East Kent Substance Misuse Service - Swale

Updated 20 June 2019

East Kent Substance Misuse Service Swale provides specialist community treatment and support for adults affected by substance misuse. The service is one of four provided by The Forward Trust and is commissioned to provide treatment for people who live in East Kent.

The service had previously been one of five services, but the former Canterbury service had recently merged with Swale following the closure of their hub. Staff saw clients who had previously been seen at the Canterbury service in a range of satellite services.

The provider recently merged with an employment specialist agency to support clients’ integration into the community.

The Kent Drug Alcohol Team funded treatment for the majority of clients at the service. Most of the referrals into the service were self-referrals.

The service offered a range of services including initial advice; assessment and harm reduction services including needle exchange; prescribed medication for alcohol and opiate detoxification; naloxone dispensing; group recovery programmes; one-to-one key working sessions and doctor and nurse clinics which included health checks and blood borne virus testing.

The service had good partnership working in the local area and across East Kent with other agencies, including social services, probation, GPs, pharmacies and homeless charities/services.

The service registered with the Care Quality Commission on 1 May 2017 to provide the regulated activity treatment of disease, disorder and injury.

The manager had recently submitted an application to CQC to become the registered manager for the service.

The service was last inspected on 7 November 2017. The provider was issued with one requirement notice that related to the following regulation under the Health and Social Care Act (Regulated Activities) Regulations 2014:

Regulation 18 HSCA (Regulated Activities) Regulations 2014 Staffing

This was because the inspection found that staff did not receive appropriate support, training and development to enable them to fulfil the requirements of their role. After the inspection, the provider submitted an action plan and demonstrated during engagement meetings that they had acted on these concerns. During this inspection, we saw that this requirement had been met.

This is the first time the service has been inspected using the ratings methodology for substance misuse services.

Updated 20 June 2019

We rated East Kent Substance Misuse Swale good overall because

• The service provided person centred care that clearly focussed on individual needs. There was a great commitment towards continual improvement and innovation. A specialist hepatitis nurse attended the service to reduce stigma and barriers to treatment. Data provided by the service showed that 15 clients had been referred for treatment since November 2015. A peer mentor supported clients attend their appointments to encourage engagement in treatment for hepatitis C. There was an alcohol pathway to support clients with alcohol issues. The service was in the process of developing a dedicated pathway for clients who used opiates and for trauma informed care.
• The service actively sought to reduce stigma and engage hard to reach and treatment naïve clients. Staff, including the clinical team, offered flexible appointments and times and saw clients in a range of settings, including at home, to reduce barriers to treatment and meet individual need. Staff supported clients with additional needs including benefits and housing. There was a daily drop in service so that people could access the service without an appointment for advice and information. The service offered a weekly evening clinic to accommodate clients who were employed or preferred to be seen outside of normal working hours. The service provided an out of hours telephone line. A member of staff carried toiletries in their car to give to clients who were homeless or in need.
• There were targeted surveys and the service invited feedback from clients throughout their treatment. There were feedback forms and a suggestion box in the waiting room to capture suggestions to improve and develop the service.
• The clinic room was clean, tidy and well equipped. There was an emergency grab bag that contained emergency medicines. The needle exchange was well stocked and harm reduction advice was displayed and available for clients to take with them. Staff stored medicines securely and there were robust systems in place for the management of prescriptions.
• There was a range of disciplines in each team which included specialist doctors, non-medical prescribers, recovery workers with a range of qualifications and peer mentors with lived experience. The clinical team had extensive knowledge and skills of working within substance misuse. All staff completed an induction which included mandatory and core training. There was specific management and leadership training for managers. Staff had lead roles including safeguarding and dual diagnosis that staff could go to for advice and support.
• Safeguarding was clearly embedded in all aspects of the service. There was a safeguarding and domestic abuse lead at the service that provided advice and bespoke training for staff.
• Managing risk was integral to the service. Staff completed risk assessments and risk management plans that were reviewed regularly. Risk was discussed during appointments. Staff were able to track and monitor risk levels on the electronic client record. Staff completed recognised screening tools and withdrawal tools to assess dependence and to monitor and respond to risk. The service provided lockable boxes to clients prescribed detoxification medicines, to reduce risk of inappropriate ingestion. Staff provided and trained clients, families, carers and relevant professionals how to administer naloxone to reduce the risk of opiate related deaths.
• The assessments and interventions provided by the service were line with National Institute of Health and Care Excellence guidelines. The provider offered a specific alcohol pathway for clients which explored the physical, mental and social effects of alcohol misuse. The service used innovative ways to provide harm reduction advice to clients including via drug alert text messages about possible adulterated drugs which could prove fatal if used.
• Staff demonstrated a genuine interest in clients’ wellbeing. Staff spoke about clients with compassion, dignity and respect. Staff were non-judgemental and strived to ensure that clients’ needs were all met. A carers lead had recently started a carers and support group.
• There was a clear management structure for the service. Leaders had the skills, knowledge and experience to perform their roles. Team leaders had a good understanding of the service and clearly explain how to provide high quality care.
• Staff said they were supported and valued by managers and colleagues and felt able to raise concerns without fear of victimisation. The service promoted equality and diversity and provided opportunities for apprentices, volunteers and peer mentors with lived experience of substance misuse.
• The service had clear quality assurance management and performance frameworks in place. There were clear frameworks of what needed to be discussed at service level to ensure that essential information, such as learning from incidents, was shared and discussed. The communications team sent a weekly e-bulletin to staff.
• Managers and clinicians completed a variety of audits to ensure a safe, effective and responsive service. Managers and staff had oversight of dashboards to monitor caseload, risk, recovery plans and clients’ care and treatment.

However:

• We reviewed five recovery plans which were basic and did not focus on client strengths. Staff told us that recovery plans were completed collaboratively with clients, but none of the recovery plans we reviewed contained a client’s signature. Staff did not routinely offer clients a copy of their recovery plan.
• Clients’ routine medical reviews were sometimes delayed because the doctor and non-medical prescriber were shared across the two teams because another doctor employed by the service had recently retired.
• Despite staff explaining risks of leaving treatment early to clients, only one of the five care records reviewed included a plan for unexpected exit from treatment.
• Care record audits only involved checking the electronic dashboards of staff and did not consider the quality of the information. Staff didn’t track the client records that had been audited.
• The business continuity plan and some of the service’ risk assessments were out of date.

Updated 20 June 2019

Updated 20 June 2019