Sheffield Drug and Alcohol Service Also known as Likewise Sheffield

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

This means we looked for evidence that people were protected from abuse and avoidable harm.  We rated this key question as good. This meant people were safe and protected from avoidable harm. Staff assessed and managed risks to clients and themselves well. Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed client safety incidents well.  

We have not awarded this service a score for Safe.

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

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service demonstrated a positive and proactive culture of safety, based on openness and
transparency. They actively listened to safety concerns and thoroughly investigated and
reported safety events.

All staff we spoke with knew what incidents to report, how to report them and did so accordingly. Staff understood the duty of candour. The service was open and transparent, and staff gave clients a full explanation when things went wrong.

Staff received feedback from investigations of incidents, both internal and external to the
service. Staff told us that when they reported incidents, they received feedback in several ways including through supervision and debrief sessions. Managers also shared information and data on incidents and deaths of clients with staff during team meetings and daily ‘flash’
meetings. Managers also shared ‘learning loop’ minutes with staff. ‘Learning loops’ are a summary of trends, good practice and things that need to change within the service. ‘Learning loops’ provided an opportunity to step back from day-to-day work and allowed staff to reflect on what was working well and where improvements could be made.

Incidents were categorised into levels 1,2 or 3.

•    Level 1 incidents were managed at service level and defined as an incident that could be readily addressed and concluded within the remit and current resources of the service and external agencies and had limited impact on the service, it’s staff and clients.

•    Level 2 incidents were managed by service level management and may require regional or organisational oversight. A serious event which is not routine and uncharacteristic of the service or individual involved. The event may have caused serious impact on the wellbeing of the individual or service and prohibited the delivery of routine service.

•    Level 3 incidents were managed by service level management or regional and organisational management. Level 3 events are likely to have significant and negative impact on reputation, viability and wellbeing of the organisation, serious financial impact, negative media attention and prohibits routine service delivery. The event is likely to lead to criminal investigations and indicate significant failings in relation to safeguarding of adults or children and require external notification.

Incidents reported as level 2 and 3 were categorised as ‘serious incidents’ and this automatically alerted the regional director so that they could support service leaders to determine how the incident should be managed.

There were 18 incidents recorded as level 1 and level 2 during the previous 12 months. Behaviour of concerns was the main outlier with 5 incidents. Other incidents included clinical (1), information governance (3), medication (4), premises/property (1) and other (2).

The service continually identified lessons learnt and embedded good practice. For example, staff members now attend city centre outreach in pairs and the emergency procedure policy and behaviour of concern policy have been reviewed and updated.
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 of clients 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.
 

We scored the service as 3. The evidence showed a good standard. The service worked
with people and healthcare partners to establish and maintain safe systems of care, in
which safety was managed or monitored. They made sure there was continuity of care,
including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient, such as GP summaries and physical and mental health histories were received to determine if the patient’s needs could safely be met.

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

Care records showed that staff gathered comprehensive information about clients prior to
commencing treatment through 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 continuity of care for clients, both within the service and post-discharge. Each client was allocated a named recovery worker and nurse prescriber. Staff offered all clients a physical health care assessment to determine any physical health needs.

Staff made referrals to mental health services on admission where necessary. The team delivered comprehensive
assessments, joint care planning, collaborative risk management and tailored interventions
that addressed client’s mental health, substance use, physical health and wider social needs.
Using flexible approaches, including assertive outreach, home visits and joint appointments,
the team successfully engaged people with complex needs who were often considered hard to reach.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. Staff were provided mandatory training in safeguarding adults and safeguarding children and at the time of our inspection the compliance rates were 99% for level 1, 96% for level 2 and 94% for level 3. The mandatory training sessions for safeguarding adults and children were combined.

The service had made 196 safeguarding referrals to the local authority in the 12 months prior to the inspection.

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.
Safeguarding referrals were submitted in a timely manner and there was evidence of oversight of these 
referrals from managers. Referrals were reviewed at least quarterly by team leaders, clinical leads, areas managers and the quality and performance team, with a record of the referral, actions, and progress recorded. Any identified learning from these reviews were shared with all staff at ‘learning loop’ meetings and presented at service-wide team meetings.
Managers 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 senior leadership meetings.

Staff were observed having a caring and compassionate approach when engaging with people. There were safeguarding leads working within the service who staff and managers could approach for advice or support. Each safeguarding lead had specialist safeguarding knowledge in a specific area such as domestic violence, or children’s services. The safeguarding leads attended meetings with external partners including the local authority to discuss clients with current safeguarding needs and/or where concerns were present.

Likewise operated an internal safeguarding hub system that enabled the designated safeguarding lead to maintain oversight of all safeguarding referrals. This system supported the timely review and progression of concerns, ensured appropriate actions were taken, promoted accountability, and provided a clear audit trail through accurate and comprehensive record keeping.

Likewise Sheffield maintained close links with Sheffield Children’s Safeguarding Partnership (SCSP) vulnerabilities manager and the specialist drug and alcohol paediatric liaison nurse, who was co-located at Portland House. This strengthened support around any child safeguarding concerns.

Mental Capacity Act 
94% of staff had received training in the Mental Capacity Act.
Staff we spoke with had a good understanding of the Mental Capacity Act, particularly the five statutory principles.

The service had arrangements to monitor adherence to the Mental Capacity Act.

There was a policy on the Mental Capacity Act, including Deprivation of Liberty Safeguards.
Staff we spoke with were aware of the policy and told us they had access to it.

Care records showed clients were supported to make decisions for themselves wherever
possible. Where clients lacked capacity to make certain decisions, staff made decisions in their best interests, and decision specific mental capacity assessments were evidenced in care plans.

If staff were concerned about a client’s mental capacity, staff would also refer to the social
worker within the service for support.
 

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to clients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour.  They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 6 client risk assessments during the inspection. Each client had an up-to-date risk assessment in place, and all were holistic in their approach. Clients were involved in the risk assessment process and were all offered copies of their recovery plans.
Staff communicated effectively with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties. The service offered use of an interpreter and leaflets in a range of languages and different formats.
We saw evidence of harm minimisation advice being discussed within clients care plans and risk assessments which formed the recovery plan. Safety planning formed an integral part of recovery plans. Staff assessed and recorded patient tolerance levels to substances based on their usage or period of abstinence, and their physical health, and this helped them to determine the risks associated with relapse.

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 had access to Naloxone (a medicine that rapidly reverses an opioid overdose), and this was also distributed to clients who were deemed at risk of overdose. We also saw that clients had a plan in place for if they unexpectedly disengaged from treatment, and strategies to re-engage the client.
We observed a morning flash meeting, where we saw managers gave key relevant information and updates. This covered high risk client information, any safeguarding concerns, and fire safety and first aid arrangements for the premises.
Clients were able to give feedback on the service they received through feedback and complaints forms, 1:1 sessions, scannable QR codes, community meetings and through satisfaction surveys. The learning from these was then fed back to the staffing team through team meetings, bulletins and lesson learned sessions. Actions taken from client feedback included the implementation of a ‘community connector’ role, graffiti being removed from an exterior wall, a quiet/multi-faith room made available and music being turned down in the recovery hub.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff did regular risk assessments of the care environment and managed potential risks
well. There was CCTV, convex mirrors and staff situated throughout the buildings to mitigate
blind spots and there were response alarms fitted in interview rooms where staff maybe alone with clients. 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.

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

Client areas, including the reception area and meeting rooms were clean and well maintained with regular cleaning audits carried out. The service used a waste removal company to dispose of clinical and non-clinical waste.

Staff carried out regular checks of specialist equipment at both sites. The service
had enough suitable equipment to help them to safely care for clients and there was adequate space to store these securely.
 

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

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.

All staff including volunteers and bank and agency staff received induction training which
included training in safeguarding, information governance, the Mental Capacity Act, equality
and diversity in the workplace, unconscious bias, and health and safety in the workplace.

Following feedback from new starters, managers and existing staff, the service undertook a comprehensive review of the local staff induction process and commenced a pilot to drive improvement.

New employees highlighted inconsistencies in the induction experience across the service. Staff reported that:

"New starters are learning from other relatively new starters, and the induction plan is not being used consistently across the service. There is no set induction plan or buddy system in place."

A multidisciplinary working group, representing all service areas, was established to co-produce an improved induction programme.

In response, a new local induction booklet was co-produced with contributions from teams across the service. The booklet provided a structured and consistent induction framework, including a manager checklist and formal sign-off process. A key requirement of the revised induction programme was that new staff members did not receive a caseload until their induction had been fully completed and approved by a senior manager.

To support a safe and effective transition into practice, client-facing responsibilities were introduced gradually through a phased caseload approach. Regular check-ins with line managers enabled progress to be reviewed, and additional support to be provided where needed. 
Feedback from new starters was overwhelmingly positive. Staff reported that the induction booklet had improved their understanding of their role, increased awareness of the different elements of the service, and helped them navigate key processes with greater confidence. 
Alongside the revised induction programme, a peer buddy system was introduced to ensure that every new starter was paired with a dedicated colleague within their team. Buddies provided day-to-day guidance, answered questions, and supported new staff to integrate successfully into the team.

Members of the senior management team met monthly with new starters. These sessions provided an opportunity to review the quality of inductions, discuss how staff were settling into their roles and teams, and gather feedback on their overall experience of working within the service and for the provider as a whole.

The service used bank and agency staff to cover 916 shifts over the previous 12-month period and 1 agency prescriber for a 6-month period whilst the recruitment process for a substantive prescriber was carried out. At the time of our inspection, the service was utilising 2 agency independent prescribers and 3 agency recovery navigators.

All agency staff were recruited through approved providers and underwent mandatory checks, training and received induction, supervision and management oversight.

The service was developing a bank prescriber workforce to improve stability and reduce reliance on agency staff. Bank staff were fully integrated into organisational communication and governance processes, providing a more consistent and cost-effective solution. The service currently had 3 independent prescribers being onboarded into bank roles.

The mandatory training provided to staff was comprehensive and met the needs of clients 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 and learning disabilities and autism. The
organisational target for mandatory training was 85% except for cyber awareness and
information governance modules, which was 95% in line with NHS requirements. Mandatory
training compliance overall was 96.4%. Managers monitored mandatory training compliance and alerted staff when they needed to update their training.

The service had 28.1 vacancies. At the time of our inspection, 15.1 vacancies were open to advert, 5 vacancies were at the shortlisting and interview stage and 9 of the vacancies were at the onboarding stage.

The service had an average annual staffing turnover rate of 28.6% over the previous 12-month
period. This equated to 35 members of staff voluntary leaving the service. Exit surveys carried out by the provider showed that 8 out of the 35 members of staff left to pursue other careers or moved to a different sector, 6 out of the 35 left due to personal circumstances and 5 left due to career progression. In the same time period, there were 45 new staff members that joined the service.

The service staff sickness rate for the previous 12-month period was 4.2%.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

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, which we saw in up-to-date cleaning records.

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 disposed of 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.

The service provided a confidential needle exchange. We found that the service ensured the
safe disposal of sharps and used needles.

 

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. Staff we
spoke with knew where to access relevant guidelines including British National Formulary
(BNF), the National Institute for Health and Care Excellence (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.
Staff accessed GP summaries to ensure they were aware of any allergies and contra-indications prior to prescribing or administering any medicines.
Staff learned from safety alerts and incidents to improve practice. We saw posters around the buildings alerting clients and staff to an increase in the risk of synthetic opioids.

Clients told us staff reviewed their medicines regularly and provided advice to them about
These, such as harm minimisation and side-effects. Care records showed that staff recorded
ongoing discussions with clients about the nature, purpose and potential side effects of their
medicines.
The service ensured that clients understood safe storage of medicines. Likewise Sheffield offered locked boxes for the safe storage of medicines in client’s homes, especially if children were present. Supervised collection and consumption of medicines were also considered for clients deemed to be a higher risk. The service was also licensed to administer Buvidal, a long-acting injection used to treat opioid dependence, which removed the need to store medicines at home.

The service provided drop-in clinics which allowed clients that had stopped engaging with
treatment plans to receive a same day prescription in most cases.
Staff made sure each client had face-to-face medicines review every 6 months or more
frequently if clinically appropriate.

We reviewed a sample of 6 prescription charts. These were accurate and staff kept them up to date. Staff stored and managed all medicines and prescribing documents safely.