New Vision Bradford

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. We rated this key question as good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a strong proactive and positive culture of safety, based on openness and transparency. They actively listened to concerns about safety and thoroughly investigated and reported safety events. All staff knew what incidents to report and how to report them through a dedicated online hub. Staff recorded incidents within 24 hours and managers graded each incident in terms of severity. Managers then determined whether they needed to complete a more detailed case review of the incident. Some incidents progressed to a case conference which took place 12 weeks after the incident.

There had been 587 incidents in the previous 12 months, 40 of which were graded as level 3 incidents which was the most serious category. We reviewed 5 incidents and saw that these were reported in a timely manner and categorised appropriately, with action identified where appropriate.

Staff received feedback from investigation of incidents, both internal and external to the service. Managers shared incidents and death in service data with staff during team meetings and daily ‘flash’ meetings. Managers also shared ‘learning loop’ minutes with staff. We reviewed two sets of learning loop minutes and saw they set out key areas of learning relating to incidents and highlighted areas of improvement for staff practice

The service continually identified lessons learnt and embedded good practice. Managers and leaders discussed incidents during monthly compliance meetings and quarterly information governance board meetings. Staff confirmed they received a debrief and were supported by managers after deaths in service and serious incidents. Staff told us that there was a positive and inclusive learning culture within the service. Staff were actively encouraged to discuss improvements and innovations to the service on a regular basis. They felt able to approach management with any concerns they had and felt assured these would be investigated fully.

Managers collated death in service data which included key themes and trends and identified learning. There were 66 client deaths during the previous 12 months. This figure included patients in active treatment, or those who had been out of treatment for less than 3 months. Managers held death in service meetings to review recent deaths, identify any learning, and share positive practice. There was a death in service lead who described how death in service data helped them support the most vulnerable clients, including those clients within the rough sleeper’s team. This included implementing robust interventions, action plans and escalating fast track access for assessment and treatment, where it was needed.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation when things went wrong. There was evidence that changes had been made as a result of feedback. Managers described an incident which led to a delay in a client receiving their medicine. They explained how they worked with a pharmacy provider to improve the dispensing process and prevent future delays.

The service continually worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met.

Clients were referred into service in a variety of ways. This included self-referrals through a single point of contact, via their GP, or through mental health or ambulance services.

Care records showed that staff gathered comprehensive information about clients prior to commencing treatment via initial contact calls and an assessment. Clients completed questionnaires about their substance use to determine the severity of their dependence, and to enable staff to allocate them to the appropriate team.

Staff involved all the necessary health and social care services to ensure patients had continuity of care, both within the service and post-discharge. Each client was allocated a recovery worker and a nurse prescriber. Staff offered all clients a physical health care assessment to determine their physical health needs. Staff made referrals to mental health services on admission where necessary and there was a designated staff member who maintained links with the local mental health trust.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Clients said that they felt supported by staff and that they helped keep them safe. They said that they felt able to share any worries or concerns with staff.

Staff received training specific for their role on how to recognise and report abuse. There was a safeguarding policy in place which was subject to regular review. Staff were knowledgeable about safeguarding and knew how to raise a concern when required. They were able to identify different forms of abuse, and the signs associated with these. Staff attended regular meetings where important information and lessons learned were shared. Staff were observed having a caring and compassionate approach when engaging with people.

We reviewed 4 safeguarding referrals and saw there were effective systems, processes and practices in place to make sure that people were protected from abuse and neglect. Each referral was submitted in time and there was evidence of very detailed oversight of safeguarding alerts by managers. Referrals were reviewed by team leaders, clinical leads, areas managers and the Quality and Performance team, with a record of the referral, actions, and progress recorded.

There were safeguarding champions within the service who staff or managers could approach for advice or support. Each safeguarding champion had specialist safeguarding knowledge in a specific area such as domestic violence, or children’s services. The safeguarding champions attended meetings with external partners including social services to discuss clients with current safeguarding concerns. Managers also held a safeguarding team monthly meeting to share updates and escalate concerns. The safeguarding team completed regular reports on safeguarding activity and reported on findings during information governance board senior leadership meetings.

There was a children’s social care lead within the services. Managers told us this role had been created following consultation with a staff member who felt this role could benefit clients and their children. The lead was responsible for attending social care team meetings and provided training to staff.

The service continually worked with people to fully understand and manage risks. They did this by having a holistic approach. Care was provided which fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. We reviewed 5 sets of care records during the inspection. These showed that staff involved clients in recovery planning and risk assessments. Staff completed risk assessments for each client on admission, using a recognised tool, and reviewed this regularly, including after any incident.

Clients were invited to participate in multidisciplinary team reviews and offered copies of their recovery plans. Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties.

Staff enabled patients to give feedback on the service they received via surveys or community meetings.

Staff used a nationally recognised tool to identify deteriorating patients and escalated their care appropriately. Staff interviews and care records showed that nurses took blood samples or measured client’s oxygen levels where needed, referring to external professionals or contacting emergency services when appropriate.

Staff assessed and recorded patient tolerance levels to substances based on their usage or period of sobriety, and their physical health, and this helped them to determine the risks associated with relapse. Staff had access to Naloxone kits and distributed them to clients that were at risk of overdose. (Naloxone is a medicine that rapidly reverses an opioid overdose). Clients we spoke with told us recovery plans included action to support them in case they relapsed and said staff revisited this with them regularly.

Staff knew about and dealt with any specific risk issues relevant to individual clients or wider risks within the community. Managers described how they were made aware a dangerous batch of drugs that were circulating in the community and how they were proactive in providing information to clients about this. This included sharing information with clients via telephone, during appointments or when they visited the service. Managers also described how they shared this information with other stakeholders and acted promptly when they became aware that some clients had accessed the specific batch of drugs. This included staff supporting clients in the community who they knew had accessed the drugs. Clients told us staff regularly provided them with information about new and different substances including the associated risks and side effects

The service provided information to clients on admission in relation to 24-hour access to mental health liaison and specialist mental health support via the local crisis service.

Staff worked with mental health services to arrange psychosocial assessments and risk assessments for patients thought to be at risk of self-harm or suicide.

Staff shared key information to keep patients safe when handing over their care to others. We observed a morning ‘flash’ meeting and saw managers gave staff relevant updates and key information to keep clients safe. This included information about appointments, high-risk clients, safeguarding concerns, and fire safety and first aid arrangements for that day.

The service was fully aware of all potential risks in the care environment and managed them well. Staff completed quarterly environmental risk assessments of the care environment. There was disabled access at each site for clients with limited mobility or physical health conditions. There was also clinic rooms located on ground floors for clients unable to use the stairs.

We reviewed 3 clinic rooms and found these were fully equipped with accessible resuscitation equipment and emergency drugs. All equipment had been checked within the appropriate timescale. Staff monitored clinic room temperatures. We reviewed a sample of clinic room temperature records and saw these were fully completed and all temperatures within the appropriate range.

Client areas, including the reception and meeting rooms were clean and well- maintained. The service used a waste removal company to dispose of clinical and non-clinical waste.

When staff completed home visits, they followed the service’s home visit/ traceability process to ensure their safety. This included identifying any risk markers for the client and informing the duty manager at the time of the visit and when the visit was complete.

Staff carried out regular safety checks of specialist equipment at all the sites we visited. The service had enough suitable equipment to help them to safely care for clients and there were adequate supplies of vaccines, thermometers, blood pressure and ECG machines, and sufficient space to store these.

The service made sure there were always staff with the right qualifications, skills, training and experience to keep clients safe from avoidable harm and to provide the right care and treatment. They worked well together to provide safe care which met people’s individual needs. Managers accurately calculated and reviewed the number of recovery workers needed for each shift in accordance with national guidance. Each recover worker was allocated a caseload of clients. Data showed that caseloads were: Opiate Recovery Co-ordination (52), Alcohol Recovery Co-ordination (47), Criminal Justice Team (25), Early Intervention Team (23), and Rough Sleeper Team (18). Staff we spoke with told us these caseloads were manageable.

Managers regularly reviewed and adjusted staffing levels and skill mix. Managers could give examples of how they had adjusted teams and caseloads to meet client need.

Managers gave bank and agency staff a full induction. Induction training included Multi- Agency Risk Assessment Conference (MARAC) training. MARAC is a meeting where professionals from different agencies come together to discuss the safety of individuals at high risk of domestic abuse. Other training during induction included safeguarding training, outreach and home visit training, relapse prevention, first aid, physical health observations, and breakaway training.

Managers arranged for new starters to shadow in all areas of the service, which they said enabled them to gain experience across the service and develop a wider range of skills. Staff we spoke with confirmed they had the opportunity to shadow in different teams and spoke positively about this.

Staff had received and were up to date with appropriate mandatory training. The mandatory training was comprehensive and met the needs of patients and staff. Training modules included health and safety, infection prevention and control, and training in the use of defibrillators. Clinical staff completed training on recognising and responding to patients with mental health needs, learning disabilities, autism and dementia. The organisational target for mandatory training was 85% except for cyber awareness and information governance modules, which was 95% in line with NHS requirements. All training compliance was above 85%, with most modules over 90%. Staff completed Oliver McGowan training (95%) and Mental Capacity Act workshop training (97%). Managers monitored mandatory training and alerted staff when they needed to update their training.

The service had low vacancy rates. There were currently 14 vacancies out of a total of 160 posts. The service had an average annual staffing turnover rate of 15%.

The service had low sickness rates. The average absence during the last 12 months was only 2.74%.

The service assessed and managed the risk of infection. Staff followed good infection prevention and control procedures in line with organisational policy, this included the use of personal protective equipment. People who used the service did not raise any concerns about infection control. They told us that they felt safe in the environment and that all areas were cleaned regularly.

Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly.

Areas were observed to be clean and tidy. Staff completed regular environmental and infection prevention and control audits and where areas of improvement had been identified, appropriate action plans were in place.

Staff demonstrated a good knowledge of infection prevention and control. Staff followed the provider’s waste disposal processes with clinical and non-clinical waste discarded and stored appropriately.

During our tour of clinic rooms, we found that staff had recorded that they cleaned equipment after each client contact. All equipment was labelled to show when it was last cleaned.

Staff followed systems and processes to prescribe and administer medicines safely. Staff we spoke with knew where to access relevant guidelines including BNF, NICE, and Drug Misuse and Clinical Dependence: UK guidelines on Clinical Management. There were relevant medicines management policies in place which were comprehensive and reviewed regularly.

Clients told us staff reviewed their medicines regularly and provided advice to them about these. Care records showed that staff recorded ongoing discussions with clients about the nature, purpose and potential side effects of their medicines.

Staff made sure each client had a face-to-face medicines review every 6 months or more frequently if clinically appropriate.

We reviewed a sample of prescription charts. These were accurate and staff kept them up to date. Staff stored and managed all medicines and prescribing documents safely.

The service used quality improvement methods to improve medicines management processes. It had developed a new opiate assessment process in August 2024 which aimed to get opiate prescriptions to people who need them quicker, following assessment. At the time of inspection clients had to wait an average of 3.1 days to receive their prescription. This has consistently reduced from prior to the new process where the average waiting time was 9.3 days. As a result of these changes data for June 2025 showed that 42% of new clients received the medicine on the same day they had their first appointment with a prescriber.

The service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. Pharmacists completed medicines audits and provided reports to managers about any prescribing outliers.

Some clients collected their medicines from the pharmacy, and other clients collected these from the service. Records for the delivery and dispensing of medicine were complete and up to date. There was a process in place for medicine to be returned to the pharmacy if clients no longer required these.