduction information in community languages

For more information on protected characteristics, read Discrimination: your rights. Also, the guidance Inclusion health: applying All Our Health provides more information on the needs of inclusion health groups.

Funding and growth of lived experience initiatives

The question that the partnership will need to explore here is what is its role in funding lived experience initiatives and recovery support services and helping them grow.

Commissioners and other system partners can encourage sustainable lived experience initiatives by:

• involving people with lived and living experience in local decision-making
• developing respectful, reciprocal relationships with lived experience initiatives to support their development
• developing different contracting approaches and providing sustainable funding for lived experience initiatives
• co-producing alternative ways of monitoring the impact of lived experience initiatives

We explore each of these ways in more detail below.

Practical resources to support the development of recovery support services and lived experience initiatives in the UK are emerging. This includes a UK-specific toolkit to help people looking to set up collegiate recovery programmes, available from Collegiate Recovery UK. This includes:

• case studies based on the existing programmes in the UK
• an outline of the first year of a UK programme

Involving people with lived and living experience in decision-making

People with lived and living experience and wider community members should be involved in making decisions about service contracting, design and delivery. For example, trained and supported peer volunteers who are representing people with lived and living experience in local alcohol and drug treatment partnerships.

Having trained and supported people with lived and living experience as part of the local decision-making will add value and make sure that commissioning processes value recovery support services and lived experience initiatives as much as treatment services. This includes:

• assessing need
• making procurement decisions
• planning and delivering services and projects
• reviewing the projects’ impact

People with lived and living experience should be an important part of these processes and given ongoing support to participate in them, including relevant training and being reimbursed for expenses.

Developing relationships to help lived experience initiatives develop

Lived experience leaders often feel that their experience or organisation is not valued as much as organisations led by people with learned experience. To encourage good relations and improve the skills of the whole system’s workforce, system partners can:

• allow access to their in-house training and include external partners as part of induction plans for new staff
• collaborate to deliver community events
• offer use of their buildings to each other for engagement opportunities, support groups and events
• support each other to develop their ways of working, service models and organisations through constructive criticism and offering each other help and guidance

Local voluntary and community organisation umbrella bodies often offer free training, advice and support to voluntary and community organisations. System partners can offer targeted support and opportunities to collaborate that suit the stage of development that lived experience initiatives are at.

The national LERO standards can guide system partners on what support would be helpful for LEROs at different stages of organisational development.

Contracting and funding RSS and lived experience initiatives

Local commissioners should build proportionate funding for RSS and lived experience initiatives into local budgets and commissioning plans.

As with any commissioned service, the funding should be able to cover:

• organisational development
• governance
• required staffing and salaries
• physical spaces to deliver services

In the USA, 10% of the 2021 to 2022 Substance Abuse and Mental Health Services Administration grant had to be spent on RSS, as outlined in the National Drug Control Budget: 2022 funding highlights (PDF, 726KB).

To better understand the current national provision of RSS in England, we undertook a survey of English local authority commissioners in May and June 2022. The survey included questions on how much of the local alcohol and drug budget was invested in RSS.

We found that local authorities spent less than 5% of their alcohol and drug treatment and recovery budgets on each type of recovery support service. We asked for spend on each type using a range, so we do not know the average spend on RSS.

Commissioners should consider procurement approaches that help peer-delivered initiatives to become increasingly independent and autonomous should they wish to, and help LEROs to maintain their independence, autonomy, culture and values. One commissioner who has maintained separate treatment and LERO contracts despite pressure to integrate them told us that this separation has allowed the LERO to act as a ‘critical friend to both the commissioner and commissioned (treatment) service’. In another local authority, the LERO is the landlord of the treatment provider and decisions are made collaboratively between the commissioner, LERO and treatment services. It is also important to remember that a place-based recovery community is not something that is contracted, but something that is nurtured to grow.

Enabling lived experience initiatives to play this role may require different funding arrangements and contractual obligations. There is existing legislation that aims to bring about the consideration of social value, stability and sustainability in the commissioning of certain services. These include the Public Services (Social Value) Act 2012, which requires commissioners who procure services under certain public services contracts to consider the social, economic and environmental wellbeing of the area for which it is contracting, as outlined in Social Value Act: information and resources. The aim of these procurement exercises should be to improve social, economic and environmental wellbeing.

The Health Care Services (Provider Selection Regime) Regulations 2023 introduced the provider selection regime (PSR), which came into force on 1 January 2024. The PSR is a set of rules for procuring healthcare services in England by organisations called ‘relevant authorities’. Relevant authorities are:

• NHS England
• integrated care boards
• NHS trusts and NHS foundation trusts
• local authorities and combined authorities

This means that local authority commissioned drug and alcohol treatment and recovery services are in scope of this legislation.

Under the legislation, procurement can be done through either a direct award, a competitive process or by identifying the most appropriate provider. The PSR has been designed to:

• introduce a flexible and proportionate process for deciding who should provide healthcare services
• provide a framework that allows collaboration to flourish across systems
• ensure that all decisions are made in the best interest of people accessing these services

For more information on the PSR, see the NHS England page NHS provider selection regime, as well as statutory guidance on the PSR.

Co-producing alternative ways of monitoring impact

There can be pressure on LEROs to be like treatment providers. This can be particularly evident where a commissioner has key performance indicators that are more appropriate for (or even the same as) treatment contracts.

Unlike treatment services in England, most LEROs do not report to the National Drug Treatment Monitoring System (NDTMS), and there is no other system routinely used to capture their activity and impact in a ROSC.

Some commissioners monitor impact through case studies that evidence the positive impact of commissioned services on individuals, their friends, family and the community.

Adult community treatment services reporting to NDTMS can also now report referrals into treatment by, and onward referrals, to peer-led initiatives. Definitions of these data items are provided in ‘NDTMS community adult business definitions’ on the NDTMS events and training materials page. These data items are intended to help track the pathways between treatment services and peer-led initiatives. These pathways will be active in both directions in an effective ROSC. Commissioners, LEROs and treatment providers could collaborate to use these data items to track how active the pathways are between treatment and LEROs.

References

Ashford RD. Building a recovery-ready ecosystem in Oregon (PDF, 1.4MB). Oregon Recovers, 2018 (accessed: 17 June 2023).

Collinson B and Best D. Promoting recovery from substance misuse through engagement with community assets: asset based community engagement. Substance Abuse: Research and Treatment 2019: volume 13, pages 1 to 14.

Du Plessis C, Whitaker L and Hurley J. Peer support workers in substance abuse treatment services: a systematic review of the literature. Journal of Substance Use 2020: volume 25, issue 3, pages 225 to 230.

Stack E, Hildebran C, Leichtling G, Waddell EN, Leahy JM, Martin E and Korthuis PT. Peer recovery support services across the continuum: in community, hospital, corrections, and treatment and recovery agency settings: a narrative review. Journal of Addiction Medicine 2022: volume 16, issue 1, pages 93 to 100.