Archived: We are With You - Hartlepool Specialist Prescribing Service

Updated 26 September 2019

Addaction Hartlepool Specialist Prescribing Service (Addaction) provides treatment to men and women over 18 years of age with alcohol or drug dependency and is a nurse-led service. The service delivers treatment in partnership with the local authority as part of the Hartlepool Action and Recovery Team. Addaction provide the clinical interventions including substitute prescribing where appropriate and the local authority are commissioned to provide the assessment, recovery co-ordination, psychosocial interventions and other wraparound support.

The provider is one of the UK’s largest specialist treatment charities for drug, alcohol and mental health. It employs over 1,100 people nationally. Addaction deliver initial care planning, risk assessments, recovery planning, prescribing, blood borne virus testing, vaccinations and clinical interventions. The local authority delivers initial care planning for clients that are on their caseloads. Addaction supports a blood borne virus team to deliver weekly hepatitis C groups for clients. Other treatments such as wound care is delivered by primary healthcare.

The provider’s income comes from a variety of sources. The majority of their funding is from local government contracts, as Addaction provide services on their behalf. Addaction is also funded through individual donations, trusts such as the Big Lottery Fund, corporate donors and sponsors.

The service has been registered with the Care Quality Commission since April 2014 to provide diagnostic and screening procedures and treatment of disease, disorder and injury. It has a registered manager who is also the contracts manager. The service has been previously inspected in November 2016 and February 2018 during which we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 9 Person-centred care:

• Care records did not capture sufficient information about clients’ care and treatment needs and were not person-centred. Clients were not given copies of their recovery or care plans and there was no evidence in their care records that they had been offered them.

Regulation 12 Safe care and treatment

• Health and safety were compromised. Only 47% of staff had completed their mandatory health and safety training. Risk management plans were not appropriate to mitigate the risks associated with clients. Fire wardens and first aiders were not easily identifiable. Hand sanitiser gels were being used beyond their expiry date and sharps bins were not signed and dated.
• Chairs in the main clinical room where examinations and venepuncture were conducted were covered in a fabric material rather than a wipeable material, which compromised infection control within the service.

Regulation 18 Staffing

• Staff did not have a good understanding of the Mental Capacity Act or apply it in practice.

• Supervision and appraisal were not recorded effectively, and some staff did not receive supervision or appraisal.

We reviewed these breaches during this latest inspection and have reported on our findings accordingly.

Updated 26 September 2019

We rated the service as good because:

• The service provided safe care. The premises where clients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
• Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients in decisions and care planning.
• The service had conducted a client satisfaction survey in June 2019 and the results were very positive. Clients felt the treatment met their needs, were treated in a kind and respectful manner, had trust in their keyworker and would recommend the service to others.
• The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
• The service was well led, and the governance processes ensured that its procedures ran smoothly.

• Staff had a good understanding of the Mental Capacity Act and we saw evidence that clients’ capacity was assessed and recorded, and clients were referred to local mental health services when required.
• The service also had its own GP liaison officer who ensured GP surgeries provided information about clients’ current physical health status in a timely manner.

• Staff had recently been provided with training in relation to optimal dosing of substitute medicines.

However, we found the following issues the service needs to improve:

• Staff caseloads within the service were high. The provider reported that the average caseload per team member was 101 clients.
• Staff did not formally record lessons learned from investigating complaints for future reference.
• Staff did not always record voided prescription forms in a timely manner. Records indicated that staff did not always record voided prescription forms on the day they were identified.

Updated 26 September 2019