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North Yorkshire Horizons Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 7 February 2019

We rated North Yorkshire Horizons as outstanding because:

  • Clients were protected by a comprehensive safety system with a proactive approach to anticipating and managing client risk. Risk management was discussed as a multidisciplinary team between the partner organisations and utilised the support of external agencies where applicable. Staff used technology to ensure prompt information sharing and support integrated care. Clients were supported to manage their risks at home. Staff maintained effective clinical audits. They introduced batch prescribing to avoid delays in clients’ receiving medicine. Lone-working protocols were embedded to safeguard staff. The team had a focus on openness, transparency and learning when things go wrong.
  • Outcomes for clients were better than expected when compared with other similar services. Staff worked with partner organisations and external services to provide holistic care. All staff had associated specialisms, such as sexual health. Staff exhibited excellent knowledge of associated national guidance. They had submitted treatment outcomes that were above the average listed by national benchmarking services. They were identified as engaging increasing numbers of detoxification clients, which contrasts the national trend. Harrogate was trialling new urine drug tests. Staff planned discharge in advance to ease care transfer. Staff monitored client’s physical health, encouraged healthy lifestyle choices and offered tests and vaccinations for blood borne viruses. Staff would transport clients to appointments external to the service if required.
  • Clients were truly respected and valued and empowered as partners in their care, practically and emotionally, by an exceptional service. Staff developed respectful relationships with clients, treating them with kindness and dignity. Clients felt staff “genuinely care”. Staff went above and beyond to support clients’ and carers’ emotional and social needs. Staff introduced links with communities and local support networks. Staff offered flexible support to meet clients’ needs. Clients informed treatment choices and their feedback informed services changes.
  • Services were tailored to individual’s needs and delivered in a way that ensured flexibility, choice and continuity of care. They delivered person-centred pathways to clients with complex needs, through relationship development. Staff were active in re-engaging clients and overcoming barriers to clients accessing care. Staff ran clinics in isolated, rural locations or attended clients’ homes to encourage engagement. Staff kept short appointments free to stay responsive to service need. Staff were proactive in understanding and responding to the needs of clients with protected characteristics. Information was available in different formats according to communication needs.
  • Leadership, governance and culture were used to drive and improve the delivery of high-quality, person-centred care. Leaders at all levels were compassionate, inclusive and highly experienced. Staff morale was very high, they were proud of the service provided and felt valued. Managers acknowledged staff strengths and supported their development. Managers supported staff work-life balance. Leaders understood the challenges and priorities of the service. There was a focus on service improvement and reflective practice. Staff could contribute to service development. Governance structures adhered to best practice.
Inspection areas

Safe

Outstanding

Updated 7 February 2019

We rated safe as outstanding because:

  • Staff had a proactive approach to anticipating and managing client risks, this was embedded and recognised as the responsibility of all staff. A client noted that staff implemented risk management strategies before the client had recognised their own decline.

  • All staff from across the partner organisations within the service were involved in risk management discussions for vulnerable or complex clients during the daily morning meeting, taking into account current best practice.

  • Staff discussed risk and managing risk with clients and carers; supporting them to manage risks at home through interventions such as providing harm minimisation advice and wound care.

  • Staff had laptops that they took to outreach appointments in the community so that updates to client records could be made in real time with their partner agencies, supporting integrated care for clients.

  • Staff had established good pathways with external agencies to encourage information sharing, all care plans reviewed evidenced external agency involvement.

  • Medicine management was routinely monitored through clinical audits and action plans were always implemented promptly; using the positive relationships formed with community pharmacists to share learning from incidents.

  • The service sent out six-week batch prescriptions to pharmacies to mitigate any potential errors or delays with the postal service.

  • The provider had not had any serious untoward incidents between August 2017 and August 2018.

  • There was a genuinely accepting culture in which staff, clients and external agencies were encouraged to raise all safety concerns to inform learning and improvement.

  • Staff were open and transparent, and understood their responsibilities around reporting incidents and near misses.

  • Duty of candour was embedded and clients were informed when things had gone wrong, with an explanation and apology given.

  • The service had embedded lone-working protocols and conducted staff risk assessments where necessary to keep staff safe.

Effective

Outstanding

Updated 7 February 2019

We rated effective as outstanding because:

  • Staff were committed to working collaboratively with partner organisations to provide a truly holistic approach to assessing, planning and delivering care and treatment to all clients.
  • All staff had been proactively encouraged and supported to acquire specialisms in different areas to better address clients’ needs, such as mental health and palliative care.
  • Staff were encouraged to share their knowledge and held learning sessions such as a liver study day.
  • Staff showed excellent knowledge of national guidance in interviews and during the three appointments we observed.
  • Staff engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking and peer review were proactively pursued, such as submitting regular treatment outcome profiles to the National Drug Treatment Monitoring Service.
  • The service was involved in a Public Health England report because they had continued to engage increasing numbers of alcohol detoxification clients against a backdrop of falling numbers nationally.
  • Harrogate hub was trialling a new urine test that isolated a metabolite associated with heroin, so staff could more effectively test whether clients were using heroin, without the potential for a positive reading for other opiates such as codeine.
  • Clients transitioned seamlessly between services because of advance planning and strong information sharing between teams; discharge staff from a partner organisation attended detoxification clients’ first appointments.
  • Staff routinely supported clients to live healthier lives, identifying clients who required extra support. The service routinely monitored client’s physical health, including blood borne virus testing, vaccination and referrals for treatment with shared follow up monitoring; as well as liver functioning tests for alcohol detox clients.

  • Staff would explore whether clients were accessing the required physical health support from external agencies, and if they were not or were unable, staff collected them from their home address and took them to appointments.

Caring

Outstanding

Updated 7 February 2019

We rated caring as outstanding because:

  • Clients were truly respected and valued as individuals and are empowered as partners in their care. All client notes reviewed evidenced that clients and carers were involved in all decisions surrounding care and treatment.

  • Feedback from clients and carers was consistently positive, stating that staff’s care and support regularly exceeded their expectations. Clients said that staff made them “feel special” and that they “genuinely care”.

  • Staff approached clients’ and carers’ emotional and social needs with the same importance as their clinical needs. For example, staff attended a client’s address daily to ensure their carer felt comfortable enough to go on holiday.

  • There was a strong person-centred culture among staff, they demonstrated a kind and dignified approach to client care and had developed caring and respectful relationships with clients and carers.

  • Staff provided support that responded to the totality of client’s needs. Staff provided interim support outside of working hours for clients and their families, while they waited for the appropriate psychiatric input on multiple occasions.

  • Staff recognised clients’ need to have links with their community and external support networks and assisted them in accessing these.

  • Staff were observed to talk about and talk to clients with kindness and dignity throughout the inspection.

  • Clients and carers were trained in Naloxone administration and provided take-home kits where appropriate.

  • The service could evidence that they had used client feedback to inform service amendments, such as creating a card for clients to present at front desk so they did not have to verbalise their reason for accessing the service.

  • Staff were flexible and available for clients, to offer support when the client needed it.

Responsive

Outstanding

Updated 7 February 2019

We rated responsive as outstanding because:

  • Services were tailored to meet the needs of individuals, ensuring they delivered a service specific to the needs of that client.

  • They had innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs. Staff members' specialist areas and the pathways they had formed with external services, such as maternity units, hepatology and sexual health clinics, ensured they provided an informed choice of care.

  • Rather than remove treatment if clients disengaged, staff tried to reengage the client, using strategies such as increased contact and visiting the client with their probation worker.

  • The service had outreach clinics in more isolated rural locations, such as Great Ayton, to make it easier for clients to access support.

  • Staff often attended appointments at clients’ home addresses or in the community if clients had difficulties attending the service.

  • There was a proactive approach to understanding the needs of different groups of people, the service could evidence multiple objectives for engaging and supporting clients with protected characteristics, including attending lesbian, gay, bi-sexual, transgender, queer and questioning Pride events and providing outreach in women’s refuges.

  • The service had developed strong links with community facilities, such as a café that provided protected time for people who are lonely.

  • The service had late night access for one evening per week, across the different hubs, for clients who could not attend during working hours.

  • Staff retained emergency appointments so they could respond quickly to new referrals or a sudden change in client need.

  • Clients were supported and encouraged to give feedback about their care, using client experience questionnaires and comment boxes in reception. The client questionnaire form was available in audio, large print and different languages.

  • The service had not received any formal complaints between August 2017 and August 2018. We spoke with one client who had raised a complaint with staff and they were satisfied with the resolution.

Well-led

Outstanding

Updated 7 February 2019

We rated well led as outstanding because:

  • The service operates as a flattened hierarchy and staff felt senior leaders in the organisation were visible and approachable. Senior members of staff at a local level, including the clinical manager, were actively involved in client care.

  • There was compassionate, inclusive and effective leadership at all levels.

  • Even when on long-term sick leave, a senior member of staff stayed in touch with the service and clients and used their experience to inspire others.

  • Staff morale was very high and there was a sense of camaraderie in the team. Staff described being proud of the care they provided and spoke highly of the culture.

  • There was a high level of staff satisfaction, staff felt valued and appreciated by the organisation.

  • Managers acknowledged staff strengths and encouraged their professional development.

  • Managers recognised the importance of staff’s personal life and allocated temporary paid leave for staff to spend with family.

  • Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care.

  • Leaders had a deep understanding of issues, challenges and priorities within their service. Staff were dedicated to designing creative ways of working to ensure that changes in budget was not reflected in client care.

  • There was strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences.

  • Strategies and plans were aligned with plans in the wider health economy. There was a demonstrated commitment to system-wide collaboration and leadership; such as the service’s efforts to engage a local mental health trust in a joint approach to dual diagnosis clients.

  • The service managers had an inspiring attitude towards client, staff and organisational development.

  • Governance arrangements were proactively reviewed and reflected best practice. Any concerns were identified, investigated and resolved promptly.

  • The Integrated Clinical Governance Board meetings showed senior staff across the partner organisations taking a cohesive, systematic approach to serious incidents, complaints, internal audits, safeguarding and considered lessons learned from these to inform system-wide working and improvement.

  • Clients and carers were encouraged to give feedback and were given regular service updates through the website and social media page.

  • Staff were aware of, and their practice reflected, the service's values and visions.

  • The senior leaders held an annual “roadshow” to keep staff informed of decisions and encourage them to ask questions.

  • Staff at all levels were able to give examples of how they had been involved in innovative practice for the service; such as developing pathways and specialist learning.

Checks on specific services

Substance misuse services

Updated 24 May 2016

Substance misuse services

Outstanding

Updated 7 February 2019