CGL Drug and Alcohol Service Warwickshire

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this service. This key question has been rated Good. Staff assessed the physical and mental health of all clients on admission. They developed individual care plans which were reviewed regularly and updated as needed. Staff provided a range of treatment and care for clients based on national guidance and best practice. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard of care. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

The service always made sure clients’ care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. We reviewed 12 care records and observed that recovery workers completed a comprehensive initial assessment of the client in a timely manner. Staff assessed clients’ physical health on admission and arranged referrals to external services for identified physical and mental health needs. Staff monitored ongoing physical health needs during their one-to-one sessions with clients.

We observed care records and recovery plans were personalised, holistic and recovery orientated. Recovery plans included the clients’ choices and preferences. The care plans we reviewed showed clients’ individual needs, wishes and preferences and had support in place to manage any risks. For example, one client was allowed to bring their dog with them to the service for when they had appointments which made them feel comfortable in the environment.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the client group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication, psychological therapies and the Drug Misuse and Dependence UK guidelines on clinical management (also referred to as the orange book).

We observed a mindfulness session which was very well structured with a clear focus to help clients with troublesome relationships and to be reflective and appreciative of others. For all of the sessions observed there was evidence-based practice in action and clients were supported to help them understand themselves and their stressors and how best to manage them. Recovery workers told us they link in with the community and reach out to groups to support individuals.

One team manager told us the service utilised a range of options to support clients such as motivational interviewing, emotional regulation groups, CBT (Cognitive Behavioural Therapy), emphasis on recovery and lived experience. They have support from volunteers who are keen to support clients to meet their needs.

Staff ensured that clients had good access to physical healthcare, including access to specialists when needed.

We observed a peer support group which clearly showed staff having good rapport with clients, lots of open questions were asked and clients were happy to answer them. Clients told us they felt it was a safe place that was therapeutic and clients and staff can use humour as well as being open about their experiences. The sessions gave assurances to clients about their detox programme, to check in and also discuss well-being.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

The team included or had access to the full range of specialists required to meet the needs of clients in the service. As well as doctors and nurses, clients can have access to dietitians, speech and language therapists and psychologists.

Comprehensive health screenings are carried out as part of the routine nursing activity. Based on the outcomes of the screenings, clients are signposted to appropriate services or referred for further care.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the client group.

Mental Health Act

Staff protected the rights of clients. This included arranging mental health assessments and referring clients to mental health services where necessary.

All staff had received training in the Mental Health Act as part of their mandatory training. This covered the code of practice and the guiding principles. The provider had the relevant policies and procedures that reflected the most recent guidance. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

We scored the service as 3. The evidence showed a good standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

The service had excellent inter-agency working with lots of options to offer support and help. The service had a harm reduction and pharmacy lead making a difference with training professionals on naloxone and overdose awareness, harm reduction as well as liaising with pharmacy partners to improve communication and reduce pharmacy related incidents. Staff held regular and effective multidisciplinary meetings. Collaborative working with the multidisciplinary team was positive and effective.

We saw evidence of health assessments carried with clients, comprehensive alcohol assessments, ambulatory detoxes, BBV (Blood Borne Virus), present in the multidisciplinary team for inpatient/rehab, general advice, referrals to GP and assisting with writing letters to the advocate and improve relationships. A comprehensive health assessment was completed and referrals carried out where required.

The teams had effective working relationships with teams outside the organisation (for example, local authority social services, key workers homeless team (HAP), housing support, police and GPs).

The service provided on-site monthly sexual health clinics led by commissioned sexual health nurses. They also hosted on-site Hepatitis C (a bloodborne viral infection) clinics, run by a specialist team from the local hospital to ensure people received swift access to treatment. The registered manager confirmed that chronic obstructive pulmonary disease (COPD) clinics were delivered at the Nuneaton hub.

There was evidence of excellent, proactive joint working with the social work teams, mental health services, GP practices and the local hospital. The provider had developed a joint working policy with the community mental health services and with midwives across the country to support clients who were pregnant. The service worked with LEROs (Lived Experience Recovery Organisations) to discuss various topics in learning hubs. They acted as a bridge between formal clinical treatment and the wider community, to provide peer support, mutual aid and advocacy to help clients sustain long-term recovery.

We scored the service as 3. The evidence showed a good standard of care. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported clients to live healthier lives – for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer.

Peer group sessions and activities helped promote a healthy lifestyle for clients, for example walking groups, sports activities, hub activities and cooking healthy meals.

The service also adopted a MECC (Making Every Contact Count) approach in their nursing care using each client interaction as an opportunity to promote health and well-being. This included offering and delivering a range of health screenings such as Blood borne virus (BBV) testing, alcohol related screening, nutrition screening and clinical risk tools.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service had good access to physical healthcare, including access to specialists when needed. We spoke with one nurse from the local hospital who carried out hepC and COPD clinics. The service had access to sexual health where clients could access free, confidential sexual health and contraceptive services through the Coventry and Warwickshire Sexual Health Hub, no smoking cessation and carried out quarterly wellbeing days. The service and its clients had access to partner agencies, the dentist, and hairdressers. We saw clients could access cupboards with dry food and have food vouchers. There were stocks on all sites, dog and cat food could be donated as well as money, books and sanitary products. This was to prevent any barriers.

Staff used recognised rating scales to assess and record severity and outcomes for example, Health of the Nation Outcome Scales as one of its primary clinical tools to assess severity, identify needs, and monitor progress as well as Treatment Outcomes Profile (TOP) for substance misuse severity.

Staff used technology to support clients effectively (for example, for prompt access to blood test results and online access to self-help tools).

Recovery plans contained appropriate assessments which were updated to measure outcomes and progress.

Staff discussed clinical and personal expectations during individual and group sessions. We saw staff communicating positively with clients.

The service monitored readmissions. The cohort known as re-presentations, those that return to the treatment within a 12-month rolling period. 7.26% of re-presentations were completed within 6-12 months at the service.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable clients to make their own decisions.

For clients who might have impaired mental capacity, staff assessed and mostly recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When clients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

Staff received up to date training in the Mental Capacity Act. Staff told us they understood how and when to assess whether a client had the capacity to make decisions about their care. The understood the relevant legislation and guidance and knew who to contact for advice.