Archived: HAGA

Updated 7 March 2017

HAGA is a community based alcohol treatment service, which provides treatment and support to people who misuse alcohol. The service is a charity and provides one to one support, community detoxification from alcohol, counselling, online appointments, a Polish speaking service and support for domestic violence. The service provides support to GP practices, called the ‘Hub clinic’, set up to reach out to people in the community.

The service has a hospital link worker who works with the local A&E department with clients who have attended A&E several times for alcohol related problems. The service produced an online service called ‘Don’t bottle it up’ in 2012. This was designed for people to assess whether their drinking was risky, make a plan to reduce drinking and seek local help and advice. ‘Don’t bottle it up’ is anonymous and reaches people who may not attend services. ‘Drink coach’ is another intervention created which is accessible by an application on a mobile phone, which allows people to set goals, reminders and offers mindfulness videos.

During 2016, the service had supported on average 123 clients per week with 12 clients to each key worker. The service provides three client pathways; counselling, detox service and a day programme. The day programme includes an abstinence based group and a stabilisation group. These programmes last for 12 weeks. The service offered a blood borne virus testing service.

The service is funded by the Haringey local authority and Haringey clinical commissioning group.

The service has a registered manager in place and is registered by the CQC to provide treatment of disease, disorder or injury. The service registered with the CQC in 2014 and has not been inspected before. The inspection team visited the service on 5, 6, 7 December and 19 December 2016.

Updated 7 March 2017

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

• Staff did not always follow the provider’s alcohol detoxification guidelines around safe detox. Staff did not always complete comprehensive risk assessments for clients who were starting a community detox or have plans in place to manage the risk of withdrawal seizures if a client stopped their detox early. The provider's guidelines did not clearly outline who would not be suitable for a community alcohol detoxification. Staff did not always record the handover of important information.

• Staff stored prescribed detox medication in unsafe places. The provider did not prescribe medication as stated in their alcohol detoxification guidelines.

• The provider had not clearly identified the level of mandatory training required for staff and staff did not receive regular supervision and appraisals.

• The provider did not have a formal procedure to demonstrate how staff should respond to a client in an emergency.

• Staff did not always complete physical health examinations during assessment or monitor physical health throughout treatment.

• The provider did not have a clear policy in place to guide staff in how to assess a client’s capacity in the event that this was required. The provider had guidance in place for assessing clients’ cognitive functioning and referred to this as their guidelines in assessing capacity. The lack of understanding across the provider meant that clients might be at risk.

• Staff we spoke with had a limited understanding of how to test a client’s capacity. We did not see records of capacity assessments, when needed for specific decisions. However, staff acknowledged that if they were concerned they would raise this with their line manager and in the team meeting.

• Staff did not routinely use the severity of alcohol dependence questionnaire (SADQ) validated tool in order to formally assess for the severity of alcohol dependence.

• Staff did not adhere to the providers discharge and re-engagement policy as staff did not follow up all clients who did not attend appointments.

• There was a lack of regular discussion about risk and how best to manage clients at risk. Whilst the service had access to local GPs for advice, the service lacked medical support and guidance. There was no system in place for the doctor and nurses to review high risk and complex clients on a regular basis.

• The service did not handle complaints consistently.

• The provider had not ensured that employment records were up to date and included references and application forms.

• The service had not ensured that all statutory notifications had been submitted to the CQC.

• As a result of the concerns identified in the report, we issued a warning notice under Section 29 of the Health and Social Care Act 2008. We took this action, as we believed people using the service might have been exposed to a serious risk of harm.

However, we also found the following areas of good practice:

• Staff discussed incidents and changed practice as a result.

• A member of the team attended the multi-agency risk assessment conferences (MARAC) every three weeks at Haringey local authority.

• The service offered blood borne virus (BBV) and hepatitis C testing.

• The service monitored their performance for successful completions and discharges. Between November 2015 and October 2016, the service had a 10.9% increase in completions, as opposed to the data that was reviewed from April 2015 to March 2016.

• Clients had access to a range of therapy groups, pre and post-detox planning as well as individual therapy sessions with a counsellor.

• Overall feedback from clients was very positive about the service and staff.

• The service provided clients opportunities to provide feedback about their care and made changes as a result of this feedback.

• The service developed a counsellor role to provide more appointments to clients who required psychological therapies.

• The service had a range of specialist support workers such as a domestic abuse support worker, a Polish speaking member of staff and a hospital link worker who provided support to clients who had been seen at the local accident and emergency department.

• Staff were committed to supporting clients in their recovery. Staff felt supported and confident to raise concerns to their line manager.

• The provider had quarterly governance meetings where staff discussed incidents and good practice. The service had a risk register and a comprehensive business continuity plan in place.