Wear Recovery

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued.

Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care.

Staff collected analysed data about outcomes and performance. They used this to identify improvements.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider’s vision was:

• To help individuals live a happier and healthier life by supporting them in making positive changes to their drug and alcohol use and,
• To support individuals with life's challenges, including problems with drinking or drugs.

Its values were:

• Personalised support: Recognising that everyone's experience is different, Wear Recovery aims to personalise care to help each person achieve their individual goals.
• Non-judgmental approach: The service works to create an environment where people feel welcomed and not judged.
• Goal-oriented recovery: The focus is on helping individuals achieve their goals, with support for developing recovery plans and SMART goals.
• Comprehensive care: Wear Recovery offers a range of support services, including one-to-one and group sessions, peer support, and assistance with prescription medications, drugs, and mental health.
• Information and advice: The service provides advice and information to help people concerned about their substance use or other life challenges.

Staff knew and understood the vision and values and how they were applied in the work of their team.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service.

Staff had the opportunity to contribute to discussions about the strategy for their service during team meetings and supervision and appraisal sessions.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles and provided clinical leadership to staff.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Leaders were visible in the service and approachable for clients and staff.

Leadership development opportunities were available, including opportunities for staff not currently in management roles.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had policies and procedures to support whistleblowing and speaking up. Staff had easy access to these policies, understood them and felt comfortable using them without fear of reprisals.

Managers promoted an open and honest culture.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

There are equality and diversity champions within the service. These included LGBT+, neurodiversity and overall diversity champions.

Staff were able to apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role.

The provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the client group.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The governance systems within the service were effective.

There were systems and procedures to ensure that the service premises were safe and clean.

There were enough trained, skilled and experienced staff to safely meet the needs of clients using the service. Staff assessed all clients and treated them well. Staff adhered to the Mental Capacity Act. Staff managed flow within the service well and planned for discharge.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on any findings when needed.

Staff knew how to handle complaints, reported incidents and made safeguarding referrals when required. Managers shared lessons learned from investigating incidents, complaints and safeguarding concerns with staff.

There was a clear framework of what must be discussed at team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. Meeting agendas included standing items to ensure these sorts of issues were routinely discussed.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts.

Staff understood the arrangements for working with other teams, both within and outside of the organisation, to meet the needs of the clients.

Staff maintained and had access to the risk register. Staff at could escalate concerns when required. Staff concerns matched those on the risk register.

The service had business continuity plans which informed staff what to do and who to contact in emergency situations such as adverse weather conditions, bomb and fire scares, loss of premises or information technology and flu outbreaks.

The service used systems to collect data that were not over-burdensome for frontline staff.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care.

Information governance systems included confidentiality of client records.

There were monthly performance and quality meetings within the service. These were used to monitor service delivery and how the service was performing in terms of the key performance indicators set by commissioners.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and client care.

Information was in an accessible format, and was timely, accurate and identified areas for improvement.

We scored the service as 4. The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

Directorate leaders engaged with external stakeholders. In the last 12 months, engagement meetings and events included:

• Meetings with commissioners and the director of public health to review the service’s risk register and progress against its key performance targets
• Attendance of drug related death panels and a drug and alcohol harm reduction group with the police, local authority and other drug and alcohol services in the locality
• Attendance of a suicide prevention action group with mental health services, the Samaritans and other local help services
• Multiagency risk assessment conferences (MARAC) meetings to discuss high-risk domestic abuse cases. There are meetings in which information is shared to create a safety plan and reduce the risk of harm to victims and their children in partnership with the police, local authority, external health services and housing services
• Attending Sunderland Neighbourhood Crime Prevention meetings with the police
• Participation in the Sunderland Altogether Improving Lives forum with the police
• Meetings with commissioners to review clients admitted to an inpatient detox and the expenditure from allocated funding and
• Participation in a mental health pilot with GPs, a mental health trust, and the police with the aim of using a multidisciplinary team approach to meeting and reviewing patients who are of concern, providing updates on patient care and engagement and improving patient experiences, care and support moving forward.

Staff within the service were part of the Regional Treatment Provider Network. This was a network attended by all providers in the region which was led by a public health organisation. It enabled attendees to share innovations and best practice. It was also an opportunity to discuss emerging issues and trends and share ideas as to how they could be effectively managed.

Clients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

The service worked with partner agencies and local third sector organisations to promote joined up care and facilitate engagement/access.

The service took part in local community activities such as Pride and other events focussed on equality and diversity.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and support to discuss opportunities for improvements and innovation.

Staff had opportunities to participate in research. This included a research trial in collaboration with a university in Scotland. The aim was to test the clinical and cost effectiveness of a diazepam maintenance intervention as opposed to a tapering dose of diazepam, to determine which intervention resulted in greater reductions in street benzodiazepine use in adults. The results of this trial could potentially influence future policy and guidance in relation to prescribing regimes for benzodiazepine dependency.

Staff also participated in research relating to gambling harms and the correlation between gambling and substance use issues. This research identified that there was a need for additional identification of gambling issues within treatment services and an early identification tool alongside relevant training for staff was in development at the time of our inspection.

Innovations were taking place in the service. The service employed a substance misuse engagement coordinator co-located within a local domestic abuse service. Their primary focus was to engage perpetrators of domestic abuse with substance misuse issues into the service with the aim of reducing likelihood of reoffending. Their role also included supporting the delivery of training to the domestic abuse team and acting as a point of contact for any queries and advice required.

A homeless link worker was employed within the service who was co-located within local housing support service. Their main role was to engage homeless people into substance misuse treatment. They also engaged with housing support services.

There was also a complex needs coordinator co-located within a police team. Their primary focus was to engage with people whose substance misuse related to anti-social behaviour and offending and encourage them to engage with treatment services with the aim of reducing reoffending. They were also a point of contact for training, advice and information to policing teams.

Other innovations included the operation of a sexual health clinic within the service hubs, offering contraception, cervical screening and testing for sexually transmitted diseases onsite, who would be unlikely to attend within a hospital setting. There was also a fibro scan clinic held within the hubs, which provided diagnostic screening and onward referrals as required in relation to liver health.

The service had identified that engagement for prison leavers who were not in receipt of clinical care was lower than the clinical population, so to support an increase in engagement, the service had implemented resettlement packages for prison leavers which included:

• A mobile phone to enable the person to access support services and enable staff to maintain contact with the prison leaver
• A food voucher to enable prison leavers to access a hot meal following their release
• Gymnasium passes to encourage a healthy lifestyle and diversionary activity to support sustained recovery post release.

The availability of the resettlement package and what it offered was communicated to people in custody prior to their release. The provider reported that this initiative had resulted in an improvement in engagement.

Due to an increase in near fatal overdoses in the locality, the provider implemented a working group to look at how to record near fatal overdoses; decide what information would be required, how it could approach this with the clients who used its services and what the information could be used for. A ‘staying alive’ plan was devised and introduced after consultation with clients. As a result, data was now recorded for each near fatal overdose. This data was reviewed each month to inform working practices such as the provision of harm minimisation advice, local drug use trends etc. The service shared its near fatal overdoses pathway with a national working group within the organisation.

Staff used quality improvement methods and knew how to apply them. The provider’s central assurance team had undertaken a mock inspection, based on the Care Quality Commission’s inspection methodology. Following the inspection a report was generated and recommendations made were implemented. The assurance team returned to review and were satisfied that all recommendations had been made. Learning from the initial inspection and subsequent review were shared with the wider team during the monthly integrated governance team meeting.

The provider identified the service was currently under the national average for the provision of naloxone, a drug which can reverse the effects of an opiate overdose. At the time of our inspection, 66% of clients had been provided with naloxone whilst the national average was 71%. In response to this, the service was reviewing data each month and was contacting clients to offer naloxone kits.

Staff participated in national audits relevant to the service and learned from them. These included a benzodiazepine audit, a peer-audit completed by doctors and non-medical prescribers across a range of Change, Grow, Live services. The aim of this audit was to understand how benzodiazepine prescribing was being delivered and managed within the provider’s services, and to track improvements since the previous audit in 2023.

The service participated in accreditation schemes relevant to the service and learned from them. These included the Better Health at Work for which the service had been given a silver award. The service had also commissioned an independent provider to evaluate effectiveness of the Drug and Alcohol Treatment Recovery and Improvement Grant. Data provided by the service was to be evaluated in relation to the effectiveness of the funding provided and an evaluation report would be provided to the local authority.